NURS 5104 Chapter 31. Attention-Deficit/Hyperactivity Disorder new exam solution docs complete multiple choice questions and answer

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NURS 5104 Chapter 31. Attention-Deficit/Hyperactivity Disorder new exam solution docs complete multiple choice questions and answer Multiple Choice Identify the choice that best completes the st... atement or answers the question. 1. First-line therapy for a school-aged child diagnosed with attention deficit-hyperactivity disorder (ADHD) is: 1. Atomoxetine 2. Clonidine patch 3. Methylphenidate 4. Lisdexamfetamine 2. A 5-year-old child does not demonstrate improvement in ADHD symptoms while taking methylphenidate. Treatment options include: 1. Change to dextroamphetamine 2. Add clonidine patch 3. Add atomoxetine 4. Switch to bupropion 3. Baseline assessment prior to starting a child on stimulants for ADHD includes: 1. Height, weight, and blood pressure 2. Fasting glucose 3. Liver enzymes 4. Electrocardiogram 4. The evidence-based first-line treatment of preschoolers with ADHD includes: 1. Methylphenidate 2. Atomoxetine 3. Dexamphetamine 4. Behavioral therapy 5. First-line therapy for an adult with ADHD is: 1. Methylphenidate 2. Atomoxetine 3. Clonidine 4. Behavioral therapy 6. An adult taking methylphenidate for ADHD reports problems with insomnia. Treatment options include: 1. Add an evening dose of clonidine. 2. Decrease dose of methylphenidate. 3. Prescribe zolpidem to use as needed for sleep. 4. Recommend a sleep study. 7. Recommended monitoring for children who are started on stimulants for ADHD includes: 1. Height, weight, and blood pressure every three months for the first year 2. Monthly monitoring of symptoms until under control 3. Prescription refill pattern 4. All of the above 8. After an adult is started on stimulants for ADHD the following should be monitored: 1. Height and weight for increased body mass index (BMI) 2. Blood pressure for hypotension 3. Refill pattern for diversion 4. All of the above 9. Discontinuation of ADHD medication involves: 1. Tapering dose of alpha 2 agonist 2. Switching from a stimulant to a nonstimulant then wean off 3. Tapering off dexamphetamine slowly to prevent withdrawal symptoms 4. Switch to every other day methylphenidate for a month then discontinue Chapter 32. Asthma and Chronic Obstructive Pulmonary Disease Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Prior to developing a plan for the treatment of asthma, the patient’s asthma should be classified according to the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel 3 guidelines. In adults mild-persistent asthma is classified as asthma symptoms that occur: 1. Daily 2. Daily and limit physical activity 3. Less than twice a week 4. More than twice a week and less than once a day 2. In children age 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms occur: 1. At nighttime one to two times a month 2. At nighttime three to four times a month 3. Less than twice a week 4. Daily 3. One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is: 1. Control of symptoms using albuterol daily 2. Minimize exacerbations to once a month 3. Keep nighttime symptoms at a maximum of twice a week 4. Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms 4. A stepwise approach to the pharmacologic management of asthma: 1. Begins with determining the severity of asthma and assessing asthma control 2. Is used when asthma is severe and requires daily steroids 3. Allows for each provider to determine their personal approach to the care of asthmatic patients 4. Provides a framework for the management of severe asthmatics, but is not as helpful when patients have intermittent asthma 5. Treatment for mild-intermittent asthma is: 1. Daily inhaled medium-dose corticosteroids 2. Short-acting beta 2 agonists (albuterol) as needed 3. Long-acting beta 2 agonists every morning as a preventative measure 4. Montelukast (Singulair) daily 6. The first-line therapy for mild-persistent asthma is: 1. High-dose montelukast 2. Theophylline 3. Low-dose inhaled corticosteroids 4. Long-acting beta 2 agonists 7. Monitoring a patient with persistent asthma includes: 1. Monitoring how frequently the patient has an upper respiratory infection (URI) during treatment 2. Monthly in-office spirometry testing 3. Determining if the patient has increased use of his or her long-acting beta 2 agonist due to exacerbations 4. Evaluating the patient every 2 to 3 months to determine if the patient needs to step up or down in their therapy 8. Asthma exacerbations at home are managed by the patient by: 1. Increasing frequency of beta 2 agonists and contacting their provider 2. Tripling inhaled corticosteroid dose 3. Inhaled beta 2 agonists every 20 minutes for two hours 4. Starting montelukast (Singulair) 9. Patients who are at risk of a fatal asthma attack include patients: 1. With moderate-persistent asthma 2. With a history of requiring intubation or intensive care unit (ICU) admission for asthma 3. Who are on daily inhaled corticosteroid therapy 4. Who are pregnant 10. Pregnant patients with asthma may safely use throughout their pregnancy. 1. Oral terbutaline 2. Prednisone 3. Inhaled corticosteroids (budesonide) 4. Montelukast (Singulair) 11. One goal of asthma management in children is: 1. They can independently manage their asthma. 2. Participation in school and sports activities 3. No exacerbations 4. Minimal use of inhaled corticosteroids 12. Medications used in the management of chronic obstructive pulmonary disease (COPD) include: 1. Inhaled beta 2 agonists 2. Inhaled anticholinergics (ipratropium) 3. Inhaled corticosteroids 4. All of the above 13. Patients with a COPD exacerbation may require: 1. Doubling of inhaled corticosteroid dose 2. Systemic corticosteroid burst 3. Continuous inhaled beta 2 agonists 4. Leukotriene therapy 14. Patients with COPD require monitoring of: 1. Beta 2 agonist use 2. Serum electrolytes 3. Blood pressure 4. Neuropsychiatric effects of montelukast 15. Education of patients with COPD who use inhaled corticosteroids includes: 1. Doubling the dose at the first sign of a URI 2. Using their inhaled corticosteroid first and then their bronchodilator 3. Rinsing their mouth after inhaler use 4. Abstaining from smoking for at least 30 minutes after using 16. Education for patients who use an inhaled beta agonist and an inhaled corticosteroid includes: 1. Use the inhaled corticosteroid first, followed by the inhaled beta agonist. 2. Use the inhaled beta agonist first, followed by the inhaled corticosteroid. 3. Increase fluid intake to 3 L per day. 4. Avoid use of aspirin or ibuprofen while using inhaled medications. Chapter 33. Contraception Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of: 1. Hemoglobin 2. Serum calcium 3. White blood count 4. Serum potassium 2. The mechanism of action of oral combined contraceptives that prevents pregnancy is: 1. Estrogen prevents the luteinizing hormone surge necessary for ovulation. 2. Progestins thicken cervical mucus and slow tubal motility. 3. Estrogen thins the endometrium making implantation difficult. 4. Progestin suppresses follicle stimulating hormone release. 3. To improve actual effectiveness of oral contraceptives women should be educated regarding: 1. Use of a back-up method if they have vomiting or diarrhea during a pill packet 2. Doubling pills if they have diarrhea during the middle of a pill pack 3. The fact that they will have a normal menstrual cycle if they miss two pills 4. The fact that mid-cycle spotting is not normal and the provider should be contacted immediately 4. A contraindication to the use of combined contraceptives is: 1. Adolescence (not approved for this age) 2. A history of clotting disorder 3. Recent pregnancy 4. Being overweight 5. Obese women may have increased risk of failure with which contraceptive method? 1. Combined oral contraceptives 2. Progestin-only oral contraceptive pill 3. Injectable progestin 4. Combined topical patch 6. Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be: 1. Recommend she return to the clinic at the start of her next menses to get a Depo- Provera shot. 2. Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first seven days. 3. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first seven days. 4. Discuss the advantages of using the topical birth control patch and recommend she consider using it. 7. When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is: 1. Immediate protection against pregnancy the first week of using the pill 2. No back-up method is needed when starting 3. Menses occur during the week 4. They can start the pill on the Sunday after the office visit 8. The topical patch combined contraceptive (Ortho Evra) is: 1. Started on the first day of the menstrual cycle 2. Recommended for women over 200 pounds 3. Not as effective as oral combined contraceptives 4. Known to have more adverse effects, such as nausea, than the oral combined contraceptives 9. Progesterone-only pills are recommended for women who: 1. Are breastfeeding 2. Have a history of migraine 3. Have a medical history that contradicts the use of estrogen 4. All of the above 10. Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects? 1. Increased migraine headaches 2. Increased risk of developing blood clots 3. Irregular vaginal bleeding for the first few months 4. Increased risk for hypercalcemia 11. An advantage of using the NuvaRing vaginal ring for contraception is: 1. It does not require fitting and is easy to insert. 2. It is inserted once a week, eliminating the need to remember to take a daily pill. 3. Patients get a level of estrogen and progestin equal to combined oral contraceptives. 4. It also provides protection against vaginal infections. 12. Oral emergency contraception (Plan B) is contraindicated in women who: 1. Had intercourse within the past 72 hours 2. May be pregnant 3. Are taking combined oral contraceptives 4. Are using a diaphragm 13. Adverse effects of depot medroxyprogesterone acetate (DMPA) (Depo-Provera) include: 1. Decrease in bone mineral density with longer-term use 2. Increase in migraines 3. Increased risk for venous thromboembolism (VTE) 4. Increased risk of cardiovascular events Chapter 34. Dermatological Conditions Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be: 1. Intermediate potency corticosteroid ointment (Kenalog) 2. A combination of a corticosteroid and an antifungal (Lotrisone) 3. A low-potency corticosteroid cream applied sparingly (hydrocortisone 1%) 4. A high-potency corticosteroid cream (Diprolene AF) 2. Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used for: 1. Short-term or intermittent treatment of atopic dermatitis 2. Topical treatment of fungal infections (Candida) 3. Chronic, inflammatory seborrheic dermatitis 4. Recalcitrant nodular acne 3. Long-term treatment of moderate atopic dermatitis includes: 1. Topical corticosteroids and emollients 2. Topical corticosteroids alone 3. Topical antipruritics 4. Oral corticosteroids for exacerbations of atopic dermatitis 4. Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with: 1. Topical antipruritics 2. Oral corticosteroids for 2 to 3 weeks 3. Thickly applied topical intermediate-dose corticosteroids 4. Isolation of the patient to prevent spread of the dermatitis 5. When a patient has contact dermatitis, wet dressings with Domeboro solution are used for: 1. Cleaning the weeping area of dermatitis 2. Bathing the patient to prevent infection 3. Relief of inflammation 4. Providing a barrier layer to protect the surrounding skin 6. Appropriate initial treatment for psoriasis would be: 1. An immunomodulator (Protopic or Elidel) 2. Wet soaks with Burow’s or Domeboro solution 3. Intermittent therapy with intermediate potency topical corticosteroids 4. Anthralin (Drithocreme) 7. Patient education when prescribing the vitamin D3 derivative calcipotriene for psoriasis includes: 1. Apply thickly to affected psoriatic areas two to three times a day. 2. A maximum of 100 g per week may be applied. 3. Do not use calcipotriene in combination with other topical corticosteroids. 4. Calcipotriene may be augmented with the use of coal tar products. 8. Mild acne may be initially treated with: 1. Topical combined antibiotic 2. Minocycline 3. Topical retinoid 4. Over-the-counter (OTC) benzoyl peroxide 9. An adolescent presents to the clinic with moderate acne. They have been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education would include: 1. He should see an improvement in his acne within the first two weeks of treatment. 2. If there is no response in a week, double the daily application of adapalene (Differin). 3. He may see an initial worsening of his acne that will improve in 6 to 8 weeks. 4. Adapalene may cause bleaching of clothing. 10. A young adult female has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be: 1. Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane). 2. Prescribe Accutane after educating her on the adverse effects. 3. Recommend she try oral antibiotics (minocycline). 4. Refer her to a dermatologist for treatment. 11. The most cost-effective treatment for two or three impetigo lesions on the face is: 1. Mupirocin ointment 2. Retapamulin (Altabax) ointment 3. Topical clindamycin solution 4. Oral amoxicillin/clavulanate (Augmentin) 12. A child has classic tinea capitis. Treatment for tinea on the scalp is: 1. Miconazole cream thoroughly rubbed in for four weeks 2. Oral griseofulvin for 6 to 8 weeks 3. Ketoconazole shampoo daily for six weeks 4. Ciclopirox cream daily for four weeks 13. An adolescent football player presents to the clinic with athlete’s foot. Patients with tinea pedis may be treated with: 1. OTC miconazole cream for four weeks 2. Oral ketoconazole for six weeks 3. Mupirocin ointment for two weeks 4. Nystatin cream for two weeks 14. A patient presents with fungal infection of two of their toenails (onychomycosis). Treatment for fungal infections of the nail includes: 1. Miconazole cream 2. Ketoconazole cream 3. Oral griseofulvin 4. Mupirocin cream 15. Scabies treatment for a 4-year-old child includes a prescription for: 1. Permethrin 5% cream applied from the neck down 2. Pyrethrin lotion 3. Lindane 1% shampoo 4. All of the above 16. A patient has been diagnosed with scabies. Education would include: 1. She should leave the scabies treatment cream on for an hour and then wash it off. 2. Scabies may need to be retreated in a week after initial treatment. 3. All members of the household and close personal contacts should be treated. 4. Malathion is flammable and she should take care until the solution dries. 17. A child has head lice and their mother is asking which products are available that are not neurotoxic. The only non-neurotoxic head lice treatment is: 1. Permethrin 1% (Nix) 2. Lindane shampoo 3. Malathion (Ovide) 4. Benzoyl alcohol (Ulesfia) 18. An adult male has male pattern baldness on the vertex of his head and has been using Rogaine for two months. He asks how effective minoxidil (Rogaine) is. Minoxidil: 1. Provides a permanent solution to male pattern baldness if used for at least four months 2. Will show results after four months of twice-a-day use 3. May not work for his type of baldness 4. Works better if he also uses hydrocortisone cream daily on his scalp Chapter 35. Diabetes Mellitus Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to ninety percent of type 1 diabetics have: 1. Autoantibodies to two tyrosine phosphatases 2. Mutation of the hepatic transcription factor on chromosome 12 3. A defective glucokinase molecule due to a defective gene on chromosome 7p 4. Mutation of the insulin promoter factor 2. Type 2 diabetes is a complex disorder involving: 1. Absence of insulin production by the beta cells 2. A suboptimal response of insulin-sensitive tissues in the liver 3. Increased levels of glucagon-like peptide in the postprandial period 4. Too much fat uptake in the intestine 3. Diagnostic criteria for diabetes include: 1. Fasting blood glucose greater than 140 mg/dL on two occasions 2. Postprandial blood glucose greater than 140 mg/dL 3. Fasting blood glucose 100 to 125 mg/dL on two occasions 4. Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dL 4. Routine screening of asymptomatic adults for diabetes is appropriate for: 1. Individuals who are older than 45 and have a body mass index (BMI) of less than 25 kg/m2 2. Native Americans, African Americans, and Hispanics 3. Persons with high-density lipoprotein (HDL) cholesterol greater than 100 mg/dL 4. Persons with prediabetes confirmed on at least two occasions 5. Diabetes screening for children who meet the following criteria should begin at age 10 and occur every three years thereafter: 1. BMI above the 85th percentile for age and sex 2. Family history of diabetes in first- or second-degree relative 3. Hypertension based on criteria for children 4. Any of the above 6. Insulin is used to treat both types of diabetes. It acts by: 1. Increasing beta cell response to low blood-glucose levels 2. Stimulating hepatic glucose production 3. Increasing peripheral glucose uptake by skeletal muscle and fat 4. Improving the circulation of free fatty acids 7. Adam has type 1 diabetes and plays tennis for his university. He exhibits a knowledge deficit about his insulin and his diagnosis. He should be taught that: 1. He should increase his carbohydrate intake during times of exercise. 2. Each brand of insulin is equal in bioavailability, so he can buy the least expensive. 3. Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts. 4. If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes. 8. Insulin preparations are divided into categories based on onset time, duration of action, and intensity of action following subcutaneous injection. Which of the following insulin preparations has the shortest onset and duration of action? 1. Lispro 2. Glulisine 3. Glargine 4. Detemir 9. The drug of choice for type 2 diabetics is metformin. Metformin: 1. Decreases glycogenolysis by the liver 2. Increases the release of insulin from beta cells 3. Increases intestinal uptake of glucose 4. Prevents weight gain associated with hyperglycemia 10. Before prescribing metformin, the provider should: 1. Draw a serum creatinine level to assess renal function. 2. Try the patient on insulin. 3. Prescribe a thyroid preparation if the patient needs to lose weight. 4. All of the above 11. Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to step 2 therapy because they: 1. Increase endogenous insulin secretion 2. Increase the risk for hypoglycemia 3. Address the insulin resistance found in type 2 diabetics 4. Improve insulin binding to receptors 12. Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: 1. Better reduction in glucose levels than other classes 2. Less weight gain than with sulfonylurea use 3. Low risk for hypoglycemia 4. Can be given twice daily 13. Control targets for patients with diabetes include: 1. HbA1C between seven and eight 2. Fasting blood glucose levels between 100 and 120 mg/dL 3. Blood pressure less than 130/80 mm Hg 4. Low-density lipoproteins (LDL) lipids less than 130 mg/dL 14. Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1 diabetes: 1. Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily. 2. Tight control is acceptable for older adults if they are without complications. 3. Plasma glucose levels are the same for children as adults. 4. Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dL. 15. Treatment with insulin for type 1 diabetics: 1. Starts with a total daily dose of 0.2 to 0.4 units per kilogram of body weight 2. Divides the total doses into three injections based on meal size 3. Uses a total daily dose of insulin glargine given once daily with no other insulin required 4. Is based on the level of blood glucose 16. When the total daily insulin dose is split and given twice daily, which of the following rules may be followed? 1. Give two-thirds of the total dose in the morning and one-third in the evening. 2. Give 0.3 units per kilogram of premixed 70/30 insulin with one-third in the morning and two-thirds in the evening. 3. Give 50% of an insulin glargine dose in the morning and 50% in the evening. 4. Give long-acting insulin in the morning and short-acting insulin at bedtime. 17. Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include: 1. Those with long-standing diabetes 2. Older adults 3. Those with no significant cardiovascular disease 4. Young children who are early in their disease 18. Prevention of conversion from prediabetes to diabetes in young children must take highest priority and should focus on: 1. Aggressive dietary manipulation to prevent obesity 2. Fostering LDL levels less than 100 mg/dL and total cholesterol less than 170 mg/dL to prevent cardiovascular disease 3. Maintaining a blood pressure that is less than 80% based on weight and height to prevent hypertension 4. All of the above 19. The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are: 1. Metformin and insulin 2. Sulfonylureas and insulin glargine 3. Split-mixed dose insulin and glucagon-like peptide-1 (GLP-1) agonists 4. Biguanides and insulin lispro 20. Unlike most type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is: 1. Weight loss in previously overweight persons 2. Involuntary loss of 10% of body weight in less than six months 3. Decline in lean body mass over a 12 month period 4. Increase in central versus peripheral body adiposity 21. The drugs recommended for older adults with type 2 diabetes include: 1. Second-generation sulfonylureas 2. Metformin 3. Pioglitazone 4. Third-generation sulfonylureas 22. Ethnic groups differ in their risk for and presentation of diabetes. Hispanics: 1. Have a high incidence of obesity, elevated triglycerides, and hypertension 2. Do best with drugs that foster weight loss, such as metformin 3. Both 1 and 2 4. Neither 1 nor 2 23. The American Heart Association states that people with diabetes have a two- to four-fold increase in risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: 1. Glycemic targets between 7% and 7.5% 2. Use of insulin in type 2 diabetics 3. Control of hypertension and hyperlipidemia 4. Stopping smoking 24. All diabetic patients with known cardiovascular disease should be treated with: 1. Beta blockers to prevent myocardial infarctions (MIs) 2. Angiotensin-converting enzyme inhibitors and aspirin to reduce risk of cardiovascular events 3. Sulfonylureas to decrease cardiovascular mortality 4. Pioglitazone to decrease atherosclerotic plaque buildup 25. All diabetic patients with hyperlipidemia should be treated with: 1. HMG-CoA reductase inhibitors 2. Fibric acid derivatives 3. Nicotinic acid 4. Colestipol 26. Both angiotensin-converting enzyme inhibitors and some angiotensin II receptor blockers have been approved in treating: 1. Hypertension in diabetic patients 2. Diabetic nephropathy 3. Both 1 and 2 4. Neither 1 nor 2 27. Protein restriction helps slow the progression of albuminuria, glomerular filtration rate, decline, and end stage renal disease in some patients with diabetes. It is useful for patients who: 1. Cannot tolerate angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 2. Have uncontrolled hypertension 3. Have HbA1C levels above 7% 4. Show progression of diabetic nephropathy despite optimal glucose and blood pressure control 28. Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include: 1. Resting tachycardia, exercise intolerance, and orthostatic hypotension 2. Gastroparesis, cold intolerance, and moist skin 3. Hyperglycemia, erectile dysfunction, and deficiency of free fatty acids 4. Pain, loss of sensation, and muscle weakness 29. Drugs used to treat diabetic peripheral neuropathy include: 1. Metoclopramide 2. Cholinergic agonists 3. Cardioselective beta blockers 4. Gabapentin 30. The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes? 1. Fasting blood glucose 2. HbA1C 3. Thyroid function tests 4. Electrocardiograms 31. Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and NovoLog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine? 1. Delay eating the midday meal until after the swimming class. 2. Increase the morning dose of NPH insulin on days of the swimming class. 3. Adjust the morning insulin injection so that the peak occurs while swimming. 4. Check glucose level before, during, and after swimming. 32. Allison is an 18-year-old college student with type 1 diabetes. Allison’s premeal blood glucose (BG) at 11:30 a.m. is 130. She eats an apple and has a sugar-free soft drink. At 1 p.m. before swimming her BG is 80. What should she do? 1. Proceed with the swimming class. 2. Recheck her BG immediately. 3. Eat a granola bar or other snack with carbohydrates (CHO). 4. Take an additional dose of insulin. 33. Bart is a 67-year-old male with type 2 diabetes mellitus (T2 DM). He is on glipizide and metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you Bart does not follow his meal plan or exercise regularly, and he hasn’t checked his BG for one week. A random glucose is drawn and it is 500. What is a likely diagnosis based on preliminary assessment? 1. Diabetic keto acidosis (DKA) 2. Hyperglycemic hyperosmolar syndrome (HHS) 3. Infection 4. Hypoglycemia 34. What would one expect to find during an assessment for HHS? 1. Low hemoglobin 2. Ketones in the urine 3. Deep, labored breathing 4. pH of 7.35 35. A patient on metformin and glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic and dizzy. She reports taking her medication that morning and having a bagel and coffee for breakfast. Blood pressure (BP) is 110/70 and random finger-stick glucose is 64. How should this patient be treated? 1. 12 oz apple juice with 1 tsp sugar 2. 10 oz diet soda 3. 8 oz milk or 4 oz orange juice 4. 4 cookies and 8 oz chocolate milk 36. Documented reduction in cardiovascular (CV) risk is linked with: 1. Selective sodium-dependent glucose cotransporters-2 (SGLT-2) medications 2. Metformin replacement with insulin 3. Early adoption of basal insulin 4. Sulfonylurea reduction 37. Thyroid medullary cancer risk has been linked with: 1. Chronic sulfonylurea use 2. Later addition of basal insulin to oral therapy 3. GLP-1 therapies 4. SGLT-2 medication 38. Genital yeast infections are increased with: 1. GLP-1 therapies 2. SGLT-2 therapies 3. Amylin-based treatment 4. Weekly noninsulin-based therapies 39. The dipeptidyl peptidase 4 (DPP-4) inhibitors have the following suffix in their names: 1. Gliptin 2. Urea 3. Exenatide 4. Flozine 40. Which type of insulin is used in insulin pumps? 1. Only regular insulin 2. Basal insulin 3. Rapid acting insulin 4. Any type is okay depending on rate and pattern of infusion Chapter Chapter 36. Gastroesophageal Reflux and Peptic Ulcer Disease Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: 1. Calcium carbonate 2. Estrogen 3. Furosemide 4. Metoclopramide 2. Lifestyle changes are the first step in treatment of GERD. Food or drink that may aggravate GERD include: 1. Eggs 2. Caffeine 3. Chocolate 4. Soda pop 3. Metoclopramide improves GERD symptoms by: 1. Reducing acid secretion 2. Increasing gastric pH 3. Increasing lower esophageal tone 4. Decreasing lower esophageal tone 4. Antacids treat GERD by: 1. Increasing lower esophageal tone 2. Increasing gastric pH 3. Inhibiting gastric acid secretion 4. Increasing serum calcium level 5. A patient with mild GERD is started on first. 1. Antacids 2. Histamine-2 receptor antagonists 3. Prokinetics 4. Proton pump inhibitors (PPIs) 6. If a patient with symptoms of GERD states that he has been self-treating at home with over-the-counter (OTC) ranitidine daily, the appropriate treatment would be: 1. Prokinetic (metoclopramide) for 4 to 8 weeks 2. PPI (omeprazole) for 12 weeks 3. Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks 4. Cytoprotective drug (misoprostol) for two weeks 7. If a patient with GERD who is taking a PPI daily is not improving, the plan of care would be: 1. Prokinetic (metoclopramide) for 8 to 12 weeks 2. PPI (omeprazole) twice a day for 4 to 8 weeks 3. Histamine-2 receptor antagonist (ranitidine) for 4 to 8 weeks 4. Cytoprotective drug (misoprostol) for 4 to 8 weeks 8. The next step in treatment when a patient has been on PPIs twice daily for 12 weeks and not improving is: 1. Add a prokinetic (metoclopramide). 2. Refer the patient for endoscopy. 3. Switch to another PPI. 4. Add a cytoprotective drug. 9. Infants with reflux are initially treated with: 1. Histamine-2 receptor antagonist (ranitidine) 2. PPI (omeprazole) 3. Antireflux maneuvers (such as elevating the head of the bed) 4. Prokinetic (metoclopramide) 10. Long-term use of PPIs may lead to: 1. Hip fractures in at-risk persons 2. Vitamin B6 deficiency 3. Liver cancer 4. All of the above 11. An acceptable first-line treatment for peptic ulcer disease with positive Helicobacter pylori (H. pylori) test is: 1. Histamine-2 receptor antagonists for 4 to 8 weeks 2. PPI bid for 12 weeks until healing is complete 3. PPI bid plus clarithromycin plus amoxicillin for 14 days 4. PPI bid and levofloxacin for 14 days 12. Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of: 1. Antimicrobial resistance 2. An ineffective antacid 3. Overuse of PPIs 4. All of the above 13. If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the next step would be: 1. A PPI b.i.d. plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days 2. To test H. pylori for resistance to common treatment regimens 3. A PPI plus clarithromycin plus amoxicillin for 14 days 4. A PPI and levofloxacin for 14 days 14. After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: 1. Testing for H. pylori eradication with a serum enzyme-linked immunosorbent assay (ELISA) test 2. Endoscopy by a specialist 3. A PPI for 8 to 12 weeks until healing is complete 4. All of the above 15. What would be the appropriate treatment for H. pylori in a patient who recently took azithromycin for “bronchitis”? 1. PPI b.i.d. plus clarithromycin plus amoxicillin for 14 days 2. Quadruple therapy with a PPI, bismuth, tetracycline, and metronidazole for 10 to 14 days 3. PPI and levofloxacin for 14 days 4. Triple therapy with PPI, bismuth, and levofloxacin Chapter 37. Headaches Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A patient with a history of chronic migraines would benefit from preventive medication. Education regarding migraine preventive medication includes: 1. Medication is taken at the beginning of the headache to prevent it from getting worse. 2. Medication alone is the best preventative against migraines occurring. 3. Medication should not be used more than four times a month. 4. The goal of treatment is to reduce migraine occurrence by 50%. 2. A first-line drug for abortive therapy in simple migraine is: 1. Sumatriptan (Imitrex) 2. Naproxen (Aleve) 3. Butorphanol nasal spray (Stadol NS) 4. Butalbital and acetaminophen (Fioricet) 3. A 56-year-old female comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her? 1. Switch her to sumatriptan (Imitrex) to treat her migraines. 2. Assess how often she is using Fiorinal and refill her medication. 3. Switch her to a beta blocker such as propranolol to prevent her migraine. 4. Recommend she take the Fiorinal daily to prevent migraine. 4. When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include: 1. Ergotamine will briefly make the migraine worse before the migraine resolves. 2. The patient may experience bradycardia and dizziness. 3. They may need premedication with an antinausea medication. 4. Ergotamine works best if the patient starts off with a full suppository to get the full effect. 5. Migraines in pregnancy may be safely treated with: 1. Acetaminophen with codeine (Tylenol #3) 2. Sumatriptan (Imitrex) 3. Ergotamine tablets (Ergostat) 4. Dihydroergotamine (DHE) 6. A 54-year-old female has a history of migraines that do not respond well to over-the-counter (OTC) migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be: 1. Prescribe the rizatriptan, but only give her four tablets with no refills to monitor the use. 2. Prescribe rizatriptan and arrange to have her observed in the clinic or urgent care with the first dose. 3. Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital). 4. Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan. 7. A 14-year-old patient presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be: 1. Prescribe nonsteroidal anti-inflammatory drug (NSAIDs) as abortive therapy and have her keep a headache diary to identify her triggers. 2. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress. 3. Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine. 4. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic. 8. A 9-year-old patient has been diagnosed with migraines for almost two years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate? 1. Prescribe amitriptyline (Elavil) daily. Start at a low dose and increase dosage slowly every two weeks until it’s effective in eliminating migraines. 2. Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache. 3. Prescribe propranolol (Inderal) to be taken daily for at least three months. 4. Explain that it is rare for a 9-year-old child to get migraines and she needs magnetic resonance imaging (MRI) to rule out a brain tumor. 9. A 24-year-old patient has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling her naratriptan, education would include: 1. Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and St. John’s Wort, and she should inform any providers she sees that she has migraines. 2. Continue to monitor her headaches, and if the migraines are consistently happening around her menses there is preventive therapy available. 3. Pregnancy is contraindicated when taking a triptan. 4. All of the above 10. When prescribing for migraines, patient education includes: 1. Triptans are safe to use as often as needed as long as the patient is healthy. 2. Use triptan before trying OTC meds such as acetaminophen or naproxen. 3. Stress reduction and regular sleep are integral to migraine treatment. 4. If migraines worsen they are to increase their medication. 11. A patient presents to the clinic with a complaint of headaches off and on for months. She reports she feels like someone is “squeezing” her head. She occasionally takes Tylenol for the pain, but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary and giving her a prescription for: 1. Sumatriptan (Imitrex) 2. Naproxen (Aleve) 3. Ergotamine (Ergostat) 4. Tylenol with codeine (Tylenol #3) 12. Nonpharmacologic therapy for tension headaches includes: 1. Biofeedback 2. Stress management 3. Massage therapy 4. All of the above 13. A patient has been diagnosed with cluster headaches. Appropriate acute therapy would be: 1. Butalbital and aspirin (Fiorinal) 2. Intramuscular (IM) meperidine (Demerol) 3. Oxygen 100% for 15 to 30 minutes 4. Indomethacin (Indocin) 14. Preventative therapy for cluster headaches includes: 1. Massage or relaxation therapy 2. Ergotamine nightly before bed 3. Intranasal lidocaine four times a day during “clusters” of headaches 4. Propranolol (Inderal) daily 15. When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. A clinical characteristic of medication-overuse headaches is that they: 1. Increase in frequency 2. Increase in intensity 3. Recur when medication wears off 4. Begin to “cluster” into a pattern Chapter 38. Heart Failure Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure (HF) because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes that take place in HF is NOT addressed by ACE inhibitors? 1. Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently 2. Reduced formation of cross-bridges so that contractile force decreases 3. Activation of the sympathetic nervous system that increases heart rate and preload 4. Decreased renal blood flow that decreases oxygen supply to the kidneys 2. One of the three types of HF involves systolic dysfunction. Potential causes of this most common form of HF include: 1. Myocardial ischemia and injury secondary to myocardial infarction (MI) 2. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction 3. Increased demands of the heart beyond its ability to adapt secondary to anemia 4. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension 3. The American Heart Association (AHA) and the American College of Cardiology (ACC) have devised a classification system for HF that can be used to direct treatment. Patients with symptoms and underlying disease are classified as stage: 1. A 2. B 3. C 4. D 4. Diagnosis of HF cannot be made by symptoms alone because many disorders share the same symptoms. The most specific and sensitive diagnostic test for HF is: 1. Chest x-rays that show cephalization and measure heart size 2. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction 3. Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate staging for end-organ damage 4. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction 5. Treatments for HF, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with: 1. Drugs for hypertension and hyperlipidemia, if they exist 2. Lifestyle management including diet, exercise, and smoking cessation only 3. ACE inhibitors to directly prevent the HF only 4. No drugs are used in this early stage 6. Class I recommendations for stage A HF include: 1. Aerobic exercise within tolerance levels to prevent the development of HF 2. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention 3. Beta blockers for all patients regardless of cardiac history 4. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias 7. Stage B patients should have nonselective beta blockers added to their HF treatment regimen when: 1. They have an ejection fraction less than 40% 2. They have had a recent MI 3. Both 1 and 2 4. Neither 1 nor 2 8. In the later part of the 20th century, increased life expectancy for patients with HF has been associated with the use of: 1. ACE inhibitors, especially when started early in the disease process 2. All beta blockers regardless of selectivity 3. Thiazide and loop diuretics 4. Cardiac glycosides 9. Stage C patients usually require a combination of three to four drugs to manage their HF. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true? 1. Diuretics reduce preload associated with fluid retention. 2. Diuretics can be used earlier than stage C when the goal is hypertension control. 3. Diuretics may produce problems with electrolyte imbalances, abnormal glucose, and lipid metabolism. 4. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB). 10. Digoxin has a very limited role in treatment of HF. It is used mainly for patients with: 1. Ejection fractions above 40% 2. An audible S3 3. Mitral stenosis as a primary cause for HF 4. Renal insufficiency 11. Which of the following classes of drugs is contraindicated in HF? 1. Nitrates 2. Long-acting dihydropyridines 3. Calcium channel blockers 4. Alpha-beta blockers 12. HF is a leading cause of death and hospitalization in older adults (greater than 65 years old). The drug of choice for this population is: 1. Aldosterone antagonists 2. Eplerenone 3. ACE inhibitors 4. ARBs 13. ACE inhibitors are contraindicated in pregnancy. While treatment of HF during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy? 1. Diuretics 2. ARBs 3. Beta blockers 4. Nitrates 14. HF is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when: 1. Symptoms markedly worsen or the patient becomes hypotensive and has syncope. 2. There is evidence of progressive renal insufficiency or failure. 3. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic. 4. Any of the above 15. ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them safely? 1. Elderly patients with reduced renal clearance 2. Pregnant women 3. Women under age 30 4. 1 and 2 16. What assessment that can be done at home is the most reliable to use for making decisions to change HF medications? 1. Weight 2. Blood pressure (BP) 3. Heart rate 4. Serum glucose 17. Evidence is strong that HF interventions are best initiated when: 1. The person enters stage C 2. The person has functional disabilities 3. At the earliest indication 4. Stage IV is determined 18. HF patients frequently take more than one drug. When are anticoagulants typically used? 1. When the patient enters stage III 2. Only in cases of diastolic failure 3. When there is concurrent AFib 4. In all cases 19. What can chest x-rays contribute to the diagnosis and management of HF? 1. They have no role. 2. They can give very precise pictures of pulmonary fluid status. 3. They provide an idea of general cardiac size and pulmonary great vessel distribution. 4. They can confirm the diagnosis. 20. Changing a diuretic to the aldosterone agonist class is frequently beneficial to HF patients except in the following circumstance: 1. When they are advancing to a later stage of failure 2. When they have moderate to severe symptoms 3. When they have persistent hyperkalemia 4. Prior to the advance of renal dysfunction 21. Once the fluid overload of a HF flare is corrected, what is the proper role of diuretics? 1. They should only to be used intermittently when fluid becomes an issue. 2. To maintain a baseline level of therapy 3. Only the aldosterone agonist class should be used. 4. The dosing should be increased aggressively to ensure maintenance of a dry weight status. 22. Eplerenone, an aldosterone antagonist medication, differs from the classic aldosterone medication because it doesn’t create the following troublesome side effect: 1. Gynecomastia 2. Retention of potassium 3. Promotion of myocardial fibrosis 4. Relaxation of the cardiac sphincter 23. The sensitivity of the myocardium to low potassium levels when a patient takes Digoxin can be off set by changing the treatment plan if the patient has frequent drops in potassium levels on their loop diuretic. What is the change that should be made? 1. Increase the dose of the loop diuretic 2. Add potassium supplements 3. Use a combination of thiazide and loop diuretic 4. Decrease the digoxin dose 24. Digoxin is used as the classic medication to demonstrate loading dose methods to get a patient to therapeutic doses of a medication. When should a loading dose approach NOT be used for this medication? 1. When the patient is frail and elderly 2. When the HF symptoms are rapidly accelerating 3. When the renal status is stable 4. When the patient has never been on digoxin before Chapter 39. Human Immunodeficiency Virus Disease and Acquired Immunodeficiency Syndrome Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The goals of treatment when prescribing antiretroviral therapy (ART) medication to patients with human immunodeficiency virus (HIV) include: 1. Prevention of vertical HIV transmission 2. Improvement in quality of life 3. Prolonging of survival 4. All of the above 2. A challenge faced with ART is: 1. Patients abusing ART 2. Drug-resistant mutations of HIV 3. Reduction of transmissibility of HIV 4. Lack of efficacy data 3. Predictors for successful treatment with ART in HIV-positive patients include: 1. They respond to a low-potency treatment regimen. 2. They have demonstrated resistance in the past and should respond to newer ART drugs. 3. The patient is strictly adherent to the ART treatment regimen. 4. Lower baseline CD4 T-cell count 4. The goal of ART in HIV-positive patients is: 1. Maximum suppression of HIV replication 2. Eradication of HIV virus from the body 3. Determining a treatment regimen that is free of adverse effects 4. Suppression of CD4 T-cell count 5. Pregnant women who are HIV positive: 1. Are treated with azidothymidine (AZT) alone to prevent birth defects 2. Are treated with a combination ART regimen 3. Should not be treated with ART due to teratogenicity of the drugs 4. Are at high risk of developing resistance to ART drugs 6. ART is recommended for HIV-positive patients who: 1. Have a history of acquired immunodeficiency syndrome (AIDS)-defining illness 2. Are pregnant 3. Have a hepatitis B co-infection 4. All of the above 7. Before starting a patient on the nucleoside reverse transcriptase inhibitor abacavir, the following is recommended: 1. Renal function testing 2. HLA B*5701 testing 3. Pancreatic enzyme level testing 4. A test for CYP450 enzyme activity 8. A female patient is pregnant and has tested HIV positive. Which ART drug should be avoided in women who are pregnant? 1. Dolutegravir 2. Zidovudine 3. Ritonavir 4. Lopinavir/ritonavir 9. The cost of HIV treatment can be prohibitive for any patient. Patients can receive assistance from the: 1. Best Pharmaceuticals for HIV/AIDS Patient Act 2. Ryan White HIV/AIDS Treatment Modernization Act 3. National Institute of Health HIV/AIDS Assistance Fund 4. Centers for Disease Control HIV/AIDS Treatment Fund 10. Resistance to ART is measured by: 1. Measuring the DNA viral load in the serum 2. Determining plasma viral ribonucleic (RNA) on two successive measurements 3. Phenotype assays of the combination of ART the patient is on 4. Elevation of T4 counts 11. Phenotype assays are used to measure of ART. 1. Effectiveness 2. Genotype 3. Sensitivity 4. Hypersensitivity susceptibility 12. Patient factors that contribute to ART failure include: 1. Being a male who has sex with males 2. HIV diagnosis in pregnancy 3. Good compliance with the ART treatment regimen 4. ART adverse effects 13. Patients who are taking ART need to have the following monitored: 1. Lipid levels 2. Sexual functioning 3. Platelet count 4. All of the above 14. Successful ART in an HIV-positive patient is determined by: 1. HIV virus eradication 2. Lowering of HIV viral load to immeasurable amounts 3. Individual measures of success based on their personal situation 4. Normal blood hematologic factors 15. An adolescent who admits to a high amount of sexual behavior and is prescribed tenofovir and emtricitabine (Truvada®) pre-exposure prophylaxis (PrEP) should be educated regarding: 1. A high risk of developing hypertension, requiring blood pressure check every three months 2. The unique dosing schedule of taking the medication just before high risk activity 3. The need for annual HIV and hepatitis B testing 4. The possibility of developing kidney problems, requiring monitoring of renal function every six months 16. Postexposure prophylaxis (PEP) to prevent HIV infection is effective: 1. When taken within 72 hours of exposure 2. In preventing perinatal HIV transmission 3. In preventing hepatitis C infections 4. When taken within seven days of exposure Chapter 40. Hormone Replacement Therapy Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: 1. Cardiovascular risk 2. Risk of stroke or other thromboembolic event 3. Risk of breast cancer 4. Vasomotor symptoms 2. The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is: 1. Two years 2. Five years 3. 10 years 4. 15 years 3. Dosage changes of conjugated equine estrogen (Premarin) are made at intervals. 1. 1 to 2 week 2. 2 to 4 week 3. 6 to 8 week 4. 12 week 4. The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is: 1. Ability to deliver higher doses of estrogen in a nonoral form 2. The vaginal cream formula provides moisture to the vaginal area. 3. Relief of symptoms without increasing cardiovascular risk 4. All of the above 5. Women with an intact uterus should be treated with HRT with both estrogen and progestin due to: 1. Increased risk for endometrial cancer if estrogen alone is used 2. Combination therapy providing the best relief of menopausal vasomotor symptoms 3. Reduced risk for colon cancer with combined therapy 4. Lower risk of developing blood clots with combined therapy 6. Ongoing monitoring for women on ERT includes: 1. Lipid levels, repeated annually if abnormal 2. Annual health history and review of risk profile 3. Annual mammogram 4. All of the above 7. Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering HRT includes: 1. Explaining that HRT is totally safe if used short term 2. Telling her to ignore media hype regarding HRT 3. Discussing the advantages and risks of HRT 4. Encouraging her to use phytoestrogens with HRT 8. What is the duration of selective estrogen receptor modifier (SERM) use for menopausal issues? 1. It matches the five year duration for estrogen products. 2. The bone health impact allows long-term use. 3. The increased risk of breast cancer encourages tapering as soon as possible. 4. The abnormal lipid profile contributes to an early termination as soon as hot flashes no longer occur. 9. Why are SERMs generally not ordered for women early into menopause? 1. The rapid onset of severe hot flashes can be unbearable. 2. The bone remodeling effect results in osteoporosis. 3. They tend to induce intermittent spotting. 4. The increased risk of breast cancer isn’t worth the benefits of a SERM. 10. Which of the following is not an indication for starting HRT? 1. Symptomatic hot flashes 2. Treatment or prevention of vaginal atrophy 3. Prevention of osteoporosis 4. Early surgical menopause 11. “Menopause” is diagnosed when: 1. The patient has no menses for 12 months. 2. The patient has onset of vasomotor symptoms with irregular menses. 3. The patient has no bleeding cycle for six months. 4. Precise laboratory values are documented. 12. All of the following are risks of exogenous hormones except: 1. Breast cancer 2. Uterine cancer 3. Increased cardiovascular problems 4. Vaginal atrophy 13. Herbals that have proven efficacy for improving vasomotor symptoms include: 1. Black cohosh 2. Red clover 3. Evening primrose 4. None of the above 14. Re-evaluation of the Women’s Health Study has resulted in what changes in HRT implementation? 1. A combination of estrogen and progestin is no longer required in patients with an intact uterus. 2. Women with breast cancer survivorship over 10 years are no longer considered “at risk.” 3. HRT can be used in the first five years of menopause without major risk increase. 4. Low-dose estrogen can be used again in women over 65. Chapter 41. Hyperlipidemia Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The overall goal of treating hyperlipidemia is: 1. Maintain a low-density lipoprotein (LDL) level of less than 160 mg/dL 2. To reduce atherogenesis 3. Lowering apo-B, one of the apolipoproteins 4. All of the above 2. When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? 1. Total LDL 2. Fasting high-density lipoprotein (HDL) 3. Coronary artery disease risk level 4. Fasting total cholesterol 3. First-line therapy for hyperlipidemia is: 1. Statins 2. Niacin 3. Lifestyle changes 4. Bile acid-binding resins 4. James is a 45-year-old patient with a very high cardiovascular (CV) risk profile, an LDL level of 120, and normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, and: 1. A statin 2. Niacin 3. Sterols 4. A fibric acid derivative 5. Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increasing fiber and plant sterols) to lower her LDL but after six months her LDL is slightly higher. The next step in her treatment would be: 1. A statin 2. Niacin 3. Sterols 4. A fibric acid derivative 6. Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past three months. Her LDL is 135 mg/dL. An appropriate treatment for her would be: 1. A statin 2. Niacin 3. A fibric acid derivative 4. Determined by her risk factors 7. Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for three months to treat his high LDL level. His LDL is still higher than his goal and his triglycerides are elevated. A reasonable change in therapy would be to: 1. Discontinue the statin and change to a fibric acid derivative. 2. Discontinue the statin and change to ezetimibe. 3. Continue the statin and add in ezetimibe. 4. Refer him to a specialist in managing patients with recalcitrant hyperlipidemia. 8. Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman? 1. A statin 2. Niacin 3. Fibric acid derivative 4. Bile acid-binding resins 9. Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a: 1. Sterol 2. Niacin 3. Fibric acid derivative 4. Bile acid-binding resin 10. Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include with a re-evaluation in six months. 1. Statins 2. Niacin 3. Sterols 4. Bile acid-binding resins 11. Monitoring of a patient who is on a lipid-lowering drug includes: 1. Fasting total cholesterol every six months 2. Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in six weeks 3. Complete blood count, C-reactive protein, and erythrocyte sedimentation rate after six weeks of therapy 4. All of the above 12. Before starting therapy with a statin, the following baseline laboratory values should be evaluated: 1. Complete blood count 2. Liver function [alanine aminotransferase/aspartate aminotransferase (ALT/AST)] and creatine kinase 3. C-reactive protein 4. All of the above 13. When starting a patient on a statin, education would include: 1. If they stop the medication their lipid levels will return to pretreatment levels. 2. Medication is a supplement to diet therapy and exercise. 3. If they have any muscle aches or pain, they should contact their provider. 4. All of the above 14. Omega-3 fatty acids are best used to help treat: 1. High HDL 2. Low LDL 3. High triglycerides 4. Any high lipid value 15. When are statins traditionally ordered to be taken? 1. At bedtime 2. At noon 3. At breakfast 4. With the evening meal 16. Which of the following patients should not have a statin medication ordered? 1. Someone with three first- or second-degree family members with history of muscle issues when started on statins 2. Someone with high lipids but low body mass index (BMI) 3. Premenopausal woman who have had a recent hysterectomy 4. A prediabetic male with known metabolic syndrome 17. Fiber supplements are great options for elderly patients who have the concurrent problem of: 1. End-stage renal failure on fluid restriction 2. Recurrent episodes of diarrhea several times a day 3. Long-term issues of constipation 4. Needing to take multiple medications around the clock every two hours 18. What is considered the order of statin strength from lowest effect to highest? 1. Lovastatin, Simvastatin, Rosuvastatin 2. Rosuvastatin, Lovastatin, Atorvastatin 3. Atorvastatin, Rosuvastatin, Simvastatin 4. Simvastatin, Atorvastatin, Lovastatin 19. The most recent treatment guidelines strongly recommend dosing primarily based on: 1. Family history 2. Personal CV risk 3. Specific lipid levels 4. Twenty-year risk of CV event 20. Which statins are most associated with soft plaque regression? 1. Lovastatin and simvastatin 2. Rosuvastatin and atorvastatin 3. Atorvastatin and pravastatin 4. Lovastatin and rosuvastatin 21. The first step in responding to a patient who complains of muscular pain with statins is: 1. Review the history and characteristics of the pain. 2. Stop the medication and draw liver function tests. 3. Switch them to another statin. 4. Draw a lipid level to determine if dosing is still indicated. 22. Omega-3 supplements can come from animal or plant sources. Which of the following is correct? 1. Both sources have equal efficacy. 2. Plant sources have more rapid impact on LDL levels than fish sources. 3. Fish sources have potential contamination with mercury. 4. Marine creature-derived supplements are safe for patients with shellfish allergies. 23. Why has nonfasting lipid testing become popular? 1. Results are close enough to fasting results and help in observing trends of the therapeutic response. 2. Screening helps identify larger numbers of patients who should be treated. 3. More patients tend to keep lab appointments when fasting is not required. 4. All of the above Chapter 42. Hypertension Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they: 1. Increase renin secretion 2. Decrease the production of aldosterone 3. Deplete body sodium and reduce fluid volume 4. Decrease blood viscosity 2. Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to take the following supplement: 1. Potassium 2. Calcium 3. Magnesium 4. Phosphates 3. All patients with hypertension benefit from diuretic therapy, but those who benefit the most are: 1. Those with orthostatic hypertension 2. African Americans 3. Those with stable angina 4. Diabetics 4. Beta blockers treat hypertension because they: 1. Reduce peripheral resistance 2. Vasoconstrict coronary arteries 3. Reduce norepinephrine 4. Reduce angiotensin II production 5. Which of the following disease processes could be made worse by taking a nonselective beta blocker? 1. Asthma 2. Diabetes 3. Both might worsen 4. Beta blockade does not affect these disorders. 6. Disease states in addition to hypertension in which beta blockade has a compelling indication include: 1. Heart failure 2. Angina 3. Myocardial infarction 4. Dyslipidemia 7. Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they: 1. Reduce sodium and water retention 2. Decrease vasoconstriction 3. Increase vasodilation 4. All of the above 8. Based on clinical trials, compelling indications for an ACE inhibitor as treatment for hypertension include: 1. Pregnancy 2. Renal parenchymal disease 3. Stable angina 4. Dyslipidemia 9. Based on clinical trials, compelling indications for an ACE inhibitor as treatment for hypertension include: 1. Pregnancy 2. Renal parenchymal disease 3. Stable angina 4. Dyslipidemia 10. An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? 1. Beta blockers 2. Diuretics 3. Nondihydropyridine calcium channel blockers 4. Angiotensin II receptor blockers 11. If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents? 1. ACE inhibitors 2. Beta blockers 3. Calcium channel blockers 4. Diuretics 12. Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true? 1. Hypertension is a chronic disease where patients may be taking drugs for a long time. 2. Most patients will require more than one drug to treat hypertension. 3. The cost includes the price of any routine or special laboratory tests that a specific drug may require. 4. Few antihypertensive drugs come in generic formulations. 13. Caffeine, exercise, and smoking should be avoided for at least how many minutes before blood pressure measurement? 1. 15 2. 30 3. 60 4. 90 14. Blood pressure checks in children: 1. Should occur with their annual physical examinations after six years of age 2. Require a blood pressure cuff that is one-third the diameter of the child’s arm 3. Should be done during every health-care visit after three years of age 4. Require additional laboratory tests such as serum creatinine 15. Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include: 1. Lifestyle changes are difficult to achieve and maintain. 2. Adverse drug reactions . 3. Costs of drugs and monitoring with laboratory tests can be expensive. 4. All of the above 16. Lifestyle modifications for patients with early hypertension include: 1. Diet and increase exercise to achieve a body mass index (BMI) greater than 25. 2. Drink 4 oz of red wine at least once per week. 3. Adopt the dietary approaches to stop hypertension (DASH) diet. 4. Increase potassium intake. 17. Which diuretic agents typically do not need potassium supplementation? 1. Loop diuretics 2. Thiazide diuretics 3. Aldosterone inhibitors 4. They all need supplementation. 18. Aldactone family medications are frequently used when the hypertensive patient also has: 1. Hyperkalemia 2. Advancing liver dysfunction 3. The need for birth control 4. Rheumatoid arthritis 19. Hypertensive African Americans are typically listed as not being as responsive to which drug groups? 1. ACE inhibitors 2. Calcium channel blockers 3. Diuretics 4. Bidil (hydralazine family of medications) 20. What educational point concerning fluid intake must be covered with diuretic prescriptions? 1. Fluid should be restricted when on a diuretic. 2. Fluids should contain at least one salty item daily. 3. Fluid intake should remain near normal for optimal performance. 4. Avoidance of potassium-rich fluids is encouraged. 21. What is a common side-effect concern with hypertensive medications and all individuals, but especially the elderly? 1. Risk of falls 2. Triggering of a hypertensive crisis 3. Erectile priapism 4. Risk for bladder cancer development 22. Which drug class is recommended for first-line treatment of hypertension in African Americans? 1. Beta blockers 2. Angiotensin II receptor blocker (ARB) medications 3. Calcium channel blockers 4. Alpha blockers 23. Current guidelines for blood pressure treatment in geriatric patients include: 1. Keep readings close to 120/80. 2. Accept the systolic pressure to be “age + 10.” 3. Loosen strict adherence to reduction below 160 systolic. 4. Discontinue medications at age 90. 24. Potassium excess risk is highest with which combination of medications: 1. Aldactone and a beta blocker 2. An ACE and a loop diuretic 3. An ARB and an aldosterone antagonist 4. A direct renin inhibitor and a thiazide 25. Which antihypertensive is safe during pregnancy? 1. ACE 2. Beta blocker 3. Direct renin inhibitor 4. ARB 26. Once-daily diuretics are typically suggested to be taken: 1. At bedtime 2. With every meal 3. Upon awakening 4. Whenever convenient Chapter 43. Hyperthyroidism and Hypothyroidism Multiple Choice Identify the choice that best completes the statement or answers the question. 1. When methimazole is started for hyperthyroidism it may take to see a total reversal of hyperthyroid symptoms. 1. 2 to 4 weeks 2. 1 to 2 months 3. 3 to 4 months 4. 6 to 12 months 2. In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for: 1. A calcium channel blocker 2. A beta blocker 3. Liothyronine 4. An alpha blocker 3. After starting a patient with Grave’s disease on an antithyroid agent such as methimazole, patient monitoring includes thyroid-stimulating hormone (TSH) and free thyroxine (T4) every: 1. 1 to 2 weeks 2. 3 to 4 weeks 3. 2 to 3 months 4. 6 to 9 months 4. A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with: 1. Methimazole 2. Propylthiouracil (PTU) 3. Radioactive iodine 4. Nothing, because treatment is best delayed until after her pregnancy ends. 5. Goals when treating hypothyroidism with thyroid replacement include: 1. Normal TSH and free T4 levels 2. Resolution of fatigue 3. Weight loss to baseline 4. All of the above 6. When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: 1. Two weeks 2. Four weeks 3. Two months 4. Six months 7. Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored for TSH and free T4 levels every: 1. Two weeks 2. Four weeks 3. Two months 4. Six months 8. Treatment of a patient with hypothyroidism and cardiovascular disease consists of: 1. Levothyroxine 2. Liothyronine 3. Liotrix 4. Methimazole 9. Infants with congenital hypothyroidism are treated with: 1. Levothyroxine 2. Liothyronine 3. Liotrix 4. Methimazole 10. When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include: 1. They should feel symptomatic improvement in 1 to 2 weeks. 2. Drug adverse effects such as lethargy and dry skin may occur. 3. It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing. 4. Because of its short half-life, levothyroxine doses should not be missed. 11. In hyperthyroid states, what, other than the cardiovascular (CV), must be evaluated to establish potential adverse issues? 1. The liver 2. The nails and skin 3. The eyes 4. The ears 12. Why are “natural” thyroid products not readily prescribed for most patients? 1. There is no reliability for the amount of hormone per dose. 2. There is higher incidence of allergic reactions. 3. There is a more reliable dose of triiodothyronine (T3) to T4 per batch lot of preparation. 4. All of the above 13. What is the desired ratio of T3 to T4 drug levels in newly diagnosed endocrine patients? 1. Ninety-nine percent of T3 and the rest is T4 to get rapid resolution. 2. Most needs to be T4 to mimic natural ratios of hormone. 3. The ratio is unimportant. 4. The mix needs to be 50-50 at first. 14. Laboratory values are different for TSH when screening for thyroid issues and when used for medication management. Which of the following holds true? 1. Screening TSH has a wider range of normal values (0.02 to 5.0); therapeutic levels need to remain above 5.0. 2. Screening values are much narrow than the acceptable range used to keep a person stable on hormone replacement. 3. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10. 4. Screening values are between 5 and 10, and therapeutic values are greater than 10. 15. What happens to the typical hormone replacement dose when a woman becomes pregnant? 1. Most women need less medication. 2. Most women do not require a dose change. 3. The average woman needs more medication during pregnancy. 4. The average woman needs more medication only if carrying multiples. 16. Hyperthyroid patients require which specialty consultation even when asymptomatic for that organ system? 1. Hepatology 2. Pulmonary 3. Ophthalmology 4. Rheumatology 17. Treatment with radioactive iodine requires which precaution in the first few days of therapy? 1. Keeping 100 ft. distance from all others 2. Not bathing 3. Not sharing dishes, cups, and utensils 4. Wearing a neck brace 18. Why are some patients unable to achieve stability on generic forms of Synthroid? 1. The U.S. Food and Drug Administration (FDA)-allowed tolerance of 20% variance per tablet is of potential issue even with very small dosage changes in this drug family. 2. Thyroid patients are sensitive to the food coloration used in the tablets. 3. It is a psychosomatic belief that emphasizes the true power of the hypothalamic pituitary adrenal (HPA) axis. 4. This only occurs during pregnancy. 19. Which body system is most impacted if congenital hypothyroid is not rapidly recognized after birth? 1. Central nervous system 2. CV system 3. Gastrointestinal (GI) system 4. Immune system 20. After decades of thyroid supplementation in a patient with TSH at the low end of the range, the patient has increased risk for what? 1. Cataracts 2. Osteoporosis 3. Cancer 4. Dementia Chapter 44. Pain Management: Acute and Chronic Pain Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the: 1. Sensory aspects of pain 2. Discriminative aspects of pain 3. Motivational aspects of pain 4. Cognitive aspects of pain 2. Patients need to be questioned about all pain sites because: 1. Patients tend to report the most severe or important in their perception. 2. Pain tolerance generally decreases with repeated exposure. 3. The reported pain site is usually the most important to treat. 4. Pain may be referred from a different site to the one reported. 3. The chemicals that promote the spread of pain locally include: 1. Serotonin 2. Norepinephrine 3. Enkephalin 4. Neurokinin A 4. Narcotics are exogenous opiates. They act by: 1. Inhibiting pain transmission in the spinal cord 2. Attaching to receptors in the afferent neuron to inhibit the release of substance P 3. Blocking neurotransmitters in the midbrain 4. Increasing beta-lipoprotein excretion from the pituitary gland 5. Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true? 1. Preterm and newborn infants do not yet have functional pain pathways. 2. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child. 3. Increases in the pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness. 4. Decreases in pain tolerance are evident in older adults. 6. Which of the following statements is true about acute pain? 1. Somatic pain comes from body surfaces and is sharp and well-localized. 2. Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates. 3. Referred pain is present at a distant site from the pain source and is based on activation of the same spinal segment as the actual pain site. 4. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area. 7. One of the main drug classes used to treat acute pain is nonsteroidal anti-inflammatory drug (NSAIDs). They are used because: 1. They have less risk for liver damage than acetaminophen. 2. Inflammation is a common cause of acute pain. 3. They have minimal gastrointestinal (GI) irritation. 4. Regulation of blood flow to the kidneys is not affected by these drugs. 8. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? 1. All opiates are scheduled drugs, which require a Drug Enforcement Administration (DEA) license to prescribe. 2. Opiates stimulate only  receptors for the control of pain. 3. Most of the adverse effects of opiates are related to  receptor stimulation. 4. Naloxone is an antagonist to opiates. 9. If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use? 1. NSAIDs, opiates, corticosteroids 2. Low-dose opiates, salicylates, increased dose of opiates 3. Opiates, nonopiates, increased dose of nonopiates 4. Nonopiates, increased dose of nonopiates, opiates 10. The goal of treatment of acute pain is: 1. Pain at a tolerable level where the patient may return to activities of daily living 2. Elimination of all pain 3. Reduction of pain with minimum adverse reactions 4. Adequate pain relief without constipation or nausea from the drugs 11. Which of the following statements is true about age and pain? 1. Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children. 2. Among the NSAIDs, indomethacin is the preferred drug because of a lower adverse effect profile than other NSAIDs. 3. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain. 4. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs. 12. Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to: 1. Determine if the diagnosis of the source of pain is correct 2. Determine if the current regimen is adequate or if different combinations of drugs and nondrug therapy are required 3. Determine if the patient is willing and able to be an active participant in his or her pain management 4. All of the above 13. Which statement is true regarding acute and chronic pain? 1. Both have decreased levels of endorphins. 2. Chronic pain has a predominance of C-neuron stimulation. 3. Acute pain is most commonly associated with irritation of peripheral nerves. 4. Acute pain is diffuse and hard to localize. 14. A treatment plan for management of chronic pain should include: 1. Negotiation with the patient to set personal goals for pain management 2. Discussion of ways to improve sleep and stress levels 3. An exercise program to improve function and fitness 4. All of the above 15. Chronic pain is a complex problem. Some specific strategies to deal with it include: 1. Telling the patient to “let pain be your guide” to using treatment therapies 2. Prescribing pain medication on a “pro re nata” (PRN) basis to keep the amount used as low as possible 3. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment 4. All of the above 16. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency? 1. Use of more than one drug to treat the pain 2. Multiple times when prescriptions are lost with requests to refill 3. Preferences for treatments that include alternative medicines 4. Presence of a family member who has abused drugs Chapter 45. Pneumonia Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The most common bacterial pathogen in community-acquired pneumonia is: 1. Haemophilus influenzae 2. Staphylococcus aureus 3. Mycoplasma pneumoniae 4. Streptococcus pneumoniae 2. The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be: 1. Ciprofloxacin 2. Azithromycin 3. Amoxicillin 4. Doxycycline 3. The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed who has pneumonia and can be treated as an outpatient would be: 1. Levofloxacin 2. Amoxicillin 3. Ciprofloxacin 4. Cephalexin 4. If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be: 1. Intravenous (IV) or intramuscular (IM) 2. IV or IM ceftriaxone 3. IV amoxicillin 4. IV ciprofloxacin 5. A 34-week-pregnant female has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe? 1. Levofloxacin 2. Azithromycin 3. Amoxicillin 4. Doxycycline 6. Adults with pneumonia who are responding to antimicrobial therapy should show improvement in their clinical status in: 1. 12 to 24 hours 2. 24 to 36 hours 3. 48 to 72 hours 4. Four or five days 7. Along with prescribing antibiotics, adults with pneumonia should be instructed on lifestyle modifications to improve outcomes, including: 1. Adequate fluid intake 2. Increased fiber intake 3. Bedrest for the first 24 hours 4. All of the above 8. A four-week-old infant has been diagnosed with chlamydial pneumonia. An appropriate treatment for his pneumonia would be: 1. Levofloxacin 2. Amoxicillin 3. Azithromycin 4. Cephalexin 9. A four-year-old patient has suspected bacterial pneumonia. He has a temperature of 102°F, oxygen saturation level of 95%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumonia? 1. Ceftriaxone 2. Azithromycin 3. Cephalexin 4. Levofloxacin 10. A 14-year-old patient presents to the clinic with symptoms consistent with mycoplasma pneumonia. What is the treatment for suspected mycoplasma pneumonia in an adolescent? 1. Ceftriaxone 2. Azithromycin 3. Ciprofloxacin 4. Levofloxacin Chapter 46. Smoking Cessation Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Nicotine withdrawal symptoms include: 1. Somnolence 2. Decreased appetite 3. Diarrhea 4. Irritability 2. If a patient wants to quit smoking, nicotine replacement therapy is recommended if the patient: 1. Smokes more than 10 cigarettes a day 2. Smokes within 30 minutes of awakening in the morning 3. Smokes when drinking alcohol 4. “Binge smokes” while out with friends 3. Instructions for a patient who is starting nicotine replacement therapy include: 1. Smoke less than 10 cigarettes a day when starting nicotine replacement. 2. Nicotine replacement will help with the withdrawal cravings associated with quitting tobacco. 3. Nicotine replacement can be used indefinitely. 4. Nicotine replacement therapy is generally safe for all patients. 4. Nicotine replacement therapy should not be used in which patients? 1. Pregnant women 2. Patients with worsening angina pectoris 3. Patients who have just suffered an acute myocardial infarction 4. All of the above 5. Instructions for the use of nicotine gum include: 1. Chew the gum quickly to get a peak effect. 2. The gum should be “parked” in the buccal space between chews. 3. Acidic drinks such as coffee help with the absorption of the nicotine. 4. The highest abstinence rates occur if the patient chews the gum when he or she is having cravings. 6. Patients who choose the nicotine lozenge to assist in quitting tobacco should be instructed: 1. Chew the lozenge well. 2. Drink at least 8 oz of water after the lozenge dissolves. 3. Use one lozenge every 1 to 2 hours (at least nine per day with a maximum of 20 per day). 4. A tingling sensation in the mouth should be reported to the provider. 7. Transdermal nicotine replacement (the patch) is an effective choice in tobacco cessation because: 1. The patch provides a steady level of nicotine without reinforcing oral aspects of smoking. 2. There is the ability to “fine tune” the amount of nicotine that is delivered to the patient at any one time. 3. There is less of a problem with nicotine toxicity than with other forms of nicotine replacement. 4. Transdermal nicotine is safer in pregnancy. 8. The most common adverse effect of the transdermal nicotine replacement patch is: 1. Nicotine toxicity 2. Tingling at the site of patch application 3. Skin irritation under the patch site 4. Life-threatening dysrhythmias 9. If a patient is exhibiting signs of nicotine toxicity when using transdermal nicotine, they should remove the patch and: 1. Wash the area thoroughly with soap and water. 2. Flush the area with clear water. 3. Reapply a new patch in eight hours. 4. Take acetaminophen for the headache associated with toxicity. 10. When a patient is prescribed nicotine nasal spray for tobacco cessation, instructions include: 1. Inhale deeply with each dose to ensure deposition in the lungs. 2. The dose is one to two sprays in each nostril per hour, up to 40 sprays per day. 3. A sensation of “head rush” indicates the medication is working well. 4. Nicotine spray may be used daily for up to 12 continuous months. 11. If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include: 1. Bupropion (Zyban) is started 1 to 2 weeks before the quit date. 2. Nicotine replacement products should not be used with bupropion. 3. If they smoke when taking bupropion they may have increased anxiety and insomnia. 4. Because they are not using bupropion as an antidepressant, they do not need to worry about increased suicide ideation when starting therapy. 12. Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to a patient who is starting varenicline include: 1. The maximum time varenicline can be used is 12 weeks. 2. Nausea is a sign of varenicline toxicity and should be reported to the provider. 3. The starting regimen for varenicline is 1 mg twice a day a week before the quit date. 4. Neuropsychiatric symptoms may occur. 13. The most appropriate smoking cessation prescription for pregnant women is: 1. A nicotine replacement patch at the lowest dose available 2. Bupropion (Zyban) 3. Varenicline (Chantix) Chapter 47. Sexually Transmitted Infections and Vaginitis Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The goals of treatment when prescribing for sexually transmitted infections include: 1. Treatment of infection 2. Prevention of disease spread 3. Prevention of long-term sequelae from the infection 4. All of the above 2. The drug of choice for treatment of primary or secondary syphilis is: 1. Ceftriaxone intramuscular (IM) 2. Benzathine penicillin G IM 3. Oral azithromycin 4. Oral ciprofloxacin 3. The drug of choice for treatment of tertiary syphilis is: 1. Ceftriaxone IM 2. Benzathine penicillin G IM 3. Oral azithromycin 4. Oral ciprofloxacin 4. A 24-year-old female patient is 32 weeks pregnant and has tested positive for syphilis. The best treatment for her would be: 1. IM ceftriaxone 2. IM benzathine penicillin G 3. Oral azithromycin 4. Any of the above 5. Treatment for suspected gonorrhea is: 1. Ceftriaxone 250 mg IM x 1 2. Ceftriaxone 2 g IM x 1 3. Ciprofloxacin 500 mg PO x 1 4. Doxycycline 100 mg bid x 7 days 6. When treating suspected gonorrhea in a nonpregnant patient, the patient should be concurrently treated for chlamydia with: 1. Azithromycin 1 g PO x 1 2. Amoxicillin 500 mg PO x 1 3. Ciprofloxacin 500 mg PO x 1 4. Penicillin G 2.4 million units IM x 1 7. Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened for gonorrhea and chlamydia in: 1. Four weeks 2. 3 to 6 weeks 3. 3 to 6 months 4. One year 8. A test of cure is recommended after treating chlamydia in which patient population? 1. Men who have sex with men 2. Adolescent females 3. Pregnant patients 4. All of the above 9. Treatment for chancroid in a nonpregnant patient would be: 1. Oral azithromycin 2. IM ceftriaxone 3. Oral ciprofloxacin 4. Any of the above 10. Follow-up testing after treatment of chancroid would be: 1. Syphilis and human immunodeficiency virus (HIV) testing at three-month intervals 2. Chancroid-specific antigen test every three months 3. Urine testing for Haemophilus ducreyi in 3 to 6 months for test of cure 4. Annual HIV testing if the patient engages in high-risk sexual behavior 11. A female patient presents with a complaint of vaginal discharge that when tested meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in nonpregnant symptomatic women would be: 1. Metronidazole 500 mg PO b.i.d. x 7 days 2. Doxycycline 100 mg PO b.i.d. x 7 days 3. Intravaginal tinidazole daily x 5 days 4. Metronidazole 2 g PO x 1 dose 12. Besides prescribing antimicrobial therapy, patients with bacterial vaginosis require education regarding the fact that: 1. The most recent partners in the past 60 days should also be treated. 2. Alcohol should not be consumed during and for 72 hours after metronidazole therapy. 3. Condoms should be used during intercourse if intravaginal clindamycin cream is used. 4. Cotreatment for chlamydia is necessary. 13. An adult female patient presents to the clinic with vulvovaginal candidiasis. Appropriate treatment for her would be: 1. Over-the-counter (OTC) intravaginal clotrimazole 2. OTC intravaginal miconazole 3. Oral fluconazole one-time dose 4. Any of the above 14. A woman with recurrent vulvovaginal candidiasis may be treated with: 1. Weekly intravaginal butoconazole for three months 2. Fluconazole 150 mg PO daily x 7 doses then monthly for six months 3. Weekly fluconazole 150 mg PO x six months 4. Intravaginal tioconazole x 14 days 15. An adult female presents with genital warts on her labia. Patient-applied topical therapy for genital warts includes: 1. Podofilox 0.5% gel 2. Podophyllin 10% resin 3. Trichloroacetic acid 4. Any of the above 16. An adult female presents with a malodorous vaginal discharge and is confirmed to have a Trichomonas infection. Treatment for her would include: 1. Metronidazole 2 g PO x 1 dose 2. Topical intravaginal metronidazole daily x 7 days 3. Intravaginal clindamycin daily x 7 days 4. Azithromycin 2 g PO x 1 dose 17. In addition to antimicrobial therapy, patients treated for Trichomonas infection should be educated regarding: 1. Necessity of treating sexual partner simultaneously 2. Abstaining from intercourse until both partners are treated 3. Need for retesting in three months due to high reinfection rate 4. All of the above Chapter 48. Tuberculosis Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Drug resistant tuberculosis (TB) is defined as TB that is resistant to at least: 1. Fluoroquinolones 2. Rifampin and isoniazid 3. Amoxicillin 4. Ceftriaxone 2. Goals when treating TB include: 1. Completion of recommended therapy 2. Negative purified protein derivative (PPD) at the end of therapy 3. Completely normal chest x-ray 4. All of the above 3. The principles of drug therapy for the treatment of TB include: 1. Patients are treated with a drug that M. tuberculosis is sensitive to. 2. Drugs need to be taken on a regular basis for a sufficient amount of time. 3. Treatment continues until the patient’s PPD is negative. 4. All of the above 4. A patient has confirmed TB and is placed on a six-month treatment regimen. This regimen consists of: 1. Two months of four-drug therapy (isoniazid [INH], rifampin, pyrazinamide, and ethambutol) followed by four months of INH and rifampin 2. Six months of INH with daily pyridoxine throughout therapy 3. Six months of INH, rifampin, pyrazinamide, and ethambutol 4. Any of the above 5. Treatment for drug-resistant TB would include: 1. INH, rifampin, pyrazinamide, and ethambutol for at least 12 months 2. INH, ethambutol, kanamycin, and rifampin 3. Treatment with at least two drugs that the TB is susceptible to 4. Levofloxacin 6. Treatment regimens for a pregnant patient with TB would include: 1. Streptomycin 2. Levofloxacin 3. Kanamycin 4. Pyridoxine 7. A 5-year-old patient has been diagnosed with primary pulmonary TB. His treatment would include: 1. Pyridoxine 2. Ethambutol 3. Levofloxacin 4. Rifabutin 8. A 9-year-old lives with a family member newly diagnosed with TB. To prevent the patient from developing TB they should be treated with: 1. Six months of INH and rifampin 2. Two months of INH, rifampin, pyrazinamide, and ethambutol, followed by four months of INH 3. Nine months of INH 4. 12 months of INH 9. Leonard is completing a six-month regimen to treat TB. Monitoring of a patient on TB therapy includes: 1. Monthly sputum cultures 2. Monthly chest x-ray 3. Bronchoscopy every three months 4. All of the above 10. Compliance with directly observed therapy can be increased by offering: 1. Convenient clinic times 2. Incentives such as food, clothing, and transportation costs 3. Gifts for compliance 4. All of the above Chapter 49. Upper Respiratory Infections, Pharyngitis, Sinusitis, Otitis Media, and Otitis Externa Multiple Choice Identify the choice that best completes the statement or answers the question. 1. An adult presents with an upper respiratory infection (URI). Treatment for his URI would include: 1. Amoxicillin 2. Diphenhydramine 3. Phenylpropanolamine 4. Topical oxymetazoline 2. A 3-year-old patient presents with a URI. Treatment for their URI would include: 1. Amoxicillin 2. Diphenhydramine 3. Pseudoephedrine 4. Nasal saline spray 3. Patients who should be cautious about using decongestants for a URI include: 1. School-age children 2. Patients with asthma 3. Patients with cardiac disease 4. Patients with allergies 4. Treatment for a low-risk child with sinusitis is: 1. Amoxicillin 2. Azithromycin 3. Cephalexin 4. Levofloxacin 5. Treatment for sinusitis in an adult who has a child in daycare is: 1. Azithromycin 500 mg a day for five days 2. Amoxicillin-clavulanate 500 mg bid for seven days 3. Ciprofloxacin 500 mg bid for five days 4. Cephalexin 500 mg qid for five days 6. The length of treatment for sinusitis in a low-risk adult patient should be: 1. 5 to 7 days 2. 7 to 10 days 3. 14 to 21 days 4. Seven days beyond when symptoms cease 7. Patient education for a patient who is prescribed antibiotics for sinusitis includes: 1. Use of nasal saline washes 2. Use of inhaled corticosteroids 3. Avoiding the use of ibuprofen while ill 4. Use of laxatives to treat constipation 8. First-line treatment for an afebrile 2-year-old with otitis media would include: 1. Azithromycin 2. Amoxicillin 3. Ceftriaxone 4. Trimethoprim/sulfamethoxazole 9. A 15-month-old patient has been on amoxicillin for two days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for the child? 1. Continue the amoxicillin for the full 10 days. 2. Change the antibiotic to azithromycin. 3. Change the antibiotic to amoxicillin/clavulanate. 4. Change the antibiotic to trimethoprim/sulfamethoxazole. 10. A child may warrant “watchful waiting” instead of an antibiotic prescription for acute otitis media if they: 1. Are low risk with temperature of less than 39oC or 102.2oF 2. Have reliable parents with transportation 3. Are older than two years 4. All of the above 11. Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should be educated about: 1. Using decongestants to provide faster symptom relief 2. Providing adequate pain relief for at least the first 24 hours 3. Using complementary treatments for acute otitis media, such as garlic oil 4. Administering an antihistamine/decongestant combination (Dimetapp) so the child can sleep better 12. First-line therapy for a patient with acute otitis externa (swimmer’s ear) and an intact tympanic membrane includes: 1. Swim-Ear drops 2. Ciprofloxacin and hydrocortisone drops 3. Amoxicillin 4. Gentamicin ophthalmic drops 13. First-line therapy for a school-age child with group A streptococcal pharyngitis is: 1. Azithromycin 10 mg/kg on day one, then 5 mg/kg/day on days 2 to 5 2. Amoxicillin 80 mg/kg/day (maximum of 2 g/day) for 10 days 3. Clindamycin 20 mg/kg/dose b.i.d. for 10 days 4. Amoxicillin 50 mg/kg/day (maximum 1,000 mg/day) for 10 days Chapter 50. Urinary Tract Infections Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The treatment goals when treating urinary tract infection (UTI) include: 1. Eradication of the infecting organism 2. Relief of symptoms 3. Prevention of recurrence of the UTI 4. All of the above 2. A 6-year-old female presents with a UTI. She is healthy, afebrile, with no use of antibiotics in the previous six months and no drug allergies. An appropriate first-line antibiotic choice for her would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Nitrofurantoin 4. Cefdinir 3. A 24-year-old female presents with a UTI. She is healthy, afebrile, and her only drug allergy is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Nitrofurantoin 4. Ciprofloxacin 4. A 28-year-old pregnant woman at 38 weeks gestation is diagnosed with a lower UTI. She is healthy with no drug allergies. Appropriate first-line therapy for her UTI would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Nitrofurantoin 4. Ciprofloxacin 5. Which of the following patients may be treated with a five day course of therapy for their UTI? 1. A 28-year-old pregnant woman 2. A six-year-old healthy female 3. A 24-year-old female 4. A 26-year-old female diabetic 6. Appropriate initial therapy for a four-year-old female with a febrile UTI would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Ceftriaxone 4. Ciprofloxacin 7. Monitoring for a healthy, nonpregnant adult patient being treated for a UTI is: 1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. Test of cure urinary analysis at completion of therapy 4. Follow-up urine culture two months after completion of therapy 8. Monitoring for a child who has had a UTI is: 1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. Test of cure urinary analysis at completion of therapy 4. Follow-up urine culture two months after completion of therapy 9. Monitoring for a pregnant woman who has had a UTI is: 1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. Test of cure urinary analysis at completion of therapy 4. Follow-up urine culture every two weeks until delivery 10. Along with an antibiotic prescription, lifestyle education for a nonpregnant adult female who has had a UTI includes: 1. Increasing her intake of vitamin C-containing orange juice 2. Voiding 10 to 15 minutes after intercourse 3. Avoiding ingesting urinary irritants, such as asparagus 4. All of the above 11. Lisa is a healthy nonpregnant adult woman who recently had a UTI. She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be: 1. Sixteen ounces per day of cranberry juice cocktail will prevent UTIs. 2. Cranberry juice will decrease UTIs. 3. There is no clear evidence that cranberry juice helps prevent UTIs. 4. Cranberry juice only works to prevent UTIs in children. Chapter 51. Women as Patients Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Prescribing for women during their childbearing years requires constant awareness of the possibility of: 1. Pregnancy unless the women is on birth control 2. Risk for silent bacterial or viral infections of the genitalia 3. High risk for developmental disorders in their infants 4. Decreased risk for abuse during this time 2. Intimate partner violence is a serious public health problem. It should be screened for: 1. At every encounter within the health-care system 2. When a women is being seen for symptoms of depression 3. Throughout pregnancy 4. If a sexually transmitted disease is diagnosed 3. Because of their longer life expectancy, women are more likely than men to experience a disabling condition. Common conditions in older women that can produce disability include: 1. Depression 2. Panic disorders 3. Dementia 4. All of the above 4. Gender differences between men and women in pharmacokinetics include: 1. Women have more rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites 2. Women have a higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution 3. Women have increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations 4. Women have slower organ blood flow rates so drugs tend to take longer to be excreted 5. Which of the following drug classes is associated with significant differences in metabolism based on gender? 1. Beta blockers 2. Antibiotics 3. Serotonin reuptake inhibitors 4. Angiotensin-converting-enzyme (ACE) inhibitors 6. Since 40% of bone accrual occurs during adolescence, building bone during this time is critical. Ways to improve bone accrual in adolescents include: 1. Use of bisphosphonates early if dual energy x-ray absorptiometry (DEXA) scans show limited bone accrual 2. Encouraging a daily dietary intake of 1,300 mg of calcium and 400 IU of vitamin D 3. Avoiding all birth control methods that include progesterone 4. Fostering the intake of iron mainly in green and leafy vegetables 7. Hot flashes are often a concern during menopause. Which of the following may help in reducing them? 1. Drink one caffeinated liquid per day. 2. Take progesterone supplementation. 3. Exercise 20 to 40 minutes/day. 4. Increase intake of carrots, yams, and soy products. 8. Factors common in women that can affect adherence to a treatment regimen include all of the following EXCEPT: 1. Number of drugs taken: Women tend to take fewer drugs over longer periods of time. 2. Fear that medications can cause disease: Information obtained from social networks may be inaccurate for a specific woman. 3. Nutritional status: Worries about possible weight gain from a given drug may result in nonadherence. 4. Religious differences: A patient’s belief system that is not congruent with the treatment regimen presents high risk for nonadherence. 9. Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is: 1. Oral contraceptive pills 2. Caffeine 3. Nonsteroidal anti-inflammatory drug (NSAIDs) 4. Aspirin 10. Premenstrual dysphoric disorder (PMDD) occurs in a fairly small number of patients. Theories of the pathology behind PMDD that are supported in research include: 1. Altered sensitivity in the serotoninergic system 2. Inhibition of the cyclooxygenase system 3. Fluctuations of the gonadal hormones 4. All of these are theories supported by research 11. Treatment of PMDD that affects all or most of the symptoms includes: 1. Tryptophan up to 6 g/day 2. Vitamin E 200 to 400 mg/day 3. Evening primrose oil 500 mg/day 4. Fluoxetine 20 mg/day 12. Of all populations with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), women are the fastest growing. HIV-infected women: 1. Are less likely to become pregnant or to carry a pregnancy to term 2. Have higher rates of cervical dysplasia and human papillomavirus (HPV)-concurrent infections 3. Are most often over 35 years of age 4. Most often come from Asian and Caucasian ethnic groups 13. Maternal-to-child transmission of HIV infection during pregnancy may be prevented by: 1. Use of antiviral drugs such as zidovudine 2. Use of condoms during intercourse 3. Both 1 and 2 4. Neither 1 nor 2 14. Erroneous information about lesbian, gay, bisexual, transgender, and questioning (LGBTQ) individuals can lead to failure to give accurate advice to them as patients. Which of the following statements is true about lesbians: 1. Lesbians cannot contract a sexually transmitted infection from their female partner. 2. Screening for cervical cancer is not required. 3. Lesbians as a group are less likely to have health-care insurance. 4. Like women in general, lesbians are more likely than gay men to seek care for health-related issues. 15. Which of the following holds true for the pharmacokinetics of women? 1. Gastric emptying is faster than that of men. 2. Organ blood flow is the same as that of men. 3. Evidence is strong concerning renal differences in elimination. 4. Medications that involve binding globulins are impacted by estrogen levels. 16. The metabolism of drugs in women is primarily impacted by: 1. Hepatic blow flow 2. Enzymes of the CYP450 system 3. The amount of gastric secretions 4. Whether they are pre- or postmenopausal 17. DEXA score interpretation in the rare cases of adolescent osteoporosis: 1. Is done using the same T scores that are established for women 2. Is impossible because of less-than-mature bones 3. Must be done using special Z scores for adolescents 4. Can only be done if bisphosphonates have already been started 18. The best way to use nonsteroidal anti-inflammatory drug (NSAIDs) for severe menstrual cramps is: 1. Take them for 2 to 3 days prior to the start of bleeding. 2. Take them 2 to 3 times a day during the first two days. 3. Take them every 2 to 3 hours. 4. They have not been found to be helpful at all. 19. Which of the following is true concerning lesbian health concerns? 1. They cannot contract a sexually transmitted infection (STI) from another woman. 2. Pap smears are not required to screen for cervical cancer. 3. Lesbian women have a tendency to be frequent clinic visitors. 4. The health risks associated with smoking, alcohol, and depression are higher than in the heterosexual population. 20. Women who experience gestational diabetes mellitus (DM) are more likely to: 1. Develop full DM in the next decade 2. Retain pregnancy-related weight 3. Develop hyperlipidemia 4. All of the above 21. Women who present with the classic chest pressure, diaphoresis, and left arm pain of a cardiovascular(CV) event are: 1. Probably having a heart attack 2. Experiencing a panic attack 3. Exaggerating an angina episode 4. Needing to belch and get an antacid 22. All of the following are reasons why have women experience worse CV outcomes than men except: 1. Failure of the system to aggressively treat risk factors on par with men 2. They do not take early action, believing they are not at risk. 3. Women have smaller hearts and vessels compared to men resulting in easier blockages with plaque over the same time period. 4. Women do not like to take medications. 23. Which of the following may signal a cardiac event in a woman? 1. Sudden, profound weakness 2. Pain or pressure in the back 3. Both 1 and 2 4. Women have the same symptoms as men. 24. Compared to men, it takes fewer drugs or less alcohol for women to become intoxicated due to which of the following? 1. Women’s livers process chemicals at a faster rate of speed. 2. Women tend to start experimenting with alcohol and drugs at a later age so have not yet “adapted” like their male peers. 3. Females have a natural higher percentage of body fat. 4. None of these Chapter 52. Men as Patients Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The factor that has the greatest effect on males developing male sexual characteristics is: 1. Cultural beliefs 2. Effective male role models 3. Adequate intake of testosterone in the diet 4. Androgen production 2. When assessing a male for hypogonadism prior to prescribing testosterone replacement, serum testosterone levels are drawn: 1. Without regard to time of day 2. First thing in the morning 3. Late afternoon 4. In the evening 3. Some research supports that testosterone replacement therapy may be indicated in which of the following diagnoses in men? 1. Age-related decrease in cognitive functioning 2. Metabolic syndrome 3. Decreased muscle mass in aging men 4. All of the above 4. The goal of testosterone replacement therapy is: 1. Absence of all hypogonadism symptoms 2. Testosterone levels in the mid-normal range one week after an injection 3. Testosterone levels in the mid-normal range just prior to the next injection 4. Avoidance of high serum testosterone levels during therapy 5. While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are: 1. Hemoglobin 14 g/dL or hematocrit 39% 2. Hemoglobin 11.5 g/dL or hematocrit 31% 3. Hemoglobin 13 g/dL or hematocrit 38% 4. Hemoglobin 17.5 g/dL or hematocrit 54% 6. Monitoring of an older male patient on testosterone replacement includes: 1. Oxygen saturation levels at every visit 2. Serum cholesterol and lipid profile every 3 to 6 months 3. Digital rectal prostate screening exam at three and six months after starting therapy 4. Bone mineral density at three and six months after starting therapy 7. When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be screened for use of: 1. Statins 2. Nitrates 3. Insulin 4. Opioids 8. Men who are prescribed PDE-5 inhibitors for erectile dysfunction should be educated regarding the adverse effects of the drug, which include: 1. Hearing loss 2. Prostate enlargement 3. Delayed ejaculation 4. Dizziness 9. Male patients who should not be prescribed PDE-5 inhibitors include: 1. Diabetics 2. Those who have had an acute myocardial infarction in the past six months 3. Those who are deaf 4. Those who are under age 60 years of age 10. Monitoring of male patients who are using PDE-5 inhibitors includes: 1. Serum fasting glucose levels 2. Cholesterol and lipid levels 3. Blood pressure 4. Complete blood count Chapter 53. Pediatric Patients Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The Pediatric Research Equity Act says that: 1. All children must be given equal access to drug research trials. 2. Children must be included in the planning phase of new drug development. 3. Children of multiple ethnic groups must be included in pediatric drug trials. 4. All applications for new active ingredients, new indications, new dosage forms, or new routes of administration require pediatric studies. 2. The Best Pharmaceuticals for Children Act: 1. Includes a pediatric exclusivity rule that extends the patent on drugs studied in children 2. Establishes a committee that writes guidelines for pediatric prescribing 3. Provides funding for new drug development aimed at children 4. Encourages manufacturers to specifically develop pediatric formulations 3. The developmental variation in phase I enzymes has what impact on pediatric prescribing? 1. None, phase I enzymes are stable throughout childhood. 2. Children should always be prescribed lower than adult doses per weight due to low enzyme activity until puberty. 3. Children should always be prescribed higher than adult doses per weight due to high enzyme activity. 4. Prescribing dosages will vary based on the developmental activity of each enzyme, at times requiring lower than adult doses and at other times higher than adult doses based on the age of the child. 4. Developmental variation in renal function has what impact on prescribing for infants and children? 1. Lower doses of renally excreted drugs may be prescribed to infants younger than six months. 2. Higher doses of water-soluble drugs may need to be prescribed because of increased renal excretion. 3. Renal excretion rates have no impact on prescribing. 4. Parents need to be instructed on whether drugs are renally excreted or not. 5. Topical corticosteroids are prescribed cautiously in young children because: 1. They may cause an intense hypersensitivity reaction. 2. Of hypothalamic-pituitary-adrenal axis suppression 3. Corticosteroids are less effective in young children. 4. Young children may accumulate corticosteroids, leading to toxic levels. 6. A woman who is breastfeeding her 2-month-old child has an infection that requires an antibiotic. What drug factors influence the effect of the drug on the infant? 1. Maternal drug levels 2. Half-life 3. Lipid-solubility 4. All of the above 7. Drugs that are absolutely contraindicated in lactating women include: 1. Selective serotonin reuptake inhibitors 2. Antiepileptic drugs such as carbamazepine 3. Antineoplastic drugs such as methotrexate 4. All of the above 8. Education of parents regarding administering oral antibiotics to a 4-month-old infant with otitis media includes: 1. How to administer an oral drug using a medication syringe 2. Mixing the medication with a couple of ounces of formula and putting it in a bottle 3. Discontinuing the antibiotic if diarrhea occurs 4. Calling for an antibiotic change if the infant chokes and sputters during administration 9. To increase adherence in pediatric patients a prescription medication should: 1. Have a short half-life 2. Be the best tasting of the effective drugs 3. Be the least concentrated form of the medication 4. Be administered three or four times a day 10. Treatment for fever in a 5-month-old infant may include: 1. “Baby” aspirin 2. Acetaminophen suppository 3. Ibuprofen suppository 4. Alternating acetaminophen and ibuprofen Chapter 53. Pediatric Patients Answer Section MULTIPLE CHOICE 1. ANS: 4 PTS: 1 2. ANS: 2 PTS: 1 3. ANS: 4 PTS: 1 4. ANS: 1 PTS: 1 5. ANS: 2 PTS: 1 6. ANS: 4 PTS: 1 7. ANS: 3 PTS: 1 8. ANS: 1 PTS: 1 9. ANS: 2 PTS: 1 10. ANS: 2 PTS: 1 Chapter 54. Transgendered Clients as Patients Multiple Choice Identify the choice that best completes the statement or answers the question. 1. The goals of treatment in treating transfeminine adults are to: 1. Lower serum estradiol levels 2. Suppress testosterone levels 3. Raise vocal pitch to feminine levels 4. Decrease male pattern facial and body hair 2. Permanent effects of estrogen therapy in transfeminine adults include: 1. Breast development 2. Decrease in muscle mass 3. Decreased libido 4. Softening of the skin 3. The estrogen formulation that most reliably leads to physiological target levels of estrogen is: 1. Patch 2. Spray 3. Topical cream 4. Intramuscular (IM) injection 4. Spironolactone is used in gender-affirming therapy: 1. As a potassium-sparing diuretic to prevent hypertension 2. To treat hypertension associated with estrogen therapy 3. As an antiandrogen and to suppress testosterone synthesis 4. To prevent male-pattern body hair growth 5. Gender-affirming therapy in transmasculine adults includes: 1. Testosterone 2. Spironolactone 3. Bicalutamide 4. Finasteride 6. When prescribing testosterone for gender-affirming therapy in transmasculine adults the provider needs to educate the patient regarding the following adverse effects: 1. Erythrocytosis, leading to thrombosis 2. Increased risk for ovarian cancer 3. Significant increase in low-density lipoproteins (LDL) 4. Increased breast size 7. Testosterone may exacerbate the following in transmasculine adults: 1. Migraines 2. Dysmenorrhea 3. Constipation 4. Prostatitis 8. Contraception options for a transmasculine adult include: 1. Combined oral contraceptive pills 2. Levonorgestrel intrauterine (IUD) 3. NuvaRing® vaginal ring 4. Vasectomy 9. Advantages of treating adolescents with gender affirming therapy include: 1. Higher levels of testosterone are achieved in transfeminine adolescents. 2. Puberty can be delayed allowing time for exploration of gender identity. 3. If started by Tanner Stage 3, secondary sex characteristics can be reversed. 4. Fertility is preserved if treatment is started early. 10. Monitoring of transgender adolescents on gonadotropin-releasing hormone (GnRH) agonists to delay puberty includes: 1. Height and weight 2. Hair growth patterns 3. Erections 4. All of the above Chapter 54. Transgendered Clients as Patients Answer Section MULTIPLE CHOICE 1. ANS: 2 PTS: 1 2. ANS: 1 PTS: 1 3. ANS: 4 PTS: 1 4. ANS: 3 PTS: 1 5. ANS: 1 PTS: 1 6. ANS: 1 PTS: 1 7. ANS: 1 PTS: 1 8. ANS: 2 PTS: 1 9. ANS: 2 PTS: 1 10. ANS: 4 PTS: 1 Chapter 55. Geriatric Patients Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Principles of prescribing for older adults include: 1. Avoiding prescribing any newer high-cost medications 2. Starting at a low dose and increasing the dose slowly 3. Keeping the total dose at a lower therapeutic range 4. All of the above 2. Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie? 1. Increased volume of distribution 2. Decreased lipid solubility 3. Decreased plasma proteins 4. Increased muscle-to-fat ratio 3. Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen? 1. Increased glomerular filtration rate (GFR) will require higher doses of some renally excreted drugs. 2. Decreased tubular secretion of medication will require dosage adjustments. 3. Thin skin will cause increased elimination via sweat. 4. Decreased lung capacity will lead to measurable decreases in lung excretion of drugs. 4. A medication review of an elderly person’s medications involves: 1. Asking the patient to bring a list of current prescription medications to the visit 2. Having the patient bring all of their prescription, over-the-counter, and herbal medications to the visit 3. Asking what other providers are writing prescriptions for them 4. All of the above 5. Steps to avoid polypharmacy include: 1. Prescribing two or fewer drugs from each drug class 2. Reviewing a complete drug history every 12 to 18 months 3. Encouraging the elderly patient to coordinate their care with all of their providers 4. Evaluating for duplications in drug therapy and discontinuing any duplications 6. Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common medication practices seen in the elderly including: 1. Use of another person’s medications 2. Hoarding medications 3. Changing his medication regimen without telling his provider 4. All of the above 7. To improve positive outcomes when prescribing for the elderly the nurse practitioner should: 1. Assess cognitive functioning in the elder. 2. Encourage the patient to take a weekly “drug holiday” to keep drug costs down. 3. Encourage the patient to cut drugs in half with a knife to lower costs. 4. All of the above 8. When an elderly diabetic patient is constipated the best treatment options include: 1. Mineral oil 2. Bulk-forming laxatives such as psyllium 3. Stimulant laxatives such as senna 4. Stool softeners such as docusate 9. Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be followed when prescribing pain management for Delta? 1. Keep the dose of oxycodone low to prevent development of tolerance. 2. Acetaminophen is the first-line drug of choice. 3. Avoid prescribing nonsteroidal anti-inflammatory drugs (NSAIDs). 4. Add in a short-acting benzodiazepine for a synergistic effect on pain. 10. Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include: 1. Diuretics 2. Trazodone 3. Clonazepam 4. Levodopa 11. The GFRs for a 91-year-old woman who weighs 93 pounds and is 5'1" with a serum creatinine of 1.1 and for a 202 pound, 25-year-old male who is 5'9" with the same serum creatinine according to the Cockcroft-Gault formula are: 1. 25 and 133 mL/min, respectively 2. 25 and 103 mL/min, respectively 3. 22 and 133 mL/min, respectively 4. 22 and 103 mL/min, respectively 12. In geriatric patients, the percentage of body fat is increased. What are the pharmacologic implications of this physiologic change? 1. A lipid-soluble medication will be eliminated more quickly and will not work as well. 2. A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged. 3. Absorption of lipid-soluble drugs is impaired in older adults. 4. The bioavailability of the lipid-soluble drug is increased in older adults. 13. All of the following statements about the Beers list are true except: 1. It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available. 2. It is derived from the expert opinion of one geriatrician and is not evidence based. 3. These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities. 4. These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration. 14. You are reviewing the data from several meta-analyses that addressed the most common causes of adverse drug reactions in the older adult. A decrease in which of the following is the most common cause of adverse drug reactions in older adults? 1. Body fat content 2. Liver function 3. Renal function/clearance 4. Plasma albumin levels 15. Which of the following is not consistent with the rules for geriatric prescribing? 1. Half-life will be longer in older adults. 2. Steady state is reached more quickly in the older adult. 3. Reduce the number of drugs in the patient's regimen whenever possible. 4. Adverse drug responses present atypically in the older adult. 16. The 2019 Beers list removed some medications because: 1. They do not truly impact geriatric patients. 2. They are no longer available in countries outside the United States. 3. They now come in less anticholinergic formulations. 4. They do not only impact geriatric patients, but all patients. 17. Timely posthospitalization medication reconciliation helps clarify: 1. Which medications stopped in the acute setting require return to use 2. Evaluation of new side effects associated with dose changes or new prescriptions 3. Which medications require more patient education 4. All of the above 18. Specialty consultation summaries need to be reviewed for: 1. Altered dosing of current medications 2. Recommendations for interventions that will require medication regimen changes 3. Interventions that will conflict with another specialty plan 4. All of the above 19. Patients who plan to retire to warm, sunny climates are at risk for which adverse reaction not typical in cooler, cloudier climates? 1. Over-hydration 2. Increased risk of falls 3. Photodermatitis 4. Failing thyroids 20. Topical medication efficacy may be impacted by which common aging change? 1. Decreased peripheral vascular flows 2. Increased ratio of water to fat in the skin 3. Dropping renal clearance 4. Loss of vellus hair [Show More]

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