MN 553 FINAL EXAM 1 – QUESTION AND ANSWERS LATEST UPDATED ANSWERS 2022/2023, Exams of Nursing

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High-dose oral amoxicillin Benzathine penicillin G IM Factoring in the cost to the patient of the medication prescribed

ANSWERS

Saved Conjunctivitis in a child that is accompanied by acute otitis media is treated with: Question 1 options: Sulfacetamide 10% ophthalmic solution (Bleph-10) Bacitracin/polymyxin B (Polysporin) ophthalmic drops Ciprofloxacin (Ciloxan) ophthalmic drops

Question 2 (4 points)

Saved The drug of choice for treatment of early latent or tertiary syphilis is: Question 2 options: Ceftriaxone IM Oral azithromycin Oral ciprofloxacin

Question 3 (4 points)

Saved Clinical judgment in prescribing includes: Question 3 options: Always prescribing the newest medication available for the disease process Handing out drug samples to poor patients Prescribing all generic medications to cut costs

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Question 4 (4 points)

Saved When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? Question 4 options:

Coronary artery disease risk level Salmeterol, an inhaled long-acting beta-agonist Percentage of fat differs between genders.

ANSWERS

Total LDL Fasting HDL Fasting total cholesterol

Question 5 (4 points)

Saved Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? Question 5 options: Betamethasone, an inhaled corticosteroid Albuterol, a short-acting beta-agonist Montelukast, a leukotriene modifier

Question 6 (4 points)

Saved A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women? Question 6 options: Body temperature varies between men and women. Muscle mass is greater in women. Proven subjective factors exist between the genders.

Question 7 (4 points)

Azithromycin

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Saved The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be: Question 7 options: Ciprofloxacin

ANSWERS

Amoxicillin Doxycycline

Question 8 (4 points)

Saved Sophie presents to the clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include: Question 8 options: Metronidazole 2 grams PO x 1 dose Topical intravaginal metronidazole daily x 7 days Intravaginal clindamycin daily x 7 days Azithromycin 2 grams PO x 1 dose

Question 9 (4 points)

Saved Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be: Question 9 options: PEG 3350 (Miralax) Bisacodyl (Dulcolax) suppository Docusate (Colace) suppository Polyethylene glycol electrolyte solution

Question 10 (4 points)

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Saved Medications are typically started for angina patients when: Question 10 options: The first permanent EKG changes occur The start of class I or II symptoms The events trigger a trip to the emergency department When troponin levels become altered

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Question 11 (4 points)

First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be: Question 11 options: OTC topical azole (clotrimazole, miconazole) Oral terbinafine Oral griseofulvin microsize Nystatin cream or ointment

Question 12 (4 points)

To improve actual effectiveness of oral contraceptives women should be educated regarding: Question 12 options: Use of a back-up method if they have vomiting or diarrhea during a pill packet Doubling pills if they have diarrhea during the middle of a pill pack The fact that they will have a normal menstrual cycle if they miss two pills The fact that mid-cycle spotting is not normal and the provider should be contacted immediately

Question 13 (4 points)

Class I recommendations for stage A heart failure include: Question 13 options: Aerobic exercise within tolerance levels to prevent the development of heart failure Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention Beta blockers for all patients regardless of cardiac history Treatment of thyroid disorders, especially if they are associated with Tachyarrhythmias

Question 14 (4 points)

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Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with: Question 14 options: Topical antipruritics Oral corticosteroids for 2 to 3 weeks Thickly applied topical intermediate-dose corticosteroids

ANSWERS

Isolation of the patient to prevent spread of the dermatitis

Question 15 (4 points)

Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: Question 15 options: Appetite and concentration improve in the first 1 to 2 weeks. Sleep should improve almost immediately upon starting citalopram. Full response to the SSRI may take 2 to 4 months after he reaches the full therapeutic dose. His dysphoric mood will improve in 1 to 2 weeks.

Question 16 (4 points)

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: Question 16 options: Increase her dose Assess for suicidal ideation Discontinue the medication immediately Decrease her dose to half then slowly titrate up the dose

Question 17 (4 points)

Which of the following holds true for the pharmacokinetics of women? Question 17 options: Gastric emptying is faster than that of men. Organ blood flow is the same as that of men. Evidence is strong concerning renal differences in elimination. Medications that involve binding globulins are impacted by estrogen levels.

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Question 18 (4 points)

Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?

ANSWERS

Question 18 options: All opiates are scheduled drugs which require a DEA license to prescribe. Opiates stimulate only mu receptors for the control of pain. Most of the adverse effects of opiates are related to mu receptor stimulation. Naloxone is an antagonist to opiates.

Question 19 (4 points)

The role of the NP in the use of herbal medication is to: Question 19 options: Maintain competence in the prescribing of common herbal remedies Recommend common over-the-counter herbs to patients Educate patients and guide them to appropriate sources of care Encourage patients to not use herbal therapy due to the documented dangers

Question 20 (4 points)

Gender differences between men and women in pharmacokinetics include: Question 20 options: More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations Slower organ blood flow rates so drugs tend to take longer to be excreted

Question 21 (4 points)

Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: Question 21 options: Increasing heart rate to improve cardiac output Reducing vascular smooth muscle tone Increasing

ANSWERS

aldosterone-mediated volume activity Reducing aqueous humor production

Question 22 (4 points)

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Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: Question 22 options: Urinary retention Cardiac output Peripheral edema Skin rash

Question 23 (4 points)

All of the following statements about the Beer’s List are true except: Question 23 options: 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. It is derived from the expert opinion of one geriatrician and is not evidence-based. These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long- term care facilities. These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration.

Question 24 (4 points)

Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry? Question 24 options: Add an H2 blocker such as ranitidine to his therapy. Discontinue the aspirin and switch him to Vicodin for the pain. Decrease the aspirin dose to one tablet daily. Have Henry take an antacid 15 minutes before taking the aspirin each day.

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Question 25 (4 points)

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Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes: Question 25 options: Complete blood count Blood glucose C-reactive protein BUN, creatinine, and creatinine clearance

Question 26 (4 points)

Which the following persons should not have a statin medication ordered? Question 26 options: Someone with 3 first- or second-degree family members with history of muscle issues when started on statins Someone with high lipids, but low BMI Premenopausal woman with recent history of hysterectomy Prediabetic male with known metabolic syndrome

Question 27 (4 points)

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? Question 27 options: Delay eating the midday meal until after the swimming class. Increase the morning dose of NPH insulin on days of the swimming class. Adjust the morning insulin injection so that the peak occurs while swimming. Check glucose level before, during, and after swimming.

Question 28 (4 points)

ANSWERS

The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is: Question 28 options: 2 years

ANSWERS

5 years 10 years 15 years

Question 29 (4 points)

Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for: Question 29 options: High vitamin D levels Hyperkalemia Hypercalcemia Hyperuricemia

Question 30 (4 points)

There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because: Question 30 options: Renal excretion is similar in both classes of drugs. When these drug classes are metabolized in the liver they both produce resistant enzymes. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms. There is not an issue with cross-resistance between the penicillins and cephalosporins.

Question 31 (4 points)

Which of the following statements is true about acute pain? Question 31 options: Somatic pain comes from body surfaces and is only sharp and well-localized. Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.

ANSWERS

Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area.

Question 32 (4 points)

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If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be: Question 32 options: Prokinetic (metoclopramide) for 4 to 8 weeks Proton pump inhibitor (omeprazole) for 12 weeks Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks Cytoprotective drug (misoprostol) for 2 weeks

Question 33 (4 points)

A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: Question 33 options: Concentration will produce therapeutic effects Concentration will produce an adverse response Time between doses must be shortened Duration of action of the drug is too long

Question 34 (4 points)

ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure 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? Question 34 options: Diuretics ARBs Beta blockers Nitrates

Question 35 (4 points)

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The most cost-effective treatment for two or three impetigo lesions on the face is: Question 35 options: Mupirocin ointment Retapamulin (Altabax) ointment

ANSWERS

Topical clindamycin solution Oral amoxicillin/clavulanate (Augmentin)

Question 36 (4 points)

Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: Question 36 options: Heart failure Angina Myocardial infarction Dyslipidemia

Question 37 (4 points)

Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include: Question 37 options: Diabetics Those who have had an acute myocardial infarction in the past 6 months Patients who are deaf Patients under age 60 years of age

Question 38 (4 points)

Preventative therapy for cluster headaches includes: Question 38 options: Massage or relaxation therapy Ergotamine nightly before bed Intranasal lidocaine four times a day during “clusters” of headaches Propranolol (Inderal) daily

Question 39 (4 points)

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The Best Pharmaceuticals for Children Act: Question 39 options: Includes a pediatric exclusivity rule which extends the patent on drugs studied in children Establishes a committee that writes guidelines for pediatric prescribing

ANSWERS

Provides funding for new drug development aimed at children Encourages manufacturers specifically to develop pediatric formulations

Question 40 (4 points)

Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: Question 40 options: For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment For pedal edema throughout therapy Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm For vision changes, such as red-green blindness, at least annually

Question 41 (4 points)

Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: Question 41 options: Iron deficiency anemia, vitamin B12 and calcium deficiency Folate and magnesium deficiency Elevated uric acid levels leading to gout Hypokalemia and hypocalcemia

Question 42 (4 points)

Which diuretic agents typically do not need potassium supplementation? Question 42 options: The loop diuretics The thiazide diuretics The aldosterone inhibitors They all need supplementation

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Question 43 (4 points)

Patients who are prescribed exogenous androgens need to be warned that decreased libido: Question 43 options: Is an unusual side effect of androgens and should be reported to the provider

ANSWERS

Is treated with increased doses of androgens, so the patient should let the provider know if he is having problems May be a sign of early prostate cancer and he should make an appointment for a prostate screening exam May occur with androgen therapy

Question 44 (4 points)

Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to: Question 44 options: Search for information using the most common search engines Serve as content experts in developing, implementing, and evaluating information Systems Write programs to assure the integrity of health information Use information technology to prescribe drugs

Question 45 (4 points)

Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: Question 45 options: Platelet count BUN and creatinine White blood cell count AST, ALT, alkaline phosphatase, and bilirubin

Question 46 (4 points)

Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because: Question 46 options: