NSG6005 FINAL EXAM 2023-2024 REAL ADVANCED PHARMACOLOGY EXAM SOUTH UNIVERSITY SCORED A+, Exams of Nursing

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NSG6005 FINAL EXAM SOUTH UNIVERSITY COMPLETE

VERIFIED EXAM VERSION 2/RETAKE ADVANCED

PHARMACOLOGY

The U.S. Food and Drug Administration (FDA) regulates: The official labeling for all prescriptions and over-the-counter drugs Nurse practitioner prescriptive authority is regulated by: The State Board of Nursing for each state Electronic health records (EHRs) Allow for all patient data to be centralized in one location for access by multiple providers Alterations in drug metabolism among Asians may lead to Slower metabolism of antidepressants, requiring lower doses Pharmacokinetics among Asians are universal to all the Asian ethnic groups. B. False Gender differences between men and women in pharmacokinetics include: Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution The factor that has the greatest effect on males developing male sexual characteristics is: Androgen production An advantage of prescribing a sublingual medication is that the medication is: A. Absorbed rapidly Infants and young children are at higher risk of ADRs due to: B. Lack of safety and efficacy studies in the pediatric population Pharmacokinetic factors that affect prescribing include: C. Bioavailability Carbamazepine has a Black Box warning recommending testing for the HLA-B1502 allele in patients with Asian ancestry prior to starting therapy due to: C. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B1502 allele Genetic polymorphisms account for differences in metabolism, including: D. All of the above A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n): A. Cytotoxic hypersensitivity reaction The elderly are at high risk of ADRs due to: D. Age-related decrease in renal function

The time required for the amount of drug in the body to decrease by 50% is called: Half-life The angiotensin converting enzyme (ACE) inhibitor lisinopril is a known teratogen. Teratogens cause Type ADR D Common OTC pain relievers such as acetaminophen or ibuprofen: Are harmful if taken in higher than recommended amounts A patient’s nutritional intake and lab work reflect hypoalbuminemia. This is critical to prescribing because: Distribution of drugs to target tissue may be affected Warfarin resistance may be seen in patients with VCORC1 mutation, leading to: Decreased response to warfarin The first step in the prescribing process according to the World Health Organization is: C. Diagnosing the patient’s problem A nurse practitioner would prescribe the liquid form of ibuprofen for a six-year-old because: A six-year-old may have problems swallowing a pill The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: C Onset of Action 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 common misconception that intermittently taken OTC medications are not an important part of his drug history Which one of the following statements about bioavailability is true? *Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained release mechanisms All brands of a drug have the same bioavailability Drugs that are administered more than once a day have a greater bioavailability than drugs given once daily Combining an active drug with an inert substance does not affect bioavailability Beta blockers treat hypertension because they: Reduce peripheral resistance Which of the following is true about procainamide and its dosing schedule?

Doses of this drug should be taken evenly spaced around the clock to keep an even blood level. Dulcea has type II diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? Gallbladder disease Patients who have angina, regardless of Class who are also diabetic should be on? ACE Inhibitors Donald has been diagnosed with hyperlipidemia. On the basis of his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: Report muscle weakness or tenderness and dark urine to his provider immediately ACE inhibitors are the drug of choice in treating hypertension in diabetic patients because they: A. Improve insulin sensitivity B. Improve renal hemodynamics C. Reduce the production of angiotensin II D. All of the above Definition First-line therapy for hyperlipidemia is: Lifestyle changes Isosorbide dinitrate is a long-acting nitrate given twice daily (BID). The schedule for administration is 7 a.m. and 2 p.m. because Nitrate tolerance can develop Jamie is a thirty-four-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman? Bile acid-binding resins Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when: Symptoms markedly worsen or the patient becomes hypotensive and has syncope. There is evidence of progressive renal insufficiency or failure. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic. All the above options are correct. Rodrigo has been prescribed procainamide after an episode of MI. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate: Onset of congestive heart failure Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials include:

Renal parenchymal disease Which of the following disease processes could be made worse by taking a nonselective beta blocker? Asthma might worsen. Diabetes might worsen. Both might worsen. The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as: C. Stage C Phil is a fifty-four-year-old male with multiple risk factors who has been on a high-dose statin for three months to treat his high LDL level. His LDL is 135 mg/dL, and his triglycerides are elevated. A reasonable change in therapy would be to: Continue the statin and add in ezetimibe Which of the following drugs has been associated with increased risk for MI in women? Estrogen replacement Treatments for heart failure, including drug therapy, are based on the stages developed by the American Heart Association and the American College of Cardiology. Stage A patients are: Treated with drugs for hypertension and hyperlipidemia, if they exist A potentially life threatening adverse response to ACE inhibitors is angioedema. Which of the following statements is true about this adverse response? Swelling of the tongue and hoarseness are the most common symptoms A stepwise approach to the pharmacologic management of asthma: Begins with determining the severity of the asthma and assessing asthma control A patient with a COPD exacerbation may require: Systemic corticosteroid burst The first-line treatment for cough related to a upper respiratory infection in a five-year-old is: Fluids and symptomatic care When treating a patient using the “step-down” approach, the patient with GERD is started on first PPIs In five- to eleven-year-old children, mild-persistent asthma is diagnosed when asthma symptoms occur: At nighttime three to four times a month

When using the “step-up” approach in caring for a patient with GERD, the “step up” from OTC antacid use is: Histamine 2 receptor antagonist (ranitidine) for four to eight weeks If a patient with H. pylori positive PUD fails first-line therapy, the second-line treatment is: DA PPI BID plus metronidazole plus tetracycline plus bismuth subsalicylate for fourteen days Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population: D. All of the above Howard is a seventy-two-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: Urinary retention Treatment failure in patients with PUD associated with H. pylori may be due to: Antimicrobial resistance Sadie is a seventy-two-year-old who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: A) Megaloblastic anemia B) Osteoporosis C) Hypertension D) Strokes Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing with their providers or a pharmacist first? A. Patients with kidney stones B. Pregnant patients C. Patients with heartburn D. Post-menopausal women Patients with allergic rhinitis may benefit from a prescription of : A. Fluticonase (Flonase) B. Certizine (Zyrtec) C. OTC cromoly nasal spray (Nasalcrom) D. Any of the above Tiotropium bromide (Spiriva) is an inhaled anticholinergic: Used for the treatment of COPD Prior to developing a plan for the treatment of asthma, the patient’s asthma should be classified according to the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel 3 guidelines. In adults, mild-persistent asthma is classified as asthma symptoms that occur: More than twice a week and less than once a day

Pregnant patients with asthma may safely use throughout their pregnancies. inhaled corticosteroids (budesonide) Patients with pheochromocytoma should avoid which of the following classes of drugs due to the possibility of developing hypertensive crisis? B. Beta- 2 - agonists Josie is a five-year-old who presents to the clinic with a forty-eight-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down, and her weight is 4 pounds less than her last recorded weight. Besides intravenous (IV) fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? Ondansetron (Zofran) Judy is being prescribed phenytoin for seizures. Monitoring includes: Assessing for phenytoin hypersensitivity syndrome three to eight weeks after starting treatment When a patient is on selective-serotonin reuptake inhibitors: There is no laboratory monitoring required. Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective-serotonin reuptake inhibitors. What is the initial dosage adjustment when starting a taper off antidepressants? D. Reduce the dose by 50% for three to four days 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: Cymbata/Duloxetine Jake, a forty-five-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with intramuscular (IM) long-acting haloperidol. Besides being monitored for his schizophrenia symptoms, the patient should be assessed by his primary care provider: With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS) symptoms 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: D.Reassure her that this is a normal side effect of topiramate and continue to monitor her weight An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: Buspirone (Buspar) When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: A. Blood pressure

Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? Valproate is a known teratogen but may be taken after the first trimester if necessary. Levetiracetam has known drug interactions with: D. Few, if any, drugs A nineteen-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: Bradykinesia, akathisia, and agitation Sarah, a forty-two-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include understanding that: Anorexiants may cause tolerance and should only be prescribed for six months. Prior to starting antidepressants, patients should have laboratory testing to rule out: Hypothyroidism Jack, eight years old, 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: Insomnia and decreased appetite An appropriate drug for the treatment of depression with anxiety would be: Escitalopram (Lexapro) The tricyclic antidepressants should be prescribed cautiously in patients with: Heart disease Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: Reduce the chance of tardive dyskinesia. 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 Henry is eighty-two years old and takes two aspirin every morning to treat the arthritis pain in his back. He states that 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? Add an H2 blocker such as ranitidine to his therapy. Term Patients need to be questioned about all pain sites because.

patients tend to report the most severe, or important, in their perception When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. The clinical characteristics of medication-overuse headaches include. headaches recurring when medication wears off Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence. the motivational aspects of pain Narcotics are exogenous opiates. They act by. attaching to receptors in the afferent neuron to inhibit the release of substance P Juanita presents to clinic with a complaint of headaches off and on for months. She reports she feels like someone is “squeezing” her head. She occasionally takes Tylenol for the pain but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary and a prescription for. naproxen (Aleve) Pathological similarities and differences between acute pain and chronic pain include which of the following options? Chronic pain has a predominance of C-neuron stimulation. Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry? Low-dose colchicines Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to determine which of the following options? If the diagnosis of source of pain is correct If the current regimen is adequate or different combinations of drugs and nondrug therapy are required If the patient is willing and able to be an active participant in his or her pain management All the given option Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be. ibuprofen (Advil) Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency? Multiple times when prescriptions are lost with requests to refill Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes which one of the following instructions? Gout may worsen with therapy.

Kelly is a fourteen-year-old who presents to clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be which of the following? Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is. Tinnitus Which of the following statements is true about age and pain? Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs. When prescribed an opioid analgesic such as acetaminophen and codeine (Tylenol #3), which of the following instructions should the patient follow? The medication may cause sedation, so the patient should not drive. Constipation is a common side effect, so the patient should increase fluids and fiber. The patient should not take any other acetaminophen-containing medications at the same time. CORRECT All the given options are correct. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of: Serum glucose One of the main drug classes used to treat acute pain is NSAIDs. They are used due to which of the following reasons? Inflammation is a common cause of acute pain. Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs? Glucocorticoids Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be: Prescribing oral contraceptives and having her start them the same day, with a back-up method used for the first seven days A woman who has migraine with aura: Should not be prescribed estrogen due to an increased risk of stroke occurring with estrogen use A contraindication to the use of combined contraceptives is: A history of clotting disorder Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk?

Black women are at risk of developing osteoporosis due to their lower calcium intake as a group. Which of the following is the mechanism of action of oral combined contraceptives that prevent pregnancy? Progestins thicken cervical mucous and slow tubal motility. When starting a patient with hypothyroidism on thyroid replacement hormones, patient education would include the following: It may take four to eight weeks to get to euthyroid symptomatically and by lab testing. Inadequate vitamin D intake can contribute to the development of osteoporosis by: Altering calcium metabolism Absolute contraindications to estrogen therapy include: Clotting disorders The drug recommended as primary prevention of osteoporosis in men over seventy years is: Alendronate (Fosamax) Men who are prescribed sildenafil (Viagra) need ongoing monitoring for: The development of chest pain or dizziness Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: Tachycardia and angina Dosage changes of conjugated equine estrogen (Premarin) are made at intervals. six to eight weeks Infants with congenital hypothyroidism are treated with Levothyroxine Progesterone-only pills are recommended for women who: Are breastfeeding Have a history of migraine Have a medical history that contradicts the use of estrogen All of the above The ongoing monitoring of patients over the age sixty-five years taking alendronate (Fosamax) or any other bisphosphonate is: Annual renal function evaluation Sallie has been diagnosed with osteoporosis and is asking about the once-a-month pill to treat her condition. How do bisphosphonates treat osteoporosis? By reducing bone resorption and inhibiting osteoclastic activity

Medroxyprogesterone (Depo Provera) injection has an US Food and Drug Administration (FDA) black box warning due to: Decreased bone density while on Depo GLP- 1 agonists: Directly bind to a receptor in the pancreatic beta cell . Prior to prescribing metformin, the provider should: Draw a serum creatinine to assess renal function. The action of “gliptins” is different from other antidiabetic agents because they: Act on the incretin system to indirectly increase insulin production DPP- 4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: Low risk for hypoglycemia Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include: Dizziness, confusion, diaphoresis, and tachycardia When the total daily insulin dose is split and given twice daily, which of the following rules may be followed? Give two-thirds of the total dose in the morning and one-third in the evening. The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes? Fasting blood glucose and Hemoglobin A1c Lispro is an insulin analogue produced by recombinant deoxyribonucleic acid (DNA) technology. Which of the following statements about this form of insulin is not true? The duration of action is increased when the dose is increased. The drugs recommended for older adults with type II diabetes include: Third-generation sulfonylureas The decision may be made to switch from twice a day (BID) NPH insulin to insulin glargine to improve glycemia control throughout the day. This is effective when: The initial dose of glargine is reduced by 20% to avoid hypoglycemia. Type I diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90% of type I diabetics have: Autoantibodies to two tyrosine phosphatases Metformin is a primary choice of drug to treat hyperglycemia in type II diabetes because it: Decreases glycogenolysis by the liver

Studies have shown that control targets that reduce the HBA1c to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include: Those with no significant cardiovascular disease Type II diabetes is a complex disorder involving: A suboptimal response of insulin-sensitive tissues especially in the liver Both ACE inhibitors and some angiotensin-II receptor blockers have been approved in treating: Hypertension in diabetic patients Diabetic nephropathy Both A and B Before prescribing metformin, the provider should: Draw a serum creatinine level to assess renal function . Unlike most type II diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is: Involuntary loss of 10% of body weight in less than six months Diagnostic criteria for diabetes include: Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl Sadie is an 82-year-old patient who has herpes zoster (shingles) and would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir she will need assessment of: Renal function The first-line drug choice for a previously healthy adult patient diagnosed with community acquired pneumonia would be: Azithromycin Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes which of the following lab assessments: AST, ALT, alkaline phosphatase, and bilirubin Rose is a 3 year old with an upper respiratory infection (URI). Treatment for her URI would include: Amoxicillin Patients who should be cautious about using decongestants for an upper respiratory infection include: Patients with cardiac disease Nicole is a 16 year old who is taking minocycline for acne. She comes to the clinic complaining of a headache. What would be the plan of care? Evaluate for pseudotremor cerebri

Which of the following patients may be treated with a 3-day course of antibiotic therapy for their urinary tract infection? Jamie, a 24 - year-old female Tetracyclines are contraindicated in children younger than 8 years because of: Adverse effects on bone growth The most common bacterial pathogen in community acquired pneumonia is: Streptococcus pneumoniae When prescribing acyclovir, patients should be educated regarding: Need to drink lots of fluids during treatment Fluoroquinolones have a Black Box warning regarding even months after treatment. Tendon rupture Nicholas has been diagnosed with Type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include: Starting oseltamivir within the first 48 hours of influenza symptoms A factor that places a patient at risk of developing an antimicrobial resistant organism include: Inappropriate use of antimicrobials When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include: Consuming alcohol in any form may cause a severe reaction Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. The appropriate antibiotic to prescribe would be: Erythromycin Samantha is 34 weeks pregnant and has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe? Azithromycin Sarah is a 25 - year-old female who is 8 weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her? Amoxicillin (Trimox)