Practice Quizzes

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

4. Bismuth subsalicylate and loperamide

Which of the following should be monitored in a patient who has started on clonidine (Catapres)? 1. Temperature 2. Complete blood count (CBC) 3. Blood glucose 4. Blood pressure

4. Blood pressure

The mother of an adolescent patient with a history of acanthosis nigricans is concerned about the risk of developing diabetes because this condition is linked to insulin resistance. The APN instructs the patient's mother that the patient should be tested for diabetes if the patient also meets which criterion? 1. HbA1c greater than 6.5% 2. Family history of type 1 diabetes 3. European American ethnicity 4. Body mass index (BMI) greater than 85th percentile for age and sex

4. Body mass index (BMI) greater than 85th percentile for age and sex

Which of the following is a consideration when planning initiation of buprenorphine in a patient with opioid use disorder? 1. Treatment beyond 9 months is not recommended. 2. Patients who are not stable on low-to-moderate doses should be initiated on a subdermal buprenorphine implant. 3. Tapering of dose should occur over 3-6 months if long-term maintenance is not desired. 4. Buprenorphine can trigger withdrawal; symptom-triggered dosing and titration are required for induction.

4. Buprenorphine can trigger withdrawal; symptom-triggered dosing and titration are required for induction.

Which antidepressant medication is devoid of the risk of serotonin syndrome? 1. Amitriptyline (Elavil) 2. Vortioxetine (Brintellix) 3. Desvenlafaxine (Pristiq) 4. Bupropion (Wellbutrin)

4. Bupropion (Wellbutrin)

The APN should avoid prescribing which medication for a patient diagnosed with gestational diabetes? 1. Metformin 2. Insulin 3. Glyburide 4. Canagliflozin

4. Canagliflozin

Fluoroquinolones fall under which pregnancy category? 1. Category B 2. Category X 3. Category A 4. Category C

4. Category C

Calcium channel blockers (CCBs) are indicated to treat which condition? 1. Migraine headache prophylaxis 2. Raynaud's syndrome 3. Esophageal spasm 4. Chronic angina

4. Chronic angina

Which factor(s) influencing pharmacoeconomic outcomes are the most important? 1. Cost and availability of medications 2. Right drug, right dose, right route, right patient 3. Reliability of the drug manufacturer, U.S. Food and Drug Administration (FDA) review of the pharmacoeconomics profile of a drug, and education from the drug sales person 4. Clinical outcomes, safety, adverse drug reactions, and patient satisfaction

4. Clinical outcomes, safety, adverse drug reactions, and patient satisfaction

Which medication is not approved for opioid withdrawal by the U.S. Food and Drug Administration (FDA)? 1. Naltrexone (Revia, Depade) 2. Methadone (Dolophine, Metadol) 3. Buprenorphine (Belbuca, Buprenex, Subutex, Probuphine) 4. Clonidine (Catapres)

4. Clonidine (Catapres)

Which known adverse reaction to a cholinergic blocker would be considered most problematic? 1. Exacerbation of Parkinson's disease 2. Urinary incontinence 3. Decreased gastric acid secretion 4. Decreased sweating

4. Decreased sweating

New drugs are tested for the "placebo" effect to see if people taking the drug are responding to it or just to the effect of taking medication. The placebo group is also monitored for adverse effects. The APN knows that which disease states are more susceptible to the placebo effect than others? 1. Cancer and heart disease 2. Dermatitis and onychomycosis 3. Arthritis and Bell's palsy 4. Depression and anxiety

4. Depression and anxiety

Which of the following benzodiazepines has the longest duration of action? 1. Alprazolam (Xanax) 2. Temazepam (Restoril) 3. Oxazepam (Serax) 4. Diazepam (Valium)

4. Diazepam (Valium)

Parkinson's disease involves the deficiency of which neurotransmitter? 1. Serotonin 2. Norepinephrine 3. Gamma-aminobutyric acid (GABA) 4. Dopamine

4. Dopamine

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

4. Drowsiness and dizziness

Which statement about computerized order entry via electronic health records (EHRs) software is accurate? 1. EHRs require use of a standard formulary of medications and thereby cut costs. 2. EHRs allow the patient and family to have influence on what medications are ordered, which increases patient-centered care. 3. EHRs and computerized pharmacy ordering can slow the workflow process because computers often do not have a good connection to the server. 4. EHRs reduce errors by making orders legible, standardizing abbreviations, and requiring complete orders.

4. EHRs reduce errors by making orders legible, standardizing abbreviations, and requiring complete orders.

Which adverse effect from beta blockade is insufficient to justify withholding beta blockers? 1. Hyperlipidemia 2. Diabetes 3. Asthma 4. Fatigue

4. Fatigue

A 36-year-old patient is diagnosed with oral candidiasis. Which regimen of fluconazole is most appropriate for this patient? 1. Fluconazole 300 mg PO on first day, followed by 50 mg once daily for 2 weeks 2. Fluconazole 300 mg PO on first day, followed by 100 mg once daily for 2 weeks 3. Fluconazole 200 mg PO on first day, followed by 50 mg once daily for 2 weeks 4. Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks

4. Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks

The pharmacodynamics of selective alpha1 antagonists prevents them from being frontline treatment of hypertension. Which of these is the best reason to limit the use of selective alpha1 antagonists for treating hypertension? 1. Reflex tachycardia 2. Orthostatic hypotension 3. Rebound hypertension 4. Fluid retention

4. Fluid retention

Which of the following is a treatment specific for benzodiazepine intoxication? 1. Methadone (Dolophine) 2. Naloxone (Revia) 3. Topiramate (Topamax) 4. Flumazenil (Romazicon)

4. Flumazenil (Romazicon)

Which statement accurately describes the requirements of a generic drug to gain U.S. Food and Drug Administration (FDA) approval? 1. Generic drugs must be approved by the U.S. Generic Drug Association, which reports to the American Medical Association, before applying for FDA approval. 2. Generic drugs have to be about 80% identical to the brand-name drug and, in some cases, can actually be better for the prescribed problem. 3. Generic drugs can be produced for a brand-name product if the brand-name product has been for sale for at least 50 years. 4. Generic drugs must contain the same ingredients as the brand-name drug, come in the same dosage, be administered the same way, be identical in strength, and be bioequivalent (be absorbed into the bloodstream at the same level).

4. Generic drugs must contain the same ingredients as the brand-name drug, come in the same dosage, be administered the same way, be identical in strength, and be bioequivalent (be absorbed into the bloodstream at the same level).

A patient with a history of pancreatitis should avoid which medication? 1. Thiazolidinedione 2. Biguanide 3. Meglitinide 4. Glucagon-like peptide-1 (GLP-1) receptor agonist

4. Glucagon-like peptide-1 (GLP-1) receptor agonist

Oral ribavirin, combined with interferon, is used to treat infection of which virus? 1. Influenza A 2. HIV-1 3. Respiratory syncytial virus (RSV) 4. Hepatitis C virus (HCV)

4. Hepatitis C virus (HCV)

A patient will be starting on a medication regime of digoxin. Which information should the APN include in his education? 1. Missing or doubling doses is acceptable due to the drug's long half-life. 2. Patients should eat a diet low in potassium. 3. Tablets cannot be crushed and administered with food. 4. Milk may have some effect on absorption, so doses should be separated by 1 hour of consumption.

4. Milk may have some effect on absorption, so doses should be separated by 1 hour of consumption.

Which medication has been associated with elongation, thickening, and enhanced pigmentation of fine body hair and has been used in treating male pattern baldness? 1. Amiodarone 2. Furosemide 3. Lisinopril 4. Minoxidil

4. Minoxidil

To be considered for insulin pump therapy, the patient should at least be able to do which of these? 1. Monitor blood sugar once a day to verify continuing glucose monitor 2. Monitor blood sugar eight times a day 3. Monitor blood sugar when fasting 4. Monitor blood sugar three times a day and when necessary

4. Monitor blood sugar three times a day and when necessary

Bipolar disorders, which present with depression and mania, are treated with which type of medication? 1. Benzodiazepines 2. Dopaminergics 3. Anorexiants 4. Mood stabilizers

4. Mood stabilizers

A patient comes to the APN and asks why when he took Amoxil, it was required to be taken three times a day and when he was taking azithromycin, he only had to take it once a day. Which response by the APN is most appropriate? 1. "Amoxil has a shorter half-life so it must be taken more often during the day." 2. "Amoxil is a less effective antibiotic than azithromycin, and therefore more has to be taken to make it as effective." 3. "Amoxil is bacteriostatic and inhibits the growth of bacteria whereas azithromycin is bactericidal and kills bacteria." 4. "Azithromycin is able to kill bacteria faster than Amoxil, and therefore only needs to be taken once daily."

1. "Amoxil has a shorter half-life so it must be taken more often during the day."

The APN is initiating an HMG-CoA reductase inhibitor. Which statement by the patient demonstrates understanding of the education of the drug? 1. "I will return in 6 to 8 weeks to repeat my lipid panel bloodwork." 2. "I will require standard serial monitoring of liver laboratory tests every 4 weeks." 3. "I will expect to experience some muscle pain 1 to 2 years after starting the medication." 4. "If my dose is increased at my next appointment, I will return in one year to repeat my laboratory tests."

1. "I will return in 6 to 8 weeks to repeat my lipid panel bloodwork."

Which condition has shown limited to no benefit with the initiation of HMG-CoA reductase inhibitors (statins)? 1. Advanced heart failure 2. Type II diabetes 3. Low-density lipoprotein (LDL) cholesterol levels above 150 mg/dL 4. Moderate atherosclerosis

1. Advanced heart failure

Which statements are most accurate regarding bone mineral density (BMD) in African American women when compared with white women? 1. African American women have higher BMD than white women, but African American women are more likely to die from hip fracture than white women. 2. African American women have higher BMD and are not at significant risk for hip fracture. 3. African American women have lower BMD than white women, and African American women are less likely to die from hip fracture than white women. 4. African American women have lower BMD than white women, and African American women have similar death rates to white women from hip fracture.

1. African American women have higher BMD than white women, but African American women are more likely to die from hip fracture than white women.

When do the symptoms of type 1 diabetes begin? 1. After 80% to 90% of beta cell loss 2. After 40% to 50% of beta cell loss 3. After 20% to 30% of beta cell loss 4. After 60% to 70% of beta cell loss

1. After 80% to 90% of beta cell loss

According to the National Survey on Drug Use and Health conducted by Substance Abuse and Mental Health Services Administration (SAMHSA), 10.6% (28.6 million people) of the U.S. population over which age had used some illicit drug in the past month? 1. Age 12 2. Age 18 3. Age 30 4. Age 50

1. Age 12

Which postmarketing adverse effect of levetiracetam is reversible when the drug is stopped? 1. Alopecia 2. Erectile dysfunction 3. Visual disturbances 4. Tinnitus

1. Alopecia

Which symptoms characterize female athlete triad? 1. Amenorrhea, disordered eating, and osteoporosis 2. Pica, binge-purge eating, and osteoporosis 3. Early onset of menstruation, disordered eating, and osteopenia 4. Secondary amenorrhea, severe caloric restriction, and low body mass index (BMI)

1. Amenorrhea, disordered eating, and osteoporosis

Which peptide hormone is cosecreted with insulin in response to food? 1. Amylin 2. Glucagon-like peptide-1 (GLP-1) 3. C-peptide 4. Glucagon

1. Amylin

The APN is caring for an 85-year-old patient with incontinence who the APN feels would benefit from the use of trospium (Sanctura). There are risks with using this in the elderly. Which condition in the patient's medical history would prevent the APN from using trospium? 1. Angle-closure glaucoma 2. Benign prostatic hyperplasia (BPH) 3. Hypertension 4. Falls

1. Angle-closure glaucoma

Patients taking allopurinol should have liver function tests (LFTs) evaluated if they develop which cardinal symptoms? 1. Anorexia, weight loss, or pruritus 2. Nausea, weight gain, or peripheral neuropathy 3. Constipation, headache, or taste disorders 4. Fatigue, sleep disruption, or depression

1. Anorexia, weight loss, or pruritus

A patient presents for a follow-up appointment of her hypertension and is taking telmisartan. The APN notes that her blood pressure is elevated today and reviews her medication profile. Which medications could decrease the antihypertensive response and result in the elevated blood pressure reading? 1. Nitrates 2. Phenothiazines 3. Other antihypertensives 4. NSAIDs

4. NSAIDs

Assessing a patient following morphine administration, the nurse notes cold, clammy skin; heart rate of 40 bpm; blood pressure of 90/40 mm Hg; and respiratory rate of 8 breaths/minute. Which medication should the nurse practitioner prepare to administer? 1. Flumazenil 2. Acetylcysteine (Mucomyst) 3. Protamine sulfate 4. Naloxone (Narcan)

4. Naloxone (Narcan)

Which of the following medications decreases alcohol cravings and reduces the likelihood of returning to drinking? 1. Disulfiram (Antabuse) 2. Lithium 3. Sertraline (Zoloft) 4. Naltrexone (Revia tablets)

4. Naltrexone (Revia tablets)

The highest rate of adverse reactions is found in which calcium channel blocker (CCB)? 1. Diltiazem ER 2. Amlodipine 3. Verapamil ER 4. Nifedipine

4. Nifedipine

Experts recommend that the use of benzodiazepines be limited to what time frame? 1. No less than 1 year 2. Six months 3. At least 12 weeks 4. No more than 2 to 4 weeks for most patients

4. No more than 2 to 4 weeks for most patients

A patient has been started on a calcium channel blocker (CCB). The APN should provide which instruction to the patient regarding use of CCBs? 1. Contact the health-care provider if the heart rate is greater than 80 beats per minute (bpm) and you experience fatigue. 2. Notify your health-care provider if you experience diarrhea and stomach cramping. 3. Contact your health-care provider if you notice any migraine headaches during the use of the medication. 4. Notify your health-care provider if you experience unusual swelling of hands, feet, or ankles, and/or decreased urine output.

4. Notify your health-care provider if you experience unusual swelling of hands, feet, or ankles, and/or decreased urine output.

A new patient presents to the clinic with a 10-year history of type 2 diabetes mellitus (DM) and hypertension. Today, she complains of blurred vision, elevated blood pressure, and bilateral lower extremity swelling. The APN begins to interview the patient and discovers that the last health-care visit was approximately 2 years ago. Her recent visit to the ophthalmologist revealed moderate nonproliferative diabetic retinopathy. She also has a history of consuming six cans of beer daily for the past 5 years. The APN's next step in diabetes management most appropriately includes which action? 1. Referral to alcohol cessation program 2. Conducting a fundoscopic examination 3. Starting a thiazide diuretic 4. Obtaining a HbA1c

4. Obtaining a HbA1c

Hydroxychloroquine (Plaquenil) can be used in combination with other drugs to treat rheumatoid arthritis (RA). Which of these is a potentially significant side effect? 1. Bone marrow suppression 2. Immune system suppression and latent disease activation 3. Gastrointestinal (GI) distress and esophageal erosion 4. Ocular issues including night blindness, retinal degeneration, and corneal deposits

4. Ocular issues including night blindness, retinal degeneration, and corneal deposits

Four specific classes of medications accounted for more than two-thirds of erectile dysfunction (ED) visits in men over 80 years of age. Which medication is one of these high-risk categories? 1. Beta blockers 2. Selective serotonin reuptake inhibitors (SSRIs) 3. Salicylates 4. Oral hypoglycemics

4. Oral hypoglycemics

A 14-year-old patient presents to the hospital with ringworm contracted while working out in the school gymnasium. The APN prescribes griseofulvin, which needs to be taken with a high-fat diet to promote absorption. Which statement regarding patient education is accurate? 1. It is the role of pharmacy personnel to teach the patient about food and drug administration, so the APN need not be concerned. 2. The APN must provide the patient a pamphlet on the drug, which will include all the information needed. 3. Providing adequate education related to all aspects of drug administration is not part of the APN role. 4. Patient education regarding the coordination of medication administration and food intake is an important part of the prescribing process.

4. Patient education regarding the coordination of medication administration and food intake is an important part of the prescribing process.

How do a patient's health beliefs affect drug adherence? 1. Health beliefs are not relevant to drug adherence. Once the patient is given a prescription, they should take the drug as ordered. 2. Health beliefs can be easily changed with pamphlets and prescription information. 3. Health beliefs do not commonly affect a person's ability to understand or follow the provider's orders. 4. Patients who believe a medication is going to help them or prevent long-term harm are more likely to adhere to a drug regimen.

4. Patients who believe a medication is going to help them or prevent long-term harm are more likely to adhere to a drug regimen.

Drug A was approved by the U.S. Food and Drug Administration (FDA) and has been on the market for several years. Recently, some adverse events began to surface, and the FDA removed the drug from the market. How is it possible for the FDA to first approve a drug and later remove it from approval? 1. Drug companies can alter the drug after approval from the FDA without permission, which can cause safety problems. 2. Patients can build up a tolerance to the drug over time, which can cause safety concerns. 3. Drug manufacturers can influence drug trials, and therefore drugs can be approved that are not determined to be unsafe until later. 4. Postmarketing surveillance can uncover new safety issues with a drug not found during phase I, II, and III trials prior to initial approval.

4. Postmarketing surveillance can uncover new safety issues with a drug not found during phase I, II, and III trials prior to initial approval.

For which alpha1 blocker is dosage data for hypertension (HTN) published? 1. Doxazosin 2. Tamsulosin 3. Terazosin 4. Prazosin

4. Prazosin

Which statement best describes prodrugs? 1. Prodrugs are productive and fight disease. 2. Prodrugs are drugs that pharmaceutical companies feel sell best. 3. Prodrugs are immediately absorbed and go directly into the bloodstream. 4. Prodrugs are by themselves inactive in the body until they are metabolized into an active drug.

4. Prodrugs are by themselves inactive in the body until they are metabolized into an active drug.

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)

4. Proton pump inhibitors (PPIs)

Which of these correctly describes the use of probiotics? 1. Fight infection, especially of the skin and respiratory tract 2. Reduce gastroesophageal reflex and indigestion 3. Increase the release of red blood cells from the kidney 4. Restore the normal balance in intestinal flora that can be disturbed by antibiotics and immunosuppressive medications

4. Restore the normal balance in intestinal flora that can be disturbed by antibiotics and immunosuppressive medications

Alzheimer's disease is associated with profound cholinergic depletion. Which drug is the most appropriate choice for slowing this depletion? 1. Donepezil 2. Memantine 3. Galantamine 4. Rivastigmine

4. Rivastigmine

The United States Preventive Services Task Force (USPSTF) recommends which of the following screening tools for alcohol misuse? 1. Mini Mental Status Exam (MMSE) 2. Tolerance, Worried, Eye-opener, Amnesia, K-Cut Down (TWEAK) 3. Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool 4. Single Alcohol Screening Question (SASQ)

4. Single Alcohol Screening Question (SASQ)

A 45-year-old male patient is complaining of feeling tired for 2 weeks. He states he cannot fall asleep. Which initial treatment should be employed? 1. Ramelteon (Rozerem) 2. Zolpidem (Ambien) 3. Triazolam (Halcion) 4. Sleep hygiene

4. Sleep hygiene

The goal of thyroid replacement in congenital hypothyroidism is to achieve normal IQ and neurological function. Close monitoring is needed when the infant diet consists of which of these? 1. Breast milk 2. Cooked cereal 3. Milk-based formula 4. Soy-based formula

4. Soy-based formula

In which stage of heart failure is use of carvedilol contraindicated? 1. Stage I 2. Stage II 3. Stage III 4. Stage IV

4. Stage IV

A 48-year-old patient with a history of type 2 diabetes mellitus (DM) has questions about the initiation of insulin. The patient is told that exogenous insulin lowers blood glucose by which mechanism? 1. Inhibiting the storage of glucose as glycogen 2. Stimulating glucose production in the liver 3. Decreasing fat storage 4. Stimulating glucose entry into the cell

4. Stimulating glucose entry into the cell

Which oral medication has the most potential for hypoglycemia? 1. Selective sodium-glucose cotransporter 2 (SGLT-2) inhibitor 2. Dipeptidyl peptidase-4 (DPP-4) inhibitor 3. Short-acting rapid insulin 4. Sulfonylurea

4. Sulfonylurea

Which statement describes the mechanism of action among tricyclic antidepressants (TCAs) versus a newer antidepressant, such as escitalopram (Lexapro)? 1. TCAs involve fewer neurotransmitter interactions. 2. TCAs are effective immediately and intended to be used short term. 3. TCAs do not involve receptors or chemical interactions. 4. TCAs are less selective.

4. TCAs are less selective.

A patient comes into the practice complaining of worsening depression, anxiety, and strange dreams. The patient was just started on clonidine for poorly controlled hypertension. In reviewing the medication list, the APN sees that the patient is on both a tricyclic antidepressant and a low-dose antipsychotic. The vital signs show a sitting and standing blood pressure of 188/100 mm Hg. Which is the best course of action? 1. Increase the clonidine or add a second medication for blood pressure. 2. Consider adjusting the antidepressant. 3. Consider adjusting the low-dose antipsychotic. 4. Taper the clonidine down and consider alternative therapy when done.

4. Taper the clonidine down and consider alternative therapy when done.

The APN is following a 68-year-old male who had an acute myocardial infarction (MI) about 4 months ago. He is not seeing a cardiologist anymore. He is doing well and has returned to all his regular activities. He is tolerating a low dose beta blocker, which was started after the heart attack. He has never had any chest pain or exercise intolerance. He has a prescription for sublingual nitroglycerine when necessary but has never needed it. He requests a refill on his Viagra. Which action taken by the APN is most appropriate? 1. Send him back to cardiology. 2. Refill the medication and teach him not to use it within 24 to 48 hours of using SL nitroglycerine. 3. Refill the medication at half the usual dose. 4. Tell him he has to wait 6 months after his heart attack to use this medication again.

4. Tell him he has to wait 6 months after his heart attack to use this medication again.

Which definition accurately describes the half-life of a drug? 1. The time it takes for half of the drug to get to the bloodstream and become bioavailable 2. The time it takes for the drug to reach the cells in the body and connect with receptors on the cell membrane 3. The time when the drug is most effective in the body 4. The time over which the drug concentration decreases by half

4. The time over which the drug concentration decreases by half

Pramlintide can be utilized in which patient? 1. Type 1 diabetic patient with a history of gastroparesis 2. Type 1 diabetic patient with history of multiple hypoglycemic episodes 3. Type 2 diabetes mellitus patient who self-monitors blood glucose once a day 4. Type 2 diabetes mellitus patient with history of renal insufficiency

4. Type 2 diabetes mellitus patient with history of renal insufficiency

During treatment with naltrexone, patients should be monitored for which of the following? 1. Complete blood count (CBC) 2. Comprehensive metabolic profile (CMP) 3. Vitamin D level 4. Urine drug testing

4. Urine drug testing

Current treatment of HIV infection functions through which mechanism of action? 1. Reduction in transmissibility 2. Pre-exposure prophylaxis 3. Eradication of infection 4. Viral suppression

4. Viral suppression

Which action should the clinician consider when treating a patient with opioids for chronic pain? 1. When starting opioid therapy, prescribe extended-release/long-acting (ER/LA) opioids instead of immediate-release opioids. 2. Start at the highest dose expected to control the patient's pain. 3. Provide a quantity of the drug for at least 30 days for acute pain to ensure continuity of pain control is maintained. 4. When opioids are started, clinicians should prescribe the lowest effective dosage.

4. When opioids are started, clinicians should prescribe the lowest effective dosage.

A 33-year-old pregnant female patient has developed community-acquired pneumonia (CAP). Which antibiotic is most appropriate for this patient? 1. Levaquin 2. Avelox 3. Noroxin 4. Zithromax

4. Zithromax

How do antagonist drugs work on the cell? 1. Antagonists produce no direct response. They occupy a receptor site to prevent other molecules from occupying the site, which thereby produces a response. 2. Antagonists cause the cell to create an irritant on the cell membrane that allows the drug to get into the cell and cause a response. 3. An antagonist binds with a drug molecule to guide it away from the cellular receptor. 4. Antagonist drugs reduce the enzyme activity of the agonist drug so that it is less potent.

1. Antagonists produce no direct response. They occupy a receptor site to prevent other molecules from occupying the site, which thereby produces a response.

Which drug class has been shown to be helpful as adjunct treatment during acute withdrawal or as an alternative for individuals who are intolerant to other commonly used treatments? 1. Anticonvulsants 2. Norepinephrine-dopamine reuptake inhibitors 3. Monoamine oxidase inhibitors (MAOIs) 4. Angiotensin receptor blockers

1. Anticonvulsants

Which medication category is associated with an increased risk of falls? 1. Antipsychotics 2. Anticholinergics 3. Corticosteroids 4. Diuretics

1. Antipsychotics

Which of the following symptoms is associated with protracted or postacute opioid withdrawal? 1. Anxiety 2. Confusion 3. Sleepiness 4. Anger

1. Anxiety

Which of these should the APN include in patient education regarding the use of bethanechol? 1. Arising slowly from a supine position 2. Being aware of the normal side effect of wheezing 3. Administrating the drug intramuscularly or intravenously only 4. Taking the drug with a meal or immediately following a meal

1. Arising slowly from a supine position

How do rates of hip fracture and vertebral fracture among Asian American women compare with those among white women? 1. Asian American women have lower hip fracture rates and higher vertebral fracture rates. 2. Asian American women have higher hip fracture rates and lower vertebral fracture rates. 3. Asian American women have lower hip fracture rates and lower vertebral fracture rates. 4. Asian American women have higher hip fracture rates and higher vertebral fracture rates.

1. Asian American women have lower hip fracture rates and higher vertebral fracture rates.

A 53-year-old patient was prescribed a monoamine oxidase inhibitor (MAOI), isocarboxazid (Marplan), while in an acute psychiatric unit for drug-resistant, refractory depression. The APN would include teaching about which food interactions? 1. Avoid cured meats. 2. Avoid peanut products. 3. Avoid grapefruit juice. 4. Avoid fresh, dark green, leafy vegetable

1. Avoid cured meats.

Which of these would the APN include in patient teaching for a male patient using topical testosterone replacement? 1. Avoid direct skin contact with women and children for 4 hours after application. 2. Apply this at bedtime and leave area open to air to increase absorption. 3. Apply to the buttocks and shower off 1 hour later to avoid transmission to sex partners. 4. If skin irritation occurs, double the dose and apply every 2 days instead of daily.

1. Avoid direct skin contact with women and children for 4 hours after application.

The APN is considering an antiepileptic drug for a patient suffering from partial seizures. Prescribing zonisamide will be avoided if the patient has a known anaphylactic reaction to which drug? 1. Bactrim 2. Ciprofloxacin 3. Amoxicillin 4. Vancomycin

1. Bactrim

As many as 40 million Americans take an herbal supplement routinely. Which reason accounts for this high level of use of herbal medications? 1. Because herbal medications are plant-based and considered more natural than the synthesized chemically-based medications from pharmaceutical companies 2. Because herbal medications are less expensive and more pleasant to take than those from pharmaceutical companies 3. Because herbal medications are more spiritual in essence and more likely to work on the whole body 4. Because herbal medications require no doctor's prescription and many adults want to feel more in control of their health

1. Because herbal medications are plant-based and considered more natural than the synthesized chemically-based medications from pharmaceutical companies

Which cholinergic blocker must be taken with food? 1. Benztropine 2. Atropine 3. Dicyclomine 4. Propantheline

1. Benztropine

Atypical antipsychotics can be preferred over typical antipsychotics due to their improved adverse effect profile. Which of these describes this profile? 1. Better patient tolerability, less cognitive impairment, and less extrapyramidal symptoms 2. Improved selectivity and blood pressure regulation and less crossing of placenta barrier 3. Better glycemic control, lipid profiles, and reduced cardiovascular risks 4. Less immunosuppression, somnolence, and weight gain

1. Better patient tolerability, less cognitive impairment, and less extrapyramidal symptoms

Type 2 diabetes mellitus (DM) has four primary alterations in glucose metabolism. One of the alterations includes tissue insensitivity to insulin. Which medications have the greatest effect on tissue insensitivity to insulin? 1. Biguanides 2. Sulfonylureas 3. Meglitinides 4. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors

1. Biguanides

The APN knows that one possible side effect of giving penicillin to someone who is allergic to that drug is anaphylaxis. This is because penicillin is a hapten drug that can have which action? 1. Binding with a protein and causing a Type I hypersensitivity reaction like anaphylaxis 2. Creating insoluble immune complexes in blood vessels that become deposited in tissues such as joints and kidney 3. Causing a Type IV hypersensitivity reaction as a result of autoimmune and infectious diseases, or contacting dermatitis 4. Being flushed out of the system before anaphylaxis occurs through renal dialysis

1. Binding with a protein and causing a Type I hypersensitivity reaction like anaphylaxis

Bisphosphonates must be taken on an empty stomach with a full glass of water. Which statement identifies the reason for this instruction? 1. Bisphosphonates are mildly acidic and have decreased bioavailability if taken with food, especially coffee or orange juice. 2. Bisphosphonates are weak bases and taking them with food will prevent their absorption in the stomach. 3. Bisphosphonates bind with food and liquids, which stops the drug from being absorbed. 4. Allowing the bisphosphonate to mix with an 8 oz glass of water stops the drug from being absorbed and allows it to pass into the intestine.

1. Bisphosphonates are mildly acidic and have decreased bioavailability if taken with food, especially coffee or orange juice.

Which recommendation should be made to a patient with a creatinine clearance (CCr) less than 30 to 35 mL/min and a serum creatinine of 5.1 regarding consideration of drug therapy with a bisphosphonate for osteoporosis treatment? 1. Bisphosphonates are not the drug of choice for treatment of your osteoporosis. 2. Bisphosphonates are safe and effective for persons such as yourself. 3. Bisphosphonates are excreted in the urine, and the recommendation is to double the standard dose. 4. Bisphosphonates are systemically metabolized, and routine liver function tests (LFTs) will be necessary.

1. Bisphosphonates are not the drug of choice for treatment of your osteoporosis.

Which drug is approved for medication-assisted treatment for opioid use disorder in an office-based setting and can be prescribed by qualified physicians, physician's assistants, and nurse practitioners who have additional training and have a waiver under the Drug Addiction and Treatment Act of 2000? 1. Buprenorphine (Belbuca, Buprenex, Subutex, Probuphine) 2. Methadone (Dolophine, Metadol) 3. Naltrexone (Revia, Depade, Vivitrol) 4. Alpha-2 adrenergic agonist lofexidine (Lucemyra)

1. Buprenorphine (Belbuca, Buprenex, Subutex, Probuphine)

How do phosphodiesterase type 5 (PDE-5) inhibitors work? 1. By blocking the catabolism of cyclic guanosine monophosphate (cGMP) 2. By increasing the catabolism of cyclic guanosine monophosphate (cGMP) 3. By increasing spermatogenesis in the testes 4. By blocking the action of type II 5-alpha-reductase inhibitor

1. By blocking the catabolism of cyclic guanosine monophosphate (cGMP)

Which warning would the APN provide to an older patient taking calcium supplements and anticoagulants (such as warfarin)? 1. Calcium supplements contain high vitamin K levels, and warfarin doses may need increasing. 2. Calcium supplements contain low vitamin K levels, and warfarin doses may need to be decreased. 3. Calcium supplements contain high vitamin K levels, and no warfarin dosage change is required. 4. Calcium supplements contain high vitamin K levels and should not be taken by older adults taking warfarin.

1. Calcium supplements contain high vitamin K levels, and warfarin doses may need increasing.

Which angiotensin-converting enzyme inhibitor (ACEI) requires frequent dosing, which can subsequently negatively impact patient adherence in therapy? 1. Captopril 2. Benazepril 3. Ramipril 4. Lisinopril

1. Captopril

The APN is taking a history from a new patient. The patient states that he consumes a six-pack of beer daily and that consumption increases to a six-pack and 4 to 5 ounces of alcohol on the weekends. The APN knows that high levels of chronic alcohol use can have which effect? 1. Cause hepatic failure and thereby inhibit the metabolizing enzymes, changing the ways drugs are metabolized 2. Cause the patient to have high levels of folic acid and B vitamins in their system 3. Cause renal failure and thereby increase the excretion of drugs through the urine 4. Cause increased risk for an iron overload and malabsorption of drugs through the gastrointestinal (GI) tract

1. Cause hepatic failure and thereby inhibit the metabolizing enzymes, changing the ways drugs are metabolized

A 22-year-old female patient with bipolar disorder is treated with valproate (Depakote). She has a positive human chorionic gonadotropin (hCG) test. Which action taken by the APN is most appropriate? 1. Change the valproate to a nonclassified mood stabilizer and avoid the first trimester. 2. Continue the therapy as previously ordered. 3. Lower the dose of valproate until the plasma level is less than 50 mcg/mL. 4. Taper the valproate and switch to lithium.

1. Change the valproate to a nonclassified mood stabilizer and avoid the first trimester.

Which drug can be used to treat hyperlipidemia in a patient with active liver disease? 1. Cholestyramine (Questran) 2. Simvastatin (Zocor) 3. Rosuvastatin (Crestor) 4. Fluvastatin (Lescol)

1. Cholestyramine (Questran)

The APN is treating a 14-year-old patient for a complicated urinary tract infection (UTI). The APN notes on the urine culture and sensitivity report that the organism is only susceptible to quinolones. Which quinolone should be prescribed? 1. Ciprofloxacin 2. Gemifloxacin 3. Moxifloxacin 4. Enoxacin

1. Ciprofloxacin

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

1. Clarithromycin, amoxicillin, and a proton pump inhibitor (PPI)

Rosiglitazone should not be used in patients with which condition? 1. Class III heart failure 2. Peripheral arterial disease 3. Obesity 4. Angina

1. Class III heart failure

The nurse practitioner is evaluating a patient who is prescribed lithium for bipolar disorder. Which laboratory result suggests that a lower dose or change of medication should be considered? 1. Creatinine 2.7 mg/dL 2. Potassium 4.2 mEq/L 3. Sodium 133 mEq/L 4. Lithium level of 0.9 mEq/L

1. Creatinine 2.7 mg/dL

Activation of central alpha2 receptors results in inhibition of cardioacceleration and vasoconstriction centers in the brain. This action causes a decrease in peripheral outflow of norepinephrine (NE), leading to which effect? 1. Decrease in renal vascular resistance 2. Increase in heart rate 3. Reduction in blood volume 4. Increased secretion of sodium

1. Decrease in renal vascular resistance

A patient is dependent on lorazepam (Ativan), which has been prescribed for a year. Which strategy should be employed to reduce the risk of severe withdrawal symptoms? 1. Decrease the dose by 0.5 mg per week, then by 0.25 mg for the last few weeks. 2. Switch the patient to an equivalent dose of clonazepam, then titrate the dose. 3. Concurrent use of an antihistamine agent for 3 days and then discontinue. 4. Coadminister a barbiturate for 3 days then discontinue.

1. Decrease the dose by 0.5 mg per week, then by 0.25 mg for the last few weeks.

Normal age-related changes alter the absorption of medications from the gastrointestinal (GI) tract. Which of these is caused by age-related changes? 1. Decreased acid production 2. Decreased gastric pH 3. Increased gastric emptying time 4. Increased esophageal peristalsis

1. Decreased acid production

Which is a long-term benefit of pharmacogenomics? 1. Development of more potent and selective drugs and a decrease in overall drug costs 2. The ability to better prevent diseases by removing genes that cause disease 3. Providing new drugs that can help all people to fight specific diseases that are caused by polymorphisms 4. To help scientists better understand the cause of diseases Rationales

1. Development of more potent and selective drugs and a decrease in overall drug costs

Treatment of rheumatoid arthritis (RA) with long-term use of steroids, such as prednisolone in doses of greater than 5 mg per day, has been linked to increased risk of developing which condition? 1. Diabetes mellitus 2. Chronic fatigue syndrome 3. Alopecia areata 4. Asthma

1. Diabetes mellitus

Which benzodiazepine is metabolized by a phase I reaction and thus requires lower doses for the same therapeutic effect? 1. Diazepam 2. Lorazepam 3. Temazepam 4. Oxazepam

1. Diazepam

Which drugs act uniquely by the direct blocking of renin itself, not on its genesis or on the angiotensin components of the renin-angiotensin-aldosterone (RAA) system? 1. Direct renin inhibitors (DRI) 2. Angiotensin-converting enzyme inhibitors (ACEIs) 3. Angiotensin II receptor blockers (ARBs) 4. Cardiac glycosides (CGs)

1. Direct renin inhibitors (DRI)

A patient has issues with poor appetite and some malabsorption tendencies. The APN wants to prescribe a cholinesterase inhibitor for its central nervous system (CNS) effects. However, the APN knows most of these drugs require food for better bioavailability. Which cholinesterase inhibitor is most appropriate for this patient? 1. Donepezil 2. Galantamine 3. Rivastigmine 4. Neostigmine

1. Donepezil

A patient has poor appetite and some malabsorption tendencies. The APN wants to prescribe a cholinesterase inhibitor for its central nervous system (CNS) effects but knows that most require food for better availability. Which cholinesterase inhibitor is most appropriate for this patient? 1. Donepezil 2. Pyridostigmine 3. Rivastigmine 4. Neostigmine

1. Donepezil

Canagliflozin should not be initiated in patients with which condition? 1. End-stage renal disease 2. Anemia 3. Obesity 4. Glycosuria

1. End-stage renal disease

Research from a Women's Health Initiative (WHI) study resulted in which evidence-based recommendation regarding the use of estrogen and selective estrogen receptor modulators (SERMs) for the sole purpose of treatment for osteoporosis? 1. Estrogen and SERMS are not first-line therapy and should never be used for the sole purpose of treating bone loss. 2. Estrogen and SERMs may be used for bone loss in those with elevated cardiovascular (CV) risk. 3. Estrogen and SERMs are more effective if used for bone loss in those 10 years (or more) after menopause. 4. Estrogen and SERMs may be used in those with high risk of osteoporosis and fracture.

1. Estrogen and SERMS are not first-line therapy and should never be used for the sole purpose of treating bone loss.

Which physiological biomarker is a metabolite of ethyl alcohol that can be detected in urine and hair samples and can be used to assess individuals with known or suspected alcohol use disorder? 1. Ethyl glucuronide (EtG) 2. Mean corpuscular volume (MCV) 3. Lipase and amylase 4. Testosterone

1. Ethyl glucuronide (EtG)

A 72-year-old male patient is taking a sodium-glucose cotransporter 2 (SGLT-2) inhibitor for type 2 diabetes mellitus. The APN should be concerned if the patient reports which symptom? 1. Falls 2. Glycosuria 3. Increased hemoglobin 4. Weight loss

1. Falls

Normal aging is associated with a decrease in serum albumin levels. How does this impact drug distribution? 1. Fewer protein molecules are available for drug binding, leading to higher levels of free, unbound drug and an increased risk for drug toxicity. 2. Protein molecules are more concentrated, leading to full binding with the drug. 3. The decrease in serum albumin levels has a neutral impact on drug distribution because older people also have more protein binding sites to compensate for the lower albumin level. 4. Exogenous sources of protein are required to keep drug levels normal.

1. Fewer protein molecules are available for drug binding, leading to higher levels of free, unbound drug and an increased risk for drug toxicity.

To minimize gastrointestinal side effects, it is recommended that bisphosphonates should be taken in which manner? 1. First thing in the morning on an empty stomach with a full 8 oz glass of water 2. Before bedtime with a small amount of food to facilitate absorption 3. Twice a day because of the short half-life 4. With juice or coffee to enhance acidity and bioavailability

1. First thing in the morning on an empty stomach with a full 8 oz glass of water

Which statement accurately describes the concept of nonlinear pharmacokinetics in children? 1. For some medications, a child may need more of a medication than an adult. 2. Children will require less medication than adults. 3. Smaller children will require more medication than larger children of the same age. 4. Smaller children will require less medication than larger children of the same age.

1. For some medications, a child may need more of a medication than an adult.

In which time frame would an APN expect to see signs of allergic reactions after an antibiotic is initiated? 1. From 20 minutes to 3 weeks 2. From 3 weeks to 6 months 3. From 6 months to 1 year 4. From 1 year to 18 months

1. From 20 minutes to 3 weeks

A patient with bipolar disorder is prescribed lithium. Which medical complication could increase the lithium level and cause toxicity for the patient? 1. Gastroenteritis 2. Diabetic ulcer 3. Water intoxication 4. Asthma

1. Gastroenteritis

A 28-year-old obese female patient who is 6 weeks pregnant has an elevated fasting blood sugar level of 200. The APN would most suspect which condition in the patient? 1. Gestational diabetes 2. Type 1diabetes mellitus (DM) 3. Type 2 diabetes mellitus (DM) 4. Prediabetes

1. Gestational diabetes

A 28-year-old obese female patient who is 6 weeks pregnant has an elevated fasting blood sugar level of 200. The APN would most suspect which condition in the patient?1. Gestational diabetes 2. Type 1diabetes mellitus (DM) 3. Type 2 diabetes mellitus (DM) 4. Prediabetes

1. Gestational diabetes

The renal system is the most common place where drugs are excreted from the body. Which aspect is most important for determining the rate of drug excretion? 1. Glomerular filtration rate (GFR) 2. Blood pressure 3. Red blood cell production 4. Renal artery viability

1. Glomerular filtration rate (GFR)

Metformin should be discontinued and switched to a different medication for which reason? 1. Glomerular filtration rate (GFR) below 30 mL/min 2. Diarrhea 3. Abdominal pain 4. Radiological study with contrast

1. Glomerular filtration rate (GFR) below 30 mL/min

A patient with type 2 diabetes mellitus (DM) is taking a rapid-acting insulin before meals and an alpha-glucosidase inhibitor three times a day. Her blood glucose log reveals a fasting glucose of 50 on several occasions. The APN instructs the patient that which of these will increase glucose levels when the patient is experiencing hypoglycemia? 1. Glucagon 2. ½ can of soda 3. 4 grapes 4. 1 cup of fruit juice

1. Glucagon

Exocrine pancreatic enzymes should be used with caution in patients with which condition?1. Gout 2. Chronic pancreatitis 3. Cholecystitis 4. Gastric reflux disease

1. Gout

A 16-year-old male patient is in your office with growth 50% below the curve for his age. To determine the presence of a growth deficiency, the APN would take measurements of which hormone? 1. Growth hormone-releasing hormone (GHRH) 2. Estrogen 3. Testosterone 4. Thyroid-stimulating hormone (TSH)

1. Growth hormone-releasing hormone (GHRH)

Which characteristics of the patient with HIV must be known prior to starting abacavir specifically? 1. HLA B*5701 testing 2. Pretreatment CD4+ T cell count 3. Pregnancy potential 4. Cardiovascular disease

1. HLA B*5701 testing

According to the American Diabetic Association (ADA) standards of medical care in diabetes, which of these is a diagnostic criterion for diabetes? 1. HbA1c 6.5% 2. Random glucose less than 200 mg/dL 3. Fasting glucose of 100 mg/dL 4. Fasting glucose less than 92 mg /dL

1. HbA1c 6.5%

The APN is testing for gestational diabetes and instructs the patient who is 24 weeks pregnant how the oral glucose tolerance test is conducted. The patient states that her mother has diabetes and has a blood test called an HbA1c, which is tested three times a year. The APN informs the patient that the HbA1c would not be an adequate measurement for diagnosis of gestational diabetes for which reason? 1. HbA1c is unreliable in early pregnancy. 2. HbA1c test is more expensive. 3. Oral glucose tolerance test (OGTT) is more effective. 4. HbA1c is unreliable in disorders with hepatic gluconeogenesis.

1. HbA1c is unreliable in early pregnancy.

A patient with left ventricular dysfunction is taking a calcium channel blocker (CCB) and a beta blocker (BB). This combination may induce which condition? 1. Heart failure or bradycardia 2. Tachycardia and hypotension 3. Angina and tachycardia 4. Hypoglycemia

1. Heart failure or bradycardia

Tumor necrosis factor (TNF) inhibitors used for the treatment of rheumatoid arthritis (RA) are associated with serious side effects, such as increased risk of which condition(s)? 1. Heart failure, vasculitis, and vision issues 2. Pulmonary fibrosis 3. All cancers except colon cancer 4. Rashes and skin discoloration

1. Heart failure, vasculitis, and vision issues

Prescription of a disease-modifying antirheumatic drug (DMARD) of any sort would be contraindicated in a patient with which condition? 1. Hepatitis B 2. Significant bone erosion 3. History of methotrexate failure 4. Moderate or severe rheumatoid arthritis (RA)

1. Hepatitis B

Which condition is a major side effect of oral ketoconazole? 1. Hepatotoxicity 2. Dry mouth and metallic taste 3. Renal dysfunction 4. Heart failure

1. Hepatotoxicity

The APN has diagnosed S. pneumoniae in an adolescent. Which antibiotic is most appropriate for the APN to prescribe? 1. High-dose amoxicillin (90 mg/kg daily, divided in two doses) 2. Low-dose amoxicillin (45 mg/kg daily, divided in two doses) 3. High-dose azithromycin (90 mg/kg daily, divided in two doses) 4. Low-dose azithromycin (45 mg/kg daily, divided in two doses

1. High-dose amoxicillin (90 mg/kg daily, divided in two doses)

Which of these is associated with testosterone therapy? 1. Higher low-density lipid (LDL) levels 2. Higher high-density lipid (HDL) levels 3. Lower low-density lipid (LDL) levels 4. Lower total cholesterol levels

1. Higher low-density lipid (LDL) levels

Which properties below are preferred in medications prescribed to a mother who is breastfeeding? 1. Highly protein bound with a short half-life 2. Highly protein bound with a long half-life 3. Minimally protein bound with a short half-life 4. Minimally protein bound with a long half-life

1. Highly protein bound with a short half-life

The patient is scheduled for a cardiac catheter this morning and has been NPO since midnight. He has a 10-year history of latent autoimmune diabetes in adults (LADA) and is currently on a basal/bolus regimen with good control. The blood glucose this morning is 170 mg/dL. The APN is writing orders for the procedure when the RN asks about the insulin dose this morning. Which action is most appropriate for the APN to instruct the RN to take? 1. Hold the morning dose of insulin because the patient administered insulin detemir the previous night. 2. Administer the usual dose of 15 units of Humulin Lispro. 3. Give an oral antidiabetic medication with a sip of water. 4. Reduce the Humulin Lispro insulin dose to 5 units.

1. Hold the morning dose of insulin because the patient administered insulin detemir the previous night.

Which medication sometimes induces a lupus-like syndrome that appears to be dose-related with an incidence highest in white women? 1. Hydralazine 2. Digoxin 3. Propranolol 4. Furosemide

1. Hydralazine

When gout occurs in postmenopausal women, it is almost exclusively associated with which factors? 1. Hypertension, renal insufficiency, and diuretic use 2. Hypothyroidism, rheumatoid arthritis (RA), and prednisone use 3. Macular degeneration, hypotension, and oral contraceptive use 4. Liver disease, osteoarthritis (OA), and NSAID use

1. Hypertension, renal insufficiency, and diuretic use

Parathyroid hormone (PTH) analogue drugs, used for the treatment of osteoporosis, are associated with which side effects after injection? 1. Hypotension and orthostasis 2. Headache and blurred vision 3. Peripheral neuropathies 4. Diarrhea and gastrointestinal (GI) distress

1. Hypotension and orthostasis

The initial dose for an angiotensin II receptor blocker (ARB) may need to be lower in which of these? 1. Impaired hepatic function 2. Congestive heart failure 3. Diabetes 4. Male gender

1. Impaired hepatic function

The APN is concerned about a patient who has developed a complication from diabetes when the patient presents which symptom?1. Impaired vision 2. Urticaria 3. Elevated thyroid levels 4. Edema

1. Impaired vision

Long-term use of benzodiazepines is not associated with which of the following? 1. Improvement of memory 2. Cognitive impairment 3. Falls 4. Motor vehicle accidents

1. Improvement of memory

For men over age 65, testosterone replacement therapy (TRT) has been shown to have which effect? 1. Improves physical function 2. Causes depression 3. Improves lipid values 4. Worsens cognitive function

1. Improves physical function

The APN is seeing a patient with a history of diabetes and hypothyroidism. The patient recently discovered that she was 8 weeks pregnant. The APN should expect to take which action? 1. Increase thyroid replacement by 25% 2. Decrease thyroid replacement by 25% 3. Decrease beta blocker by 50% 4. Increase beta blocker by 50%

1. Increase thyroid replacement by 25%

Polycystic ovarian syndrome (PCOS) is associated with which laboratory results? 1. Increased testosterone and luteinizing hormone (LH) 2. Decreased follicle-stimulating hormone (FSH) and luteinizing hormone (LH) 3. Increased testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) 4. Decreased estrogen and follicle-stimulating hormone (FSH), increased luteinizing hormone (LH)

1. Increased testosterone and luteinizing hormone (LH)

Which course of action taken by the nurse is most likely to increase medication adherence? 1. Informing the patient of how the medication works and should be taken, as well as the benefits and possible adverse reactions to the medication 2. Insisting strongly that the patient take the medication, including adverse consequences if the patient does not comply 3. Reviewing the pharmacokinetics of the medication and how long it has been on the market 4. Warning the patient that not taking the medication as directed will result in the patient needing to find another provider

1. Informing the patient of how the medication works and should be taken, as well as the benefits and possible adverse reactions to the medication

Which of these would the APN need to consider when selecting the best option for the patient beginning testosterone replacement therapy? 1. Injectable testosterone is the least expensive. 2. Testosterone patches have few to no skin reactions. 3. Oral preparations are favored by insurance companies. 4. Surgically implanted pellets provide 5 years of continuous therapy.

1. Injectable testosterone is the least expensive.

Steroid injections to relieve pain and inflammation in large joints may be associated with which iatrogenic risk? 1. Inoculation of bacteria into the joint 2. Bruising and scarring 3. Loss of synovial joint fluid 4. Need for repeated computed tomography (CT) scans for needle placement

1. Inoculation of bacteria into the joint

At a transmembrane receptor, an active hormone can bind to an extracellular site, changing the receptor conformation and causing two receptors to bind to each other. This binding causes an activation of the enzyme. Which of these uses this type of cellular binding? 1. Insulin 2. Beta adrenergic antagonist 3. Thyroid hormone 4. Antibiotics

1. Insulin

A 32-year-old male patient with type 2 diabetes mellitus (DM) reports a recent episode of hypoglycemia in the morning. The APN is reviewing the medications and decides that adjustment of which medication would be most appropriate? 1. Insulin detemir 2. Sitagliptin 3. Glyburide 4. Insulin lispro

1. Insulin detemir

The APN diagnoses the patient with diabetes after obtaining an HbA1c of 12% in the office. The fasting blood glucose today is 135. The patient complains of a history of polyphagia, polydipsia, and polyuria. Which medication would be most appropriate to start today? 1. Insulin lispro and insulin glargine 2. Metformin 3. Glipizide 4. Metformin and sitagliptin

1. Insulin lispro and insulin glargine

Voriconazole is used in the treatment of which condition? 1. Invasive aspergillosis 2. Oropharyngeal candidiasis 3. Onychomycosis 4. Tinea capitis

1. Invasive aspergillosis

The APN understands that a pregnant female who has tuberculosis can be treated with which medication regimen? 1. Isoniazid, rifampin, pyrazinamide, and ethambutol 2. Isoniazid, rifampin, cycloserine, and ethionamide 3. Levofloxacin, moxifloxacin, pyrazinamide, and ethambutol 4. Levofloxacin, moxifloxacin, cycloserine, and ethionamide

1. Isoniazid, rifampin, pyrazinamide, and ethambutol

Which medications are included in the 6-month regimen to effectively treat tuberculosis? 1. Isoniazid, rifampin, pyrazinamide, and ethambutol 2. Isoniazid, rifampin, cycloserine, and ethionamide 3. Levofloxacin, moxifloxacin, pyrazinamide, and ethambutol 4. Levofloxacin, moxifloxacin, cycloserine, and ethionamide

1. Isoniazid, rifampin, pyrazinamide, and ethambutol

The APN knows that older adults are at increased risk of ADRs for which reason? 1. Polypharmacy and decreased hepatic and renal function, which leads to decreased metabolism of drugs and increases the potential for toxicity 2. Reduced mental function, which often leads to inappropriate home administration of medication 3. Increased immune function and CYP drug interactions 4. Inattention to weight-based dosing

1. Polypharmacy and decreased hepatic and renal function, which leads to decreased metabolism of drugs and increases the potential for toxicity

To monitor the effectiveness of insulin lispro, the APN will instruct the patient to closely monitor which of these? 1. Postprandial glucose 2. Fasting glucose 3. Bedtime glucose 4. Preprandial glucose

1. Postprandial glucose

An antiepileptic drug can be useful when combined to form an anorexiant. Which mechanisms promote these beneficial effects? 1. Potentiates gamma-aminobutyric acid (GABA) and promotes weight loss in up to 16% of patients 2. Antagonizes glutamate and causes excitation, which speeds the metabolism for weight loss 3. Modulates sodium channels, which keeps the channel inactive longer and requires more energy expenditure and weight loss 4. Slows the influx of sodium in neurons and slows the spread of abnormal seizure activity, which promotes gastrointestinal motility and weight loss

1. Potentiates gamma-aminobutyric acid (GABA) and promotes weight loss in up to 16% of patients

Which of the following patients should not be prescribed buprenorphine with naloxone (Suboxone)? 1. Pregnant women 2. A patient who has a history of diversion 3. A male who has a history of injectable drug use 4. A patient with a history of opioid addiction

1. Pregnant women

A frail, 78-year-old female patient with a history of type 2 diabetes mellitus (DM), obesity, chronic obstructive pulmonary disease, and coronary artery disease is returning for a follow-up evaluation. She has a previous history of hypoglycemia. Her current medication regimen includes max dose of biguanide and a dipeptidyl peptidase-4 (DPP-4) inhibitor. Her HbA1c is 7.8%. Which action is most appropriate for the APN to take? 1. Prescribe no additional medication. 2. Prescribe rapid-acting insulin (RAI) before meals. 3. Prescribe nasally inhaled human insulin. 4. Prescribe a sulfonylurea.

1. Prescribe no additional medication.

Which drug is most appropriate for a patient with high uric acid levels who undersecretes uric acid and has adequate renal function? 1. Probenecid 2. Allopurinol and febuxostat 3. Pegloticase 4. Lesinurad

1. Probenecid

Which of these is a microvascular complication of uncontrolled diabetes? 1. Proliferative retinopathy 2. Cardiovascular disease 3. Stroke 4. Peripheral vascular disease

1. Proliferative retinopathy

Which recommendation is most appropriate for a person who requires chronic lowering of uric acid levels before initiation of therapy with febuxostat (Uloric)? 1. Prophylactic administration of an NSAID or colchicine 2. Strict adherence to the Dietary Approaches to Stop Hypertension (DASH) diet 3. Screening for glucose-6-phosphate dehydrogenase (G6PD) deficiency 4. Discontinuation of all other drugs

1. Prophylactic administration of an NSAID or colchicine

When adding a new drug, such as another disease-modifying antirheumatic drug (DMARD) or biologic, to the treatment regimen of a patient with rheumatoid arthritis (RA) who is taking methotrexate, consideration of which characteristics is most important? 1. Protein-binding characteristics of the new drug 2. Hydrophilic characteristics of the new drug 3. Potential for acceleration of folic acid production 4. Adding another DMARD or biologic is contraindicated.

1. Protein-binding characteristics of the new drug

The APN administers an IV dose of morphine for a fractured ankle. Fifteen minutes after the administration, the APN notes the patient's respirations have decreased from 28 breaths/minute to 20/minute. Which action is the priority? 1. Reassess the patient's current pain. 2. Provide a smaller dose for the next administration. 3. Change the medication due to this adverse reaction. 4. Assess for adverse effect of constipation.

1. Reassess the patient's current pain.

Which basic unit of physiology provides a theoretical framework for understanding and predicting drug actions and the relationship between dose and effect? 1. Receptors: Interactions between drug and receptor change the physiological processes and produce cellular changes that result in a response. 2. Enzymes: Each enzyme is paired with a drug and acts on that drug to cause a response in the body. 3. Blood: Blood carries the drug to the area of the body required for the drug's action to take place and be effective. 4. Proteins: These carry most drugs to the entire body to enable them to be effective.

1. Receptors: Interactions between drug and receptor change the physiological processes and produce cellular changes that result in a response.

Which of these correctly identifies the benefits of having adequate amounts of fiber in a person's diet? 1. Reduces constipation, improves cholesterol levels, and provides better glucose control for diabetics 2. Reduces high blood pressure, provides stomach coating for ulcers, and provides fuel for extra energy 3. Reduces leg pain, increases blood calcium levels, and provides for better kidney function 4. Reduces metabolic waste, allows the body to increase efficient fuel usage, and provides better renal function

1. Reduces constipation, improves cholesterol levels, and provides better glucose control for diabetics

Which medication is preferred for treatment of gestational diabetes? 1. Regular insulin 2. Insulin glargine 3. Human inhaled insulin 4. Metformin

1. Regular insulin

A 24-year-old patient with a history of Lennox-Gastaut syndrome and has a shortened QT interval should avoid which antiseizure medication? 1. Rufinamide 2. Phenytoin 3. Valproic acid 4. Topiramate

1. Rufinamide

The Pediatric Research Equity Act (PREA) requires that any new drug considered for approval include which of these? 1. Safety statement for use in children 2. Topical preparation for use in children 3. List of products safe to mix with the drug to make it taste better 4. Handout on how to calculate the correct dose for a child using the adult preparation

1. Safety statement for use in children

Which of the following can occur with abrupt discontinuation of benzodiazepines? 1. Seizure activity 2. Arrhythmias 3. Migraine headache 4. Visual loss

1. Seizure activity

HbA1c can be unreliable in which medical condition? 1. Sickle cell disease 2. Cystic fibrosis 3. Cardiovascular disease 4. Peripheral artery disease

1. Sickle cell disease

Which of these is the strongest determinant of men's health? 1. Socio-economic status (SES) 2. Unemployment 3. Access to primary care 4. Stress

1. Socio-economic status (SES)

A 33-year-old female with a medical history of diabetes mellitus, hypertension, and new onset of hyperthyroidism complains of palpitations and recent 5-pound weight loss. Which medication adjustments would be priority for this patient? 1. Start propranolol 2. Increase levothyroxine 3. Decrease methimazole 4. Start digoxin

1. Start propranolol

You have prescribed a clonidine transdermal patch. Which of the following actions should be performed? 1. Start the patient on oral clonidine for the first 3 days. 2. Instruct the patient to monitor for irregular heart rate while taking the medication. 3. Discontinue methadone or buprenorphine once clonidine transdermal is initiated. 4. Begin tapering at day 7

1. Start the patient on oral clonidine for the first 3 days.

A 50-year-old male patient with acanthosis nigricans is concerned about the risk of diabetes. The APN would inform the patient that he can decrease his risk of diabetes through which strategy? 1. Starting metformin 2. Maintaining a body mass index (BMI) of 30 3. Exercising for 60 minutes per week 4. Measuring his HbA1c every 3 years

1. Starting metformin

Topiramate (Topamax) is being prescribed to a school-aged child for partial seizures. As the summer approaches and temperatures rise, the nurse practitioner needs to include which teaching? 1. Stay hydrated and avoid extreme high temperatures due to risk of decreased sweating and high fever. 2. Take a probiotic with topiramate to reduce the adverse effects. 3. Take an aspirin with topiramate to reduce the adverse effect profile. 4. Avoid the sun and wear sunblock due to increased photosensitivity.

1. Stay hydrated and avoid extreme high temperatures due to risk of decreased sweating and high fever.

Which method of action do injectable parathyroid hormone (PTH) analogues (such as Forteo) have on bone remodeling? 1. Stimulating osteoblastic activity 2. Stimulating osteoclastic activity 3. Decreasing osteoblastic activity 4. Stimulating release of osteocytes

1. Stimulating osteoblastic activity

An 8-year-old male patient has been started on growth hormones for treatment of short statue. The APN instructs the mother that growth hormones work by which mechanism? 1. Stimulating synthesis of somatomedins 2. Decreasing protein synthesis 3. Augmenting fat stores 4. Increasing cholesterol levels

1. Stimulating synthesis of somatomedins

To minimize the risk of osteonecrosis of the jaw, persons with cancer who have been taking IV doses of bisphosphonates or oral doses of bisphosphonates for more than 3 years, and who are planning elective invasive dental procedures, should take which action? 1. Stop bisphosphonate therapy 3 months before the dental procedure. 2. Stop bisphosphonate therapy 6 months before the dental procedure. 3. Stop bisphosphonate therapy 1 year before the dental procedure. 4. Continue taking bisphosphonates as directed before the dental procedure, but stop it postprocedure.

1. Stop bisphosphonate therapy 3 months before the dental procedure.

Which action should be considered when planning the management of angiotensin II receptor blockers (ARBs)? 1. Stop diuretics for 2 to 3 days to allow hydration before starting an ARB. 2. Start at the highest dose and titrate as needed. 3. Increase the dose at 1- to 2-day intervals. 4. Increase the dose of diuretics before initiation of an ARB.

1. Stop diuretics for 2 to 3 days to allow hydration before starting an ARB.

Which pathogen is the most common cause of bacterial pneumonia in children of all ages? 1. Streptococcus pneumoniae 2. Klebsiella pneumoniae 3. Haemophilus influenza 4. Mycoplasma pneumoniae

1. Streptococcus pneumoniae

Which serious complication is caused by tuberculosis (TB) in children younger than 5 years of age and usually occurs within 6 months of primary infection? 1. TB meningitis 2. Extrapulmonary TB 3. Hepatitis 4. Peripheral neuropathy

1. TB meningitis

Scheduled drugs are identified by the U.S. Drug Enforcement Administration (DEA) and are classified based on their potential for abuse. Which of these must the APN understand when dealing with scheduled drugs? 1. The state laws regarding prescription of scheduled drugs 2. The number of scheduled drug prescriptions written in a given month 3. The national prohibition on APNs prescribing scheduled drugs 4. The DEA number provided to all APNs upon certification and state licensure

1. The state laws regarding prescription of scheduled drugs

Historically, barbiturates were used to treat seizure disorders, anxiety, and insomnia, but new agents have fewer adverse effects. Which risk associated with barbiturates represents the biggest concern for using them over other anxiolytics or sedative-hypnotics? 1. Their risk for tolerance and dependence 2. Their risk for intractable nausea and vomiting 3. Their risk for megacolon 4. Their risk for tardive dyskinesia

1. Their risk for tolerance and dependence

When considering pharmacogenomics in prescribing, the APN should be aware of a recent development in the discovery of single-nucleotide polymorphisms (SNPs). How do these SNPs change the understanding of pharmacogenomics? 1. These SNPs account for allotypic phenotype variations that can change the way a drug responds in any individual. 2. These SNPs protect the body from any changes in the way drugs react in the body. 3. All humans have the same SNPs, making it possible to prescribe medications to all people in a similar fashion. 4. SNPs are not related to genetics, but rather are a subset of CYP 450 enzymes that metabolize drugs in the body.

1. These SNPs account for allotypic phenotype variations that can change the way a drug responds in any individual.

The CYP-450 system metabolizes drugs in the body. Which statement describes drugs that are induced by the CYP system? 1. They are metabolized, thereby causing an increase in the removal of the drugs from the body. 2. They are allowed to stay in the bloodstream for a longer period of time. 3. They are induced to become more active and stronger, thereby increasing the possibility of drug interactions. 4. They are shifted over to the renal system for excretion.

1. They are metabolized, thereby causing an increase in the removal of the drugs from the body.

Which statement about the experiences of transgender people is most accurate? 1. They are more likely to experience violence than cisgender persons. 2. They use health-care resources about the same as cisgender people. 3. They report that their health-care providers are typically well informed on transgender health issues. 4. They are healthier than cisgender people.

1. They are more likely to experience violence than cisgender persons.

Which statement about alpha-5 reductase inhibitors is most accurate? 1. They may increase the risk of prostate cancer. 2. They can cause high blood pressure. 3. They decrease testosterone levels. 4. They cause gynecomastia.

1. They may increase the risk of prostate cancer.

A 59-year-old male presents with severe alcohol withdrawal, a history of poor diet, and overt signs of malnutrition. Which of the following should be ordered? 1. Thiamine 250 mg for 3 to 5 days parentally 2. Multivitamin supplement parentally 3. Thiamine 100 mg every day by mouth 4. Magnesium 250 mg every day by mouth

1. Thiamine 250 mg for 3 to 5 days parentally

Patients that are diagnosed with type 1 diabetes mellitus (DM) should also be screened for which condition? 1. Thyroid dysfunction 2. Cardiovascular disease 3. Intermittent claudication 4. Elevated creatinine

1. Thyroid dysfunction

Testing of which levels best monitors the effectiveness of thyroid replacement? 1. Thyroid-stimulating hormone (TSH) 2. Serum triiodothyronine (T3) 3. Levothyroxine 4. Serum thyroxine (T4)

1. Thyroid-stimulating hormone (TSH)

A 24-year-old patient was diagnosed with bacterial vaginosis. Which medication dosage is most appropriate for this patient? 1. Tinidazole 2 g oral dose once daily for 2 days taken with food 2. Tinidazole 1 g oral dose once daily for 2 days taken with food 3. Tinidazole 1 g oral dose once daily for 7 days taken with food 4. Tinidazole 2 g oral dose once daily for 7 days taken with food

1. Tinidazole 2 g oral dose once daily for 2 days taken with food

When initiating long-term drug therapy with proton pump inhibitors (PPIs) for patients with severe gastroesophageal reflux disease (GERD), which of these is one of the four goals of treatment? 1. To reduce symptoms of reflux 2. To remove barriers to adherence 3. To prevent the development of vitamin B12 deficiency 4. To cure the disorder

1. To reduce symptoms of reflux

Treatment for a patient with pneumonia has which long-term goal? 1. To return to the previous respiratory status 2. To improved clinical condition 3. To end fever 4. Resolution of leukocytosis

1. To return to the previous respiratory status

In addition to increasing skeletal growth for the treatment of short stature, growth hormones may also be indicated for which other use? 1. Treatment of lipodystrophy 2. Treatment of acromegaly 3. Decreasing tumor growth 4. Decreasing parathyroid hormone levels

1. Treatment of lipodystrophy

Which basic principle must the APN apply when treating tuberculosis (TB)? 1. Treatment regimens must contain multiple drugs. 2. Failing treatment regimens must be bolstered with the addition of a single drug at a time. 3. Treatment for tuberculosis must include three phases: bactericidal, intensive, and sterilizing. 4. Treatment must be ceased at 6 months to avoid severe adverse drug reactions.

1. Treatment regimens must contain multiple drugs.

Which of the following benzodiazepines has the shortest duration of action? 1. Triazolam (Halcion) 2. Diazepam (Valium) 3. Clonazepam (Klonopin) 4. Chlordiazepoxide (Librium)

1. Triazolam (Halcion)

Selective estrogen receptor modulators (SERMs) such as raloxifene should not be prescribed for pre- or perimenopausal women because of which possibility? 1. Triggering intolerable hot flashes 2. Increasing risk of bleeding 3. Increasing total and low-density cholesterol levels 4. Increasing risk of breast cancer

1. Triggering intolerable hot flashes

A patient with HIV was prescribed an antibiotic, and 7 days later the patient developed an erythema multiforme rash. Which antibiotic is most consistent with this side effect? 1. Trimpex 2. Macrobid 3. Zithromax 4. Biaxin

1. Trimpex

Which medication is U.S. Federal Drug Administration (FDA)-approved for pre-exposure prophylaxis (PrEP) in patients who are at high risk for contracting HIV? 1. Truvada 2. Atripla 3. Emtriva 4. Stribild

1. Truvada

Which statement accurately describes the current recommendation regarding the use of oral estrogen replacement therapy in women with intact uteruses? 1. Unopposed oral estrogen is contraindicated. 2. Unopposed oral estrogen should be limited to low doses for short periods. 3. Unopposed oral estrogen may be used with caution and close monitoring. 4. Unopposed oral estrogen may be justified in those with severe osteoporosis.

1. Unopposed oral estrogen is contraindicated.

Gout is caused by an alteration in purine metabolism, resulting in high levels of which of these? 1. Uric acid 2. Calcium oxalate 3. Potassium 4. Dopamine

1. Uric acid

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

1. Verapamil

Oral ferrous sulfate is better absorbed and tolerated when taken with which of these? 1. Vitamin C after a meal 2. A cup of tea with cinnamon and honey 3. A full meal 4. A low-dose aspirin and a high-fat snack at bedtime

1. Vitamin C after a meal

Which of these is a pharmacokinetic concept used to describe the time it takes for a drug to reach target levels in tissues and organ systems? 1. Volume of distribution (VD) 2. Metabolism 3. Absorption 4. Elimination

1. Volume of distribution (VD)

A patient with a history of chronic alcohol consumption presents with confusion, ataxia, and ophthalmoplegia. Which condition should you suspect? 1. Wernicke's encephalopathy 2. Alcoholic fatty liver disease 3. Psychotic disorder 4. Epilepsy

1. Wernicke's encephalopathy

Calcium carbonate supplements should be taken in which regimen to enhance absorption? 1. With food 2. On an empty stomach 3. One hour before bedtime with water 4. With a proton pump inhibitor

1. With food

The rate of decline of bone loss is greatest for women during which period of their lives? 1. Within 2 years of menopause 2. During pregnancy 3. After the age of 70 4. During late adolescence

1. Within 2 years of menopause

When does the World Health Organization (WHO) endorse starting antiretroviral therapy (ART) in a newly-diagnosed patient with HIV? 1. Within 7 days to the same day of newly-diagnosed HIV patient 2. Within 20 days of newly-diagnosed HIV patient 3. After the viral load numbers 4. Within 6 months of newly-diagnosed HIV patient

1. Within 7 days to the same day of newly-diagnosed HIV patient

Which responsibilities belong to the NP prescriber and should be followed when prescribing a medication for any patient? 1. Determine the diagnosis, choose the drug with the most appropriate method of action for the diagnosis, and monitor the expected outcomes of therapy. 2. Obtain genetic proof for a diagnosis, provide a list of possible drug options, and provide the amount of drug needed for the life of the problem. 3. Determine the diagnosis and provide a range of drugs that could possibly assist in decreasing disease issues. 4. Prescribe the least expensive drug for the diagnosis.

1. Determine the diagnosis, choose the drug with the most appropriate method of action for the diagnosis, and monitor the expected outcomes of therapy.

The APN is seeing a patient who is on five different medications for different health issues. The APN is concerned about polypharmacy and wants to review current medications with the patient. Which of these would the APN consider to ensure that drug treatment is optimal? 1. Selection of the best possible agents, close monitoring for pharmacokinetics, pharmacodynamics, adverse drug reactions, and cost 2. Selection of the most cost-effective agent 3. Selection of the optimal drugs for treatment based on textbooks and pharmaceutical marketing materials 4. Selection of drugs based on a formulary

1. Selection of the best possible agents, close monitoring for pharmacokinetics, pharmacodynamics, adverse drug reactions, and cost

The APN would avoid use of saxagliptin (Onglyza) in which patient? 1. 63-year-old patient with body mass index (BMI) of 40 who is currently using insulin glargine 2. 52-year-old patient with history of pancreatitis 3. 50-year-old patient with creatinine of 1.6 and glomerular filtration rate of 75 mL/min 4. 38-year-old patient who was newly diagnosed with type 2 diabetes mellitus with occasional mild nausea

2. 52-year-old patient with history of pancreatitis

The 43-year-old patient comes into the clinic with flu-like symptoms. The patient's onset of symptoms is less than 48 hours. The APN will prescribe oseltamivir and understands that the half-life is which of the following? 1. 20 to 24 hours 2. 6 to 10 hours 3. 2.5 to 5 hours 4. 12 to 16 hours

2. 6 to 10 hours

Which patient is at risk for cardiac glycoside (CG) toxicity? 1. A 65-year-old healthy older adult 2. A 45-year-old who is on loop diuretics 3. A 25-year-old Type II diabetic 4. A 56-year-old who is on albuterol

2. A 45-year-old who is on loop diuretics

A pregnant 29-year-old patient has developed community-acquired pneumonia. The APN understands that a fluoroquinolone cannot be prescribed due to the risk of malformation of the fetus. Which regimen would be most appropriate? 1. A beta-lactam plus a carbapenem 2. A beta-lactam plus a macrolide 3. A beta-lactam plus a tetracycline 4. A beta-lactam plus a cephalosporin

2. A beta-lactam plus a macrolide

Which aspect is most important for APNs to consider when prescribing for a patient with any disease process? 1. The cost and timing of the medication 2. A patient-centered approach that results in the desired outcome for the patient 3. Ensuring that the drug ordered follows the practices of others, including physicians 4. Avoiding prescribing any drug that could possibly cause any adverse reaction in the patient, even minor adverse reactions

2. A patient-centered approach that results in the desired outcome for the patient

Beta blockers used for hypertension can cause an upregulation in receptor sites on the cell. Which effect could be caused if the drug is abruptly stopped? 1. A rebound hypotension 2. A rebound hypertension 3. A resistance to beta adrenergic stimulation 4. An increase in thyroid hormone

2. A rebound hypertension

A 42-year-old pregnant female patient comes to the clinic with an outbreak of herpes simplex to the lips. Which medication would be most appropriate for the patient? 1. Famciclovir 2. Acyclovir 3. Famvir 4. Valganciclovir

2. Acyclovir

Which symptom should be reported to the health-care provider and may be a reason to discontinue an antithyroid medication? 1. Weight gain 2. Agranulocytosis 3. Weakness 4. Headache

2. Agranulocytosis

Which is a purpose of clinical decision support systems? 1. Take medical decision making away from human health-care providers and let machines make the decisions 2. Alert health-care providers to patient allergies, drug-drug interactions, and laboratory/medication inconsistencies to avoid ADRs 3. Protect health-care providers from legal actions that could be taken by a patient because it is all documented in the clinical decision making program 4. Allow the health-care provider who has caused an ADR to shift the blame to the computer program

2. Alert health-care providers to patient allergies, drug-drug interactions, and laboratory/medication inconsistencies to avoid ADRs

Which drug inhibits the enzyme that converts T4 to T3, has iodine as a major component, and has a risk for patients with underlying predisposition to thyroid disease to develop thyrotoxicosis or hypothyroidism? 1. Enalapril 2. Amiodarone 3. Digoxin 4. Hydralazine

2. Amiodarone

Which statement describes the absorption and distribution of anorexiants? 1. Anorexiants carry a high risk of tolerance and dependence. 2. Anorexiants are lipid-soluble, widely distributed, and cross the blood-brain barrier. 3. Anorexiants are chemically changed by the liver and eliminated by the kidneys. 4. When anorexiants are combined with monoamine oxidase inhibitors, they have the potential to cause a hypertensive crisis.

2. Anorexiants are lipid-soluble, widely distributed, and cross the blood-brain barrier.

Which classes of drugs can eliminate the extrapyramidal symptoms (EPSs) from typical antipsychotics? 1. Antibiotics, antihistamines, and beta agonists 2. Antiparkinson, antihistamine, and anticholinergic drugs 3. Beta-adrenergic antagonists, antiparkinson drugs, and muscarinic agonists 4. Anticholinergic, anti-inflammatory, and antiparkinson drugs

2. Antiparkinson, antihistamine, and anticholinergic drugs

The clinician is ordering labs on a patient who has a history of alcohol use. Which of the following would confirm a history of excessive alcohol use? 1. Low gamma-glutamyl transpeptidase (GGT) 2. Aspartate aminotransferase (AST) elevated above alanine aminotransferase (ALT) by a ratio of 2:1 3. Decreased mean corpuscular volume (MCV) 4. Hypokalemia, hypophosphatemia, and hypomagnesemia

2. Aspartate aminotransferase (AST) elevated above alanine aminotransferase (ALT) by a ratio of 2:1

A patient presents to the clinic for an urgent visit with symptoms of abdominal cramps, salivation, flushing, nausea, and vomiting. The APN finds out that the patient was out picking mushrooms, and she or he diagnoses the patient with muscarinic poisoning. Which of these is the treatment of choice? 1. Scopolamine 2. Atropine 3. Trospium 4. Oxybutynin

2. Atropine

Clonidine is U.S. Food and Drug Administration (FDA)-approved for which disease state in adolescents? 1. Opiate withdrawal 2. Attention deficit-hyperactivity disorder (ADHD) 3. Hypertension 4. Cerebrovascular disease

2. Attention deficit-hyperactivity disorder (ADHD)

Which of the following acts on the gamma-aminobutyric acid (GABA) pathway as an agonist and has been shown to be helpful in the treatment of alcohol withdrawal syndrome (AWS), with reduction of cravings? 1. Ramelteon (Rozerem) 2. Baclofen 3. Memantine (Namenda) 4. Lisdexamfetamine (Vyvanse)

2. Baclofen

Fluoroquinolones are considered to be which type of agent? 1. Bacteriostatic 2. Bactericidal 3. Cytotoxic 4. Enteric

2. Bactericidal

A 78-year-old patient with a history of uncontrolled type 2 diabetes mellitus (DM), diabetic retinopathy, and peripheral neuropathy has an HbA1c of 10%. She is taking the maximum dose of three oral agents and should begin insulin therapy as the next step. Which medication would be most appropriate for this patient?1. Rapid-acting insulin (RAI) before each meal 2. Basal insulin pen to be injected at bedtime 3. Sulfonylurea 4. Sodium-glucose cotransporter 2 (SGLT-2) inhibitor

2. Basal insulin pen to be injected at bedtime

When possible, the clinician should avoid prescribing what drug for a patient who is taking an opioid pain medication? 1. Anticonvulsants 2. Benzodiazepines 3. Anticholinergics 4. Corticosteroids

2. Benzodiazepines

Arrhythmias are caused either by abnormal pacemaker activity or by abnormal impulse conduction. The goal of therapy with an antiarrhythmic is to reduce ectopic pacemaker activity or alter abnormal conduction. By which major mechanism do antiarrhythmics act to do this? 1. Increasing chloride serum levels 2. Blockade of sympathetic nervous system (SNS) effects on the heart 3. Shortening of the refractory period 4. Increases of sodium levels in the blood

2. Blockade of sympathetic nervous system (SNS) effects on the heart

Which medications are first-line agents to treat Parkinson's disease in its mild to moderate stages? 1. Levodopa, entacapone, or selegiline 2. Bromocriptine, pergolide, pramipexole, or ropinirole 3. Entacapone, pergolide, pramipexole, or ropinirole 4. Selegiline, amantadine, or bromocriptine

2. Bromocriptine, pergolide, pramipexole, or ropinirole

Which statement about drug absorption through the stomach is true? 1. Nutrients can induce metabolic processes but not inhibit these processes, and therefore rarely affect the bioavailability of a drug. 2. Changes in pH from antacids can reduce absorption of folic acid, iron, and vitamin B12, which can cause different types of metabolic symptoms and diseases. 3. Foods and nutrients cannot create adverse reactions to a drug. This can only happen with drug interactions and allergies to the drug. 4. Vitamins are not nutrients and therefore are not considered when discussing nutrient intake.

2. Changes in pH from antacids can reduce absorption of folic acid, iron, and vitamin B12, which can cause different types of metabolic symptoms and diseases.

Angiotensin-converting enzyme inhibitors (ACEIs) can be prescribed in which condition? 1. Bilateral renal artery stenosis 2. Congestive heart failure 3. Pregnancy 4. Renal impairment

2. Congestive heart failure

The patient is taking warfarin, a drug that is highly protein-bound. The patient is involved in an accident that results in loss of blood and a low albumin level. Which consideration would be appropriate regarding the patient's warfarin? 1. Consider increasing the warfarin dose to maintain effective concentration. 2. Consider decreasing the warfarin to balance the expected increase in free drug. 3. Consider adding a diuretic to increase excretion of free drugs. 4. Consider adding a drug that will decrease the half-life of the warfarin.

2. Consider decreasing the warfarin to balance the expected increase in free drug.

Using the "I Can PresCribE A Drug" mnemonic in Chapter 3, which of these is part of the drug prescribing process? 1. Influence of patient's social circle 2. Cost for the patient 3. Education of the patient on the drug's uses 4. Support of the pharmaceutical company

2. Cost for the patient

The APN is consulting with the patient about the thyroid panel from the previous visit. The APN instructs the patient to stop the 0.25-mcg tablet and continue with the 100-mcg tablet. The patient has a low health literacy and does not have the medication available for the "teach back" method. How can the APN assist with the identification of the medication to ensure the correct dosing on this visit? 1. Give instructions to a family member during a phone call during office hours on the following day. 2. Give instructions using the colors of the tablets. 3. Have the patient return with the medication bottles. 4. Call the pharmacy for assistance.

2. Give instructions using the colors of the tablets.

Which neurotransmitter is involved in the mechanism of action for the antiepileptic perampanel? 1. Serotonin 2. Glutamate 3. Gamma-aminobutyric acid (GABA) 4. Dopamine

2. Glutamate

CYP3A4 isoenzymes are involved in the metabolism of all calcium channel blockers (CCBs). The APN should educate that which food should be avoided if the patient is taking certain CCBs? 1. Celery 2. Grapefruit juice 3. Diet cola 4. Yogurt

2. Grapefruit juice

Which of these represents a rare adverse reaction associated with cardiac glycosides (CGs)? 1. Nausea 2. Gynecomastia 3. Vomiting 4. Anorexia

2. Gynecomastia

Protease inhibitors are used to treat HIV and which other viral infection? 1. Herpes simplex 2. Hepatitis C 3. Herpes zoster 4. Cytomegalovirus

2. Hepatitis C

Which statement about herbal medicine is most accurate? 1. Herbal medicine is relatively new and has yet to become established as an important aspect of pharmacotherapeutics. 2. Herbal medicine began with shamanistic or religious practices stemming from the idea that plants can be used to treat diseases. 3. Herbal medicine is currently only used by those who have studied or have access to a doctor of natural medicine. 4. Herbal medicine should be discouraged in all patients because it is not well understood and few studies have been completed in this area.

2. Herbal medicine began with shamanistic or religious practices stemming from the idea that plants can be used to treat diseases.

Which condition is a potential complication of a growth hormone (GH) injectable? 1. Hypoglycemia 2. Hyperglycemia 3. Hypothyroidism 4. Acromegaly

2. Hyperglycemia

The growth hormone-releasing hormone (GHRH) is secreted by the hypothalamus in response to which of these? 1. Anterior pituitary secretion 2. Hypoglycemia 3. Testosterone secretion 4. Hyperglycemia

2. Hypoglycemia

A 70-year-old patient is visiting the office for medication reconciliation. The APN recognizes that a drug combination prescribed is contraindicated. Which combination would cause this concern? 1. Imipramine (Tofranil) and lorazepam (Ativan) 2. Imipramine (Tofranil) and isocarboxazid (Marplan) 3. Amitriptyline (Elavil) and levetiracetam (Keppra) 4. Doxepin (Sinequan) and gabapentin (Neurontin)

2. Imipramine (Tofranil) and isocarboxazid (Marplan)

The patient is prescribed a drug that has a high acid content. Where will this drug most easily be absorbed through passive diffusion? 1. In the acid environment of the stomach 2. In the basic environment of the small intestine 3. Throughout the gastrointestinal (GI) tract, because acid-base issues are not important 4. Only after there has been an adjustment based on acid content of the liver

2. In the basic environment of the small intestine

Indomethacin (COX-1 inhibitor) is no longer the first choice for pain and inflammation relief in gout due to which factor? 1. Lack of therapeutic effect 2. Increased risk of gastric bleeding 3. Extreme expense 4. Requirement of many dietary restrictions

2. Increased risk of gastric bleeding

Which of the following is an important prescribing consideration when treating a patient with methadone? 1. Methadone treatment should be started when the patient is exhibiting signs of sedation or intoxication. 2. Increasing methadone dose too quickly can lead to respiratory depression and death. 3. The dosage should be increased quickly to prevent withdrawal symptoms and relapse. 4. Due to the long half-life, methadone can be tapered rapidly.

2. Increasing methadone dose too quickly can lead to respiratory depression and death.

The pregnant female should receive which vaccination during pregnancy? 1. Measles, mumps, and rubella (MMR) 2. Influenza 3. Varicella 4. Pneumococcal

2. Influenza

Denosumab (Prolia), a nuclear factor kappa B ligand (RANKL) inhibitor, is administered according to which guidelines? 1. Orally every morning on an empty stomach 2. Injected twice each year 3. Injected monthly for 2 years 4. IV once each year

2. Injected twice each year

One of the major differences between type 1 diabetes mellitus (DM) and type 2 DM is that type 2 DM has which feature? 1. Insulin is not necessary for survival. 2. Insulin resistance 3. Loss of beta cell function 4. Initial noninsulin endogenous requirements

2. Insulin resistance

The pH of a drug affects its absorption and ionization. Which statement describes the expected action of aspirin in the acidic environment of the stomach? 1. It becomes trapped in the acid and cannot be absorbed. 2. It becomes unionized, leading to easy passage into the mucosal cells. 3. It ionizes, leading to quick passage into the intestines. 4. It is inert in the gastric environment.

2. It becomes unionized, leading to easy passage into the mucosal cells.

Which statement regarding topical absorption of medications is accurate? 1. It is increased in adults due to larger body surface area in relation to their size. 2. It is increased in children due to larger body surface in relation to their size. 3. It is decreased in adults due to their thin stratum corneum. 4. It is decreased in children due to their thin stratum corneum.

2. It is increased in children due to larger body surface in relation to their size.

The APN diagnosed a 54-year-old patient with onychomycosis. Which medication regimen is most appropriate for this patient? 1. Itraconazole 100 mg PO once daily with meal for 12 consecutive weeks 2. Itraconazole 200 mg PO once daily with meal for 12 consecutive weeks 3. Terbinafine 200 mg PO once daily with meal for 12 consecutive weeks 4. Terbinafine 100 mg PO once daily with meal for 12 consecutive weeks

2. Itraconazole 200 mg PO once daily with meal for 12 consecutive weeks

A 66-year-old patient with diabetes and chronic heart disease has been diagnosed with atypical pneumonia. Which antibiotic would be most appropriate for this patient? 1. Zithromax 2. Levaquin 3. Macrobid 4. Keflex

2. Levaquin

Which insulin injectable has the shortest onset of action? 1. Regular insulin 2. Lispro 3. Insulin glargine 4. Inhaled human insulin

2. Lispro

Which laboratory abnormality can commonly occur with treatment of loop diuretics? 1. Elevated thyroid-stimulating hormone levels 2. Low potassium levels 3. Elevated hepatic enzymes 4. Hematuria

2. Low potassium levels

Why might older adults need higher doses of vitamin D (more than 800 IU daily) to prevent bone fractures? 1. Many older adults are unwilling to take daily vitamins and supplements. 2. Many older adults do not get as much exposure to daily sunshine as younger people. 3. The high cost of vitamin D supplements discourages many older adults from purchasing them. 4. The U.S. Preventive Services Task Force (USPSTF) does not recommend vitamin D replacement.

2. Many older adults do not get as much exposure to daily sunshine as younger people.

A patient just turned 65. He will be on Medicare now and have better access to health care. He says he is confused about Medicare Part D. Which information about Medicare Part D would the APN provide to the patient? 1. Medicare Part D is an optional piece of Medicare insurance that covers nursing homes and home health. 2. Medicare Part D is a prescription drug benefit that is mandatory for all Medicare recipients. 3. Medicare Part D is an extension of Medicare Part B and pays for whatever medical bills are not covered by Medicare Part B. This is a benefit that is optional, but most Medicare recipients have this coverage, because it is not expensive. 4. Medicare Part D was a prescription drug benefit. However, the current administration has overturned this benefit, and it no longer exists.

2. Medicare Part D is a prescription drug benefit that is mandatory for all Medicare recipients.

Which drug used to treat Alzheimer's disease acts through preventing stimulation of N-methyl-D-aspartate (NMDA) receptors? 1. Donepezil 2. Memantine 3. Rivastigmine 4. Galantamine

2. Memantine

It is important that thyroid levels are normal in congenital hypothyroidism to prevent which complication? 1. Depression 2. Mental retardation 3. Obesity 4. Hyperreflexia

2. Mental retardation

A 17-year-old patient diagnosed with type 2 diabetes mellitus (DM) should be started on which oral medication? 1. Repaglinide (Prandin) 2. Metformin (Glucophage) 3. Insulin glargine (Lantus) 4. Sitagliptin (Januvia)

2. Metformin (Glucophage)

A centrally acting alpha2 agonist is typically a second-line consideration for treatment of hypertension. However, it can be considered first line with pregnant women. Which drug belongs to this class and is most appropriate for administration in pregnancy? 1. Labetalol 2. Methyldopa 3. Clonidine 4. Chlorthalidone

2. Methyldopa

Which medication has been shown to be safe in children between the ages of 2 and 12 years? 1. Elocon lotion 2. Mometasone ointment 3. Betamethasone dipropionate cream 4. Diprolene ointment

2. Mometasone ointment

Sudden withdrawal of calcium channel blockers (CCBs) can precipitate which condition? 1. Liver failure 2. Myocardial ischemia 3. Edema 4. Decreased heart rate

2. Myocardial ischemia

Which medication is the standard treatment for an opioid overdose? 1. Benzodiazepine 2. Naloxone 3. Alpha-2 adrenergic agonist 4. Methadone

2. Naloxone

The sympathetic nervous system plays a significant role in adequate heart function. In patients with damaged heart muscle, beta adrenergic receptor blockers could worsen its function. Which action is likely to have the greatest impact on heart muscle function? 1. Negative chronotropism 2. Negative inotropism 3. Negative dromotropism 4. Negative preload

2. Negative inotropism

Which calcium channel blocker (CCB) is the drug of choice during lactation if a CCB is required? 1. Verapamil 2. Nifedipine 3. Diltiazem 4. Nicardipine

2. Nifedipine

Which medication is approved for C. parvum in children 11 years old or younger? 1. Tinidazole 2. Nitazoxanide 3. Ivermectin 4. Metronidazole

2. Nitazoxanide

Which drug classification contains drugs that are well absorbed by oral, buccal, sublingual, and transdermal routes? 1. Angiotensin II receptor blockers (ARBs) 2. Nitrates 3. Peripheral vasodilators 4. Diuretics

2. Nitrates

Which class of antianginal drugs negatively affects hypercholesterolemia by increasing triglycerides and low-density lipoprotein (LDL) cholesterol and reducing the level of high-density lipoprotein (HDL)? 1. Angiotensin-converting enzyme inhibitors (ACEIs) 2. Nonselective beta blockers 3. Cardioselective beta blockers 4. Calcium channel blockers

2. Nonselective beta blockers

A 19-year-old patient was diagnosed with bacterial conjunctivitis. Which antibiotic would be most appropriate for this patient? 1. Cipro tablets 2. Ocuflox solution 3. Levaquin tablets 4. Cleocin solution

2. Ocuflox solution

Which cholinesterase inhibitors should be avoided clinically? 1. Donepezil 2. Organophosphate 3. Rivastigmine 4. Galantamine

2. Organophosphate

Which issue is most problematic for the APN in patients taking herbal medications? 1. There is no reason why any patient should take an herbal supplement. 2. Patients do not include herbal medicines when discussing and listing medications for their provider 3. Patients often do not know the real name of the herbal medication or the dose they are taking. 4. The APN should not bother listing all of the herbal medications because they are not significant to a patient's health.

2. Patients do not include herbal medicines when discussing and listing medications for their provider.

Cholinergic blockers have a number of adverse reactions. Which patient education should be given to avoid complications? 1. Patients should be taught to take their own pulse and report heart rate above 80 bpm. 2. Patients should drink at least 2 quarts of noncaffeinated fluid daily to maintain adequate hydration. 3. Cholinergic blockers should be taken with food or immediately after meals. 4. If a dose has been missed, patients should take two doses together at the time of next dose.

2. Patients should drink at least 2 quarts of noncaffeinated fluid daily to maintain adequate hydration.

The patient is an 80-year-old man who was diagnosed with hypertension. He also had a small heart attack 2 years ago. The APN prescribes a beta blocker (metoprolol) 25 mg twice daily. After 2 weeks, his blood pressure is reduced somewhat, but still above the appropriate level. The APN increases the beta blocker to 50 mg every 12 hours. The patient calls 2 days later and states he gets dizzy on standing and feels tired and listless. He comes to the office where his blood pressure is now below normal at 100/50 mm Hg. Into which classification of adverse reaction does this fit? 1. Idiosyncratic 2. Pharmacological 3. Expected 4. Antibody mediated

2. Pharmacological

Which physiological biomarker can be helpful in detecting steady alcohol use over weeks? 1. Vitamin B12 2. Phosphatidylethanol (PEth) 3. Complete blood count (CBC) 4. Alkaline phosphatase (ALP)

2. Phosphatidylethanol (PEth)

Phase II enzymes are responsible for synthesis of water-soluble drugs, such as morphine. Which statement regarding morphine is accurate? 1. This medication should not be prescribed to children under age 3 years. 2. Plasma clearance of morphine is variable in young patients. 3. Plasma clearance is higher, so children may require more frequent dosing intervals. 4. It can be used safely because studies have shown that morphine clearance is the same for adults and children.

2. Plasma clearance of morphine is variable in young patients.

A patient with type 2 diabetes mellitus and a history of cardiomyopathy has an ejection fraction (EF)% of 35%. The patient is currently taking metformin and canagliflozin (Invokana). Which laboratory finding would indicate immediate treatment? 1. Glycosuria on dipstick 2. Positive nitrates on dipstick 3. HbA1c of 7.9% 4. Serum potassium of 3.5 mEq/L

2. Positive nitrates on dipstick

A 27-year-old patient is diagnosed with maturity-onset diabetes of the young (MODY) and was prescribed an alpha-glucosidase inhibitor. The APN instructs the patient that which glucose time is most appropriate for evaluating the effectiveness of the medication? 1. Fasting 2. Postprandial 3. Bedtime 4. Preprandial

2. Postprandial

Norepinephrine, which is a key component in regulation of the sympathetic nervous system, plays an active role in the pathophysiology of posttraumatic stress disorder (PTSD)-related nightmares. Alpha1-adrenergic antagonists are being studied as a method of treatment. Which of these is the best choice for this therapy? 1. Tamsulosin 2. Prazosin 3. Terazosin 4. Alfuzosin

2. Prazosin

A patient presents with a history of obesity and a Candida infection on last visit. Today the patient complains of polyuria and mild polydipsia. The HbA1c is 6.0%. The APN most suspects which condition in the patient? 1. Type 1 diabetes mellitus (DM) 2. Prediabetes 3. Type 2 diabetes mellitus (DM) 4. Latent autoimmune diabetes in adults (LADA)

2. Prediabetes

Pernicious anemia can develop in patients having long-term treatment with which class of drugs? 1. Histamine2 receptor antagonists (H2RAs) 2. Proton pump inhibitors (PPIs) 3. Antacids 4. Prokinetic agents

2. Proton pump inhibitors (PPIs)

Acarbose (Precose) has which feature? 1. Expedited carbohydrate absorption 2. Reduced postprandial peaks of plasma glucose 3. Short-term induction process 4. Enhanced pancreatic beta cell secretion

2. Reduced postprandial peaks of plasma glucose

According to the Centers for Disease Control (CDC) Recommendations for Prescribing Opioids for Chronic Pain Outside of Active Cancer, Palliative, and End-of-Life Care, use of opioids for acute pain beyond which time frame is noted to be rarely needed? 1. Four weeks 2. Seven days 3. Two months 4. Six months

2. Seven days

A patient with type 2 diabetes mellitus (DM) has concerns about starting insulin because of his current occupation. He states that his food intake has increased in the past 2 months, which has resulted in elevated home blood sugars. After a review of the home blood glucose readings, the APN decides on a medication to improve pre- and postprandial blood glucose levels. The addition of which medication is most appropriate? 1. Dulaglutide 2. Sitagliptin 3. Pramlintide 4. Nateglinide

2. Sitagliptin

Compared with men taking highly active antiretroviral therapy (HAART), women on HAART have been shown to experience which of these? 1. Fewer gastrointestinal adverse effects 2. Slower rates of disease progression 3. Higher rates of cardiovascular adverse side effects 4. Fewer neurological adverse effects

2. Slower rates of disease progression

Why should codeine be prescribed cautiously, if at all, to children ages 3 years and under? 1. It has not been shown to be an effective pain medication in the very young. 2. Some people metabolize codeine to morphine very rapidly, leading to an increased risk for respiratory depression. 3. Codeine use from birth to 3 years has been positively linked to opioid addiction in adulthood. 4. Young children cannot reliably differentiate pain to justify the use of a strong narcotic.

2. Some people metabolize codeine to morphine very rapidly, leading to an increased risk for respiratory depression.

A 40-year-old female patient presents to your office accompanied by her caregiver with complaints of increased nocturia. She has a history of type 2 diabetes mellitus and rheumatoid arthritis since childhood. She ambulates with a walker due to severe limitation in her lower extremities. Her blood glucose log reveals fasting blood glucose levels ranging from 50 to 65 and postprandial blood glucose levels 200 to 290. Which medication adjustment would be priority to initiate first?1. Start linagliptin. 2. Stop glimepiride. 3. Decrease dapagliflozin. 4. Start NovoLog 5 units subcutaneously before each meal.

2. Stop glimepiride.

Which pathogen is most common in nursing home-acquired pneumonia? 1. Staphylococcus aureus 2. Streptococcus pneumoniae 3. Klebsiella pneumoniae 4. Haemophilus influenzae

2. Streptococcus pneumoniae

Due to increased risk of tolerance and dependence, patients taking anorexiants should also be screened for which medical condition? 1. Anxiety with posttraumatic stress disorder 2. Substance use disorder with cocaine 3. Constipation and overuse of bisacodyl 4. Hypothyroidism

2. Substance use disorder with cocaine

Probenecid, taken to control uric acid levels, should not be prescribed for persons allergic to which of the following? 1. Penicillin 2. Sulfa-containing drugs 3. Milk and dairy products 4. Tree nuts

2. Sulfa-containing drugs

Which of the following is characteristic of opioid use? 1. The potential for overdose is decreased after a period of abstinence as tolerance has decreased. 2. The route of administration, dose, potency, and onset of action play a role in both the acute effects and withdrawal. 3. Although opioid overdose is a major consequence of opioid use, there has been a sharp decrease in the number of deaths in recent years. 4. Opioid withdrawal is life threatening.

2. The route of administration, dose, potency, and onset of action play a role in both the acute effects and withdrawal.

Which of these would the APN include in patient education for central alpha2 receptor medications? 1. Patients should exercise daily while on medication, even in warm weather. 2. These drugs must be withdrawn slowly over 2 to 3 days. 3. Centrally acting alpha2 agonists are safe for use with herbals. 4. Clonidine patches should be applied to the same site upon readministration.

2. These drugs must be withdrawn slowly over 2 to 3 days.

CYP450 enzymes are responsible for drug biotransformation and are essential to the chemical reaction of drugs in the body. Which statement is true about the CYP 450 enzymes? 1. They are highly homogenous genetically and work in roughly the same way to metabolize drugs in the body. 2. They have a high genetic variability and are the most important of the phase I metabolizing enzymes. 3. They are found only in the liver and therefore the liver is solely responsible for drug biotransformation. 4. They are responsible for the amount of drug that is bioavailable at any given time and are regulated by the bone marrow and adrenal glands.

2. They have a high genetic variability and are the most important of the phase I metabolizing enzymes.

In selecting the most appropriate beta blocker, first consideration is usually given to beta1 selectivity, sometimes referred to as being cardioselective. What is the importance of being beta1 selective? 1. They have a longer half-life. 2. They impact beta2 receptors less. 3. They have limited central nervous system (CNS) impact. 4. They have minimal kidney concerns.

2. They impact beta2 receptors less.

Premenopausal anovulatory women should consider a birth control method when taking which medication? 1. Sulfonylurea 2. Thiazolidinediones (TZD) 3. Biguanide 4. Meglitinide

2. Thiazolidinediones (TZD)

A patient is prescribed a drug that unexpectedly causes a rash and joint pain. Which type of ADR is this and why? 1. This is a pharmacological or intrinsic ADR because it affects the skin and joints. These are less likely to be serious than other types of reactions, such as anaphylaxis. 2. This is an idiosyncratic ADR because it is unpredictable. This type of ADR is often more likely to result in mortality. 3. This is an idiosyncratic ADR because it is caused by the drug being unsafe. The U.S. Food and Drug Administration (FDA) should be notified immediately because this could become a common problem with this drug. 4. This is a pharmacological ADR that is based on secondary pharmacology. This type of ADR is harmless and should be expected.

2. This is an idiosyncratic ADR because it is unpredictable. This type of ADR is often more likely to result in mortality.

The APN prescribes a drug that is not specifically labeled for use with the issue the patient reports. The APN has read studies, attended lectures related to use of this drug for the patient's problem, and has used this drug with good effect in other patients. However, this drug is being used by the APN for off-label use. Which statement correctly identifies the legal consequences of using a drug "off-label?" 1. The APN could be in danger of litigation from the U.S. Food and Drug Administration (FDA) for using a drug for an off-label reason. 2. This use of the drug is legal, because the proper and efficacious therapeutic use of these drugs is the prescriber's responsibility. 3. The U.S. Food and Drug Administration (FDA) monitors the use of all drugs in clinical situations to be sure they are not off-label. 4. U.S. Food and Drug Administration (FDA) approval of off-label drug use is based on the amount the pharmaceutical company pays to get the drug approved for other uses.

2. This use of the drug is legal, because the proper and efficacious therapeutic use of these drugs is the prescriber's responsibility.

An independent 87-year-old patient has annual laboratory tests, and her low-density lipoprotein (LDL) cholesterol is 210 (goal is <130). Her blood pressure (BP) is normal, and she has no significant cardiac history. Which factor is most important to consider when deciding whether to start her on a cholesterol-lowering medication? 1. Side effects 2. Time until benefit 3. Medication cost 4. Control of symptoms

2. Time until benefit

There is some debate about the use of metformin in patients with type 1 diabetes mellitus (DM) because metformin is more effective in patients with which characteristics? 1. Complete loss of beta cell function 2. Tissue insensitivity to insulin 3. Excessive liver glucose production 4. Increase of glucagon-like peptide-1 (GLP-1) levels

2. Tissue insensitivity to insulin

Glucagon-like peptide-1 (GLP-1) inhibitors are used most effectively in patients with which condition? 1. Latent autoimmune diabetes in adults (LADA) 2. Type 2 diabetes mellitus (DM) 3. Type 1 diabetes mellitus (DM) 4. Maturity-onset diabetes of the young (MODY)

2. Type 2 diabetes mellitus (DM)

Which statement regarding the classification of ADRs is correct? 1. Type A is a reaction from chronic medication use. 2. Type B is often the most dangerous. 3. Type C reactions are delayed. 4. Type D reactions are dose-dependent and predictable.

2. Type B is often the most dangerous.

Which dose is the recommended maximum daily dose of calcium supplementation with vitamin D advocated by the Institute of Medicine (IOM)? 1. Up to 1,000 IU/d 2. Up to 10,000 IU/d 3. Up to 50,000 IU/d 4. Up to 100,00 IU/d

2. Up to 10,000 IU/d

A U.S. Food and Drug Administration (FDA) update recommends an application of pharmacogenomics for a certain drug because of the VKORC1 genetic variant that creates resistance in it. Which drug does the recommendation concern? 1. Ketoconazole 2. Warfarin 3. Tamoxifen 4. Fluoxetine

2. Warfarin

How often should the clinician evaluate benefits and harms with patients when starting opioid therapy for chronic pain or at dose escalation? 1. Within 3 days 2. Within 1 to 4 weeks 3. After 6 weeks 4. Within 9 weeks

2. Within 1 to 4 weeks

Which diagnostic test used to evaluate the treatment of growth hormones is most cost-effective? 1. Magnetic resonance imaging (MRI) 2. X-ray 3. Computed tomography (CT) scan 4. Positron emission tomography (PET) scan

2. X-ray

Because adolescents have not reached peak bone mass, bone density should be calculated using which statistical measure? 1. T scores 2. Z scores 3. M scores 4. B scores

2. Z scores

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."

3. "Attaining a healthy weight will help reduce symptoms of GERD."

The APN is prescribing sublingual nitroglycerin (NTG) to a patient. Which statement by the patient indicates that he understands the education regarding the drug? 1. "Once I open the nitroglycerin bottle, it is generally effective for 2 years." 2. "I can store the unopened bottle on my car dash in case I need it." 3. "If my chest pain is not relieved by the second dose of the nitroglycerin, I should take a third dose and call 911." 4. "This medication takes a long time to start working."

3. "If my chest pain is not relieved by the second dose of the nitroglycerin, I should take a third dose and call 911."

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."

3. "Older adults may have few symptoms, despite having significant disease."

Which of the following is considered first-line treatment for alcohol withdrawal and can work as a replacement for alcohol and reduce or eliminate withdrawal by stimulating gamma-aminobutyric acid-A (GABA-A) receptors? 1. Selective serotonin reuptake inhibitors 2. Stimulants 3. Benzodiazepines (BDZs) 4. Tricyclic antidepressants

3. Benzodiazepines (BDZs)

Which of the four main receptor types is primarily associated with stimulation of adenylyl cyclase and is found mostly in the heart? 1. Alpha1 2. Alpha2 3. Beta1 4. Beta2

3. Beta1

Why is bethanechol contraindicated in patients with hyperthyroidism? 1. Bethanechol can cause hypertension. 2. Bethanechol can cause tachycardia. 3. Bethanechol can lead to the release of norepinephrine (NE). 4. Bethanechol can lead to excessive secretion of gastric acid.

3. Bethanechol can lead to the release of norepinephrine (NE).

A patient with type 2 diabetes mellitus (DM) is exercising for 30 minutes three times a week. Her HbA1c is not at goal and will require an additional medication. The addition of which medication is most appropriate? 1. Low-dose basal insulin 2. Sulfonylureas 3. Biguanide 4. Dipeptidyl peptidase-4 (DPP-4) inhibitor

3. Biguanide

A 45-year-old patient is suffering from back pain due to severe muscle spasms. A centrally acting muscle relaxant, tizanidine (Zanaflex), is prescribed. By which mechanism of action does tizanidine act? 1. Inhibiting calcium ion channels to the muscle fibers 2. Agonizing the spinal synaptic reflexes 3. Binding to alpha2 adrenergic receptors, which increases the presynaptic motor neuron inhibition and reducing spasticity 4. Binding to gamma-aminobutyric acid (GABA) benzodiazepine receptors complexes

3. Binding to alpha2 adrenergic receptors, which increases the presynaptic motor neuron inhibition and reducing spasticity

Many common clinically useful actions of adrenergic antagonists result from their action on alpha1 and beta1 receptors at different locations in the body. Which of these is a common cause of clinically useful action of adrenergic antagonists? 1. Activation of alpha1 receptors in the blood vessels 2. Activation of beta1 receptors in the heart 3. Blockade of alpha1 receptors at the bladder, neck, and prostate gland 4. Blockade of beta1 receptors in the lungs

3. Blockade of alpha1 receptors at the bladder, neck, and prostate gland

Beta blockers play a key role in the reduction of catecholamine response that stimulates the sympathetic nervous system (SNS). How do these medications perform their action? 1. By binding to catecholamines and other beta agonists before they can reach the beta-receptor site 2. By removing catecholamines and other beta agonists from the beta-receptor site 3. By occupying beta-receptor sites and preventing catecholamines and other beta agonists from occupying them 4. By eliminating catecholamines and other beta agonists near the targeted beta-receptor site

3. By occupying beta-receptor sites and preventing catecholamines and other beta agonists from occupying them

Which enzyme is known to be highly active in metabolizing several drugs, particularly in the liver and the gastrointestinal tract? 1. CYP2B6 2. CYP2D6 3. CYP3A4 4. CYP3A5

3. CYP3A4

Which osteoporosis treatment plan is appropriate for adolescents? 1. Alendronate, plus 1,300 mg of calcium and vitamin D daily 2. Ibandronate by monthly infusion, plus omeprazole and calcium 1,300 mg daily 3. Calcium 1,300 mg daily and vitamin D 4. Oral contraceptives with medium to higher doses of estrogen plus calcium 1,300 mg daily

3. Calcium 1,300 mg daily and vitamin D

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

3. Calcium carbonate

Which classification of drugs are inappropriate for use in the geriatric population? 1. Alpha1 antagonists 2. Beta-adrenergic antagonists 3. Centrally acting alpha2 agonists 4. Combined alpha- and beta-adrenergic antagonists

3. Centrally acting alpha2 agonists

A patient being treated for hypothyroidism returns for a follow-up office visit. The APN is concerned that the patient is taking an excessive amount of the thyroid hormone replacement when the patient reports which symptom? 1. Weight gain 2. Fatigue 3. Chest pain 4. Bradycardia

3. Chest pain

Which of these describes the mechanism of cholinergic blockers? 1. Cholinergic blockers disable muscarinic receptors at the site. 2. Cholinergic blockers stop production of acetylcholine. 3. Cholinergic blockers prevent the receptor from being activated. 4. Cholinergic blockers slow transmission intracellularly.

3. Cholinergic blockers prevent the receptor from being activated.

The 53-year-old patient just completed a 14-day course of antibiotic and developed Clostridium difficile colitis. Which antibiotic most likely caused this patient to have Clostridium difficile colitis? 1. Zithromax 2. Biaxin 3. Cleocin 4. Prilosec

3. Cleocin

Which of these is an aspect of Stage 1 of the Meaningful Use of the American Recovery and Reinvestment Act (ARRA) and Healthcare Information Technology for Economic and Clinical Health (HITECH)? 1. Removing decision making from health-care providers to decrease medical errors 2. Using the electronic medical records to determine who is eligible for health-care benefits 3. Communicating health information for care coordination 4. Determining which patients are compliant with medication administration

3. Communicating health information for care coordination

The route of administration of a drug affects the way it travels through the body and works to produce the desired effect. The APN knows that which of these is an effect of route of administration? 1. Dosage 2. Cost 3. Compliance 4. Disease state

3. Compliance

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

3. Crofelemer

Diabetes mellitus (DM) can result from which condition?1. Hyperlipidemia 2. Hypertension 3. Cystic fibrosis 4. Coronary heart disease

3. Cystic fibrosis

After being prescribed eszopiclone (Lunesta), a 45-year-old patient complains of daytime drowsiness. He rises for work at 5 a.m. and takes the medication if he cannot fall asleep, which is usually at midnight. Which explanation by the APN is most appropriate? 1. Eszopiclone has a long duration. 2. The patient must have used alcohol or some other sedative against the advice of the APN. 3. Daytime drowsiness is expected if eszopiclone (Lunesta) is taken 6 hours or less before awakening. 4. The patient may be more sensitive to the medication.

3. Daytime drowsiness is expected if eszopiclone (Lunesta) is taken 6 hours or less before awakening.

For the diabetic patient with hypothyroidism, the APN should expect to take which action? 1. Add a 3 a.m. blood glucose 2. Increase insulin doses 3. Decrease basal insulin 4. Increase doses of thyroid hormone

3. Decrease basal insulin

Which of these does testosterone replacement therapy (TRT) cause? 1. Decreased reticulocyte counts 2. Decreased osteoblastic activity 3. Decreased fat mass 4. Decreased hemoglobin

3. Decreased fat mass

Colchicine, a medication used in treatment of gout, has a primary method of action that includes which of these? 1. Decreasing purine metabolism 2. Decreasing uric acid levels 3. Decreasing inflammation by uric acid crystals 4. Promoting lactic acid formation

3. Decreasing inflammation by uric acid crystals

One nutraceutical recommended for many people is fatty acids, or essential acids. There are many studies reviewing the effects of omega-3 and -6 fatty acids. Which major beneficial effect do omega-3 fatty acids have on cholesterol levels? 1. Lowering of total cholesterol 2. Raising of total cholesterol 3. Decreasing triglycerides 4. Increasing triglycerides

3. Decreasing triglycerides

Alpha-glucosidase inhibitors function by which primary mechanism of action? 1. Increasing endogenous insulin secretion 2. Suppressing glucogenesis 3. Delaying the absorption of complex carbohydrates (CHO) 4. Inhibiting the reabsorption of glucose in the kidney

3. Delaying the absorption of complex carbohydrates (CHO)

Which is the best course of action for the APN when discussing vitamin therapy with patients? 1. Tell all patients that they should get vitamins from food and not from pills. 2. Provide a general list of vitamins and their benefits to health to patients as sufficient education. 3. Discuss nutritional supplementation and what to take when. 4. Send patients to a nutritionist for counseling related to foods, vitamins, and health.

3. Discuss nutritional supplementation and what to take when.

Which of the following drugs is an inhibitor of the enzyme aldehyde dehydrogenase and causes tachycardia, flushing, headache, nausea, and vomiting if alcohol is ingested within 12 to 24 hours of administration? 1. Naltrexone (Revia) 2. Acamprosate (Campral) 3. Disulfiram (Antabuse) 4. Topiramate (Topamax)

3. Disulfiram (Antabuse)

Cholinesterase inhibitors have possible effect on the sinoatrial (SA) and atrioventricular (AV) nodes in the heart, and bradycardia is an issue. This is especially prevalent in the older population. If a patient presents with a clear need for a cholinesterase inhibitor and has a cardiac history that includes drugs such as furosemide, digoxin, and warfarin, which medication would be the most appropriate choice for this patient? 1. Rivastigmine 2. Neostigmine 3. Donepezil 4. Memantine

3. Donepezil

Which medication has shown positive effects in the treatment of Alzheimer's disease for at least 2 years? 1. Neostigmine 2. Pyridostigmine 3. Donepezil 4. Bethanechol

3. Donepezil

Which of these is a potential pharmacodynamic difference in children as compared with adults? 1. Drug absorption 2. Drug metabolism 3. Drug vehicle 4. Drug excretion

3. Drug vehicle

For which reason would growth hormones (GHs) be dosed every other day? 1. To maintain thyroid levels 2. To decrease hypoglycemic episodes 3. Due to duration of blood levels 4. If growth is more than 2 cm from the previous year

3. Due to duration of blood levels

A 45-year-old female patient arrives to the clinic for a physical examination. Her body mass index (BMI) is 37. She has a history of type 2 diabetes mellitus with neuropathic pain. Her new complaints are depressed mood, loss of interest, sleeping too much, loss of concentration, and feelings of worthlessness. These symptoms have been bothersome for the past 2 months. Considering her past medical history, physical examination, and complaints, which drug is most appropriate? 1. Fluoxetine (Prozac) 2. Trazodone (Desyrel) 3. Duloxetine (Cymbalta) 4. Lorcaserin (Belviq)

3. Duloxetine (Cymbalta)

Which measure provides the most accurate information on the effectiveness of metformin? 1. An annual HbA1c 2. The percentage of weight loss 3. Fasting blood glucose (FBG) 4. Postprandial blood glucose

3. Fasting blood glucose (FBG)

Which adverse effect of metformin is most common? 1. Weight loss 2. Lactic acidosis 3. Flatulence 4. Reduction of low-density lipoprotein (LDL) levels

3. Flatulence

Which drug blocks synthesis of cholesterol in the liver by competitively inhibiting HMG-CoA reductase activity and induces an increase in high-affinity low-density lipoprotein (LDL) receptors, resulting in an increased catabolism of LDL, and an increase in the liver's extraction of LDL precursors? 1. Ezetimibe (Zetia) 2. Colestipol (Colestid) 3. Fluvastatin (Lescol) 4. Gemfibrozil (Lopid)

3. Fluvastatin (Lescol)

Which laboratory test can be utilized when HbA1c is considered unreliable, such as in the case of hemolytic anemia? 1. C-peptide 2. Insulin level 3. Fructosamine 4. Glucose tolerance test

3. Fructosamine

Each selective alpha1 antagonist carries a risk for significant first-dose orthostatic hypotension that may result in syncope and tends to occur within 30 to 90 minutes of drug administration. How can this adverse reaction be minimized? 1. Adding another hypertensive to the treatment regimen 2. Interrupting therapy 3. Giving the first dose at bedtime 4. Increasing dosage

3. Giving the first dose at bedtime

Which foods can inhibit drug metabolism due to the CYP3A4 enzyme that decreases first-pass metabolism in drugs? 1. Green, cruciferous vegetables 2. Foods high in protein 3. Grapefruit and pomelo juices 4. Foods high in vitamin K, like kale

3. Grapefruit and pomelo juices

Which alpha2 agonist is likely to have the least effect of orthostatic hypotension based on its pharmacokinetics? 1. Methyldopa 2. Clonidine 3. Guanfacine 4. Guanabenz

3. Guanfacine

Which is a side effect of the phosphodiesterase type 5 (PDE-5) inhibitors? 1. Detumescence 2. Glaucoma 3. Hearing loss 4. Cataracts

3. Hearing loss

A 50-year-old male with recent diagnosis of acromegaly is concerned about adverse effects of pegvisomant (Somavert). Which of these is a possible effect? 1. Dementia 2. Gastrointestinal (GI) bleed 3. Hepatic impairment 4. Altered glucose levels

3. Hepatic impairment

A new patient presents today for evaluation of hypertension. The patient states that he has been feeling weak and thinks that his heartbeat is irregular at times. The APN notes that the patient is being treated with lisinopril and spironolactone. Which condition would the APN most likely suspect? 1. Hypernatremia 2. Renal insufficiency 3. Hyperkalemia 4. Hypokalemia

3. Hyperkalemia

Alterations in cardiac conduction are a significant risk when prescribing tricyclic antidepressants (TCAs). Which mechanisms cause this risk? 1. Increased availability of serotonin and histamine are contributing factors of cardiac conduction alterations. 2. Over time, regular use of TCAs can cause fibrosis of the heart muscle from its histamine interaction. 3. Increased availability of norepinephrine, anticholinergic effects, and a slowing of depolarization are contributing factors of cardiac conduction alterations. 4. Over time, regular use of TCAs can cause hypertension due to their beta adrenergic agonism, which leads to cardiac conduction problems.

3. Increased availability of norepinephrine, anticholinergic effects, and a slowing of depolarization are contributing factors of cardiac conduction alterations.

Although generally considered safe, chronic use of glucosamine to manage the pain of osteoarthritis may cause which side effect when used by older adults? 1. Elevation of liver function test readings 2. Postural hypotension 3. Increased intraocular pressure 4. Peripheral neuropathies

3. Increased intraocular pressure

Intensive insulin regimens have proven their effectiveness with the greatest impact on lowering blood glucose. Which of these is an intensive insulin regimen? 1. Humalog 70/30 subcutaneously twice a day 2. Metformin bid and Novolin 75/25 daily at bedtime 3. Insulin glargine 10 daily at bedtime and insulin lispro 5 units before each meal 4. Neutral protamine Hagedorn (NPH) subcutaneously every evening

3. Insulin glargine 10 daily at bedtime and insulin lispro 5 units before each meal

Growth hormones (GHs) should be used with caution in the patient with diabetes because the hormone can lead to which condition? 1. Hypoglycemia 2. Acromegaly 3. Insulin resistance 4. Hypothyroidism

3. Insulin resistance

The APN is teaching the mother of a 6-month-old infant with a diagnosis of congenital hypothyroidism. Which information would the APN include regarding levothyroxine (Synthroid)? 1. It should not be crushed. 2. It is given as a suspension from the pharmacy. 3. It should be crushed and added to infant formula. 4. It will not begin until the child is 1 year old.

3. It should be crushed and added to infant formula.

The mother of a 12-year-old male patient with history of type 1 diabetes mellitus (DM) is concerned about end organ complication from diabetes. The APN states that one of the potential complications is nephropathy and provides the mother with which information regarding testing for the development of nephropathy? 1. It will take place at every medical visit. 2. It will take place at the time of diagnosis. 3. It will take place after the duration of DM has been at least 5 years. 4. It will begin in 5 years.

3. It will take place after the duration of DM has been at least 5 years.

The APN is seeing a patient in the office. The patient's blood pressure and heart rate remain elevated despite lifestyle changes and a trial of medications. As part of his regimen, the patient routinely goes for drug testing via a urine test. This is court mandated, and the APN is unsure for how long. The APN feels that a beta blocker would be best for this patient. Which beta blocker could be a problem for this patient? 1. Metoprolol 2. Carvedilol 3. Labetalol 4. Atenolol

3. Labetalol

Which of the following is a symptom that can be associated with opioid withdrawal? 1. Constipation 2. Pupil constriction 3. Lacrimation 4. Cough

3. Lacrimation

A 22-year-old female patient suffering from irritable bowel syndrome (IBS) with constipation is seen at the clinic. Which medication would be most appropriate for this patient? 1. Lactulose 2. Mineral oil 3. Lubiprostone 4. Polycarbophil

3. Lubiprostone

Patients who require exogenous insulin should be cautioned to drink alcohol in moderation, because alcohol can have which effect? 1. Increase the risk of cardiovascular disease 2. Result in 25% weight increase 3. Mask the symptoms of diabetes 4. Increase blood glucose levels

3. Mask the symptoms of diabetes

Which malignant neoplasm is carbidopa-levodopa known to activate? 1. Colon cancer 2. Lung cancer 3. Melanoma 4. Leukemia

3. Melanoma

Which genetic differences can be responsible for variations in efficacy and toxicity of medications? 1. Previous drug use and overall health 2. Ethnicity and weight 3. Metabolism and genetic polymorphisms 4. CYP450 differences and the use of prodrugs

3. Metabolism and genetic polymorphisms

First-generation cephalosporins are active against which organisms? 1. Methicillin-resistant Staphylococcus Aureus 2. Gram-negative organisms 3. Methicillin-sensitive Staphylococcus Aureus 4. Enterococcus organisms

3. Methicillin-sensitive Staphylococcus Aureus

Which statement about drugs binding to proteins is accurate? 1. The drug has a higher affinity with the cellular receptor if it is protein bound. 2. Drug-protein binding is facilitated when a person has a diet high in protein. 3. Protein-bound drugs cannot bind with a receptor site. 4. Protein-binding drugs often cause drug interactions as they compete for the protein molecules in the body.

3. Protein-bound drugs cannot bind with a receptor site.

Which of these is the gold standard for increasing adherence in taking medications, especially in patients with chronic diseases? 1. Having the pharmacy call the patient daily to ask about drug adherence 2. Asking the patient to place their medications in envelopes with times and dates on them 3. Providing the patient with a clearly written, personalized drug schedule and containers with compartments for drug dosing 4. Having a home health-care provider go to the patient's home for a follow-up medication adherence visit

3. Providing the patient with a clearly written, personalized drug schedule and containers with compartments for drug dosing

A 26-year-old female patient, who is 30 weeks pregnant, comes to the clinic complaining of constipation and asking which over-the-counter (OTC) medication from the many choices available is safe for her to take. Which medication would be recommended? 1. Castor oil 2. Mineral oil 3. Psyllium 4. Glycerin suppository

3. Psyllium

Current U.S. Preventative Services Task Force (USPSTF) guidelines make which recommendation for the use of raloxifene (a selective estrogen receptor modulator [SERM]) for primary prevention of osteoporotic fragility fracture in postmenopausal women? 1. Raloxifene is contraindicated for osteoporotic fragility. 2. Raloxifene is a first-line therapy for those with osteoporotic fragility. 3. Raloxifene is a second-line therapy for those unable to tolerate other osteoporotic prevention therapies. 4. Raloxifene may be used as therapy for those with osteoporotic fragility with thrombotic risk.

3. Raloxifene is a second-line therapy for those unable to tolerate other osteoporotic prevention therapies.

Foods included in the "gout diet" include alkaline diet (urate-lowering) foods and restrictions on which foods? 1. Leafy green vegetables 2. Artificial sweeteners 3. Refined sugars 4. Bananas

3. Refined sugars

A 46-year-old patient is newly diagnosed with hepatitis C. The APN understands that hepatitis B serum will need to be drawn prior to starting any hepatitis C virus (HCV) medications for which reason? 1. Risk of hepatitis C reactivation 2. Risk of hepatitis A reactivation 3. Risk of hepatitis B reactivation 4. Risk of hepatitis D reactivation

3. Risk of hepatitis B reactivation

The U.S. Food and Drug Administration (FDA) approves drugs that meet requirements for which two criteria? 1. Targeted cells and effective elimination 2. Level of absorption and allergic reactions 3. Safety and efficacy 4. Biological response and drug interactions

3. Safety and efficacy

A patient presents to the clinic after seeing the urologist and has been taking the drug bethanechol, occasionally intramuscularly as well as subcutaneously, depending on the needle available. The patient has noticed shortness of breath, dizziness, and change in stool with occasional melena. Which course of action by the APN should be taken first? 1. Reduce the dose of the bethanechol to a more tolerable dosage. 2. Call the urologist and ask what the plan should be, because there are some adverse issues. 3. Send the patient to the emergency room for possible bethanechol toxicity. 4. Advise the patient to wait a few days to see if it improves.

3. Send the patient to the emergency room for possible bethanechol toxicity.

Which is a basic activity of daily living (ADL)? 1. Grocery shopping 2. Paying bills and investing money 3. Shaving and showering 4. Keeping up with house repairs

3. Shaving and showering

Which dosing consideration should the APN consider when initiating a calcium channel blocker (CCB) in the older adult? 1. Start at the highest dose and decrease the dose as needed. 2. Start on a fourth of the usual dose and increase daily. 3. Start on half the usual dose and increase doses gradually. 4. No dosing changes are needed in the older adult.

3. Start on half the usual dose and increase doses gradually.

The APN should expect the need to prescribe pancreatic enzymes for the patient with history of bariatric surgery with which symptom? 1. Diarrhea 2. Abdominal pain 3. Steatorrhea 4. Constipation

3. Steatorrhea

A 3-year-old patient with Lennox-Gastaut syndrome is being treated with valproate sodium, but seizures are not well controlled. Lamotrigine (Lamictal) is being started as adjunctive therapy. Which serious adverse drug reaction is more risky when lamotrigine is coadministered with valproate sodium? 1. Electrocardiogram (ECG) changes become an adverse effect when lamotrigine is administered with valproate. 2. Oligohidrosis can lead to hyperthermia and heatstroke when lamotrigine and valproate are coadministered. 3. Stevens-Johnson syndrome (SJS) is a risk of lamotrigine, and the combination of valproate increases the risk further. 4. Alopecia has been reported when lamotrigine is coadministered with valproate.

3. Stevens-Johnson syndrome (SJS) is a risk of lamotrigine, and the combination of valproate increases the risk further.

A patient presents to the clinic today for follow up on hypertension. He states that he has noticed a dry "hacking" cough since he started lisinopril 4 weeks ago. He denies other respiratory or cardiovascular symptoms. Which action taken by the APN is most appropriate?t 1. Increase the dose of lisinopril and evaluate the patient in 2 weeks. 2. Treat the patient with an antibiotic and prednisone. 3. Stop the lisinopril and start losartan. 4. Add aliskiren to the current medication regime.

3. Stop the lisinopril and start losartan.

Which of these is one of the three core principles of geriatric assessment and health management? 1. Competency 2. Patient's goals 3. Independence 4. Presence or lack of multimorbidity

2. Patient's goals

Which medication is used to reduce the severity of benzodiazepine withdrawal symptoms? 1. Paroxetine (Paxil) 2. Lamotrigine (Lamictal) 3. Carbamazepine (Tegretol) 4. Bupropion hydrochloride (Wellbutrin)

3. Carbamazepine (Tegretol)

Which of these is the first step of viral replication? 1. Adsorption to and penetration into susceptible cells 2. Uncoating of viral nucleic acid 3. Synthesis of early, regulatory proteins 4. Synthesis of RNA or DNA

1. Adsorption to and penetration into susceptible cells

A patient asks the APN about the use of mushrooms. She said a friend told her that certain types of mushrooms can strengthen the immune system. The patient suffers from many upper respiratory infections in a given year and would like to strengthen her immune system. Which response by the APN is most appropriate? 1. "Mushrooms have shown some ability in studies to strengthen the immune system, but knowing the type of mushroom you are using and the studies available is important." 2. "Mushrooms are fungi and therefore are more likely to decrease the function of the immune system." 3. "Mushrooms can be detrimental to a person's health and should never be taken in case there are poisonous mushrooms included in the blend." 4. "Mushrooms have some healing properties, but have not been shown to improve the immune system."

1. "Mushrooms have shown some ability in studies to strengthen the immune system, but knowing the type of mushroom you are using and the studies available is important."

The APN has diagnosed the patient with atypical pneumonia and prescribes the patient empirical antibiotics. The patient asks how long it will take to feel better. Which response by the APN is most appropriate? 1. "You should feel better within 48 to 72 hours." 2. "You should feel better within 12 to 24 hours." 3. "You should feel better within 24 to 48 hours." 4. "You should feel better within 6 to 12 hours."

1. "You should feel better within 48 to 72 hours."

A patient presents to the clinician's clinical setting today and states that she wants to stop the benzodiazepine that she has taken for several years. You should educate the patient regarding which of the following? 1. "You should not discontinue a benzodiazepine abruptly because it can cause serious complications including seizures and death." 2. "You can stop the medication today." 3. "You must continue taking the medication since you have taken it long-term." 4. "You must taper over 3 days to avoid withdrawal symptoms from occurring before you stop the medication."

1. "You should not discontinue a benzodiazepine abruptly because it can cause serious complications including seizures and death."

Osteoporosis is defined as having a bone density (T score) by dual energy x-ray absorptiometry (DEXA) scan of how many standard deviations below the average adult peak bone mass? 1. 2.5 standard deviations 2. 2.0 standard deviations 3. 1.5 standard deviations 4. 1.0 standard deviations

1. 2.5 standard deviations

A more stringent HbA1c goal of 6.5% may be indicated for which patient? 1. 22-year-old type 1 diabetic patient who is concerned about family planning 2. 68-year-old type 2 diabetic patient with a history of hypoglycemia 3. 78-year-old type 2 diabetic patient with a history of dementia in an assisted living facility 4. 45-year-old type 1 diabetic patient who is unable to get dressed without assistance

1. 22-year-old type 1 diabetic patient who is concerned about family planning

A health-care provider was exposed to HIV by a needle stick. The APN understands that post-exposure prophylaxis (PEP) is effective only if the exposure occurred within which time frame? 1. 72 hours 2. 48 hours 3. 24 hours 4. 12 hours

1. 72 hours

An APN is prescribing oseltamivir for the onset of flu-like symptoms to a 44-year-old patient. Which dosage is appropriate for this patient? 1. 75 mg PO bid for 5 days and start within 48 hours of symptoms 2. 75 mg PO bid for 4 days and start within 48 hours of symptoms 3. 75 mg PO bid for 3 days and start within 48 hours of symptoms 4. 75 mg PO bid for 2 days and start within 48 hours of symptoms

1. 75 mg PO bid for 5 days and start within 48 hours of symptoms

You are planning to prescribe a benzodiazepine as a treatment for alcohol withdrawal in a patient. Special consideration should be given for which of the following patients? 1. A patient with severe liver disease 2. A middle-aged adult 3. A patient with hypertension 4. A patient with frequent urinary tract infections

1. A patient with severe liver disease

A 23-year-old patient was diagnosed with Trichomonas vaginal infection. Which medication is most appropriate for this patient? 1. A single dose of 2 g metronidazole 2. A single dose of 1 g metronidazole 3. A single dose of 5 g tinidazole 4. A single dose of 500 mg tinidazole

1. A single dose of 2 g metronidazole

An APN evaluates a 75-year-old female patient for major depression. She has been on phenelzine (Nardil) for many years. The patient has a history of type 2 diabetes mellitus, and the APN decides to switch the medication due to new mildly impaired renal studies. Which medication of choice and approach are most appropriate for this patient? 1. A washout period of 14 days and switch to escitalopram (Lexapro) 2. A washout period of 2 to 4 days and switch to fluoxetine (Prozac) 3. A washout period of 14 days and switch to desipramine (Norpramin) 4. No washout period is necessary. Switch to citalopram (Celexa).

1. A washout period of 14 days and switch to escitalopram (Lexapro)

The APN prescribed exenatide for a 56-year-old female patient with a history of type 2 diabetes mellitus (DM) on her last visit. The APN should be concerned if the patient reports which symptom? 1. Abdominal pain and nausea 2. Nausea 3. Diarrhea 4. Reduced appetite

1. Abdominal pain and nausea

Parasympathomimetics promote or mimic the action of which neurotransmitter? 1. Acetylcholine 2. Norepinephrine 3. Epinephrine 4. Dopamine

1. Acetylcholine

A 33-year-old female has been diagnosed with genital herpes, and this is her first outbreak. Which recommended dose of antiviral will the APN prescribe to this patient? 1. Acyclovir 200 mg 5 times per day for 10 days 2. Acyclovir 500 mg 5 times per day for 10 days 3. Acyclovir 200 mg 3 times per day for 10 days 4. Acyclovir 500 mg 3 times per day for 10 days

1. Acyclovir 200 mg 5 times per day for 10 days

A 76-year-old patient was diagnosed with a first episode of herpes zoster. Which medication regimen is most appropriate for the APN to prescribe? 1. Acyclovir 800 mg 5 times per day for 7 to 10 days 2. Acyclovir 800 mg 5 times per day for 10 to 12 days 3. Acyclovir 800 mg 3 times per day for 7 to 10 days 4. Acyclovir 800 mg 3 times per day for 10 to 12 days

1. Acyclovir 800 mg 5 times per day for 7 to 10 days

Seizures for a 25-year-old female patient with epilepsy have been managed best with oral phenytoin (Dilantin). The patient has just discovered she is pregnant. Which measure can reduce teratogenesis to the fetus? 1. Administration of daily oral folic acid 2. Administration of vitamin K-dependent clotting factors 3. Administration of the intravenous route of phenytoin (Dilantin) instead of the oral route 4. Maintenance of a therapeutic plasma drug level of 18 mcg/mL

1. Administration of daily oral folic acid

A patient presents to the emergency room (ER) with abdominal pain, nausea, and vomiting. The ER is able to access the patient's records through the electronic medical record (EMR), which states that the patient has been diagnosed with severe cervical spine arthritis and disc disease. He has received a prescription for his primary care physician for ibuprofen 500 mg three times daily. How does accessing this record assist the ER staff to more quickly identify and address the patient's problem? 1. It allows the ER staff to focus on the probability of stomach irritation from NSAIDs as the underlying reason for the patient's problems. The ability to access his complete record allows for a holistic view of the patient. 2. It provides the ER with some information but none that is useful at this time. 3. Although the information may help the ER, the patient's records are private and cannot be shared with providers or health-care facilities. 4. Going to the ER is considered unplanned care and has no connection with what is needed in an emergency.

1. It allows the ER staff to focus on the probability of stomach irritation from NSAIDs as the underlying reason for the patient's problems. The ability to access his complete record allows for a holistic view of the patient.

The Kefauver-Harris (K-H) Amendment was passed in 1962 after thousands of infants were born deformed when their mothers took a sedative during pregnancy. Which effect did this amendment have? 1. It mandated animal trials before human use. 2. It mandated inclusion of pregnant women in clinical trials. 3. It mandated safety and review of over-the-counter (OTC) medications. 4. It mandated evidence of safe use of medications for children.

1. It mandated animal trials before human use.

A transfeminine patient is preparing for feminizing hormone therapy. Which of these would the APN include in teaching about the effects of hormone therapy?1. It may take months and even up to a year for the patient to see the full effect of the hormones. 2. The patient's voice quality and tone will become more feminine over 1 to 3 months. 3. The patient will probably need to shave the face for 1 to 3 months, but after that not at all. 4. Breast development is a temporary effect of the hormone therapy.

1. It may take months and even up to a year for the patient to see the full effect of the hormones.

Which statement describes the effects of spironolactone as it is used to treat hirsutism? 1. It reduces the effects of aldosterone and suppresses testosterone synthesis. 2. It changes male-patterned body hair growth. 3. It offers a permanent solution for hair removal. 4. The potassium sparing effect stops hair growth.

1. It reduces the effects of aldosterone and suppresses testosterone synthesis.

A 63-year-old healthy patient was diagnosed with community-acquired pneumonia. Which antibiotic would be most appropriate for this patient? 1. Levaquin 2. Penicillin 3. Macrobid 4. Keflex

1. Levaquin

Which statement describes the mechanism by which the intracellular receptors allow medications to get into the cell? 1. Lipid-soluble hormones pass through the cell membrane and bind to intracellular receptors. Drugs and hormones in this category include thyroid hormones and corticosteroids. 2. Water-soluble hormones pass through the cell membrane and bind to intracellular receptors. Drugs and hormones in this category include sex hormones, insulin, and vitamin D. 3. All drugs pass through the cell membrane, especially hormones and drugs given parenterally. 4. All drugs take active energy in the form of adenosine triphosphate (ATP) to pass through the cell membrane; however, endogenous hormones can pass through the cell membrane without the cell generating ATP.

1. Lipid-soluble hormones pass through the cell membrane and bind to intracellular receptors. Drugs and hormones in this category include thyroid hormones and corticosteroids.

Which of these characterizes primary hypogonadism (testicular failure)? 1. Low testosterone and elevated gonadotropins 2. High testosterone and elevated gonadotropins 3. Low testosterone and low gonadotropins 4. High testosterone and low gonadotropins

1. Low testosterone and elevated gonadotropins

A man and woman ingest the same amount of alcohol over the same period of time. Why would the woman be expected to have a higher blood alcohol level? 1. Lower gastric levels of alcohol dehydrogenase 2. Higher gastric levels of alcohol dehydrogenase 3. Higher level of CYP 3A4 activity 4. Lower level of CYP 1A2 activity

1. Lower gastric levels of alcohol dehydrogenase

Which pathogen is associated with asthma exacerbation? 1. M. pneumoniae 2. S. aureus 3. H. influenzae 4. P. aeruginosa

1. M. pneumoniae

Which assessment measure indicates that exocrine pancreatic enzymes have been effective? 1. Maintenance of good nutritional status 2. Increased steatorrhea 3. Decreased abdominal pain 4. Increased weight loss

1. Maintenance of good nutritional status

Which method of contraception has a Black Box Warning due to causing significant bone mineral density (BMD) loss in adolescents? 1. Medroxyprogesterone acetate 2. Nexplanon 3. Copper intrauterine device (IUD) 4. Micronor oral contraceptives

1. Medroxyprogesterone acetate

Which medication has been shown to be beneficial in treating Alzheimer's disease (AD) in women? 1. Memantine 2. Clomipramine 3. Estrogen 4. Remifemin

1. Memantine

Which receptor is thought to be responsible for the reward effect of opioids? 1. Mu 2. Delta 3. Kappa 4. Phi

1. Mu

Which medication is indicated for emergency treatment of known or suspected opioid overdose, is carried by first responders, and is prescribed to known opioid users? 1. Naloxone nasal spray 2. Flumazenil (Romazicon) 3. Citalopram (Celexa) 4. lofexidine (Lucemyra)

1. Naloxone nasal spray

Which medication is an injectable and can be used for patients with moderate to severe alcohol use disorder? 1. Naltrexone (Vivitrol) 380 mg intramuscular (IM) every 4 weeks 2. Paliperidone (Invega) 117 mg IM monthly 3. Haloperidol (Haldol Decanoate) 50 mg IM once weekly 4. Promethazine (Phenergan) 25 mg IM PRN

1. Naltrexone (Vivitrol) 380 mg intramuscular (IM) every 4 weeks

Which cholinesterase inhibitor can be used in the treatment of myasthenia gravis? 1. Neostigmine 2. Galantamine 3. Donepezil 4. Memantine

1. Neostigmine

A patient has been treated for chronic arthritis and degenerative disc disease. Her daughter wants to take her to a specialist in her town, which is in a state across the country. The patient wants to take her current records with her so this new doctor will know what has been done to date. Which Health Insurance Portability and Accountability Act (HIPAA) regulations are related to the transfer of records and the ability of patients to access their records? 1. New HIPAA regulations mandate that providers must provide patients with copies of the electronic medical records through digital recording, e-mail, or electronic storage devices. 2. The patient will have to obtain an attorney to access her records, because they are a part of her current practices records and not available for viewing by anyone outside of the office. 3. The office manager tells the patient and her daughter that if any of her records are released, the office could receive a large HIPAA fine. 4. This office tells the patient and her daughter that if they release the records to anyone, including herself, the insurance company will not pay for future visits.

1. New HIPAA regulations mandate that providers must provide patients with copies of the electronic medical records through digital recording, e-mail, or electronic storage devices.

To relieve the acute pain of a flare of gout, which drug is the currently recommended first-line treatment? 1. Nonsteroidal anti-inflammatory drugs (NSAIDS) 2. COX-1 inhibitors 3. Opioids 4. Colchicine

1. Nonsteroidal anti-inflammatory drugs (NSAIDS)

The APN finds three medications that would be acceptable for a patient to take to combat upper respiratory infection. Which aspect of the drug is most important to consider to increase adherence? 1. Number of doses per day 2. Readability of label 3. Ease of opening container 4. Number of drugs being taken daily

1. Number of doses per day

Which drug is approved for cases of high triglycerides that do not respond to primary interventions? 1. Omega-3 carboxylic acid drug group 2. Fluvastatin 3. Atorvastatin 4. Rosuvastatin

1. Omega-3 carboxylic acid drug group

A patient comes into the office to be seen prior to going on a cruise. The patient is concerned about getting seasick and wants to discuss using a "patch." As a provider, how would the APN educate the patient on use of scopolamine? 1. One disk should be applied to the clean, dry, postauricular skin at least 4 hours before the antiemetic effect is desired. 2. The patch should not be changed before 7 days have passed. 3. A second patch can be added if the first does not have desired effect. 4. If the patient touches the eyes after application, wash them out with soap and water.

1. One disk should be applied to the clean, dry, postauricular skin at least 4 hours before the antiemetic effect is desired.

When should the patient be taught to administer bethanechol? 1. One hour before a meal 2. Thirty minutes before a meal 3. Concurrently with a meal 4. One hour after a meal

1. One hour before a meal

The APN understands that the patient prescribed ethambutol must be followed up with by specialists in which department? 1. Ophthalmology 2. Cardiology 3. Gynecology 4. Urology

1. Ophthalmology

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

1. Oral rehydration therapy (ORT)

Which information should be included in the education for a patient taking an antilipidemic? 1. Other drugs should be taken 1 hour before or 4 hours after the bile-acid sequestrant. 2. Lovastatin should be taken first thing in the morning. 3. Bile-acid sequestrants should be taken after meals. 4. A high-fiber diet may reduce the chance for muscle pain associated with reductase inhibitors.

1. Other drugs should be taken 1 hour before or 4 hours after the bile-acid sequestrant.

Cystic fibrosis requires enzymatic supplementation due to which defect? 1. Pancreatic insufficiency 2. Mucus plugging of the lungs 3. Steatorrhea 4. Excessive sodium loss

1. Pancreatic insufficiency

Which statement is most accurate regarding biosimilar drugs used to treat rheumatoid arthritis (RA)? 1. Patients taking biosimilar drugs should be monitored for adverse effects in the same manner as those taking the parent drug. 2. Biosimilar drugs are usually more expensive than the parent drug. 3. The U.S. Food and Drug Administration (FDA) does not require additional labeling of biosimilar drugs, making switching from one biosimilar to another difficult. 4. The path to U.S. Food and Drug Administration (FDA) approval for biosimilar drugs is longer than the parent drug to prevent adverse reactions.

1. Patients taking biosimilar drugs should be monitored for adverse effects in the same manner as those taking the parent drug.

Steroid injections into the knee to control pain are recommended for which patients? 1. Patients who have failed oral and topical agents 2. Patients without inflammatory symptoms 3. Patients requiring monthly injections 4. Patients with limited ability to mount an immune response

1. Patients who have failed oral and topical agents

Which medication would both reduce the pain relief of a pure opioid and initiate an abstinence syndrome if given to a narcotic-addicted patient? 1. Pentazocine (Talwin) 2. Propoxyphene (Darvon) 3. Methadone (Dolophine) 4. Methamphetamine (Desoxyn)

1. Pentazocine (Talwin)

Bethanechol is contraindicated in the presence of which disease? 1. Peptic ulcer disease 2. Hypothyroidism 3. Preexisting hypertension 4. Glaucoma

1. Peptic ulcer disease

Which phase of drug trials looks at how the drug is tolerated at different doses? 1. Phase I 2. Phase II 3. Phase III 4. Phase IV

1. Phase I

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

1. Polyethylene glycol

Which of these is a frequent cause of delirium? 1. Polypharmacy 2. Abrupt cessation of medication 3. Use of nonopioid pain medication 4. Hip fracture

1. Polypharmacy

A patient comes to the office because he is confused by his drug plan and does not understand why he pays more for his brand-name Synthroid than for the generic levothyroxine. Which response by the APN is most appropriate? 1. The APN tells the patient that the usual plan has several "tiers" that have different costs, with generics usually on the lowest tier with the least co-pay, and brand-name drugs having higher co-pays depending on their average wholesale price. 2. The APN tells the patient to refer to his drug benefits officer for all explanations because the APN is not an expert in these areas. 3. The APN tells the patient that brand-name drugs are better than generic drugs, and that is why they cost more. In this case, Synthroid is able to provide a better level of thyroid hormone then levothyroxine. 4. The APN tells the patient that generic drugs are insufficient to meet medical needs and should not be prescribed.

1. The APN tells the patient that the usual plan has several "tiers" that have different costs, with generics usually on the lowest tier with the least co-pay, and brand-name drugs having higher co-pays depending on their average wholesale price.

A 48-year-old new patient admission has been added to the APN's schedule. She has a history of latent autoimmune diabetes in adults (LADA). She is currently utilizing a mixed insulin twice a day and a rapid-acting insulin (RAI) with meals according to her sliding scale. Her fasting blood glucose is 95 mg/L and the HbA1C is 6.5%. Which action taken by the APN today would be most appropriate? 1. The APN would indicate that no adjustments are needed. 2. The APN would change to basal bolus method. 3. The APN would request additional information before making changes at this appointment. 4. The APN would instruct the patient to include RAI before meals.

1. The APN would indicate that no adjustments are needed.

Which statement regarding rheumatoid arthritis (RA) is most accurate? 1. The earlier the pharmacologic interventions, such as use of disease-modifying antirheumatic drugs (DMARDs) is begun, and the more aggressive the intervention, the better the patient outcomes. 2. Aggressive pharmacologic interventions, such as use of disease-modifying antirheumatic drugs (DMARDs) should be reserved for those failing high dose oral steroid treatments. 3. Classic RA is linked with underproduction of tumor necrosis factor (TNF), often requiring TNF replacement. 4. Disease-modifying antirheumatic drugs (DMARDs) are usually restricted for use during RA flares and exacerbations.

1. The earlier the pharmacologic interventions, such as use of disease-modifying antirheumatic drugs (DMARDs) is begun, and the more aggressive the intervention, the better the patient outcomes.

Which mechanism explains the development of extrapyramidal symptoms (EPSs) when using typical antipsychotics? 1. The excessive blocking of dopamine-2 2. The excessive agonism of dopamine-2 3. The effects of comorbid hyperthyroidism at start of treatment 4. The lowering of the prolactin level

1. The excessive blocking of dopamine-2

If a patient has not clinically improved within 72 hours of starting an antibiotic, then the APRN must consider which possibility? 1. The pathogen is not being treated appropriately. 2. The antibiotic should be discontinued. 3. Another antibiotic needs to be added. 4. A probiotic needs to be added.

1. The pathogen is not being treated appropriately.

A 32-year-old patient, who has been prescribed rufinamide for 1 year, has had an occasional seizure. To gain better control, carbamazepine was added to the regimen. The patient suddenly complains of more seizure activity. Which explanation is most plausible? 1. The patient has experienced a drug interaction causing rufinamide to be subtherapeutic. 2. The patient's seizure type is changing. 3. The patient has factitious disorder. 4. The patient has Munchausen syndrome.

1. The patient has experienced a drug interaction causing rufinamide to be subtherapeutic.

A 28-year-old patient in the APN's practice identifies as cisgender. Which statement accurately describes this patient? 1. The patient identifies with the sex assigned at birth. 2. The patient has an internal conflict between gender identity and the sex assigned at birth. 3. The patient does not subscribe to a set gender and identifies as neither male nor female. 4. The patient had gender-affirming surgery to align the body with gender identity.

1. The patient identifies with the sex assigned at birth.

The patient, who is breastfeeding her new baby, develops an infection in her breast that is extremely painful. She is prescribed an opioid pain medication and told not to breastfeed while this medication is in her system. The half-life of this medication is 8 hours. Which of these would the nurse include in instructions to the patient? 1. The patient should pump and dump her breast milk for 40 hours after the last dose of pain medication. 2. The patient should pump and dump her breast milk for 40 hours after the first dose of pain medication. 3. The patient will have to stop breastfeeding her baby and switch to bottle-feeding, because her milk will "dry up" while she is on the medication. 4. The patient can restart breastfeeding 8 hours after completing the medication.

1. The patient should pump and dump her breast milk for 40 hours after the last dose of pain medication.

Beta blockers (BBs) are generally contraindicated in which patient? 1. The patient who has unstable asthma 2. The patient who has had a myocardial infarction (MI) 3. The patient who has hypertension 4. The patient who has stable Type II diabetes

1. The patient who has unstable asthma

Which information is most important to understand for an APN practicing in a state where medical marijuana is legal? 1. The relative proportions of THC and CBD in different marijuana strains can change the effects of the plant. 2. All forms of marijuana have psychoactive properties and can cause a person to hallucinate and experience changes in personality. 3. Marijuana is primarily used in treatment of renal disease. 4. Marijuana has an anorexic property that causes a patient to stop or decrease food intake.

1. The relative proportions of THC and CBD in different marijuana strains can change the effects of the plant.

Which risk is highest in tricyclic antidepressants (TCAs) compared with newer antidepressants? 1. The risk of fatal overdose for high-risk suicidal patients 2. The risk of serotonin syndrome if a patient takes another serotonergic at the same time 3. The risk of suicidal thoughts and behavior 4. The risk of postural hypotension and suppression of myocardial pain

1. The risk of fatal overdose for high-risk suicidal patients

A patient is taking three medications: one for hypertension, one for hyperlipidemia, and one for arthritis. She tells the APN that she is having trouble remembering why she takes these medications and wonders if she could stop taking them. Which response by the APN is most appropriate? 1. Spend time speaking with the patient about the purpose of each medication and caution her that patients who stop using their drugs have more complications from their diseases. 2. Remind the patient that she can stop medications at any time, because it is her choice, but that the APN cannot be held responsible for the outcome of her health if she stops the medications. 3. Explain that the APN is only responsible for prescribing the drugs, not making her take them, and suggest she stop seeing the APN if she does not want to take drugs. 4. Tell the patient that if she stops taking her medications, she should stop coming to this practice and find another, because the APN cannot be responsible for noncompliant patients.

1. Spend time speaking with the patient about the purpose of each medication and caution her that patients who stop using their drugs have more complications from their diseases.

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."

2. "I take it with a glass of orange juice."

A husband and wife in the APN's practice are both being treated for hypertension with verapamil. The husband requires a higher dose to get his blood pressure under control. He asks for the same dose as his wife because he believes that less medicine is better. Which response by the APN is most appropriate? 1. "Women metabolize verapamil more quickly than men do. This means that verapamil works faster in women than men, resulting in better blood pressure control at a lower dose." 2. "Men metabolize verapamil more quickly than women do. This means men get rid of verapamil more quickly, causing men to need a higher dose to get the desired result." 3. "Okay, let's lower your dose and see what happens." 4. "Women need less medication because they are smaller than men."

2. "Men metabolize verapamil more quickly than women do. This means men get rid of verapamil more quickly, causing men to need a higher dose to get the desired result."

A mother asks the APN about using an over-the-counter (OTC) medication for her child because the label says, "Consult your provider for use instructions as safety and effectiveness have not been established." Which response by the APN is most appropriate? 1. "The drug meets OTC label requirements, but studies in children have not been conducted." 2. "Pediatric studies have shown this drug to be either unsafe or ineffective in children." 3. "This drug is safe in adults and so usually we should use half the recommended dose for children." 4. "This medication is perfectly safe to use. Let me calculate the dose for your child."

2. "Pediatric studies have shown this drug to be either unsafe or ineffective in children."

After starting a patient on drug therapy to treat osteoporosis, follow-up dual energy x-ray absorptiometry (DEXA) screening is recommended at which interval to assess effectiveness of drug treatment? 1. 6 months 2. 1 to 2 years 3. 3 years 4. 5 years

2. 1 to 2 years

The United States Preventive Services Task Force (USPSTF) recommends screening for alcohol misuse in primary care settings for what age group? 1. 12 and older 2. 18 and older 3. 30 and younger 4. 65 and younger

2. 18 and older

Which phenobarbital result suggests that it is in the therapeutic range? 1. 50 mcg/mL 2. 20 mcg/mL 3. 5 mcg/mL 4. 60 mcg/mL

2. 20 mcg/mL

The recommended maximum daily dose of acetaminophen for a person who is suffering from moderate osteoarthritis (OA) pain and has a history of alcohol and drug use with hepatic issues is a maximum of how many grams per day? 1. 5 grams/day 2. 3 grams/day 3. 4 grams/day 4. 2 grams/day

2. 3 grams/day

Serum levels of vitamin D for optimal bone health should range between which values? 1. 10 and 30 ng/mL 2. 30 and 100 ng/mL 3. 100 and 150 ng/mL 4. 150 and 250 ng/mL

2. 30 and 100 ng/mL

The APN notices that many of the patients being treated in the practice have diabetes. To provide quality care for this population, the APN would like to conduct a cost-of-illness analysis for the diabetics in the practice. The APN realizes that cost-of-illness is a good baseline number when looking at different treatment and prevention strategies. Which of these are components of a cost-of-illness analysis? 1. The cost of drugs needed to treat this disease and the intangible costs of pain and suffering 2. Cost of medical resources to treat the illness (including medications), the cost of nonmedical resources (such as physical therapy), and loss of productivity 3. Comparing several different treatment alternatives to see which would be the least costly for the patient and for the health-care system 4. Comparing two different treatments to see which does the best job on the patient's symptoms and costs the least (such as how many mm HG blood pressure points are decreased)

2. Cost of medical resources to treat the illness (including medications), the cost of nonmedical resources (such as physical therapy), and loss of productivity

The APN is caring for a transgender man who is experiencing menstrual bleeding despite longstanding testosterone therapy. Which option for reducing menstrual bleeding is most appropriate for this patient? 1. Levonorgestrel (LNg) intrauterine device (IUD) 2. Depot medroxyprogesterone acetate (DMPA) 3. Etonogestrel implant 4. Danazol

2. Depot medroxyprogesterone acetate (DMPA)

The action of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and direct renin inhibitors on the renin-angiotensin-aldosterone (RAA) system lowers blood pressure and reduces the adverse effects of which disease on the kidney? 1. Peripheral artery disease 2. Diabetes 3. Glycosuria 4. Multiple sclerosis

2. Diabetes

The patient is an older adult who has a diagnosis of Type II diabetes mellitus and hypertension. The APN is prescribing her a beta blocker today. The APN should teach her that which symptom is an indication of hypoglycemia that is not masked by beta blockers? 1. Dizziness 2. Diaphoresis 3. Fatigue 4. Syncope

2. Diaphoresis

Which of the following drugs can be used as a fixed-schedule dosing to detoxify patients with acute withdrawal syndrome? 1. Chlordiazepoxide (Librium) is dosed at 12.5 mg every 12 hours for 1 day, then 5 mg daily for eight doses. 2. Diazepam (Valium) is dosed at 10 mg every 6 hours for four doses, then 5 mg every 6 hours for eight doses. 3. Lorazepam (Ativan) is dosed at 0.5 mg every 12 hours for four days. 4. Hydroxyzine (Vistaril) is prescribed.

2. Diazepam (Valium) is dosed at 10 mg every 6 hours for four doses, then 5 mg every 6 hours for eight doses.

Doxycycline is not used during pregnancy because it may cause which effect in neonates? 1. Growth stunt 2. Discoloration of deciduous teeth 3. Cardiac malformation 4. Decrease in lung surfactant

2. Discoloration of deciduous teeth

Which of the following neurotransmitters can lead to symptoms of withdrawal and a lowered seizure threshold in alcohol withdrawal? 1. Norepinephrine 2. Dopamine 3. Histamine 4. Serotonin

2. Dopamine

All antidepressants hold a Black Box Warning risk of suicidal thoughts and behaviors. Under which circumstances does this risk increase most? 1. When the treatment regimen continues beyond 2 years and the depression is in remission 2. During the first 2 months of treatment and less than 24 years of age 3. When the drug is subtherapeutic 4. During drug holidays, when the drug is temporarily withdrawn

2. During the first 2 months of treatment and less than 24 years of age

Risk factors for erectile dysfunction (ED) include which chronic illness? 1. Psoriasis 2. Dyslipidemia 3. Asthma 4. Osteoarthritis (OA)

2. Dyslipidemia

An infant is diagnosed with chlamydial pneumonia. Which medication regimen adheres to the standard of treatment for this patient? 1. Clarithromycin 50 mg/kg daily for 14 days 2. Erythromycin 50 mg/kg daily for 14 days 3. Azithromycin 50 mg/kg daily for 14 days 4. Clindamycin 20 mg/kg daily for 14 days

2. Erythromycin 50 mg/kg daily for 14 days

A 33-year-old female patient is diagnosed with vaginal candidiasis. Which medication and dosage are most appropriate for the APN to prescribe? 1. Itraconazole 100 mg as single PO dose 2. Fluconazole 150 mg as single PO dose 3. Fluconazole 100 mg as single PO dose 4. Itraconazole 150 mg as single PO dose

2. Fluconazole 150 mg as single PO dose

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.

2. Fluid and electrolyte imbalances can occur.

An 8-year-old has been diagnosed with major depression. Which medication is preferred for this patient? 1. Paroxetine 2. Fluoxetine 3. Isocarboxazid 4. Vortioxetine

2. Fluoxetine

The patient has been having some issues with memory loss, and the APN suspects some components of early Alzheimer's disease. The APN wants to start the patient on a cholinesterase inhibitor. The patient also has some history of elevated liver enzymes and questions of a fatty liver remain. Which of these should be avoided based on clearance? 1. Donepezil 2. Galantamine 3. Rivastigmine 4. Memantine

2. Galantamine

Which of these affects drug absorption in the gastrointestinal (GI) tract? 1. Type and quantity of food eaten within 4 hours of drug administration 2. Gastric emptying time and the absorptive surface area of the stomach 3. Lipid content of the drug administered and esophageal fluctuation 4. A delay in gastric emptying because of a low-fat, high-carbohydrate diet

2. Gastric emptying time and the absorptive surface area of the stomach

Generic drugs have the same active ingredient as the brand-name drug but may act differently in the body for which reason? 1. There may be less of the active ingredient in the generic drug. This causes the generic drug to be less effective than the brand-name drug. 2. Generic formulations may have variations from the brand-name drug in the way it is absorbed, and therefore the speed and rate of absorption may differ. 3. Generic drugs only have to be 85% as effective as the brand-name drug, which usually is enough to get a similar response. 4. Generic drugs mimic the brand-name drug, but can use different active ingredients so that the generic drug may have a different effect from the brand-name drug.

2. Generic formulations may have variations from the brand-name drug in the way it is absorbed, and therefore the speed and rate of absorption may differ.

Traditional Chinese medicine (TCM) relies on herbal and plant products but looks at them in a different way than Western herbal medicine. When speaking to a patient who uses TCM as well as allopathic medicine, which information about TCM is important for the APN to know? 1. TCM uses a magical type of thinking and relies on spirits, demons, and other magical creatures to point the way to healing. 2. TCM does not use a disease-based method for prescribing, but rather the individual consuming the herb. TCM requires looking at an energy and cycle-based approach to prescribing herbs and treatment. 3. TCM and Western medicine are not very different; both diagnose and treat patients as populations. 4. TCM has a list of healing herbs that are used for different diseases and uses that list when treating patients.

2. TCM does not use a disease-based method for prescribing, but rather the individual consuming the herb. TCM requires looking at an energy and cycle-based approach to prescribing herbs and treatment.

The patient comes to the office with a broken arm that happened 6 weeks ago after a skateboarding accident. He was sent to the emergency department, where his arm was casted, and he was given opioid pain relievers. About 2 weeks ago, the patient had the cast removed. This week, the patient returns to see the APN complaining that he needs more pain medication. Upon careful assessment, the APN notes that his arm has full range of motion. However, he states his pain is a 9 out of 10. Which assessment and action regarding prescribing pain medication would be most appropriate? 1. Tell the patient that he is obviously not in pain and no more medication will be prescribed. 2. Tell the patient that his pain from the break should be resolved at this time and that you will send him to physical therapy for further evaluation. In addition, recommend Tylenol extra strength three times a day as needed for the remaining pain. 3. Provide the patient with a prescription for another 6 weeks of pain medication. 4. Refer the patient to a pain management clinic.

2. Tell the patient that his pain from the break should be resolved at this time and that you will send him to physical therapy for further evaluation. In addition, recommend Tylenol extra strength three times a day as needed for the remaining pain.

Which statement accurately describes the overall role of the APN in helping patients decide whether or not to use a particular herbal therapy? 1. The APN should dissuade them from using any herbal therapy, because the dangers cannot be known and ADRs might occur with any herbal therapy. 2. The APN should be open to all possible ways to treat health issues and explore resources on the use of herbal therapies, critique the information provided, and assist the patient to find practitioners that are versed in alternative therapies. 3. The APN should be well educated in complementary and alternative medicine therapies and should be able to recommend herbal therapies with confidence. 4. The APN should instruct the patient that all herbs are safe to take because they are so mild and have such a small effect.

2. The APN should be open to all possible ways to treat health issues and explore resources on the use of herbal therapies, critique the information provided, and assist the patient to find practitioners that are versed in alternative therapies.

The patient was given a prescription for a brand-name diabetic medication. She was very surprised to see a different name for the medication on her bottle, but also very pleased that the medication came at no cost. Because she wanted to be careful and know that she was taking the correct medication, the patient called the APN. Which response by the APN is most appropriate? 1. The APN should tell the patient that because the name is not what was prescribed, the patient should take the medication back to the pharmacy, because it is most likely a mistake on the part of the pharmacy. 2. The APN should inform the patient that pharmacists may substitute a generic equivalent for a brand-name drug unless the prescriber specifies "Dispense as Written" on the prescription. 3. The APN should make sure that the patient is not confused about which prescription she took to the pharmacy, because this could be the reason the bottle has a different name than she suspected. 4. The APN should tell the patient that it is not her job to determine what medications the pharmacy dispenses and she cannot help her.

2. The APN should inform the patient that pharmacists may substitute a generic equivalent for a brand-name drug unless the prescriber specifies "Dispense as Written" on the prescription.

A patient has had her stomach banded to lose weight. She is doing well and has come to the doctor for follow-up care. Her only minor complaint is a slight numbness in her hands. Her complete blood count shows that she is anemic and has a high mean corpuscular volume (MCV). The APN diagnoses a possible B12 deficiency, and indeed her B12 level is low. Which is a probable reason for this deficiency? 1. B12 must be extracted from dietary sources and absorbed from the gastrointestinal (GI) system into the bloodstream. She is not eating enough foods with B12 in them. 2. The absorption of vitamins and drugs can be delayed if gastric absorption is reduced. In this case, the stomach banding provides less surface area for absorption in the stomach. 3. The patient may have thalassemia and not be able to use B12 in the body. 4. B12 is not an important vitamin, and occasionally levels can be low before resolving to normal levels. This will probably take care of itself over time.

2. The absorption of vitamins and drugs can be delayed if gastric absorption is reduced. In this case, the stomach banding provides less surface area for absorption in the stomach.

Which doses of zolpidem (Ambien) are recommended for women versus men? 1. The dose for women and men is the same. 2. The dose for women is 5 mg and for men is 10 mg. 3. The dose for women is 10 mg and for men is 5 mg. 4. The dose for women is 5 mg, but zolpidem is contraindicated for men with fertility potential.

2. The dose for women is 5 mg and for men is 10 mg.

The U.S. Food and Drug Administration (FDA) currently stipulates that a drug must fulfill which requirements before it is available for marketing? 1. The drug must be pure and have no illegal substances. 2. The drug must be safe and efficacious. 3. The drug must have no generic formulations or substitutes. 4. The drug must be used for only very rare diseases.

2. The drug must be safe and efficacious.

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.

2. The patient's creatinine clearance is 32 mL/minute.

A patient is taking a blood pressure medication (Amlodipine 10 mg) to correct her hypertension. After the patient takes the drug for 2 months, the APN wants her to start on a second medication (Benazepril 20 mg) along with the first one to reduce her blood pressure. The patient asks why she has to take two medications instead of simply taking a higher dose of the first one. Which response by the APN is most appropriate? 1. "Adding a second drug will save you money, because the second drug is less expensive than a higher dose of the original drug." 2. "Adding a second drug increases the potency of the first drug so that the drugs work together to produce the strongest effect." 3. "The risk of toxicity is too great at a high dose of Amlodipine, so another drug is added to reach the satisfactory level of blood pressure." 4. "Both drugs are taken once daily so if one drug is taken in the morning, and the other in the evening, it will have a more lasting effect on blood pressure."

3. "The risk of toxicity is too great at a high dose of Amlodipine, so another drug is added to reach the satisfactory level of blood pressure."

How long is insulin stable at room temperature once opened? 1. 3 months 2. 7 days 3. 30 days 4. 14 days

3. 30 days

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

3. 5 mEq HCl per dose

Which of the following is the initiation dose of disulfiram (Antabuse)? 1. 750 mg daily for 2 weeks 2. 250 mg daily for 4 weeks 3. 500 mg once a day for 1 to 2 weeks 4. 100 mg twice a day for 6 weeks

3. 500 mg once a day for 1 to 2 weeks

A 14-year-old female with a history of metabolic syndrome and Turner's syndrome presents as a new patient to the office. She is currently taking somatropin, and she questions the APN about when the medication should be discontinued. The APN informs the patient the medication should be continued until which of these? 1. Diabetes development 2. Adulthood 3. 75th percentile of growth curve 4. 50th percentile of growth curve

3. 75th percentile of growth curve

Nitrates can be used in which patient? 1. A 60-year-old patient with a recent cerebral hemorrhage 2. A 32-year-old patient with closed-angle glaucoma 3. A 55-year-old patient with bronchospastic asthma 4. A 40-year-old patient who has a hypersensitivity response to nitrates

3. A 55-year-old patient with bronchospastic asthma

Which of the following patients should not receive Naltrexone (Vivitrol extended-release injection)? 1. A patient who has mild renal insufficiency 2. A patient who is currently not consuming alcohol but may use alcohol socially 3. A patient who is currently using an opioid 4. A patient who has diabetes mellitus type II

3. A patient who is currently using an opioid

Which of these represents the four aspects of pharmacokinetics? 1. Absorption, transmembrane receptors, enzymes, and distribution 2. Dose response curve, drug response, drug selectivity, and ion channel receptors 3. Absorption, distribution, metabolism, and excretion 4. Cell membrane receptors, intracellular receptors, non-Receptor mechanisms, and excretion

3. Absorption, distribution, metabolism, and excretion

Which medication has been shown to be beneficial to the diabetic patient with hypertriglyceridemia? 1. Saxagliptin 2. Metformin 3. Acarbose 4. Amylin

3. Acarbose

Which statement regarding the roles of drugs at receptors is correct? 1. Agonists bind with receptors and simply prevent other molecules from binding to them. 2. Antagonists occupy receptor sites and act to both stimulate and stop reactions. 3. Agonists stimulate a change in the cell each time they bind. 4. Antagonists stimulate only some of the receptor sites through intrinsic activity.

3. Agonists stimulate a change in the cell each time they bind.

Which of these can increase HbA1c? 1. Chronic renal failure 2. Blood loss 3. Alcohol use 4. Pregnancy

3. Alcohol use

Evaluation of which indicator is used to diagnose and signal need for treatment in Paget's disease? 1. Thyroid-stimulating hormone (TSH) 2. Serum calcium 3. Alkaline phosphatase 4. 25-hydroxy vitamin D

3. Alkaline phosphatase

Which factor is most important in preventing influenza? 1. Wearing a mask 2. Wearing gloves 3. Annual vaccination 4. Good hygiene

3. Annual vaccination

A 66-year-old who is prescribed nortriptyline (Pamelor) is complaining of dizziness upon standing, visual changes, sleepiness, dry mouth, low appetite due to nausea, and constipation. The APN would most suspect which problem? 1. Hyperpyrexia 2. Physical dependence 3. Anticholinergic adverse effects 4. Parkinsonism

3. Anticholinergic adverse effects

Carbamazepine has a Black Box Warning regarding the development of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). There is a strong association with the HLA-B*1202 allele variant. Patients of which ethnicity are most at risk and should be screened for this allele before starting the drug? 1. African American 2. Caucasian 3. Asian 4. Hispanic

3. Asian

Which component is most important for the APN to include in patient education on beta blockers? 1. Avoid in pregnancy. 2. Do not double the doses for a missed dose. 3. Avoid abrupt withdrawal. 4. Take with food.

3. Avoid abrupt withdrawal.

A 32-year-old patient is started on clonazepam (Klonopin), a benzodiazepine for anxiety. Which information would the APN include in patient education regarding clonazepam? 1. Red-green color blindness may occur and should be reported. 2. Doses should not be missed to remain effective. If a dose is missed, the patient can double the next dose. 3. Avoid alcohol when taking the clonazepam (Klonopin). 4. Ocular pain and visual changes are an expected adverse effect at the beginning of therapy. This usually resolves within a week of therapy.

3. Avoid alcohol when taking the clonazepam (Klonopin).

A patient presents to the clinician's practice setting with seizure activity and symptoms of clouded sensorium, confusion, altered level of consciousness, and poor performance on the Mini-Mental Status Exam (MMSE). The advanced practice nurse should suspect which of the following? 1. Opioid withdrawal 2. Abrupt cessation of the alpha-2 adrenergic agonist clonidine 3. Benzodiazepine withdrawal 4. Use of naloxone

3. Benzodiazepine withdrawal

An 85-year-old patient has been seeing the APN for 5 years. Based on yearly blood work, the APN notes that the patient's creatinine clearance (CrCl) is decreased, as has his estimated glomerular filtration rate (eGFR). These levels are new, because the patient has always had CrCl and eGFR close to normal limits. How does this change in his laboratory work affect the patient's risk for ADRs? 1. It decreases his risk, because he will not clear drugs as quickly and therefore they will have more of an opportunity to work in the body. 2. These two laboratory values have little to do with drug clearance, and therefore do not affect drug metabolism in the body or ADRs. 3. Most drugs are cleared through the kidneys and therefore the APN should review drugs being taken to see if adjustments in dosages should be made to reduce the risk of ADRs. 4. The APN should stop all of the patient's drugs immediately until more tests of renal function can be completed and more is known about potential ADRs.

3. Most drugs are cleared through the kidneys and therefore the APN should review drugs being taken to see if adjustments in dosages should be made to reduce the risk of ADRs.

The APN understands that most drugs are absorbed through passive diffusion. Which definition accurately describes passive diffusion? 1. Movement of drug molecules from an area of low concentration to one of high concentration 2. Movement of drug molecules against a concentration gradient through the use of adenosine triphosphate (ATP) 3. Movement of water-soluble drug molecules through aqueous channels 4. Movement of ionized drug molecules freely across the biologic membranes

3. Movement of water-soluble drug molecules through aqueous channels

Levothyroxine (Synthroid) is contraindicated in the patient with which comorbidity? 1. Diabetes 2. Osteoporosis 3. Myocardial infarction (MI) 4. Peripheral vascular disease

3. Myocardial infarction (MI)

A patient who the APN has been treating with simvastatin presents today with complaints of diffuse myalgias and muscle tenderness and weakness. The APN notes that his creatine kinase (CK) value is more than 10 times the upper limit of normal. Which condition would the APN most likely suspect? 1. Hepatic injury 2. Renal insufficiency 3. Myopathy 4. Impaction

3. Myopathy

Which of these correctly identifies some adverse effects of marijuana? 1. Painful urination, cough, and neck stiffness 2. Diarrhea and mucous membrane irritation 3. Nausea, vomiting, drowsiness, vertigo, and somnolence 4. Tendon rupture, skin rash, and joint pain

3. Nausea, vomiting, drowsiness, vertigo, and somnolence

Which adverse reaction is uncommon with use of angiotensin-converting enzyme inhibitors (ACEIs)? 1. Dizziness 2. Fatigue 3. Neutropenia 4. Cough

3. Neutropenia

The APN understands that which statement is accurate about providing high quality health care to all patients? 1. A physician must have the last word on how heath is assessed and treated in all patients. 2. Collaboration and teamwork are preferable, but not necessary, to provide high quality care for patients. 3. No single member of the health-care team can provide high quality care without collaborating with other team members. 4. Asking for the advice and input of others indicates that the provider is not competent to do the job.

3. No single member of the health-care team can provide high quality care without collaborating with other team members.

The APN prescribes a drug that has a high protein binding affinity. Which statement about this drug is true? 1. The drug will have a large volume of distribution. 2. Protein binding is an irreversible process. 3. Only the unbound portion of the drug will be therapeutically active. 4. Gastric pH determines protein binding.

3. Only the unbound portion of the drug will be therapeutically active.

A patient presents with a new complaint of nausea, vomiting, palpitations, and yellow-green halos around lights since he completed an antibiotic for a sinus infection. He has been taking brand name Lanoxin (digoxin) for several years with normal laboratory ranges. He recently had a basic chemistry profile, thyroid stimulating hormone, and a renal profile, all of which were within normal ranges. Which action taken by the APN is most appropriate? 1. Change his Lanoxin to generic digoxin. 2. Start sodium supplements and order laboratory tests to assess for renal impairment. 3. Order a digoxin level due to the recent use of an antibiotic. 4. Increase Lanoxin (digoxin) and order laboratory tests to assess potassium and sodium levels.

3. Order a digoxin level due to the recent use of an antibiotic.

The lowest dose possible of levothyroxine (Synthroid) should be given to the patient with which condition? 1. Pregnancy 2. Diabetes 3. Osteoporosis 4. Simple nontoxic goiter

3. Osteoporosis

These drugs are useful in the treatment of hypertension (HTN) and act by direct relaxation and dilation of arteriolar smooth muscle, thereby decreasing peripheral vascular resistance. They do not dilate the epicardial coronary arteries and do not relax venous smooth muscle. This best describes which type of drug? 1. Calcium channel blockers (CCBs) 2. Nitrates 3. Peripheral vasodilators 4. Cardiac glycosides (CGs)

3. Peripheral vasodilators

Which precaution or contraindication is noted with the use of diuretics? 1. Hepatic dysfunction is an absolute contraindication to the use of a diuretic. 2. The use of diuretics can improve hyperuricemia in patients with a history of gout or renal calculi. 3. Potassium-sparing diuretics have an absolute contraindication for patients with severely impaired renal function. 4. Older adults are at increased risk for hypertension.

3. Potassium-sparing diuretics have an absolute contraindication for patients with severely impaired renal function.

All calcium channel blockers (CCBs) are in which pregnancy category? 1. Pregnancy Category A 2. Pregnancy Category B 3. Pregnancy Category C 4. Pregnancy Category D

3. Pregnancy Category C

Which of these varies in the United States by ethnic group? 1. Rate of prediabetes progressing to diabetes 2. Incidence of type 1 diabetes mellitus (DM) 3. Prevalence of type 2 diabetes mellitus (DM) 4. Cost-effectiveness of lifestyle interventions

3. Prevalence of type 2 diabetes mellitus (DM)

The APN is caring for a transmasculine patient who comes in requesting contraception. Which medication would be most appropriate for this patient? 1. Ortho-Evra patch 2. Nuvaring vaginal ring 3. Progesterone only oral contraceptive 4. Combined estrogen/progesterone oral contraceptive

3. Progesterone only oral contraceptive

Which medication would most likely result in maximum central nervous system (CNS) effect? 1. Atenolol 2. Metoprolol 3. Propranolol 4. Nebivolol

3. Propranolol

The patient presents to the hospital with an enlarged prostate (BPH) and slight hypertension. The APN understands that an alpha blocker like terazosin can work on both BPH and hypertension. The APN is also aware of a first-dose ADR that can occur with the initial prescribing of terazosin. Which of these correctly identifies that ADR and how it is best managed? 1. The ADR involves tolerance such that the first dose is not usually effective, which is best managed by increasing the dose after the first day. 2. The ADR involves restlessness and inability to sleep, which is best managed by prescribing a sleeping pill along with the alpha blocker for a few days. 3. The ADR involves dizziness caused by orthostatic hypotension, which is best managed through patient education on the possibility of the ADR and giving the drug at bed time. 4. The ADR involves excessive and painful urination for 3 to 4 days, which is best managed by increasing fluid intake and prescribing pain medication.

3. The ADR involves dizziness caused by orthostatic hypotension, which is best managed through patient education on the possibility of the ADR and giving the drug at bed time.

The APN is taking a history from a new patient. The patient indicates that she takes 1 mg of Xanax four times a day and has been taking that amount for about 5 years since her husband died. Which of these is the best course of action for the APN at this time? 1. The ARN would inform the patient that she should take no more Xanax, because she may be addicted, and would not write a prescription for any further scheduled medications. 2. The APN would write a prescription for Xanax, because the patient's former physician would not have prescribed it without a reason. 3. The APN would taper the dosage over 4 to 8 weeks to eventually get the patient off of this drug. 4. The APN would switch the patient to Valium, because it is a longer-acting benzodiazepine.

3. The APN would taper the dosage over 4 to 8 weeks to eventually get the patient off of this drug.

Polymorphisms occur in several of the most common CYP enzymes. The APN has a patient who finds that Percocet is not an effective pain reliever for him and complains that he needs something "stronger." The APN understands that in some patients, a polymorphism in the CYP2D6 enzyme may be the cause of this lack of efficacy of Percocet. Which statement accurately describes what happens in these patients? 1. Patients with this problem cannot tolerate the codeine in Percocet and often expel it via vomit so that the drug does not reach systemic circulation. 2. Patients with this problem have used so many narcotic medications that they have developed a tolerance and need higher doses of narcotic pain medication to relieve pain. 3. The CYP2D6 enzyme polymorphism may be unable to convert the codeine in Percocet to morphine and therefore prevent any clinical benefit from the narcotic. 4. The CYP2D6 enzyme polymorphism blocks the absorption of Percocet from the stomach to the bloodstream, thus reducing bioavailability.

3. The CYP2D6 enzyme polymorphism may be unable to convert the codeine in Percocet to morphine and therefore prevent any clinical benefit from the narcotic.

Which statement best describes what happens in a diabetic person's body after an injection of insulin? 1. The insulin is absorbed through the gut and enters the liver, thereby decreasing blood sugar production in the liver. 2. The insulin enters the bloodstream and absorbs the blood sugar to excrete the sugar in the urine. 3. The insulin attaches itself to the sugar molecules in the bloodstream and binds with the cell to unlock the cell and allow the sugar molecule to enter. 4. The insulin destroys the sugar molecules in the bloodstream.

3. The insulin attaches itself to the sugar molecules in the bloodstream and binds with the cell to unlock the cell and allow the sugar molecule to enter.

A 13-year-old patient who suffered from tonic-clonic seizures was recently discharged from an acute care hospital. The patient and parents need continued teaching regarding the daily administration of phenytoin (Dilantin). Which statement by the APN demonstrates the important teaching needed when phenytoin (Dilantin) is administered? 1. If one dose is missed, the patient should double the next dose. If two doses are missed, the patient should triple the next dose. 2. Phenytoin (Dilantin) causes a fruity odor to the urine. 3. The patient should avoid alcohol. 4. Antifungal shampoos can be used to avoid dandruff, which is a common adverse effect.

3. The patient should avoid alcohol.

Which of these would the APN include in teaching for the transmasculine patient starting testosterone replacement therapy? 1. The patient's voice should deepen quickly, within the first month of therapy. 2. The patient can expect acne to get better and even go away. 3. The patient's periods should stop within 6 months. 4. The patient should be able to grow a beard within 3 to 6 months.

3. The patient's periods should stop within 6 months.

The Fracture Risk Assessment Tool (FRAX) estimates which of these? 1. The bone mass density of the femoral neck 2. The need for yearly dual energy x-ray absorptiometry (DEXA) scanning 3. The probability of bone fractures 4. The risk of falls in older woman

3. The probability of bone fractures

Chronic alcohol consumption is noted to lead to depletion of which vitamins? 1. Magnesium and iron 2. Vitamins C and D 3. Thiamine and magnesium 4. Vitamin E and thiamine

3. Thiamine and magnesium

A patient presents today for initiation of medication for his hypertension. He has a history of gout and takes antigout medication. Which medication can cause hyperuricemia in this patient? 1. Calcium channel blockers 2. Angiotensin-converting enzyme inhibitors 3. Thiazide diuretics 4. Nitrates

3. Thiazide diuretics

A patient presents today for initiation of medication for his hypertension. He has a history of gout and takes antigout medication. Which medication can cause hyperuricemia in this patient?1. Calcium channel blockers 2. Angiotensin-converting enzyme inhibitors 3. Thiazide diuretics 4. Nitrates

3. Thiazide diuretics

To reduce the risk of toxicity and rise in serum urate levels, which class of antihypertensives should be avoided in persons with hypertension taking allopurinol? 1. Beta blockers 2. Calcium channel blockers 3. Thiazide diuretics 4. Angiotensin II receptor blockers (ARBs)

3. Thiazide diuretics

A patient with a history of latent autoimmune diabetes in adults (LADA), coronary artery disease (CAD), and peripheral arterial disease (PAD) presents to the office with uncontrolled glucose levels. The APN considers switching the patient from a premixed insulin preparation to a basal bolus insulin combination for which reason? 1. This combination lowers exogenous insulin requirements. 2. This combination increases the number of insulin receptors. 3. This combination mimics endogenous insulin production. 4. This combination decreases cardiovascular risk.

3. This combination mimics endogenous insulin production.

The APN is speaking to a diabetic patient. The patient tells the APN that he has had some diarrhea and nausea since starting metformin. He has been on metformin about 5 days now. Which action by the APN is most appropriate? 1. This is a late reaction to the medication and is coming because of prolonged use. Removing the metformin from his diabetic treatment is the best option here. 2. This is a delayed reaction and, even if he stops the metformin, he could still have nausea and diarrhea for a while. 3. This is an early reaction and does not require discontinuation of the drug because in a very short time, he will adapt to the medication. 4. It does not matter what type of ADR this is. The patient should immediately stop taking the metformin because it could lead to more dangerous symptoms.

3. This is an early reaction and does not require discontinuation of the drug because in a very short time, he will adapt to the medication.

Depression and anxiety are common reasons for seeking medical assistance. Which information about depression and anxiety is important for the primary care APN to understand? 1. All patients indicating depression or anxiety must be referred to a psychiatric provider for treatment. Pharmacologic management for depression and anxiety require potent and dangerous medications that require careful management beyond the scope of a primary care provider. 2. Because depression and anxiety are risks for suicide, anyone presenting to a primary care provider must be sent for inpatient and pharmacologic treatment. Pharmacologic treatment for depression and anxiety are difficult to manage in primary care. 3. Those seeking treatment for depression and anxiety often visit their primary care provider because of the ease of access and the trust that has been built up with this provider over time. Primary care providers are able to use pharmacologic treatments to help patients with depression and anxiety. 4. It is beyond the scope of the APN to diagnose and treat patients with depression and anxiety. If a patient presents to primary care for treatment, the patient should only be seen by the physician.

3. Those seeking treatment for depression and anxiety often visit their primary care provider because of the ease of access and the trust that has been built up with this provider over time. Primary care providers are able to use pharmacologic treatments to help patients with depression and anxiety.

A patient tells the APN that he has severe right shoulder pain that is constant and sharp. He looks anxious and appears to be in pain. Upon examination, he cries out when the APN rotates his shoulder. The APN wants to send him for an x-ray, but he states he cannot stand the pain another moment. The APN prescribes a controlled substance pain reliever for the patient, but the APN is concerned that the patient may have received pain medication from other providers. How can the APN determine whether this is the case? 1. The APN must rely on the patient to be honest about whether or not he has received other prescriptions for pain medications. 2. The APN can call the U.S. Drug Enforcement Administration (DEA) hotline and ask about the patient's history of controlled substance drug use. 3. Through the use of technology, the APN can access the state's controlled substance database to find out if other prescriptions for pain medications have been provided to the patient. 4. The APN should not give the patient any pain medications because it can be assumed that he is a seeker and is not really in pain.

3. Through the use of technology, the APN can access the state's controlled substance database to find out if other prescriptions for pain medications have been provided to the patient.

The patient is a 45-year-old woman with colon cancer. As part of her treatment, the team, including the APN, completes a pharmacogenomics assessment of which drugs will target her particular cancer type. Which of these is a goal of pharmacogenomics? 1. To identify which drugs work on which genes in the general population 2. To identify an empirical therapy that works for anyone with an identified problem 3. To identify patterns of genetic variation that are used to guide the choice of medications for an individual patient 4. To identify genes that may be causing an illness and how those genes can be stopped

3. To identify patterns of genetic variation that are used to guide the choice of medications for an individual patient

The alpha-2 adrenergic agonist lofexidine (Lucemyra) is used for which of the following? 1. As an adjunctive treatment with naltrexone (Vivitrol) 2. In patients experiencing opioid overdose 3. To treat symptoms of opioid withdrawal 4. To treat symptoms of arrhythmia in patients who are taking opioids

3. To treat symptoms of opioid withdrawal

Cholinergic blockers are useful adjuncts early in the course of Parkinson's disease to control tremor by relaxing smooth muscle and to control oral secretion, where drooling can be an issue. Which of these could potentially worsen Parkinson's symptoms if given concurrently with levodopa? 1. Benztropine 2. Droxidopa 3. Trihexyphenidyl 4. Northera

3. Trihexyphenidyl

Four weeks after completing treatment for an H. pylori-induced duodenal ulcer, which test would the APN order to confirm eradication of the bacterium? 1. Barium swallow 2. Abdominal x-ray 3. Urea breath test 4. Fecal occult blood test

3. Urea breath test

When considering cholinesterase inhibitors as treatment, which disease state would absolutely require a provider to find an alternative to treatment? 1. Peptic ulcer disease 2. Seizure disorder 3. Urinary obstruction 4. Bronchospastic disease

3. Urinary obstruction

A 23-year-old female patient presents to the clinic with a 24-hour history of zoster outbreak. When would therapy with a nucleoside analog be initiated for greatest effect? 1. Within 3 days 2. Within 4 days 3. Within 2 days 4. Within 5 days

3. Within 2 days

According to American Association of Clinical Endocrinologists (AACE) guidelines, dual energy x-ray absorptiometry (DEXA) scans are appropriate for which patients? 1. Women with family history of osteopenia 2. Women with known hypertension 3. Women over 40 years old who have sustained a fracture 4. All women over 50 years old

3. Women over 40 years old who have sustained a fracture

A patient who is presently using heroin presents to the clinician's clinical setting. He has asked when withdrawal symptoms can be expected after the last dose of this drug. What should your response be? 1. "Typically, symptoms develop around 24 hours after the last dose." 2. "Symptoms start in 1 to 3 days and gradually subside over a week." 3. "Symptoms start 1 hour before the next expected dose." 4. "Symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin."

4. "Symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin."

The APN prescribes a drug with a half-life of 8 hours. The APRN expects that the drug will be completely eliminated in how many hours? 1. 8 hours 2. 16 hours 3. 24 hours 4. 40 hours

4. 40 hours

Transgender men on testosterone replacement are more likely to experience which adverse drug reaction? 1. Adverse lipid changes 2. Insulin resistance of diabetes 3. Heart attack or stroke 4. A worsening of migraine headaches

4. A worsening of migraine headaches

Which intervention is recommended by most experts to relieve moderate pain in osteoarthritis (OA)? 1. Low dose opioids 2. NSAIDs 3. Topical salicylates 4. Acetaminophen

4. Acetaminophen

A 32-year-old patient with ulcerative colitis and type 2 diabetes mellitus (DM) should avoid which medication? 1. Biguanide 2. Meglitinide 3. Sulfonylurea 4. Alpha-glucosidase inhibitor

4. Alpha-glucosidase inhibitor

The patient is started on atenolol, a beta1 antagonist. Which statement best describes an antagonist? 1. An antagonist has affinity and efficacy. 2. An antagonist is more potent than an agonist. 3. An antagonist enhances the action of its receptor. 4. An antagonist has affinity but no efficacy.

4. An antagonist has affinity but no efficacy.

Which drug is considered to be a first-line therapy for the treatment of heart failure? 1. Non-dihydropyridine calcium channel blockers (CCBs) 2. Coenzyme Q10 3. Clopidogrel (Plavix) 4. Angiotensin-converting enzyme inhibitors (ACEIs)

4. Angiotensin-converting enzyme inhibitors (ACEIs)

Which of these best describes an adverse drug reaction (ADR)? 1. Any reaction to a drug that is unusual and does not meet the standard for the expected reaction to the drug 2. Any reaction to a drug that reaches the level of severity outlined by the U.S. Food and Drug Administration (FDA) 3. Any reaction that the provider considers serious enough to be life threatening to the patient 4. Any undesirable or unintended effect following the administration of a medical product, whether or not it is considered related to the medical product

4. Any undesirable or unintended effect following the administration of a medical product, whether or not it is considered related to the medical product

Angiotensin-converting enzyme inhibitors (ACEIs) have a higher risk of angioedema and cough in which race? 1. Native American 2. Hispanic 3. White 4. Asian

4. Asian

Persons with gout who are taking uric acid-lowering drugs should have their serum uric acid levels assessed at which interval(s)? 1. No specific recommendations for routine monitoring 2. At baseline and after 1 day of drug therapy 3. After 1 week of drug therapy 4. At baseline and after 1 to 3 weeks of drug therapy

4. At baseline and after 1 to 3 weeks of drug therapy

Ayurvedic medicine came from India and is the oldest form of medicine in the world. Which statement about Ayurvedic medicine is accurate? 1. Ayurvedic medicine relies on the teachings of the Koran. 2. Ayurvedic medicine is not permitted to be practiced in the U.S. and those that use it must keep practices secret. 3. Ayurvedic medicine is so old that most of the wisdom and usages have been forgotten. 4. Ayurvedic medicine treats patients based on their constitution and attempts to balance the patients' constitution.

4. Ayurvedic medicine treats patients based on their constitution and attempts to balance the patients' constitution.

A patient is diagnosed in the clinic with type 2 diabetes mellitus (DM). Which of these is the initial medication of choice for type 2 DM? 1. Amylin agonists 2. Dipeptidyl peptidase-4 (DPP-4) inhibitors 3. Thiazolidinediones (TZDs) 4. Biguanides

4. Biguanides

Which definition best describes bioavailability? 1. Bioavailability is the amount of drug given at each dose. 2. Bioavailability is how the drug interacts with the cell to become available to the intracellular space. 3. Bioavailability is the amount of drug that is needed for the drug to be effective. 4. Bioavailability is the amount of drug that is in the bloodstream.

4. Bioavailability is the amount of drug that is in the bloodstream.

A patient who is taking St. John's wort for mild depression asks the APN which brand of herbal supplement would be most efficacious. Which information would the APN consider when responding to the patient? 1. Herbal supplements are strictly regulated by the U.S. Food and Drug Administration (FDA) and must pass the same rigorous tests and trials that all medications must pass to be sold in the United States. 2. The Dietary Supplement Health and Education Act (DSHEA) carries out studies on herbal products so that they can be certified for a disease or treatment. 3. Herbs cannot help depression, so the patient should be taking a medication prescribed by a health-care provider. 4. Herbal supplements are not regulated by the U.S. Food and Drug Administration (FDA), but the good manufacturing practices (GMP) label on an herbal product means it has met standards set by the FDA for GMP.

4. Herbal supplements are not regulated by the U.S. Food and Drug Administration (FDA), but the good manufacturing practices (GMP) label on an herbal product means it has met standards set by the FDA for GMP.

Most antiepileptic drugs, such as perampanel, carry an increased risk of suicidal behavior or ideation. In addition to this adverse effect, which other psychosocial precaution is included for perampanel? 1. Gaiety and a distorted time perception 2. Tolerance 3. Increased sense of relaxation and taste 4. Hostility, aggression, and homicidal ideation

4. Hostility, aggression, and homicidal ideation

Hypoglycemia should be avoided in children with diabetes for which reason? 1. Growth delay 2. Increased cardiovascular risk 3. Vision impairment 4. Impaired brain development

4. Impaired brain development

A patient with type 1 diabetes mellitus (DM) is concerned about long-term complications as the result of a history of diabetes for the past 10 years. The APN assures the patient that complications from diabetes can be minimized through which strategy? 1. Maintaining an HbA1c low enough that does not result in hypoglycemia 2. Keeping fasting blood glucose at goal 3. Undergoing an annual ophthalmic examination 4. Implementing lifestyle changes

4. Implementing lifestyle changes

Which adverse drug reaction to a selective alpha1 antagonist would be the best reason to change to a different class of medication? 1. Chronic pain with use of NSAIDs 2. Rhinitis 3. Drowsiness 4. Impotence

4. Impotence

The APN knows that children are often at higher risk for ADRs for which two reasons? 1. Inability to swallow tablets, which often causes only partial drug absorption, and decreased renal function in most young children 2. Lack of evidence for which dose to prescribe for children, and fewer options for appropriate drugs for children 3. Higher rates of complaints from children than adults when taking drugs and children's heightened immune systems 4. Inattention to weight-based dosing and immature organ function, which makes dosing more complicated

4. Inattention to weight-based dosing and immature organ function, which makes dosing more complicated

A 29-year-old male patient with a history of type 2 diabetes mellitus presents to the office for a routine health maintenance visit. His HbA1C has increased by 2% within the past 4 months. The APN discusses the option of adding an additional medication. The patient informs the APN that he is concerned about his weight but is unable to start a weight loss program at this time due to the complexity of his schedule. Which medication change should be considered?1. Decrease linagliptin 2. Increase glipizide 3. Decrease canagliflozin 4. Increase metformin

4. Increase metformin

The patient is currently taking carvedilol, a beta blocker for hypertension, which is metabolized via the CYP2D6 pathway. The patient presents to a psychiatrist for depression and is started on paroxetine, an antidepressant and a potent CYP2D6 inhibitor. The APN is aware that which effect could occur? 1. Decreased levels of CYP26 2. Decreased antihypertensive effects of carvedilol 3. Increased levels of CYP26 4. Increased antihypertensive effect of carvedilol

4. Increased antihypertensive effect of carvedilol

The purpose of an antithyroid agent is to have which action? 1. Decreasing triiodothyronine (T3) production 2. Increasing thyroid-stimulating hormone (TSH) levels 3. Decreasing the conversion from T3 to TSH 4. Inhibiting the synthesis of thyroid hormone

4. Inhibiting the synthesis of thyroid hormone

The effect of an antagonist drug or enzyme depends on its blood levels and its affinity for the receptor. How can antagonists be reversed? 1. Other antagonists can bind to the same receptor. 2. All antagonists are irreversible binders and cannot be unbound once given. 3. Antagonists and agonists can bind to receptors at the same time, producing no effect from the drug. 4. It is possible to overcome the antagonist effects with higher concentrations of a competing agonist.

4. It is possible to overcome the antagonist effects with higher concentrations of a competing agonist.

Which pharmacokinetics are unique to levetiracetam compared with other antiepileptic drugs? 1. It has a highly variable half-life, which requires careful monitoring with drug levels. 2. It is highly protein bound and extensively metabolized by CYP450 enzymes, which gives it many drug-drug interactions. 3. To be effective, the concentration of levetiracetam needs to be close to toxic due to the short half-life. 4. It is unbound, metabolized by hydrolysis, and does not use CYP450 enzymes.

4. It is unbound, metabolized by hydrolysis, and does not use CYP450 enzymes.

The advanced practice nurse is developing a treatment plan for a patient with alcohol withdrawal. Which of the following is considered a first-line choice? 1. Carbamazepine (Tegretol) 2. Phenytoin (Dilantin) 3. Divalproex sodium (Depakote) 4. Lorazepam (Ativan)

4. Lorazepam (Ativan)

For which type of diabetes is treatment with oral agents often sufficient? 1. Type 1 diabetes mellitus (DM) 2. Type 2 diabetes mellitus (DM) 3. Latent autoimmune diabetes in adults (LADA) 4. Maturity-onset diabetes of the young (MODY)

4. Maturity-onset diabetes of the young (MODY)

A truck driver with a history of maturity-onset diabetes of the young (MODY) and obesity complains of increased dysuria and polydipsia. After review of his home glucose readings, the APN notes a trend of elevated postprandial glucose levels. The addition of which oral medication is most appropriate? 1. Sulfonylurea 2. Insulin glargine 3. Insulin lispro before meals 4. Meglitinide

4. Meglitinide

A patient with early-onset Alzheimer's disease has come into the clinic and is concerned about some of the side effects that the cholinesterase inhibitors have. Which inhibitor would be the most appropriate choice? 1. Donepezil 2. Galantamine 3. Rivastigmine 4. Memantine

4. Memantine

Meaningful use of electronic data helps with medication reconciliation. What are the aspects included in medication reconciliation and when should it be completed? 1. A review of medications taken in the past, why they were discontinued, and whether they should be restarted should be done yearly. 2. Providing the patient with a clearly written document related to the medications they should be taking should be done at every visit. 3. Providing the insurance company with a rationale for why each medication has been ordered, and what the goals are for taking this medication, should be done yearly. 4. An accurate list of medications, doses, frequency, and route should be compiled at every visit and after long gaps in care, as determined by provider.

4. An accurate list of medications, doses, frequency, and route should be compiled at every visit and after long gaps in care, as determined by provider.