NURS-6521N-61-Advanced Pharmacology-2021 Midterm Exam

NURS-6521N-61-Advanced Pharmacology-2021 Midterm Exam

A patient with a long history of alcohol abuse has been admitted to an acute medical unit with signs and symptoms of hepatic encephalopathy. His current medication orders include QID doses of oral lactulose. What desired outcomes should the nurse associate with this drug order?

		Patient will have three to four loose bowel movements each day.
		Patient will express relief from constipation.
		Patient will have formed bowel movements that do not contain frank or occult blood.
		Patient will express an understanding of his current bowel regimen.

A

A 67-year-old man is admitted to the hospital with pneumonia. He reports to the nurse that he has chronic arthritis and circulation problems. Further assessment by the nurse reveals that the patient has a history of mild hypertension. He explains that he owns a business and lives alone. The nurse determines that he is within the normal weight range for his height and age but has a fondness for spicy foods and sweets. Which of the mentioned patient variables will have the greatest impact on the effectiveness of the patient’s drug therapy?

		Vascular impairment
		Mild hypertension
		Dietary habits
		Chronic arthritis

A

A patient has been prescribed a Scheduled 5 drug, an example of this drug is

		Antianxiety
		Narcotic Analgesics
		Barbituates
		Antitussives

D

Federal legislation dictates a lengthy and rigorous process of testing for new drugs. What is the primary purpose of this testing process?

		To protect state and federal departments from legal liability
		To maximize autonomy and treatment options for citizens
		To facilitate the efficiency of health care delivery
		To ensure the safety of the public

D

Which of the following is a contraindication for antimuscarinic drugs?

		Overactive bladder
		nausea and vomiting
		Parkinson disease
		pyloric stenosis

D

The Elderly are at high risk of  Adverse Drug Reactions due to:

		having greater muscle mass than younger adults, leading to higher volume of distribution
		the extensive studies that have been conducted on drug safety in this age group
		age related decrease in renal function
		the blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effects

C

A 77-year-old man’s chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?

		The man’s glomerular filtration rate and creatinine levels are within reference ranges.
		The man’s heart rate is between 60 and 70 beats per minute with a regular rhythm.
		The man’s potassium and sodium levels remain with reference ranges.
		The man’s chest sounds are clear and his ankle edema is lessened.

D

The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the 

		Minimum adverse effect level
		peak of action
		therapeutic range
		onset of action

D

Which of the following patients should be advised by the Nurse Practitioner to avoid over-the-counter cold and allergy preparations that contain phenylephrine?

		A 47-year-old female with hypertension
		A 52-year-old male with adult-onset diabetes
		A 17-year-old female with symptoms of an upper respiratory infection
		A 62-year-old male with gout

A

Mr. Contreras is a 64-year-old patient with Type 2 diabetes. He has recently been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes?

		Diuretics
		Beta Blocker
		Calcium Channel Blocker
		ACE Inhibitor

D

Which mechanism of platelet inhibition is exhibited by aspirin?  

		Adenosine diphosphate (ADP) antagonism
		Cyclooxygenase (COX) inhibition
		Phosphodiesterase inhibition
		Glycoprotein (GP) IIb/IIIa inhibition

B

A nurse practitioner understands when prescribing a medication that there are certain questions to address. Check all that apply.

		Is there a need for the drug in treating the presenting problem?
		Is this the best drug for the presenting problem?
		Can the patient take the prescribed drug?
		None of the above.

A,B, and C

During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse’s assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives

		may cause nutrient deficiencies.
		may counter the therapeutic effect of other drugs.
		causes acidic urine and urinary tract infections.
		inhibits biotransformation of drugs.

A

Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which of the following medications will likely be used in an attempt to eradicate the patient’s H. pylori infection? (Select all that apply.)

		Antibiotics
		A PPI
		Aluminum hydroxide
		Ondansetron (Zofran)
		Cisapride (Propulsid)

A and B

A female patient is taking 0.125 mg of digoxin daily for heart failure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. The nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is concerned that the additional weight will necessitate an increase in the medication. Which of the following is an appropriate response by the nurse?

		“Yes, the drug dosage will probably have to be increased.”
		“No, the drug dosage will likely stay the same.”
		“No, the drug dosage will have to be decreased.”
		“I don’t know; I will have to ask your physician.”

B

A 70-year-old woman has a complex medical and a current drug regimen that includes calcium and vitamin D supplements for osteoporosis, metformin (Glucophage) for type 2 diabetes, phenelzine (Nardil) for depression, and metoprolol (Lopressor) and furosemide (Lasix) for hypertension. The woman is requesting dextromethorphan for the treatment of a recurrent cough. What component of her drug regimen contraindicates the use of dextromethorphan?

		Calcium supplements
		Metformin (Glucophage)
		Phenelzine (Nardil)
		Metoprolol (Lopressor)

C

What drug class will decrease the facial flushing that occurs with niacin?

		Vasopressors
		Antihistamines
		Acne products
		NSAIDS

D

A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments?

		Blood pressure
		Urinary output
		Heart rate
		Blood urea nitrogen (BUN)

A

A patient has been prescribed lovastatin for a high cholesterol level. The nurse’s teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels because it

		is a hormone.
		is a bile-acid resin.
		inhibits cholesterol syntheses.
		consists of a fibric acid derivative.

C

A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states, “I take it as soon as I feel heartburn coming on, but it doesn’t seem to help at all.” How should the nurse best respond to this patient’s statement?

		“It could be that Prilosec isn’t the right drug for you, so it would be best to talk this over with your care provider.”
		“Prilosec won’t really decrease the sensation of heartburn, but it is still minimizing the damage to your throat and stomach that can be caused by the problem.”
		“Prilosec will help your heartburn but it’s not designed to provide immediate relief of specific episodes of heartburn.”
		“A better strategy is to take a dose of Prilosec 15 to 30 minutes before meals or drinks that cause you to get heartburn.”

C

The nurse practitioner orders Amoxicillin 500 mg tid? What is the total amount of medication patient will take per day?

		500 mg
		1000 mg
		1500 mg
		150 mg

C

The APRN is caring for a patient taking a calcium channel blockers for hypertension.  The APRN should monitor the patient for what common side effects of this medication?

		hyperkalemia, dry cough, angioedema
		peripheral edema, dry cough, hypokalemia
		bronchospasm, dry cough, angioedema
		peripheral edema, constipation, dizziness

D

Which of the following will a Nurse Practitioner inform the patient is one of the most common adverse effects of guaifenesin (Robitussin)?

		Gastrointestinal distress
		Increased blood pressure
		Increased blood glucose
		Urinary retention

A

A 22 year old patient is transitioning from oral agents to insulin.  He will be taking 20 units of lantus at bedtime and regular insulin before meals.  What instructions should the NP provide about the timing and dose of regular insulin?  

		Take 5 units of regular insulin immediately after each meal
		Take 1 unit of regular insulin for each 10 grams of carbohydrate to be consumed 15 minutes before each meal
		Take 5 units of regular insulin for each 15 grams of carbohydrate consumed immediately after each meal.
		Take 1 unit of regular insulin for each 5 grams of carbohydrate to be consumed 30 minutes before each meal.

B

A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. In which of the following conditions is dicyclomine therapy contraindicated?

		Hypertension
		Diabetes mellitus
		Glaucoma
		Rheumatoid arthritis

C

A patient has been started on a treatment regimen that includes levothyroxine. Select the dosage regimen that is most appropriate for a mean replacement dosage. The patient has been started on a treatment regimen that includes levothyroxine. Select the dosage regimen that is most appropriate for a mean replacement dosage.

		1.2 mcg/kg of body weight per day
		1.4 mcg/kg of body weight per day
		1.5 mcg/kg of body weight per day
		1.7 mcg/kg of body weight per day

D

A 29-year-old female patient has been prescribed orlistat (Xenical) for morbid obesity. The nurse is providing patient education concerning the drug. An important instruction to the patient would be to

		omit the dose if the meal does not contain fat.
		take orlistat and multivitamins together.
		take orlistat in one dose at breakfast.
		omit the dose if the meal does not contain protein.

A

A Nurse Practitioner is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the Nurse Practitioner to monitor for

		hepatic encephalopathy.
		ototoxicity.
		vascular thrombosis.
		dehydration.

B

In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient’s hypertension?

		The adverse effects of each drug may cancel each other out.
		Using two drugs for a health problem tends to increase patient compliance with the drug regimen.
		Using lower doses of two separate drugs may lessen the risk of adverse reactions.
		Using the two drugs to treat a health problem may create a synergistic effect.

D

A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion. Which of the following lab values would be a priority for the nurse to assess before administration?

		Blood glucose levels
		Serum potassium levels
		Serum sodium levels
		Triglyceride levels

D

A patient who is a steroid-dependent asthmatic is started on a beclomethasone inhaler. Which should be part of patient education?

		Use the inhaler when an asthmatic attack begins
		Keep the inhaler refrigerated at all times
		Adjust the number of puffs daily as needed
		Rinse the mouth well after each use

D

Which of the following is TRUE about long acting beta agonist use in asthma patients?

		It is useful in exercise induced asthma
		It may be used as solo treatment in step 2 of asthma treatment
		It can be combined with an inhaled corticosteroid to improve asthma control
		It is effective to use in acute exacerbations

C

Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient’s age will have what effect on her use of nitroglycerin?

		The woman may experience paradoxical vasoconstriction when taking nitroglycerin.
		Decreased saliva production will inhibit the absorption of the drug in her mucosa.
		The woman will need to allow more time between doses in order to facilitate absorption.
		The woman will be more susceptible to hypotension than a younger patient.

D

Which statement is FALSE regarding the treatment of hyperthyroidism?

		Since methimazole (Tapazole) is stronger than Propylthiouracil (PTU), Methimazole should be initiated at 15 mg/day compared to 300 mg/day for Propylthiouracil for treatment of mild disease
		Long-acting beta-blocking agents are given as adjunctive therapy until Propulthiouracil (PTU) or methimazole (Tapazole) restores the patient to euthyroid
		Propylthiouracil (PTU) reduces peripheral conversion of T4 to the more potent T3
		Methimazole (Tapazole) is the drug of choice for pregnant or lactating females.

D

You decide to start your pt, Ms. Rodrigues, on spironolactone (Aldactone) 50 mg PO daily. As the NP, you will instruct the patient to call the clinic if which symptoms are experienced?

		Muscle twitching, numbness, tingling, burning sensations of the limbs, and diarrhea
		Increased irritability, abdominal cramping, and lower extremity weakness.
		Decreased reflex response, nausea, and vomiting.
		Weight gain, excessive thirst, and fever.

A

The APRN is prescribing a medication that is known to induce hepatic enzymes. What effect should you anticipate?

		Induction decreases the rate of metabolism, thereby increasing serum levels of drug
		Induction increases the drug’s pharmacologic effect
		Induction increases the chance for drug toxicity
		Induction increases the rate of metabolism, thereby decreasing serum levels of drug

D

An adult male comes to the clinic with complaints that he is experiencing increased difficulty breathing over the past few days. He has a history of asthma and coronary artery disease. He was recently diagnosed with hypertension. Examination reveals no jugular vein distention and no productive cough. Breath sounds are present, but expiratory wheezes are noted bilaterally, and he denies any chest pain. His vital signs are pulse of 74 beats/min, respirations of 32 breaths/min, and BP of 160/100 mm Hg. His current medications are albuterol (Proventil) inhaler 2 puffs every 4 hours prn for wheezing, nitroglycerin transdermal patch, and propranolol (Inderal) 60 mg PO bid. What is the best treatment for this patient?

		Discontinue propranolol and begin verapamil (Calan) 80 mg PO tid qd.
		Begin theophylline (Theo-24; methylxanthine) 200 mg q12h PO.
		Discontinue propranolol (Inderal) and begin atenolol (Tenormin) 50 mg PO qd.
		Start beclomethasone (Beclovent) inhaler 2 puffs 3 to 4 times daily

A

John is a newly diagnosed diabetic that contacts the office with complaints of severe nausea and vomiting.  What instructions should the APRN provide related to his insulin doses?

		Monitor your blood sugar every 4 hours and take regular insulin based on the blood sugar reading.
		I will call in a prescription for metformin for you to take in place of your insulin.
		Stop your insulin while you are not eating and restart it at half strength when you can keep liquids down.
		There is no need to change your insulin dosage while sick.  Continue your regular doses

A

Which of the following is a side effect or precaution associated with ACE inhibitors?  

		Hypokalemia
		Angioedema
		Productive cough
		Contraindicated in diabetic patients

B

A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks?

		Xanthines
		Beta2-adrenergic agonists
		Leukotriene modifiers
		Anticholinergics

C

A patient with a known history of benign prostatic hyperplasia (BPH) presents to the clinic 4 days after developing a cold. He tells you he began experiencing a sore throat and nasal congestion and began to take an over the counter decongestant.  Today, he complains of not urinating over the last 12 hours.  He also has suprapubic fullness on exam.  Which of the following medications are most likely responsible for this patient’s urinary retention?

		Tamsulosin
		Phenylephriine
		Clonazepam
		Finasteride

B

Jillian is a Nurse Practitioner.  She recognizes that Nurse Practitioner prescriptive  authority Is regulated by:

		The U.S.  Drug Enforcement Administration
		The State board of pharmacy
		The state board of nursing for each state
		The national Council of state boards of nursing

C

A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient’s

		blood pressure.
		potassium level.
		use of alcohol.
		use of salt in his diet.

C

To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will instruct the patient to take the medication

		once a day.
		twice a day.
		every 2 hours.
		four times a day.

D

A Nurse Practitioner has been following a male patient who is taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks of medication therapy, the patient begins to complain of numbness and tingling in his hands and feet. The Nurse Practitioner suspects that these signs or symptoms are

		a result of new onset diabetes.
		an adverse effect of the diuretic.
		signs of peripheral neuritis.
		an idiosyncratic reaction to clonidine.

C

Mr. Lastinger was prescribed warfarin sodium (Coumadin).  You advise him to avoid eating large amounts of leafy green vegetables because:

		The high vitamin K levels will decrease the INR
		They have too much ascorbic acid, which can interact with the medicine
		The high-fiber content will decrease the absorption of the Coumadin
		The vitamins in the vegetables will bind with, and inactivate the Coumadin

A

What critical piece of information is missing from the following medication order: Amoxicillin 250 mg every 8 hours?

		Dose
		Route
		Frequency
		Trade name of the drug

B

Typical adverse reactions to oral calcium-channel blockers include: 

		dyspnea
		edema
		fatigue
		cough

B

Which of the following oral medications is the safest to use during pregnancy?

		Losartan
		Methyldopa
		Amlodipine
		Lisinopril

B

A female patient calls the clinic and reports that since she has been taking dextromethorphan (Robitussin), she has been extremely drowsy and dizzy. The nurse will question the patient about which of the following?

		The amount of tea or soft drinks she has during the day
		The amount of grapefruit or orange juice she has during the day
		The number of cups of coffee she has during the day
		The amount of water she drinks every day

B

Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency?

		Reduction of severe hypertension
		Increased level of consciousness
		Restoration of normal sinus rhythm
		Resolution of respiratory acidosis

C

A 79-year-old woman who takes several medications for a variety of chronic health problems has been prescribed an oral antiplatelet aggregator that is to be taken once daily. The nurse has encouraged the woman to take the pill at the same time of day that she takes some of her other medications. What is the most likely rationale for the nurse’s advice?

		Integrating the new drug into the patient’s existing schedule promotes adherence.
		Combining a new drug with one or more existing drugs mitigates the risk of adverse effects.
		Taking several drugs at one time maximizes recovery time for the liver and kidneys.
		Rapid drug clearance fostered when a patient is able to minimize the number of drug administration times.

A

A physician has ordered subcutaneous injections of morphine, a narcotic, every 4 hours as needed for pain for a motor vehicle accident victim. The nurse is aware that there is a high abuse potential for this drug and that it is categorized as a

		C-I drug.
		C-II drug.
		C-III drug.
		C-IV drug.

B

An expected outcome for a patient who has just taken sublingual nitroglycerin should be

		increased heart rate and decreased blood pressure.
		decreased heart rate and decreased blood pressure.
		increased heart rate and increased blood pressure.
		decreased heart rate and increased blood pressure.

A

A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient’s characteristics likely to influence possible treatment with phenytoin?

		The patient will require oral phenytoin rather than intravenous administration.
		Phenytoin is contraindicated within 48 hours of alcohol use due to the possibility of paradoxical effects.
		The patient’s heavy alcohol use will compete with phenytoin for binding sites and he will require a higher-than-normal dose.
		The patient’s protein deficit will likely increase the levels of the free drug in his blood.

D

The  Family nurse practitioner prescribed losartan 50 mg PO daily for a hypertensive patient. This medication promotes vasodilation by:

		Blocking the action of angiotensin II
		Promoting the synthesis of prostaglandins
		Inhibiting calcium influx into smooth muscle cells
		Promoting the release of aldosterone

A

A 22-year-old male college senior has lived with a diagnosis of Crohn’s disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn’s disease?

		Tositumomab plus 131I (Bexxar)
		Muromonab-CD3 (Orthoclone OKT3)
		Infliximab (Remicade)
		Eculizumab (Soliris)

C

The Nurse Practitioner’s assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this?

		“I tend to get sick in the stomach when I take antibiotics.”
		“I’ve been told that aspirin might have caused my stomach bleed a few years back.”
		“I broke out in hives and got terribly itchy when I started a new prescription last year.”
		“When I fell last year, the doctor said that it might have been because of my blood pressure pills.”

C

Typical adverse reactions to oral calcium-channel blockers include: 

		dyspnea
		edema
		fatigue
		cough

B

The APRN would use what class of medication to manage COPD?

		Anticholinergic agents
		Methylxanthine derivatives
		Short-acting and long acting inhaled beta2 agonists
		Mucolytic agents

C

Topical inhaled alpha adrenergic blocking agents or nasal vasoconstricting decongestants should not be used chronically (>5 days) because they can cause

		rebound insomnia
		rebound coughing
		rebound rhinitis/congestion
		None of the above

C

In which of the following patients would a Nurse Practitioner expect to experience alterations in drug metabolism?

		A 35-year-old woman with cervical cancer
		A 41-year-old man with kidney stones
		A 50-year-old man with cirrhosis of the liver
		A 62-year-old woman in acute renal failure

C

A 48-year-old woman who works as an office manager is prescribed metoclopramide (Reglan) for diabetic gastroparesis. The nurse will be sure to assess the patient for

		tachycardia.
		depression.
		hypotension.
		anemia.

B

A patient is taking cholestyramine. The Nurse Practitioner will assess for which of the following common adverse effects of the drug?

		Abdominal pain
		Headache
		Constipation
		Indigestion

C

All of the following agents are used to control the inflammatory changes seen in the lungs of asthmatics except:

		Albuterol inhaler (proventil)
		Triamcinolone (Azmacort)
		Montelukast (Singulair)
		Cromolyn sodium inhaler (Intal)

A

A patient is taking gabapentin (Neurontin) for spasticity associated with multiple sclerosis. Which of the following should be the priority for monitoring?

		Hepatic function
		Cardiac function
		Respiratory function
		Renal function

A

A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse’s assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension. The patient lives in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the patient’s

		home environment.
		diet.
		activity level.
		medication history.

D

Acetazolamide is categorized as which of the following?  

		Alpha-adrenergic a
		Beta-adrenergic b
		Carbonic anhydrase i
		Miotic

C

Some first generation antihistamines are used: 

		as stimulants
		to prevent motion sickness
		as laxatives
		as anticonvulsants

B

Shirley, age 58, has been diabetic for 7 years. Her blood pressure for the last three office visits have been 154/100, 144/94, and 144/90. What would you prescribe today during her routine office visit?

		No hypertension medication
		An ACE Inhibitor
		A beta blocker
		A calcium channel blocker

B

You are seeing a 55 year old patient recently diagnosed with a bleeding ulcer. What should be the initial treatment choice for this patient?

		A Proton Pump Inhibitor
		Lifestyle Modifications including smoking cessation
		An H2 Receptor Blocker
		Sucralfate (Carafate)

A

A Nurse Practitioner is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The Nurse Practitioner will question the patient about her intake of which of the following?

		Coffee
		Alcohol
		Salt
		Vitamin C

A

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident’s medication regimen make create a risk for

		constipation.
		falls.
		xerostomia (dry mouth).
		depression.

B

A 39 y/o female is diagnosed with Graves disease.  She also has a small goiter =.  Her symptoms are not deemed to be severe and propylthiouracil is prescribed.  Whare is the most serious potential adverse effect of this medication?

		Hypocalcemia
		Renal Failure
		Agranulocytosis
		Hematouria

C

A 47-year-old woman has been diagnosed with open-angle glaucoma. Pilocarpine drops are prescribed. The nurse’s assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to

		apply the contact lenses and wait 5 minutes before applying the drops.
		remove the contact lenses before applying the drops.
		apply the drops directly on the contact lenses.
		stop wearing the contact lenses during the pilocarpine therapy.

B

A common side effect of metformin (Glucophage) therapy is: 

		weight gain
		lactic acidosis
		Hypoglycemia
		diarrhea

D

A Nurse Practitioner is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following?

		The amount of the drug that must be given to produce a particular response
		How well a drug produces its desired effect
		A drug’s strength of attraction for a receptor site
		A drug’s ability to stimulate its receptor

B

A Nurse Practitioner is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the Nurse Practitioner to monitor?

		Electrocardiogram results
		Potassium levels
		Sodium levels
		Liver enzymes

B

A Nurse Practitioner is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the Nurse Practitioner to monitor?

		Electrocardiogram results
		Potassium levels
		Sodium levels
		Liver enzymes

B

A Nurse Practitioner has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The Nurse Practitioner notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to

		passive diffusion.
		active transport.
		glomerular filtration.
		first-pass effect.

D

A patient comes to primary clinic for strep throat. A throat swab culture is sent to lab. What information is required for the nurse practitioner to disclose on lab transmittal?

		National Provider Identification (NPI)
		Centers for Medicare & Medicaid Services (CMS)
		Health Insurance Portability and Accountability Act of 1996 (HIPPA)
		None of the above

A

Glargine (Lantus) is an insulin analog that essentially has no peak and is usually administered:

		before meals
		With lispro insulin (Humalog) in one injection.
		Before breakfast and dinner.
		Once a day.

D

Which of the following can block the action of heparin?

		Phytomenadione
		Vitamin K
		Idarucizumab
		Protamine sulfate

D

A primary therapy for patients with mild ulcerative colitis is:

		Metronidazole (Flagyl).
		Mesalamine (Pentasa).
		Ciprofloxacin (Cipro).
		Prednisone (Deltasone).

B

The Nurse Practitioner is conducting a medication reconciliation of a new resident of a long-term care facility. The Nurse Practitioner notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug?

		To balance urate concentration and prevent gout attacks
		To promote the remodeling of damaged synovium
		To potentiate the metabolism of dietary purines
		To achieve pain relief in joints affected by gout

A

Which can elevate theophylline levels?

		Concomitant treatment with cimetidine (Tagamet).
		Intravenous ampicillin.
		Heavy smoking.
		History of seizure disorder.

A

A Nurse Practitioner is a member of a research team that is exploring unique differences in responses to drugs that each individual possesses, based on genetic make-up. This area of study is called

		pharmacotherapeutics.
		pharmacodynamics.
		pharmacoeconomics.
		pharmacogenomics.

D

A female patient with a diagnosis of type 1 diabetes mellitus has been experiencing increasing neuropathic pain in recent months, a symptom that has not responded appreciably to conventional analgesics. The patient’s care provider has begun treatment with gabapentin (Neurontin). How is the addition of this drug likely to influence the management of the patient’s existing drug regimen?

		The patient may be required to temporarily hold her other medications until a stable serum level of gabapentin is achieved.
		It is unlikely to influence the patient’s other medications because gabapentin does not interact with other drugs.
		Gabapentin is contraindicated with the use of exogenous insulin.
		The patient’s medication-related risk for renal failure must be assessed prior to the use of gabapentin.

B

The APRN’s ability to prescribe controlled substances is regulated by:

		FDA
		DEA
		State Law
		All of the above

C

The Nurse Practitioner is treating a patient that takes frequent doses of antacids for his heartburn and is also taking an enteric coded aspirin.  What instructions should be provided to the patient?

		The medications should be taken at least 2 hours apart.
		There is no effect of the antacid on the aspirin so they can be taken when it is convenient for you
		The antacid destroys the aspirin so you should stop taking any antacids
		The aspirin is less effective when taken with an antacid so you need to increase the dose.

A

Which of the following statements accurately describes digoxin? 

		It is widely used to augment cardiac output.
		It blocks the Na-K ATPase pump.
		It is broken down by the liver.
		It increases ventricular contraction by activating the AV node.

A

A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells?

		Giving the drug with food in order to delay absorption
		Administering the drug in small, frequent doses
		Limiting the patient’s protein intake and encouraging fluids
		Administering the drug intravenously rather than orally
D

A woman has a long history of seasonal allergies that are typically accompanied by rhinorrhea, red eyes, and frequent sneezing. Sneezes are a result of

		a CNS reflex that is initiated by receptors in the nasal cavities.
		a reflex that is caused when irritants come into contact with cilia.
		elevated CO2 levels that are detected by chemoreceptors in the large vessels.
		stimulation of goblet cells and mast cells by the presence of microorganisms.

A

A 68-year-old man complains of a chronic, nonproductive cough. He states that he has to have relief, that he has been coughing every 2 to 3 minutes, and he is worn out. Dextromethorphan is prescribed for him. Before he leaves the clinic he asks how long it will take for the medicine to work. The nurse will advise him that he should experience therapeutic effects in

		5 minutes.
		10 minutes.
		15 to 30 minutes.
		60 minutes.

C

A patient is being treated for respiratory infection. He is a recovering alcoholic and has impaired liver function. The nurse will instruct the patient to be especially cautious when taking

		an elixir.
		a tablet.
		a syrup.
		a troche.

A

A Nurse Practitioner explains to a patient that nitroglycerin patches should be applied in the morning and removed in the evening. This medication schedule reduces the potential for

		adverse effects.
		nitrate dependence.
		nitrate tolerance.
		toxic effects.

C

A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

		Wash hands before and after taking the medicine
		Keep track of any gastrointestinal tract infections
		Monitor glucose levels closely
		Note the time the medicine is taken each day

C

You are seeing a 65 year old  male with a long history of COPD who has recently developed hypertension. Which class of antihypertensive agents should the Nurse Practitioner avoid for this patient?

		Beta-Blockers
		Calcium Channel Blockers
		ACE inhibitors
		Diuretics

A

A Nurse Practitioner who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients?

		A 72-year-old man who has emphysema and a 55-pack-year history of cigarette smoking
		An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
		A female client who had a laparoscopic cholecystectomy (gall bladder removal) earlier this year
		A resident of a long-term care facility whose Alzheimer disease is being treated with donepezil (Aricept)

B

A patient with class-IV CHF has a medication regimen consisting of metoprolol (Lopressor), enalapril (Vasotec), and furosemide (Lasix). In addition to regularly assessing the patient s heart rate, the nurse should prioritize assessment of the patient’s

		intake and output.
		blood pressure.
		cognition.
		exercise tolerance.

B