NR 566 Final Exam-with 100% verified solutions 2024-2025, Exams of Nursing

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NR 566 Final Exam-with 100% verified

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1. What is the first line treatment for Chlamydia that only needs to be taken orally once?

• ANSWER-Azithromycin 1000mg 2. What is the first line treatment for Chlamydia that is taken BID for 7 days? - ANSWER- Doxycycline 100mg 3. What is the IM treatment for uncomplicated gonorrhea? - ANSWER- Ceftriaxone 500mg 4. IM ceftriaxone can be given with or without this medication to treat gonorrhea. - ANSWER-Doxycycline 100mg BID 5. Treatment for bacterial vaginosis in a non pregnant patient. - ANSWER- Metronidazole 500mg BID for 7 days What are two treatments for bacterial vaginosis in a pregnant patient. - ANSWER- Vaginal metronidazole 2% for 7 days. Clindamycin 1% for 7 days. First line treatment for HSV. - ANSWER-Acyclovir 400mg three times a day for 7-10 days. Second line treatment for HSV. - ANSWER-Acyclovir 800mg BID for 5 days. Trichomoniasis treatment for women. - ANSWER-Metronidazole 500mg BID for 7 days. Tinidazole 2grams single dose. Trichomoniasis treatment for men. - ANSWER-Metronidazole 2grams single dose. Tinidazole 2grams single dose. What are doxazosin side effects? - ANSWER-hypotension, dizziness, nasal congestion What is doxazosin used to treat? - ANSWER-BPH Dutasteride (Avodart) is used to treat what? - ANSWER-BPH How long does it take to see effects of Dutasteride (Avodart)? - ANSWER-May

take months. Patient should continue to take it even if improvement is not seen right away.

What are side effects of Dutasteride (Avodart)? - ANSWER-May lower ejaculatory volume. May lower libido. How do you know that Terazosin (Hytrin) is working? - ANSWER-Symptoms of dysuria, urgency, UTI, and hesitancy improve. When is it not safe to prescribe progesterone? - ANSWER-If a patient is pregnant or has had a hysterectomy. Breast cancer. Arterial disease. Previous diagnosis of depression. What are side effects of progestin oral contraceptives? - ANSWER-irregular bleeding Patient teaching about progestin oral contraceptives. - ANSWER-Must take at the same time every day to be effective. May cause inconsistent bleeding. Benefits of using medroxyprogesterone acetate? (Depo-Provera) - ANSWER- Does not cause thrombolytic disorders, headache, nausea, or other adverse effects associated with combo OC's. Testosterone replacement therapy routes. - ANSWER-Pill, injection, patch. What are teaching points about testosterone patch? - ANSWER-Wash hands after applying Cover site after dried Wash application site before skin to skin contact May cause rash at application site When is androgen therapy appropriate for short term use? - ANSWER- Pressure of delayed sexual maturation causes significant distress. When is androgen therapy appropriate for long term use? - ANSWER- Delayed puberty related to hypogonadism. Side effects of testosterone replacement therapy. - ANSWER-hot flashes, bone fractures, decreased libido, insulin resistance, erectile dysfunction, acne, hypertension, sterility, aggression, mood swings. What is alprostadil used for? - ANSWER-erectile dysfunction Routes of administration for alprostadil. - ANSWER-Intracavernosal (Immediate erection) Intraurethral pellet (Erection 5-10 mintutes)

How does carbamazepine impact OC's? - ANSWER-Accelerate the metabolism reducing the effect. How would an OC be prescribed with carbamazepine? - ANSWER-Increase the estrogen dose, combine with a second form of birth control, or switch to an alternate birth control. What is carbamazepine used to treat? - ANSWER-Seizure disorders What are the benefits of the etonogestrel sub-dermal implant (Nexplanon)? - ANSWER- Very effective Long-term option- 5 years Reversible after removed Women with a history of thrombosis can use this What is papaverine/phentolamine used to treat - ANSWER-erectile dysfunction What are patient education points for papaverine/phentolamine? - ANSWER-Do not inject more than once in 24 hours. Notify of duration and efficacy of erection. Consult physician before taking new medications. Seek medical attention if erection lasts more than 3 hours. What is the first line treatment for syphilis? - ANSWER-Penicillin G IV What is Pramipexole (Mirapex)? When is it best prescribed? - ANSWER- Dopamine receptor agonist Best when used in the early stages of PD What are adverse effects of pramipexole (mirapex)? - ANSWER-nausea, dizziness, daytime sleep attacks(extreme/irresistible urge), insomnia, constipation, weakness, hallucinations, impulse control When to prescribe COMT inhibitors - ANSWER-When levodopa is not working long enough and starts to wear off between doses. This medication extends the half-life of levodopa. What seizure medications reduce oral contraceptive efficacy? - ANSWER- Carbamazepine Eslicarbazephine

Lamotrigine Oxcarbazepi ne Phenytoin Phenobarbita l Rufinamide Topiramate What can patients do to minimize adverse effects of bromocriptine (dopamine agonist)?

• ANSWER-Take medication with food to decrease GI upset or decrease dose What is levodopa/carbidopa used for? - ANSWER-Treatment and replacement of dopamine for PD. Helps improve ADL function. What are adverse effects of levodopa/carbidopa? - ANSWER-orthostatic hypotension, psychosis, dyskinesia Phenytoin (Dilantin) common side effects - ANSWER-CNS side effects, gingival hyperplasia, leathery skin, GI upset, blurred vision, suicidal behavior, cognitive decline. Ways to prevent gingival hyperplasia when taking phenytoin - ANSWER- Good oral hygiene How long should a patient wait before they start driving after being diagnosed with a seizure disorder? - ANSWER-1 year What vitamin should a patient take when on phenytoin besides folic acid? - ANSWER- Vitamin D. Phenytoin and contraceptive interaction - ANSWER-Makes OC's less effective, should have backup or increase dose. How is phenytoin effectiveness monitored? - ANSWER-Serum drug level. Absence of seizures during trial drug period. What anticonvulsant would be given for adjunctive therapy for partial seizures with or without secondary generalization? - ANSWER-Lamotrigine What medication (with example) can be used preventatively for migraines? - ANSWER- Beta blockers such as metoprolol/propranolol What is abortive therapy? - ANSWER-Abortive therapy is aimed at alleviating pain during the aura phase (if present) or soon after the headache has started.

What are examples of abortive therapy for migraines? - ANSWER-NSAIDS, opioids, triptans, ergot alkaloids What is the first line treatment for acute mid/moderate migraines without vomiting? - ANSWER-NSAIDs such as naproxen or ASA When is it appropriate to prescribe a patient preventative therapy for migraines? - ANSWER-Frequent attacks 3 or more a month, or attacks that do not respond to abortive therapy, severe migraines. What are examples of opioid analgesics for severe migraines? - ANSWER- Butorphanol nasal spray. Spray each nostril Q60 min PRN What is the mechanism of action for sumatriptan? - ANSWER-Suppresses release of CGRP from trigeminal neurons. This leads to vasoconstriction and decreased perivascular inflammation to relieve migraine pain. The first dose of triptan should be under medical supervision for what reason? - ANSWER-In the case of any unknown underlying cardiac condition. What are contraindications to triptans? - ANSWER-Ischemic heart disease HTN CV disease Pregnanc y Basilar or hemiplegic migraine can cause cerebral vasoconstriction Use of an ergot alkaline within 24 hours cause prolonged cerebral vasospasm What is rivastigmine (Exelon) used for? - ANSWER-Combat symptoms of Alzheimer's disease. Slows progression of disease-not a cure What are patient teachings for rivastigmine (Exelon)? - ANSWER- bradycardia, fainting, falls risk, falls-related fractures. What is Donepezil (Aricept) used to treat? - ANSWER-Symptoms of Alzheimer's disease When would it be appropriate to increase the patient's dose of Donepezil (Aricept)? - ANSWER-When the patient is stable on the initial dose for at least 1-3 months.

Cholinesterase inhibitor side effects are usually related to what? - ANSWER-Dosing. Dosing should start low and titrate up.

Common dose-related side effects of cholinesterase inhibitors - ANSWER-Nausea, diarrhea, insomnia. What is most likely happen as a result of the cardiac side effects of cholinesterase inhibitors? - ANSWER-Falls due to bradycardia What can be done to prevent weight loss that can be associated with cholinesterase inhibitors? - ANSWER-Nutritional shakes, encourage snacks between meals, meet with a dietician. When taking medications for Alzheimer's disease, what medication should be added before herbals, supplements, NSAIDs, - ANSWER-Memantine- Dementia medication that decreases abnormal brain activity. What should be considered in the renally impaired when prescribing memantine? - ANSWER-Dosage adjustment. Especially in patients with a creatinine clearance of less than 30ml/min. What medication is the first-line treatment for panic disorder? - ANSWER-SSRIs What are examples of SSRIs? - ANSWER-Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (Paxil) What is the first line treatment for performance anxiety? - ANSWER-Beta blockers such as propranolol (Inderal) What is the first line treatment for general anxiety disorder? - ANSWER- SSRIs and SNRIs What are examples of SNRIs used for general anxiety disorder? - ANSWER- Venlafaxine (Effexor XR) Duloxetine (Cymbalta) Buspirone What are examples of SSRIs used for general anxiety disorder? - ANSWER- Paroxetine (Paxil) Escitalopram (Lexapro) What drugs are used to treat depression? - ANSWER-

SSRIs SNRIs Bupropion

Mirtazapine (atypical antidepressant) How long should a patient be on treatment for depression before switching to a different medication/adding another medication is considered? - ANSWER-4- 8 weeks. What should the provider consider if a treatment for depression is not working? - ANSWER-Switch to a drug of the same class Switch to a drug of another class Add a drug like an atypical antidepressant When are initial and maximal results seen when a patient is on antidepressants? - ANSWER-Initial: 1-3 weeks Maximal: 12 weeks What is a black box warning for all antidepressants? - ANSWER-Increased suicide risk What populations are at higher risk for increased suicide risk when starting on antidepressants? - ANSWER-Children, adolescents, adults younger than 25 What medication can help a patient fall asleep but does not effect staying asleep? - ANSWER-Melatonin What is the first line treatment for sleep disturbances? - ANSWER- Benzodiazepine (Triazolam) Benzodiazepine-Like Drugs (Zolpidem ,Zaleplon, eszopiclone) Barbiturate (Secobarbital) Melatonin Receptor Agonist (Ramelteon , melatonin) Orexin Receptor Agonist (Suvorexant) What is the therapeutic range of lithium? - ANSWER-0.6-0.8 mEq/L is ideal level Can be anywhere from 0.4-1.0mEq/L What medications interact with lithium? - ANSWER- Diuretics NSAIDs Anticholinergics What is a side effects of first generation antipsychotics? - ANSWER-Severe movement disorders known as extrapyramidal symptoms and tardive dyskinesia.

What should a patient be educated on when taking a first generation antipsychotic? - ANSWER-Hypotension signs and management What drugs interact with SSRIs? - ANSWER- MAOIs Antiplatelet (ASA) Anticoagulant (Eliquis, Xeralto) What baseline data is needed in older adults and those on diuretics before starting therapy with an SSRI or SNRI? - ANSWER-Sodium levels What is a strategy to minimize adverse effects of SSRIs? - ANSWER-Report thoughts of suicide or self harm. Do not abruptly discontinue. What are common adverse effects of SSRIs? - ANSWER-Sexual dysfunction weight gain serotonin syndrome What baseline data is needed before starting tricyclic antidepressants? - ANSWER- ECG, especially if they are known to have a dysrhythmia or are above the age of 40 What side effect of tricyclic antidepressants should patients be educated on? - ANSWER-Hypotension What baseline data is needed before starting an MAOI? - ANSWER-BP What can happen to patients when taking MAOIs and what are the symptoms? - ANSWER-Hypertensive crisis

• headache, tachycardia, palpitations, N/V, sweating. What is the dietary restriction with MAOIs? - ANSWER-Tyramine What kinds of foods contain tyramine? - ANSWER-Fermented, aged, bean curd, cured meats, protein supplements, chocolate, caffeine, avocado, banana. What are examples of benzodiazepine-like drugs? - ANSWER- Zolpidem Zaleplon Eszopicolone (Lunesta) Triazolam is an example of what drug class? - ANSWER-Benzodiazepines

What are examples of melatonin receptor agonists? - ANSWER-Ramelteon (Rozerem) Melatonin What are symptoms of serotonin syndrome? - ANSWER-Dizziness, headache, nausea, sensory disturbances, tremor, anxiety, dysphoria. When can symptoms of serotonin syndrome begin and how long can they last? - ANSWER-Begin days to weeks. Persist 1-3 weeks. What are adverse effects of Kava? - ANSWER-hepatotoxicity, severe liver injury What are adverse effects of ginkgo biloba and how can these be reduced? - ANSWER- GI upset, headaches, dizziness Reduce dose = reduced symptoms What kind of precautions do patients need to be on when taking ginkgo biloba? - ANSWER-Seizure precautions What are adverse effects of ginger root? - ANSWER-CNS depression Cardia dysrhythmias GI disturbances Doses over 5 grams can stimulate the uterus What are adverse effects of St. John's Wort? - ANSWER-Allergic skin reactions, especially if patient has allergies to daisies and ragweed. CNS effects (insomnia, vivid dreams, restless, anxiety, agitation) GI effects Phototoxicity in high doses Echinacea is contraindicated in what patient populations? - ANSWER-HIV, TB Immunocompromised, Autoimmune disorders What should patients know before taking flax seeds? - ANSWER- May reduce absorption of other medications. Take 1 hour before or two hours after other medications.

What improvements are seen with coenzyme Q-10 - ANSWER-Improve cardiac function and recover May improve sperm count and quality What is feverfew used for? - ANSWER-Prophylaxis of migraines 50-300mg twice daily. What is the purpose of the Dietary Supplement Health and Education Act of 1994? - ANSWER-Dietary supplements are food supplements and not drugs, therefore they are exempt from the FDA approval process. What is the purpose of the Food, Drug, and Cosmetic Act? - ANSWER- Requires drugs, both prescription and OTC, go through rigorous evaluation of safety before receiving FDA approval. What does the Dietary Supplement and Nonprescription Drug Consumer Protection Act of 2006 mandate? - ANSWER-Reporting of serious adverse effects of nonprescription drugs and dietary supplements. What is the purpose of the Current Good Manufacturing Practices ruling of 2007? - ANSWER-Regulates supplement manufacturing and labeling to make sure supplements are free of contaminates and to prevent mislabeling. What is the treatment for PID? - ANSWER-Doxycycline 100mg BID for 14 days Must either add one single dose of ceftriaxone 250mg or one IM injection of cefoxitin Should also add flagyl 500mg PO BID for 14 days When is it safe to use progesterone? - ANSWER-Menopausal hormone therapy, endometrial cancer and hyperplasia, amenorrhea, dysfunctional uterine bleeding. When are COMPT inhibitors prescribed for PD? - ANSWER-When levodopa doses wear off too soon before another dose is due. Extends half-life of levodopa.