AQA A Level Biology Paper 1 (1), Exams of Advanced Education

Download AQA A Level Biology Paper 1 (1) and more Exams Advanced Education in PDF only on Docsity! Advanced Pharmacology Modules 1 -5 In every state, prescriptive authority for NPs includes the ability to write prescriptions: A. for controlled substances. B. for specified classifications of medications. C. without physician-mandated involvement. D. with full, independent prescriptive authority. - B. for specified classifications of medications. A primary care NP wishes to order a drug that will be effective immediately after administration of the drug. Which route should the NP choose? Rectal Topical Sublingual Intramuscular - Sublingual According to the Texas BON rules and regulations, a prescription must include: - (1) the patient's name and address; (2) the name, strength, and quantity of the drug to be dispensed; (3) directions to the patient regarding taking of the drug and the dosage; (4) the intended use of the drug, if appropriate; (5) the name, address, and telephone number of the physician with whom the APRN has a prescriptive authority agreement (6) address and telephone number of the site at which the prescription drug order was issued; (7) the date of issuance; (8) the number of refills permitted; (9) the name, prescription authorization number, and original signature of the APRN who authorized the prescription drug order; and (10) the United States Drug Enforcement Administration numbers of the APRN and the delegating physician, if the prescription drug order is for a controlled substance. The primary care nurse practitioner (NP) writes a prescription for an antibiotic using an electronic drug prescription system. The pharmacist will fill this prescription when: the electronic prescription is received. the patient brings a written copy of the prescription. a copy of the written prescription is faxed to the pharmacy. the pharmacist accesses the patient's electronic record to verify. - the electronic prescription is received. A patient receives an inhaled corticosteroid to treat asthma. The patient asks the nurse why the drug is given by this route instead of orally. The nurse should explain that the inhaled form: is absorbed less quickly. has reduced bioavailability. has fewer systemic side effects. provides dosing that is easier to regulate. - has fewer systemic side effects. A primary care NP is prescribing a drug for a patient who does not take any other medications. The NP should realize that: CYP450 enzyme reactions will not interfere with this drug's metabolism. Minor upper respiratory infection or gastroenteritis, with or without fever, is not an indication for withholding a scheduled vaccine dose. DIF: Cognitive Level: Applying (Application) REF: 757 A patient has been using a nicotine patch for several weeks and uses the 15 mg/16 hour patch. The patient reports having frequent continual cravings for cigarettes, especially on awakening in the morning. The MSN-prepared nurse should: prescribe varenicline (Chantix). prescribe bupropion (Wellbutrin). change to a 21 mg/24 hour nicotine patch. suggest adding nicotine nasal spray for cravings. - change to a 21 mg/24 hour nicotine patch. It is important to begin therapy with a dose sufficient to deliver enough nicotine so that patients will not want to smoke. Patients who awaken with nicotine cravings should wear a 24-hour patch. Prescribing varenicline or bupropion may be necessary if the patch fails after appropriate dosing is established. Whichever nicotine replacement method is chosen, the patient should use only one particular product to avoid nicotine toxicity. DIF: Cognitive Level: Applying (Application) REF: 785 A patient who smokes reports repeated attempts to quit smoking using a nicotine replacement patch. The patient says, "I always do well for a few weeks and then I just start smoking again." The advance practice nurse with prescriptive authority should prescribe: nortriptyline. Nicorette gum. a Nicotrol inhaler. varenicline (Chantix). - varenicline (Chantix). Varenicline interferes with the enjoyment of nicotine so that smokers do not get pleasure when they smoke. Nicotine replacement medications do not improve relapse rates, and this patient has relapsed several times. Nortriptyline is not a first-line smoking cessation medication. DIF: Cognitive Level: Applying (Application) REF: 780 A parent calls a clinic for advice about giving an over-the-counter cough medicine to a 6-year-old child. The parent explains that the medication label does not give instructions about how much to give a child. The best action is to: order a prescription antitussive medication for the child. ask the parent to identify all of the ingredients listed on the medication label. calculate the dose for the active ingredient in the over-the-counter preparation. tell the parent to approximate the dose at about one third to one half the adult dose. - ask the parent to identify all of the ingredients listed on the medication label. Over-the-counter cough medications often contain dextromethorphan, which can be toxic to young children. It is important to identify ingredients of an over-the-counter medication before deciding if it is safe for children. A prescription antitussive is probably not warranted until the cough is evaluated to determine the cause. Until the ingredients are known, it is not safe to approximate the child's dose based on only the active ingredient. DIF: Cognitive Level: Applying (Application) REF: 89 A child who weighs 22 lb, 2 oz needs a medication. The advance practice nurse learns that the recommended dosing for this drug is 25 to 30 mg per kg per day in three divided doses. The advance practice nurse should order: 100 mg daily. 100 mg tid. 300 mg daily. 300 mg tid. - 100 mg tid The NP should first convert the child's weight to kg, which is about 10 kg. The dose is then calculated to be 250 to 300 mg per day in three divided doses, which is 83 to 100 mg per dose given tid. DIF: Cognitive Level: Applying (Application) REF: 65 A previsit health history on a new patient is obtained. The patient reports taking vitamins every day. The best response is to: ask the patient to bring all vitamin bottles to the clinic appointment. recommend natural vitamin products over synthetic vitamin products. reassure the patient that vitamins that are high in folic acid are safe to take. tell the patient that some vitamins, such as vitamin C, are safe in large doses. - ask the patient to bring all vitamin bottles to the clinic appointment. niacin. thiamine. folic acid. vitamin B6. - thiamine. Patients who are alcohol abusers are prone to thiamine deficiency. DIF: Cognitive Level: Applying (Application) REF: 807 A woman who takes an angiotensin converting enzyme inhibitor for hypertension tells her primary care nurse practitioner that she is trying to get pregnant. The nurse practitioner should: consider replacing her angiotensin converting enzyme inhibitor with methyldopa. lower her angiotensin converting enzyme inhibitor dose during the first trimester. counsel her to increase her antihypertensive medications during pregnancy. add an angiotensin receptor blocker (ARB) during the first trimester of her pregnancy. - consider replacing her angiotensin converting enzyme inhibitor with methyldopa. Angiotensin converting enzyme inhibitors, ARBs, and statins are contraindicated during the first trimester of pregnancy and should be discontinued before conception and replaced by safer alternatives, such as methyldopa. The use of antihypertensives during pregnancy remains controversial; increasing the dose is not indicated. DIF: Cognitive Level: Applying (Application) REF: 80 A patient is diagnosed with lupus and reports occasional use of herbal supplements. The nurse should caution this patient to avoid: ginseng. echinacea. ginkgo biloba. St. John's wort. - echinacea. Patients with lupus who take echinacea may experience an increase in symptoms, even if the patient is taking immunosuppressants. DIF: Cognitive Level: Understanding (Comprehension) REF: 98 The mother of a 3-year-old child who weighs 15 kg tells the advance practice nurse that she has liquid acetaminophen at home but does not know what dose to give her child. The advance practice nurse should tell the mother: to give 1 teaspoon every 4 to 6 hours as needed. to throw away the old medication and get a new bottle. that she may give 5 to 7.5 mL per dose every 4 to 6 hours. to find out whether she has a preparation made for infants or children. - to find out whether she has a preparation made for infants or children. Acetaminophen drops for infants are three times as concentrated as the oral liquid for children. The drops have been pulled from the market, but many parents may still have old preparations on hand. The NP should first determine which preparation this mother has before giving dosage recommendations. If the mother has the oral liquid for children, answers A and C would both be acceptable because the concentration is 160 mg per 5 mL. The mother should not be counseled to throw away the medication until the NP has more information. DIF: Cognitive Level: Applying (Application) REF: 65 A MSN-prepared nurse is caring for a 70-year-old patient who reports having seasonal allergies with severe rhinorrhea. Using the Beers criteria, which of the following medications should the MSN- prepared nurse recommend for this patient? Loratadine (Claritin) Hydroxyzine (Vistaril) Diphenhydramine (Benadryl) Chlorpheniramine maleate (Chlorphen 12) - Loratadine (Claritin) Loratadine is the only nonsedating antihistamine on this list. Older patients are especially susceptible to sedation side effects and should not use these medications if possible. DIF: Cognitive Level: Applying (Application) REF: 57 Persistent atrial fibrillation (AF) is diagnosed in a patient who has valvular disease, and the cardiologist has prescribed warfarin (Coumadin). The patient is scheduled for electrical cardioversion in 3 weeks. The patient asks the family care nurse practitioner (FNP) why the procedure is necessary. The FNP should tell the patient: this medication prevents clots but does not alter rhythm. change to an aldosterone antagonist medication. - add an angiotensin-converting enzyme inhibitor. Evidence-based guidelines suggest that optimal control of hypertension to less than 130/80 mm Hg could prevent 37% of cardiovascular disease in men and 56% in women, so this patient, although showing improvement, could benefit from the addition of another medication. An angiotensin- converting enzyme inhibitor is an appropriate drug for patients who also have diabetes. β-Blockers and aldosterone antagonist medications are not recommended for patients with diabetes. DIF: Cognitive Level: Applying (Application) REF: 229| Table 17-6 An African-American patient who is obese has persistent blood pressure readings greater than 150/95 mm Hg despite treatment with a thiazide diuretic. The prescriber should consider starting a(n): angiotensin receptor blocker. β-blocker. ACE inhibitor. calcium channel blocker. - calcium channel blocker. African-American patients are considered good candidates for calcium channel blockers to treat hypertension. Treatment with calcium channel blockers as monotherapy in African-American patients has proved to be more effective than some other classes of antihypertensive agents. DIF: Cognitive Level: Applying (Application) REF: 268 A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The woman is sedentary with a body mass index of 26. The woman asks the prescriber about using a statin medication. The prescriber should: recommend dietary and lifestyle changes first. begin therapy with atorvastatin 10 mg per day. discuss quality-of-life issues as part of the decision to begin medication. tell her there is no clinical evidence regarding efficacy of statin medication in her case. - begin therapy with atorvastatin 10 mg per day. This woman would be using a statin medication for secondary prevention because she already has a history of MI, so a statin should be prescribed. Dietary and lifestyle changes should be a part of therapy, but not the only therapy. She is relatively young, and quality-of-life issues are not a concern. There is no clinical evidence to support use of statins as primary prevention in women. DIF: Cognitive Level: Applying (Application) REF: 296 A patient who has atrial fibrillation (AF) has been taking warfarin (Coumadin). The prescriber plans to change the patient's medication to dabigatran (Pradaxa). To do this safely, the prescriber should: initiate dabigatran when the patient's international normalized ratio (INR) is less than 2. start dabigatran 7 to 14 days after discontinuing warfarin. begin giving dabigatran 1 week before discontinuing warfarin. order frequent monitoring of the patient's INR after dabigatran therapy begins. - initiate dabigatran when the patient's international normalized ratio (INR) is less than 2. There are no requirements for monitoring the INR or other measures for patients taking dabigatran. When changing from warfarin, it is recommended that dabigatran be initiated when the INR is less than 2. DIF: Cognitive Level: Applying (Application) REF: 315 A patient who is taking an ACE inhibitor sees the Family Nurse Practitioner for a follow-up visit. The patient reports having a persistent cough. The FNP should: consider changing the medication to an ARB. order a bronchodilator to counter the bronchospasm caused by this drug. ask whether the patient has had any associated facial swelling with this cough. reassure the patient that tolerance to this adverse effect will develop over time. - consider changing the medication to an ARB. A persistent cough may occur with ACE inhibitors and may warrant discontinuation of the drug. An ARB would be the next drug of choice because it does not have this side effect. The cough is not related to bronchospasm. Angioedema is not related to ACE inhibitor-induced cough. Patients do not develop tolerance to this side effect. DIF: Cognitive Level: Applying (Application) REF: 275 A patient is in the clinic for a follow-up examination after a myocardial infarction (MI). The patient has a history of left ventricular systolic dysfunction. The nurse should expect this patient to be taking: nadolol (Corgard). carvedilol (Coreg). timolol (Blocadren). propranolol (Inderal). - carvedilol (Coreg). A patient has been treated for severe contact dermatitis on both arms with clobetasol propionate cream. At a follow-up visit, the primary care NP notes that the condition has cleared. The NP should: prescribe triamcinolone cream for 2 weeks. recommend continuing treatment for 2 more weeks. discontinue the clobetasol and schedule a follow-up visit in 2 weeks. discontinue the clobetasol and recommend prn use for occasional flare-ups. - prescribe triamcinolone cream for 2 weeks. Treatment should be discontinued when the skin condition has resolved. Tapering the corticosteroid will prevent recurrence of the skin condition. Tapering is best done by gradually reducing the potency and dosing frequency at 2-week intervals. This patient was on a very high potency steroid, so changing to a medium frequency with follow-up in 2 weeks is an appropriate action. Discontinuing the steroid abruptly can lead to recurrence. DIF: Cognitive Level: Applying (Application) REF: 160 A family nurse practitioner (FNP) is evaluating a patient with asthma who reports having wheezing and coughing 1 or 2 days each week and awakening from sleep three or four times each month with asthma symptoms. The patient's forced expiratory volume in 1 second (FEV1) is 80% of the predicted value. The patient's current medication regimen is an albuterol metered-dose inhaler, 2 puffs every 4 hours as needed. The FNP should prescribe: montelukast (Singulair) po daily. ipratropium bromide bid with albuterol. a low-dose inhaled corticosteroid (ICS), 2 puffs bid. a long-acting β-adrenergic agonist (LABA), 1 puff bid. - a low-dose inhaled corticosteroid (ICS), 2 puffs bid. This patient has symptoms of mild, persistent asthma. The preferred controller medication in adults and children with persistent asthma is a low-dose ICS. Montelukast is a leukotriene modifier, which may be considered as an alternative to a low-dose ICS but is not the first option to try. Ipratropium is often used during an acute exacerbation but not for long-term control. LABA medications are used in patients with moderate persistent symptoms. DIF: Cognitive Level: Applying (Application) REF: 210 A 5-year-old child has atopic dermatitis that is refractory to treatment with hydrocortisone acetone 2.5% cream. The prescriber should prescribe: desonide cream 0.01%. triamcinolone acetonide. fluocinolone cream 0.2%. betamethasone dipropionate ointment 0.05%. - triamcinolone acetonide. An over-the-counter steroid has failed to treat this child's dermatitis, so the NP should prescribe something in a higher strength. Triamcinolone is a medium-strength steroid and should be used. The other three are in groups I and II, which are high-strength steroids and are not recommended in children. DIF: Cognitive Level: Applying (Application) REF: 154| 156 A FNP sees a child who has honey-crusted lesions with areas of erythema around the nose and mouth. The child's parent has been applying Polysporin ointment for 5 days and reports no improvement in the rash. The FNP should prescribe: mupirocin. neomycin. a systemic antibiotic. Polysporin with a corticosteroid. - mupirocin. Treatment with a topical antiinfective agent should be reevaluated in 3 to 5 days if there is no improvement. Polysporin ointment is bacteriostatic, not bacteriocidal. Mupirocin is indicated for impetigo caused by Staphylococcus aureus, which is most common in children. Neomycin is an aminoglycoside and is not effective againstS. aureus. A systemic antibiotic is not indicated unless the mupirocin fails to treat the infection. Adding a corticosteroid would increase the likelihood that the infection will worsen. DIF: Cognitive Level: Applying (Application) REF: 157 A 70-year-old patient asks an NP about using diphenhydramine (Benadryl) to control intermittent allergic symptoms that include runny nose and sneezing. The NP should counsel this patient to: take the lowest recommended dose initially. monitor for hypertension while taking the drug. take the antihistamine with a decongestant for best effect. watch for symptoms of paradoxical excitation with this medication. - take the lowest recommended dose initially. Antihistamines are more likely to cause excessive sedation, syncope, dizziness, confusion, and hypotension in elderly patients; a decrease in dose is usually necessary. Hypotension is likely; there is no A patient is newly diagnosed with type 2 diabetes mellitus. The family NP reviews this patient's laboratory tests and notes normal renal function, increased triglycerides, and decreased HDL levels. The FNP should prescribe: nateglinide (Starlix). glyburide (Micronase). colesevelam (Welchol). metformin (Glucophage). - metformin (Glucophage). Metformin is recommended as initial pharmacologic treatment for type 2 diabetes. It has been shown to decrease triglycerides and LDLs. DIF: Cognitive Level: Understanding (Comprehension) REF: 592 A patient who has diabetes is taking metformin 1000 mg daily. At a clinic visit, the patient reports having abdominal pain and nausea. The primary care NP notes a heart rate of 98 beats per minute. The NP should: obtain LFTs. decrease the dose of metformin. change metformin to glyburide. order a basic metabolic panel, ketones, and serum glucose. - order a basic metabolic panel, ketones, and serum glucose. Symptoms of lactic acidosis include nausea, abdominal pain, and tachycardia. Tests should include electrolytes, ketones, and serum glucose. DIF: Cognitive Level: Applying (Application) REF: 598 A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The advance practice registered nurse orders thyroid function tests. The tests show TSH is decreased and FT4 is increased. The APRN should consult with an endocrinologist and order: thyrotropin. methimazole. levothyroxine. armour thyroid - methimazole. Patients with hyperthyroidism, or Graves' disease, will require radioactive iodine. Elderly patients and patients with cardiovascular disease should be pretreated with an antithyroid medication such as methimazole. Thyrotropin is used to diagnose thyroid cancer. Levothyroxine is used to treat hypothyroidism. Propylthiouracil is also a thyroid suppressant, but methimazole is preferred. DIF: Cognitive Level: Applying (Application) REF: 586 A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day. The child weighs 15 kg. The family NP sees the child for a 3-year-old check-up. The FNP should consult with a pediatric endocrinologist to discuss: increasing the dose to 90 mcg/day. decreasing the dose to 30 mcg/day. stopping the medication and checking TSH and T4 in 4 weeks. discussing the need for lifetime replacement therapy with the child's parents. - stopping the medication and checking TSH and T4 in 4 weeks. In congenital hypothyroidism, therapy may be stopped for 2 to 8 weeks after the patient reaches 3 years of age. If TSH levels remain normal, thyroid supplementation may be discontinued permanently. DIF: Cognitive Level: Applying (Application) REF: 587 A 70-year-old patient with COPD who is new to the clinic reports taking 10 mg of prednisone daily for several years. The prescriber should: tell the patient to take the drug every other day before 9:00 AM. order a serum glucose, potassium level, and bone density testing. perform pulmonary function tests to see if the medication is still needed. begin a gradual taper of the prednisone to wean the patient off the medication. - order a serum glucose, potassium level, and bone density testing. Serum glucose and potassium levels are part of monitoring for side effects of steroids. Because elderly patients are more prone to certain potential catabolic adverse effects of steroid therapy, caution is required. Osteoporosis is often seen with elderly patients, so bone density testing should be performed. The medication dosing regimen should not be changed unless there is an indication of adverse effects. DIF: Cognitive Level: Applying (Application) REF: 577 An 80-year-old female patient with a history of angina has increased TSH and decreased Free T4. The nurse practitioner should prescribe _____ mcg of _____. Metformin is the only drug listed that is recommended for children. DIF: Cognitive Level: Understanding (Comprehension) REF: 598 A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and hemoglobin A1c is 7.3%. The FNP should: begin insulin therapy. change to therapy with colesevelam (Welchol). add a third oral antidiabetic agent to this patient's drug regimen. enroll the patient in a weight loss program to achieve better glycemic control. - begin insulin therapy. The target hemoglobin A1c goal for adults is less than 7%. Insulin therapy is indicated if maximum doses of two oral antidiabetic drugs are not effective. This patient is taking the maximum recommended doses of metformin and glyburide. Colesevelam does not decrease hemoglobin A1c. Adding a third oral antidiabetic agent is not recommended. A weight loss program may be a part of this patient's treatment, but insulin is necessary to maintain glycemic control. DIF: Cognitive Level: Applying (Application) REF: 596 At what points should the Hep B vaccine be given to an infant? - At birth before discharge, at 1 to 2 months of age, and at 6 months of age When should the TDaP be given to children? - First dose at between 6 and 8 weeks of life, subsequent doses at 4 and 6 months (at least 6 weeks between doses), fourth dose given after age of 15 months (at least 6 months should pass between third and fourth doses), fifth dose after age of 48 months; Subsequent doses of TdaP given every 10 years What is the contraindication/warning/precaution for the Hib vaccine in children? - Children with impaired immune systems (HIV) may not mount sufficient immunity with the recommended vaccine dosage and may require an additional dose. What is the immunization schedule for children for the Hib vaccine? - First dose at 2 months, with subsequent doses at 4, 6, and 12 to 15 months Hib is not recommended for children over what age? - 60 months or 5 years When should the IPV vaccine be given to children? - First dose at 2 months, second at 4 months, third from 6 to 18 months, and fourth age 4 to 6 years When should the MMR vaccine be given to children? - First dose at 12 to 15 months, with booster given at elementary school entry (4-6 years; May be given after 4 weeks have elapsed since first dose) When should the influenza vaccine be given to children? - Starting at 6 months old, then every year When should children receive the pneumonia (PCV) vaccine? - At 2, 4, 6, and and 12 to 15 months; Supplement dose at 2-6 years To what population should the RSV prophylaxis be given? - At risk premature infants (born before 32 weeks) & infants and children younger than 24 months who receive medical therapy & infants born at 32 to 35 weeks gestation who are younger than 3 months of age at start of RSV season or born during RSV season When should the Hep A vaccine be given to children? - At 12 months, then 6-18 months after that dose When should the RV vaccine be administered to children? - 2, 4, and possibly 6 months (If received at 2 and 4 months, 6 month dose not necessarily needed) At what age should RV administration not be initiated? - Infants older than 12 weeks of age All three doses of RV should be administered by what age in children? - 32 weeks of age When should young children receive the HPV vaccine? - Can be administered starting at age 9, but recommendation is for age 11-12; three dose series, dose 2 and 3 are given 2 and 6 months later respectively What drugs should be avoided at all costs during pregnancy (Catagory X)? - finasteride (Proscar, Propecia) (Should not handle crushed or broken tabs); isotretinoin (Accutane) (Child-bearing aged women must be prescribed 2 types Contraception, neg pregnancy test 1 month before, during and 1 month after); High Dose Vit A; warfarin (Coumadin); misoprostol (Cytotec); androgenic hormones (Testosterone, OCPs, HRT); Live virus vaccines; Thalidomide, DES, methimazole (D), methotrexate, chemotherapeutic agents, radiation Which CAM should be used for a pt with Vit A deficiency or "goose bumps" on the skin? - beta carotene Which vitamin should be prescribed for an alcohol abuser? - thiamine 100mg PO daily Which vitamin can help with hyperemesis in pregnancy? - pyridoxine Which vitamin is a good overall supplement for older adults? - B Complex What is an adequate amount of Calcium in older adults per day? - 1200 mg Which supplement should be prescribed for Vegans? - Zinc (Can interfere with absorption of quinolones and tetracycline) What supplement must be prescribed with any statin? - CoQ10 Main Points for Bile Acid Sequestrants