Pharmacology > EXAM > NR 508 Advanced Pharmacology Final Exam Fall 2019 – Chamberlain College of Nursing / NR508 Advance (All)

NR 508 Advanced Pharmacology Final Exam Fall 2019 – Chamberlain College of Nursing / NR508 Advanced Pharmacology Final Exam Fall 2019

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NR 508 Advanced Pharmacology Final Exam Fall 2019 – Chamberlain College of Nursing NR 508 Final Exam 66 Questions Question 1 2 / 2 pts A patient who has diabetes reports intense discomfor... t when needing to void. A urinalysis is normal. To treat this, the primary care NP should consider prescribing:    flavoxate (Urispas).      bethanechol (Urecholine).      phenazopyridine (Pyridium).   Correct!    oxybutynin chloride (Ditropan XL).   This patient is describing urge incontinence, or overactive bladder, which occurs when the detrusor muscle is hyperactive, causing an intense urge to void before the bladder is full. Urge incontinence is associated with many conditions, including diabetes. Oxybutynin chloride, which is an anticholinergic, acts to decrease detrusor overactivity and is indicated for treatment of urge incontinence. Flavoxate is used to treat dysuria associated with UTI. Bethanechol is indicated for urinary retention. Phenazopyridine is used to treat dysuria.   Question 2 2 / 2 pts A patient reports difficulty returning to sleep after getting up to go to the bathroom every night. A physical examination and a sleep hygiene history are noncontributory. The primary care NP should prescribe:    zaleplon.   Correct!    ZolpiMist.      ramelteon.      chloral hydrate.   ZolpiMist oral spray is useful for patients who have trouble returning to sleep in the middle of the night. Zaleplon and ramelteon are used for insomnia caused by difficulty with sleep onset. Chloral hydrate is not typically used as outpatient therapy.   Question 3 2 / 2 pts A 5-year-old child who has no previous history of otitis media is seen in clinic with a temperature of 100° F. The primary care NP visualizes bilateral erythematous, nonbulging, intact tympanic membranes. The child is taking fluids well and is playing with toys in the examination room. The NP should:    prescribe azithromycin once daily for 5 days.      prescribe amoxicillin twice daily for 10 days.     prescribe amoxicillin-clavulanate twice daily for 10 days.   Correct!   initiate antibiotic therapy if the child’s condition worsens.   Signs and symptoms of otitis media that indicate a need for antibiotic treatment include otalgia, fever, otorrhea, or a bulging yellow or red tympanic membrane. This child has a low-grade fever, no history of otitis media, a nonbulging tympanic membrane, and no otorrhea, so watchful waiting is appropriate. When an antibiotic is started, amoxicillin is the drug of choice.   Question 4 2 / 2 pts An 80-year-old patient with congestive heart failure has a viral upper respiratory infection. The patient asks the primary care NP about treating the fever, which is 38.5° C. The NP should: Correct!    recommend acetaminophen.      recommend high-dose acetaminophen.     tell the patient that antibiotics are needed with a fever that high.   tell the patient a fever less than 40° C does not need to be treated. Patients with congestive heart failure may have tachycardia from fever that aggravates their symptoms, so fever should be treated. High doses should be given with caution in elderly patients because of possible decreased hepatic function. Antibiotics should not be given without evidence of bacterial infection.   Question 5 2 / 2 pts A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing freezing episodes between doses. The primary care NP should consider using:    selegiline.      amantadine.   Correct!    apomorphine.      modified-release levodopa.   Apomorphine injection is used for acute treatment of immobility known as “freezing.”   Question 6 2 / 2 pts A patient is being tapered from long-term therapy with prednisolone and reports weight loss and fatigue. The primary care NP should counsel this patient to:    consume foods high in vitamin D and calcium.     begin taking dexamethasone because it has longer effects.     expect these side effects to occur as the medication is tapered. Correct!   increase the dose of prednisolone to the most recent amount taken. Sudden discontinuation or rapid tapering of glucocorticoids in patients who have developed adrenal suppression can precipitate symptoms of adrenal insufficiency, including nausea, weakness, depression, anorexia, myalgia, hypotension, and hypoglycemia. When patients experience these symptoms during a drug taper, the dose should be increased to the last dose. Vitamin D deficiency is common while taking glucocorticoids, but these are not symptoms of vitamin D deficiency. Changing to another glucocorticoid is not recommended. Patients should be taught to report the side effects so that action can be taken and should not be told that they are to be expected.   Question 7 2 / 2 pts The primary care nurse practitioner (NP) sees a 50-year-old woman who reports frequent leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also reports having an increased urge to void even when her bladder is not full. She is not taking any medications. The NP should: Correct!    perform a dipstick urinalysis.      prescribe desmopressin (DDAVP).      prescribe oxybutynin chloride (Ditropan XL).      teach exercises to strengthen the pelvic muscles.   A focused history with a careful physical examination is essential for determining the cause of incontinence. Urinalysis can rule out urinary tract infection (UTI), which can cause incontinence. Medications are prescribed after determining the cause, if any, and treating underlying conditions. Exercises to strengthen the pelvic muscles are part of treatment.   Question 8 2 / 2 pts A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the primary care NP notes a decrease in the child’s linear growth rate. The NP should consult the child’s asthma specialist about:    gradually tapering the child off the prednisone.      a referral for possible growth hormone therapy.   Correct!    giving a double dose of prednisone every other day.      dividing the prednisone dose into twice-daily dosing.   Administration of a double dose of a glucocorticoid every other morning has been found to cause less suppression of the HPA axis and less growth suppression in children. Because the child has severe asthma, an oral steroid is necessary. Growth hormone therapy is not indicated. Twice-daily dosing would not change the HPA axis suppression.   Question 9 2 / 2 pts A patient who is taking isoniazid and rifampin for latent TB is seen by the primary care NP for a routine follow-up visit. The patient reports having nausea, vomiting, and a decreased appetite. The NP should: Correct!    ask about alcohol intake.      suggest taking the medications with food.     reassure the patient that these side effects are common.      order liver and renal function tests and serum glucose.   Concomitant use of alcohol with isoniazid increases the risk of hepatitis. This patient shows signs of hepatitis, so the NP should ask about alcohol consumption. Isoniazid should be taken on an empty stomach.   Question 10 2 / 2 pts A primary care NP sees a child with asthma to evaluate the child’s response to the prescribed therapy. The child uses an ICS twice daily and an albuterol metered-dose inhaler as needed. The child’s symptoms are well controlled. The NP notes slowing of the child’s linear growth on a standardized growth chart. The NP should change this child’s medication regimen to a:    combination ICS/LABA inhaler twice daily.     short-acting β2-agonist (SABA) with oral corticosteroids when symptomatic.    combination ipratropium/albuterol inhaler twice daily.   Correct!    SABA as needed plus a leukotriene modifier once daily.   A leukotriene modifier may be used as an alternative to ICS for children who experience systemic side effects of the ICS. This child’s symptoms are well controlled, so there is no need to step up therapy to include a LABA. Oral corticosteroids should be used only for severe exacerbations. Ipratropium and albuterol are used for severe exacerbations.   Question 11 2 / 2 pts A patient is newly diagnosed with Alzheimer’s disease stage 6 on the Global Deterioration Scale. The primary care NP should prescribe:    donepezil (Aricept).      rivastigmine (Exelon).   Correct!    memantine (Namenda).      galantamine (Razadyne).   Patients with moderate to severe dementia (stages 5 to 7) may be started on memantine.   Question 12 2 / 2 pts The primary care NP sees a 12-month-old infant who needs the MMR, Varivax, influenza, and hepatitis A vaccines. The child’s mother tells the NP that she is pregnant. The NP should: Correct!    administer all of these vaccines today.      give the hepatitis A and influenza vaccines.      give the Varivax, hepatitis A, and influenza vaccines.     withhold all of these vaccines until after the baby is born.   Although live-virus vaccines should not be administered to mothers during pregnancy, they may be given to children whose mothers are pregnant.   Question 13 2 / 2 pts A parent brings a 5-year-old child to a clinic for a hospital follow-up appointment. The child is taking a medication at a dose equal to an adult dose. The parent reports that the medication is not producing the desired effects. The NP should:    order renal function tests.     prescribe another medication to treat this child’s symptoms.   discontinue the drug and observe the child for toxic side effects. Correct!   obtain a serum drug level and consider increasing the drug dose. By a child’s first birthday, the liver’s metabolic capabilities are not only mature but also more vigorous than the adult liver, meaning that certain drugs may need to be given in higher doses or more often. It is prudent to obtain a serum drug level and then consider increasing the dose to achieve the desired effect. Renal function tests are not indicated. Unless the child is experiencing toxic effects, the drug does not need to be discontinued.   Question 14 2 / 2 pts An NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterol metered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing for a 65-year-old patient with recent onset of reactive airways disease who reports symptoms occurring every 1 or 2 weeks. At a follow-up appointment several months later, the patient reports no change in frequency of symptoms. The NP’s initial action should be to:    order spirometry to evaluate pulmonary function.     prescribe a systemic corticosteroid to help with symptoms.   Correct!   ask the patient to describe how the medications are taken each day.   give the patient detailed information about the use of metered-dose inhalers. It is essential to explore with the older patient what he or she is actually doing with regard to daily medication use and compare this against the “prescribed” medication regimen before ordering further tests, prescribing any increase in medications, or providing further education. - - - - - - - - - - - - - - Question 66 2 / 2 pts A child has been taking methylphenidate 5 mg at 8 AM, 12 PM, and 4 PM for 30 days after a new diagnosis of AD/HD and comes to the clinic for evaluation. The child’s mother reports that the child exhibits some nervousness and insomnia but is doing much better in school. The primary care NP should suggest: Correct!    discontinuing the 4 PM dose.      increasing the dose to 10 mg each time.      giving 10 mg at 8 AM and 5 mg at noon.      changing the dosing to 15 mg twice daily.   Nervousness and insomnia are the most common adverse effects and are usually controlled by reducing the dose or omitting the afternoon or evening dose.   Question 67 2 / 2 pts A 60-year-old woman is in the clinic for an annual well-woman examination. She has been taking alendronate (Fosamax) 10 mg daily for 4 years. Her last bone density test yielded a T-score of 2.0. Her urine NTx level today is 22. She walks daily. Her fracture risk is low. The primary care NP should recommend that she: Correct!    take a 1- to 2-year drug holiday.      change to 70 mg of alendronate weekly.      decrease the alendronate dose to 5 mg daily.     change to ibandronate (Boniva) 3 mg IV every 3 months.   The American Association of Clinical Endocrinologists recommends patients have a “drug holiday” after 4 to 5 years of bisphosphonate treatment if osteoporosis is mild and the fracture risk is low. The other options are all viable treatment regimens but are not appropriate in this case.   Question 68 2 / 2 pts The primary care nurse practitioner (NP) is seeing a patient who reports chronic lower back pain. The patient reports having difficulty sleeping despite taking ibuprofen at bedtime each night. The NP should prescribe:    diazepam (Valium).      metaxalone (Skelaxin).      methocarbamol (Robaxin).   Correct!    cyclobenzaprine (Flexeril).   Cyclobenzaprine (Flexeril) is indicated for chronic low back pain and provides an added benefit of aiding sleep, which is a common problem among patients with back pain. The other medications are used for acute lower back pain.   Question 69 2 / 2 pts A patient reports smoking two or more packs of cigarettes per day and expresses a desire to quit smoking. The primary care NP learns that the patient smokes heavily during breaks at work and during the evening but with no established schedule. The NP should recommend:    bupropion (Wellbutrin).   Correct!    nicotine replacement gum or nasal spray.      a high-dose 24-hour nicotine patch.      intensive smoking cessation counseling.   Nicotine replacement gum and nasal spray both can be used when patients have cravings and are especially useful for patients who do not smoke at particular times. The patch is useful when patients smoke consistently throughout the day. Bupropion is not indicated. Intensive counseling is often necessary for patients who have difficulty stopping and have failed several times.   Question 70 2 / 2 pts A patient is seen in the clinic with a 1-week history of frequent watery stools. The primary care NP learns that a family member had gastroenteritis a week prior. The patient was treated for a UTI with a sulfonamide antibiotic 2 months prior. The NP should suspect: Correct!    Clostridium difficile–associated disease (CDAD).    viral gastroenteritis.      serum sickness reaction.      recurrence of the UTI.   Cases of CDAD have been reported 2 months after a course of antibiotics, and CDAD should be suspected in all patients who present with diarrhea after antibiotic use. Viral gastroenteritis is possible, but the possibility of CDAD must be investigated. Serum sickness reaction is not usually associated with diarrhea and generally occurs within weeks of drug administration.   Question 71 2 / 2 pts A female patient has vaginal candidiasis and has taken a single dose of fluconazole without resolution of the infection. The primary care NP obtains a culture and should order:    oral ketoconazole.      griseofulvin for 4 weeks.      another dose of fluconazole.   Correct!    topical miconazole (Monistat).   Topical miconazole is still recommended as the drug of first choice and should be given when oral fluconazole has failed. Fluconazole has been approved for single-dose treatment of vulvovaginal candidiasis, although the Centers for Disease Control and Prevention continues to recommend topical therapy with an imidazole derivative because of fluconazole-resistant candidiasis. Ketoconazole and griseofulvin are not recommended first-line treatments for vulvovaginal candidiasis. Another dose of fluconazole would not be effective if resistance is present.   Question 72 2 / 2 pts A patient reports difficulty falling asleep and staying asleep every night and has difficulty staying awake during the commute to work every day. The NP should:    suggest the patient try diphenhydramine first.   Correct!    perform a thorough history and physical examination.      teach about avoiding caffeine and good sleep hygiene.     suggest melatonin and consider prescribing Ambien if this is not effective. Before treating insomnia with drug therapy, it is important first to rule out any physiologic causes of a sleep disorder. The other interventions may be tried if no serious cause of the disorder is found.   Question 73 2 / 2 pts A patient who is newly diagnosed with schizophrenia is overweight and has a positive family history for type 2 diabetes mellitus. The primary care NP should consider initiating antipsychotic therapy with: Correct!    ziprasidone (Geodon).      olanzapine (Zyprexa).      risperidone (Risperdal).      chlorpromazine (Thorazine).   Many antipsychotics increase the risk of metabolic syndrome in patients. Ziprasidone does not have effects on weight. The other agents all increase the risk of weight gain and metabolic syndrome.   Question 74 2 / 2 pts A patient asks an NP about using an oral over-the-counter decongestant medication for nasal congestion associated with a viral upper respiratory illness. The NP learns that this patient uses loratadine (Claritin), a β-adrenergic blocker, and an intranasal corticosteroid. The NP would be concerned about which adverse effects?    Liver toxicity      Excessive drowsiness      Rebound congestion   Correct!    Tremor, restlessness, and insomnia   β-Adrenergic blockers and monoamine oxidase inhibitors may potentiate the effects of decongestants, such as tremor, restlessness, and insomnia. Liver toxicity, excessive drowsiness, and rebound congestion are not known adverse effects of drug interactions.   Question 75 2 / 2 pts A patient has been taking paroxetine (Paxil) for major depressive symptoms for 8 months. The patient tells the primary care NP that these symptoms improved after 2 months of therapy. The patient is experiencing weight gain and sexual dysfunction and wants to know if the medication can be discontinued. The NP should:    change to a tricyclic antidepressant medication.     begin to taper the paroxetine and instruct the patient to call if symptoms increase.   tell the patient to stop taking the medication and to call if symptoms get worse. Correct!   continue the medication for several months and consider adding bupropion (Wellbutrin). Once a patient achieves remission, a continuation phase of 16 to 20 weeks followed by a maintenance phase of 4 to 9 months should be carried out. Some responders, called apathetic responders, may have a decrease in most symptoms but continue to have lack of pleasure, decreased libido, and lack of energy. Bupropion can be added to therapy to treat these symptoms. Patients should not change medications during this phase, should not begin a drug taper, and should never stop the medication abruptly. [Show More]

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