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Test bank pharmaco.docx NURSING NGR 5035 Chapter 11-15

Test bank NURSING NGR 5035 Chapter 11-15 Chapter 11: Information Technology and Pharmacotherapeutics Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Being competent in the use of information technology in clinical practice is expected in professional nurses. Nurse practitioner competence includes the ability to: A. Search for information using the most common search engines B. Serve as content experts in developing, implementing, and evaluating information systems C. Write programs to assure the integrity of health information D. Utilize IT to prescribe drugs ____ 2. You are going to prescribe a drug that has been on the market for less than 2 months. Your best source of drug information at this time (besides calling the pharmacist) is: A. The Physician’s Desk Reference B. Any nurse’s drug handbook C. Micromedix Online D. Pharmacist’s Drug Reference ____ 3. Which of the following is a primary benefit of the use of computerized physician order entry (CPOE) for patient medications? A. Reduces time that prescribing drugs takes B. Eliminates the need to chart drugs prescribed C. Decreases prescribing and transcription errors D. Helps keep the number of drugs prescribed to a minimum ____ 4. A number of barriers and concerns exist before the goals of a safe and efficient IT system can be realized. Which of the following is NOT a barrier to adoption and use of IT in prescribing drugs? A. Cost of initial set up B. Access to highly skilled experts C. Compatibility between systems D. Patient confidentiality risks ____ 5. Electronic Health Records (EHRs): A. Are bring discouraged by the Centers for Medicare and Medicaid Services due to cost issues B. Allow for all patient data to be centralized in one location for access by multiple providers C. Use macros and templates to individualize care D. Use standardized software to facilitate interoperability between systems ____ 6. Factors that facilitate keeping patient information confidential in an EHR system include: A. Designing software so that only those who need the information can gain access B. Requiring providers to log-off at the end of the clinical day C. Keeping a file of the login and password information for each provider in a secure place D. Having patients sign informed consent documents to have their data on an EHR ____ 7. Decision support systems often provide medication alerts that tell the prescriber: A. Patient history data with a summary of their diagnoses B. The usual dosage for the drug being prescribed C. The patient’s latest lab values, such as potassium levels D. Potential drug-to-drug interactions with other medications the patient is taking ____ 8. Prescribers have been shown to override a medication alert about a patient’s allergies when: A. The history showed that the patient had tolerated the medication in the past B. The benefit outweighed the risk C. The medication was therapeutically appropriate and needed D. All of the above ____ 9. One barrier to use of the Web for both prescribing and for patient teaching is: A. Lack of free public access to the Internet B. Age, with older adults rarely understanding how to use a computer C. Web pages and hyperlinks may change, be deleted, or be replaced D. Few sites with information about drugs are free ____ 10. IT can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to: A. Prioritize what is needed information and avoid spending time reading “interesting” information not central to the problem at hand B. Integrate professional and person searching so that the same browser does not need to be accessed repeatedly C. Check e-mail frequently so that patient questions can be addressed promptly D. Check for viruses, spyware, and malware ____ 11. Data in the EHR that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review: A. The patient’s current diagnosis and history B. Drugs the patient is currently taking C. Any recent previous encounter for the same problem as this visit and what was done D. All of the above ____ 12. IT can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true? A. Patients feel the provider does not care about them if they are not seen in a face-to-face encounter. B. Data collected from patients between encounters via IT is less accurate and complete. C. Collecting data between encounters via IT may mean a more efficient face-to-face encounter. D. Between encounters is a good time to collect screening data. ____ 13. Discharge summaries using IT have several advantages. They can: A. Replace the need for oral instruction since the patient has printed material to read at home B. Be filed with the patient’s chart to document patient teaching C. Both A and B D. Neither A nor B ____ 14. IT can also be used for patient teaching during the encounter and after it. The provider can help patients and their families become savvy consumers of health-care information by: A. Warning them about the questionable quality of health information online B. Telling them to contact the office about any web sites they have questions about C. Teaching them how to identify high quality web sites and “red flags” to inaccurate content D. All of the above ____ 15. Incorporating IT into a patient encounter takes skill and tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by: A. Turning the screen around so the patient can see material being recorded B. Not placing the computer screen between the provider and the patient C. Both A and B D. Neither A nor B Chapter 12: Pharmacoeconomics Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Pharmacoeconomics is: A. The study of the part of the U.S. economy devoted to drug use B. The study of the impact of prescription drug costs on the overall economy C. The analysis of the costs and consequences of any health care-related treatment or service D. The analysis of the clinical efficacy of the drug ____ 2. The direct costs of drug therapy include: A. The actual cost of acquiring the medication B. The loss of income due to illness C. Pain and suffering due to inadequate drug therapy D. The cost of a funeral associated with premature death ____ 3. Indirect costs associated with drug therapy include: A. The cost of diagnostic tests to monitor therapeutic levels B. Health-care provider time to prescribe and educate the patient C. Child-care expenses incurred while receiving therapy D. Loss of wages while undergoing drug therapy ____ 4. The intangible costs of drug therapy include: A. Loss of wages while undergoing therapy B. Inconvenience, pain, and suffering incurred with therapy C. Cost of medical equipment in the lab used to monitor therapeutic drug levels D. Cost of prescription drug coverage, such as Medicare Part D ____ 5. When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as: A. Cost-minimization analysis B. Cost-of-illness analysis C. Cost-effectiveness analysis D. Cost-benefit analysis ____ 6. Cost-effectiveness analysis compares two or more treatments or programs that are: A. Not necessarily therapeutically equivalent B. Considered equal in efficacy C. Compared with the dollar value of the benefit received D. Expressed in terms of patient preference or quality-adjusted life years ____ 7. When the costs of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as: A. Cost-minimization analysis B. Cost-of-illness analysis C. Cost-effectiveness analysis D. Cost-benefit analysis ____ 8. Mary has a two-tiered prescription benefit plan, which means: A. She can receive differing levels of care based on whether she chooses an “in-plan” provider or not B. She is eligible for the new Medicare Part D “donut hole” reduction of costs program C. She pays a higher copay for brand-name drugs than for generic drugs D. She must always choose to be treated with generic drugs first ____ 9. Prescribing less expensive generic drugs or drugs off the $4 retail pharmacy lists: A. Increases the complexity of the pharmacoeconomics of prescribing for the individual patient B. Increases compliance by reducing the financial burden of drug costs to the patient C. Is not sound prescribing practice due to the inferiority of the generic products D. Will increase the overall cost of drugs to the system due to the ease of overprescribing less expensive drugs ____ 10. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be: A. Order cognitive testing to determine the source of his confusion B. Sit down with him and explain the whole Medicare Part D process C. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him D. Request his son come to the next appointment so you can explain the benefit to him ____ 11. The “donut hole” in Medicare Part D: A. Will be totally eliminated with the federal health-care reform enacted in 2010 B. Refers to the period of time when annual individual drug costs are between $250 and $2250 per year and drugs costs are covered 75% C. Refers to the period between when the annual individual drug costs are $2250 and $5100 and the patient pays 50% of the costs of brand name drugs (2011) D. Has no effect on whether patients continue to fill their prescriptions during the coverage gap ____ 12. Research has shown that when patients who are covered by Medicare Part D reach the “donut hole” in coverage they: A. Ask for extra refills of medication to get them through the months of no coverage B. Fill their prescriptions less, including critical medications such as warfarin or a statin C. Fill their critical medications, but hold off on filling less critical medications D. Demonstrate no change in their prescription filling pattern Chapter 13: Over-the-Counter Medications Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must: A. Be safe and labeled for appropriate use B. Have a low potential for abuse or misuse C. Be taken for a condition the patient can reliably self-diagnose D. All of the above ____ 2. In the United States, over-the-counter drugs are regulated by: A. No one, there is no oversight for over-the-counter medications B. The U.S. Food and Drug Administration Center for Drug Evaluation and Research C. The Drug Enforcement Administration D. MedWatch ____ 3. As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to: A. Get a new patent for the over-the-counter form of the drug B. Lower the costs, since most prescription benefit plans do not cover generics C. Market the drug to a whole new population, as they are able to market to patients instead of just providers D. Continue to make large profits from their blockbuster brand-name drug ____ 4. New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do. A. True B. False ____ 5. The ailment that generates the greatest over-the-counter annual drug sales is: A. Constipation B. Cough and colds C. Heartburn D. Acute and chronic pain ____ 6. Common over-the-counter pain relievers such as acetaminophen or ibuprofen: A. Are always safer for the patient than prescription pain medication B. Are harmful if taken in higher than recommended amounts C. Have minimal interaction with prescription medications D. Should never be given to children unless recommended by their provider ____ 7. When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of: A. His appropriately only telling you about his regularly prescribed medications B. His hiding information regarding his inappropriate use of aspirin from you C. A common misconception that intermittently taken over-the counter medications are not an important part of his drug history D. A common misuse of over-the-counter aspirin ____ 8. The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act: A. Requires all providers screen their patients for methamphetamine use B. Restricts the prescribing of amphetamines to U.S. citizens C. Requires a prescription be written for all methamphetamine precursors in all states D. Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales ____ 9. When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: A. Not to take their regularly prescribed medications while on these antibiotics B. Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption C. Not to take antacids while on these medications, as the antacid decreases absorption D. That there are no drug interactions with these antibiotics ____ 10. The OTC antidiarrheal bismuth subsalicylate (Pepto Bismol) is recommended: A. As traveler’s diarrhea prophylaxis B. For all children with diarrhea C. To be combined with aspirin to be the most effective D. To be stopped immediately if blackened stool occurs ____ 11. Sadie’s adult daughter reports that when Sadie (age 84 years) takes Tylenol PM (acetaminophen and diphenhydramine) to help her sleep she has “strange dreams” including wandering and thinking she is at her childhood home. You understand: A. This is a sign of early dementia and she should undergo cognitive testing B. Sadie is not taking an effective dose to help her stay asleep C. Sadie is exhibiting signs of an allergic reaction to the diphenhydramine in the Tylenol PM D. Delirium is a common adverse reaction seen when elderly patients take diphenhydramine ____ 12. Vanessa is a 19-year-old female who calls the advice nurse worried that a condom broke yesterday when she was having intercourse. She reports a normal menses 10 days ago. One recommendation for care is: A. She should come into the clinic immediately for a pregnancy test B. She may purchase emergency contraception OTC at a local drugstore C. She should call the clinic back if she does not have a normal menses when it is due D. She should come into the clinic within the next couple days for a “same day start” prescription for birth control Chapter 14: Drugs Affecting the Autonomic Nervous System Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: A. Increases peripheral vasoconstriction B. Decreases detrusor muscle contractility C. Lowers supine blood pressure more than standing pressure D. Relaxes smooth muscle in the bladder neck ____ 2. To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT: A. Take the dose at bedtime B. Sit up slowly and dangle their feet before standing C. Monitor their blood pressure and skip a dose if the pressure is less than 120/80 D. Weigh daily and report weight gain of greater than 2 pounds in one day ____ 3. John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should: A. Not miss a dose or stop taking the drug because of potential rebound hypertension B. Increase fiber in the diet to treat any diarrhea that may occur C. Reduce fluid intake to less than 2 liters per day to prevent fluid retention D. Avoid sitting for long periods, as this can lead to deep vein thrombosis ____ 4. Clonidine has several off-label uses, including: A. Alcohol and nicotine withdrawal B. Post-herpetic neuralgia C. Both A and B D. Neither A nor B ____ 5. Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: A. Increasing heart rate to improve cardiac output B. Reducing vascular smooth muscle tone C. Increasing aldosterone-mediated volume activity D. Reducing aqueous humor production ____ 6. Which of the following adverse effects are less likely in a beta1-selective blocker? A. Dysrhythmias B. Impaired insulin release C. Reflex orthostatic changes D. Decreased triglycerides and cholesterol ____ 7. Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual lab work and find a CrCl of 25 ml/min. What action should you take related to his nadolol? A. Extend the dosage interval B. Decrease the dose by 75% C. Take no action since this value is expected in the older adult D. Schedule a serum creatinine level to validate the CrCl value ____ 8. Beta blockers are the drugs of choice for exertional angina because they: A. Improve myocardial oxygen supply by vasodilating the coronary arteries B. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance C. Both A and B D. Neither A nor B ____ 9. Adherence to beta blocker therapy may be affected by their: A. Short half-lives requiring BID dosing B. Tendency to elevate lipid levels C. Effects on the male genitalia, which may produce impotence D. None of the above ____ 10. Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: A. Symptoms are severe B. Patient has not responded to other therapies C. Patient has concurrent hypertension D. As soon as LV dysfunction is diagnosed ____ 11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with: A. Angina B. Coronary artery disease C. Both A and B D. Neither A nor B ____ 12. To prevent life-threatening events from rapid withdrawal of a beta blocker: A. The dosage interval should be increased by 1 hour each day B. An alpha blocker should be added to the treatment regimen before withdrawal C. The dosage should be tapered over a period of weeks D. The dosage should be decreased by one-half every 4 days ____ 13. Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose? A. Dizziness B. Increased heart rate C. Nervousness and shakiness D. Diaphoresis ____ 14. Combined alpha-beta antagonists are used to reduce progression of heart failure because they: A. Vasodilate the peripheral vasculature B. Decrease cardiac output C. Increase renal vascular resistance D. Reduce atherosclerosis secondary to elevated serum lipoproteins ____ 15. Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes? A. Histamine 2 blockers B. Quinolones C. Serotonin re-uptake inhibitors D. All of the above ____ 16. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? A. White B. Asian C. African American D. Native American ____ 17. Bethanechol: A. Increases detrusor muscle tone to empty the bladder B. Decreases gastric acid secretion to treat peptic ulcer disease C. Stimulates voluntary muscle tone to improve strength D. Reduces bronchial airway constriction to treat asthma ____ 18. Clinical dosing of this drug: A. Begins at the highest effective dose to obtain a rapid response B. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved C. Requires dosing only once daily D. Is the same for both the oral and parenteral route ____ 19. Patients are taught to avoid which drug due to its antimuscarinic effects? A. Levothyroxine B. Prilosec C. Dulcolax D. Diphenhydramine ____ 20. Anticholinesterase inhibitors are used to treat: A. Peptic ulcer disease B. Myasthenia gravis C. Both A and B D. Neither A nor B ____ 21. Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic? A. Donepezil B. Memantine C. Rivastigmine D. Galantamine ____ 22. Taking which drug with food maximizes it bioavailability? A. Donepezil B. Galantamine C. Rivastigmine D. Memantine ____ 23. Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women? A. Memantine B. Pyridostigmine C. Galantamine D. Rivastigmine ____ 24. There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include: A. Dizziness and headache B. Nausea C. Decreased salivation D. Fasciculations of voluntary muscles ____ 25. Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily? A. Tacrine B. Donepezil C. Memantine D. Pyridostigmine ____ 26. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine? A. Vasodilation and decreased heart rate B. Increased secretion of gastric acid and motility of the GI smooth muscle C. Release of dopamine at the pleasure center D. Stimulation of the locus ceruleus ____ 27. Nicotine gum products are: A. Chewed to release the nicotine and then swallowed for a systemic effect B. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine release C. Bound to exchange resins so the nicotine is only released during chewing D. Approximately the same in nicotine content as smoking two cigarettes ____ 28. Nicotine replacement therapy (NRT): A. Is widely distributed in the body only when the gum products are used B. Does not cross the placenta and so is safe for pregnant women C. Delays healing of esophagitis and peptic ulcers D. Has no drug interactions when a transdermal patch is used ____ 29. Success rates for smoking cessation using NRT: A. Are about the same regardless of the method chosen B. Vary from 40% to 50% at 12 months C. Both A and B D. Neither A nor B ____ 30. Cholinergic blockers are used to: A. Counteract the EPS effects of phenothiazines B. Control tremor and relax smooth muscle in Parkinson’s disease C. Inhibit the muscarinic action of ACh on bladder muscle D. All of the above ____ 31. Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? A. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. B. Additive antimuscarinic effects may occur with antihistamines. C. Cholinergic blockers may decrease the sedative effects of hypnotics. D. Cholinergic blockers are contraindicated with antipsychotics. ____ 32. Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to: A. Apply the transdermal disk at least 4 hours before the antiemetic effect is desired B. Swallow the tablet 1 hour before traveling where motion sickness is possible C. Place the tablet under the tongue and allow it to dissolve D. Change the transdermal disk daily for maximal effect Chapter 15: Drugs Affecting the Central Nervous System Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include: A. Understanding that obesity is a contraindication to prescribing phentermine B. Anorexiants may cause tolerance and should only be prescribed for 6 months C. Patients should be monitored for postural hypotension D. Renal function should be monitored closely while on anorexiants ____ 2. Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as SSRIs and St John’s Wort due to: A. Additive respiratory depression risk B. Additive effects affecting liver function C. The risk of serotonin syndrome D. The risk of altered cognitive functioning ____ 3. Antonia is a 3 year old who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for____ to be used for an episode of status epilepticus. A. IV phenobarbital B. Rectal diazepam (Diastat) C. IV phenytoin (Dilantin) D. Oral carbamazepine (Tegretol) ____ 4. Rabi is being prescribed phenytoin for seizures. Monitoring includes: A. Assessing for phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment B. Assessing for pedal edema throughout therapy C. Assessing heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm D. Assessing for vision changes, such as red-green blindness, at least annually ____ 5. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: A. Dwayne hasn’t been taking his carbamazepine because it causes insomnia B. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance C. Dwayne was not originally prescribed the correct amount of carbamazepine D. Carbamazepine is probably not the right antiseizure medication for Dwayne ____ 6. Carbamazepine has a Black Box warning due to life-threatening: A. Renal toxicity, leading to renal failure B. Hepatotoxicity, leading to liver failure C. Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis D. Cardiac effects, including supraventricular tachycardia ____ 7. Long-term monitoring of patients who are taking carbamazepine includes: A. Routine troponin levels to assess for cardiac damage B. Annual eye examinations to assess for cataract development C. Monthly pregnancy tests for all women of childbearing age D. Complete blood count every 3 to 4 months ____ 8. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: A. Increased seizure activity, as this drug may auto-induce seizures B. Altered renal function, including renal failure C. Blood dyscrasias, which are uncommon but possible D. Central nervous system excitement, leading to insomnia ____ 9. Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be: A. Increase her dose B. Assess for suicidal ideation C. Discontinue the medication immediately D. Decrease her dose to half then slowly titrate up the dose ____ 10. Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: A. Tell her to increase her caloric intake to counter the effects of the topiramate B. Consult with a neurologist, as this is not a common adverse effect of topiramate C. Decrease her dose of topiramate D. Reassure her that this is a normal side effect of topiramate and continue to monitor her weight ____ 11. Monitoring of a patient on gabapentin to treat seizures includes: A. Routine therapeutic drug levels every 3 to 4 months B. Assessing for dermatologic reactions, including Steven’s Johnson C. Routine serum electrolytes, especially in hot weather D. Recording seizure frequency, duration, and severity ____ 12. Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes: A. He should not play sports due to the risk of increased seizures B. He should monitor his temperature and ability to sweat in the heat while playing C. Reminding him that he may need higher dosages of topiramate when exercising D. Encouraging him to use sunscreen due to photosensitivity from topiramate ____ 13. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: A. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures B. To wear sunscreen due to photosensitivity from levetiracetam C. To get an annual eye exam while on levetiracetam D. To report weight loss if it occurs ____ 14. Levetiracetam has known drug interactions with: A. Oral contraceptives B. Carbamazepine C. Warfarin D. Few, if any, drugs ____ 15. Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: A. Reassuring her she has a viral infection and to call if she isn’t better in 4 or 5 days B. Ruling out a hypersensitivity reaction that may lead to multi-organ failure C. Rapid strep test and symptomatic care if strep test is negative D. Observation only, with further assessment if she worsens ____ 16. Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for oral contraceptives. Combined oral contraceptives (OCs) interact with lamotrigine and may cause: A. Contraceptive failure B. Excessive weight gain C. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine D. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed ____ 17. The tricyclic antidepressants should be prescribed cautiously in patients with: A. Eczema B. Asthma C. Diabetes D. Heart disease ____ 18. A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other MAOIs: A. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) B. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce C. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment D. All of the above ____ 19. Taylor is a 10 year old diagnosed with major depression. The appropriate first line antidepressant for children is: A. Fluoxetine B. Fluvoxamine C. Sertraline D. Escitalopram ____ 20. Suzanne is started on paroxetine (Paxil), an SSRI, for depression. Education regarding her antidepressant includes: A. SSRIs may take 2 to 6 weeks before she will have maximum drug effects B. Red-green color blindness may occur and should be reported C. If she experiences dry mouth or heart rates greater than 80, stop taking the drug immediately D. She should eat lots of food high in fiber to prevent constipation ____ 21. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be: A. Fluoxetine (Prozac) B. Paroxetine (Paxil) C. Amitriptyline (Elavil) D. Duloxetine (Cymbalta) ____ 22. Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider: A. For excessive weight loss B. With the Abnormal Involuntary Movement Scale (AIMS) for EPS symptoms C. Monthly for tolerance to the haloperidol D. Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients ____ 23. Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: A. Reduce the chance of tardive dyskinesia B. Potentiate the effects of the drug C. Reduce the tolerance which tends to occur D. Increase CNS depression ____ 24. Patients who are prescribed olanzapine (Zyprexa) should be monitored for: A. Insomnia B. Weight gain C. Hypertension D. Galactorrhea ____ 25. A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: A. Bradykinesia, akathisia, and agitation B. Excessive weight gain C. Hypertension D. Potentially fatal agranulocytosis ____ 26. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: A. Chlordiazepoxide (Librium) B. Clonazepam (Klonopin) C. Alprazolam (Xanax) D. Oxazepam (Serax) ____ 27. A patient with anxiety and depression may respond to: A. Duloxetine (Cymbalta) B. Fluoxetine (Prozac) C. Oxazepam (Serax) D. Buspirone (Buspar) and a SSRI combined ____ 28. When prescribing temazepam (Restoril) for insomnia, patient education includes: A. Take temazepam nightly approximately 15 minutes before bedtime B. Temazepam should not be used more than three times a week for less than 3 months C. Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep better D. Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of temazepam ____ 29. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: A. Zolpidem should be taken just before going to bed B. Zolpidem may cause dry mouth and constipation C. Patients may need to double the dose for effectiveness D. They should stop drinking alcohol at least 30 minutes before taking zolpidem ____ 30. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: A. Orthostatic hypotension B. Agitation and irritability C. Drowsiness and nausea D. Painful urination and abdominal distention ____ 31. Tom is taking lithium for bipolar disorder. He should be taught to: A. Take his lithium with food B. Eat a diet with consistent levels of salt (sodium) C. Drink at least 2 quarts of water if he is in a hot environment D. Monitor blood glucose levels ____ 32. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? A. Valproate is safe during all trimesters of pregnancy. B. She can get pregnant while taking valproate, but she should take adequate folic acid. C. Valproate is not safe at any time during pregnancy. D. Valproate is a known teratogen, but may be taken after the first trimester if necessary. ____ 33. When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include: A. The medication may cause sedation and they should not drive B. Constipation is a common side effect and they should increase fluids and fiber C. Patients should not take any other acetaminophen-containing medications at the same time D. All of the above ____ 34. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first line medication would be: A. Ibuprofen (Advil) B. Acetaminophen with hydrocodone (Vicodin) C. Oxycodone (Oxycontin) D. Oral morphine (Roxanol) ____ 35. Kasey fractured his ankle in two places and is asking for pain medication for his pain. The appropriate first line medication would be: A. Ibuprofen (Advil) B. Acetaminophen with hydrocodone (Vicodin) C. Oxycodone (Oxycontin) D. Oral morphine ((Roxanol) ____ 36. Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: A. Slurred speech and insomnia B. Bradycardia and confusion C. Dizziness and orthostatic hypotension D. Insomnia and decreased appetite ____ 37. Monitoring for a child on methylphenidate for ADHD includes: A. ADHD symptoms B. Routine height and weight checks C. Amount of methylphenidate being used D. All of the above ____ 38. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: A. Blood pressure B. Blood glucose levels C. Urine ketone levels D. Liver function

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27. März 2019
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