NURSING MSN571 FINAL EXAM QUESTIONS WITH ANSWERS NEW UPDATES 2023/2024, Exams of Nursing

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NURSING MSN571 FINAL EXAM QUESTIONS

WITH ANSWERS NEW UPDATES 2023/

1) A 40-year old female patient is being followed up for diabetes mellitus. She is currently on Metformin 1 gram twice a day and has been tolerating it well for about six months. Her hemoglobin A1c a week ago was 8.9%. The plan is to initiate liraglutide therapy in addition to the metformin. Which of the following statements is true with regards to liraglutide. ▪ Liraglutide may be stored in the refrigerator or freezer prior to first use. ▪ The brand name is Bydureon ▪ Nausea and/or vomiting are common side effects of therapy ▪ It should be administered intramuscularly into the upper arm. 2) The patient who takes insulin has just been prescribed a beta blocker drug. You recognize that the interaction of the beta blocker and the insulin may have which result? ▪ Decreased activity of the beta blocker drug ▪ Enhanced activity of the beta blocker drug ▪ Masked signs of hypoglycemia ▪ Masked signs of hyperglycemia 3) The drug of choice for type 2 diabetics is metformin. Metformin: ▪ Increases intestinal uptake of glucose ▪ Decreases glycogenolysis by the liver ▪ Increases the release of insulin from beta cells ▪ Prevents weight gain associated with hyperglycemia 4) Which classification of oral hypoglycemic drugs decreases hepatic glucose production and increases insulin sensitivity and peripheral glucose uptake? ▪ Sulfonylureas (glyburide) ▪ Meglitinides (glinides) ▪ Biguanide (metformin) ▪ alpha-glycosidase inhibitor (miglitol) 5) A breast-feeding mother is seen in your clinic wanting contraceptive and plans on breast-feeding for a year. What is an inappropriate choice for this patient? ▪ Depo-Provera 150mg IM every 3 months ▪ Progestin-only OC ▪ Combination OC ▪ Intrauterine device 6) Which of the following is (are) true about oral contraceptives (OCs)? ▪ Estrostep, Ortho Tri-Cyclen, Beyaz, and YAZ are approved for managing acne in women ▪ All the answrs are correct ▪ OCs favorably affect menstrual symptoms: cramps reduction, reduced menstrual flow volume and duration. ▪ OCs decrease the risk for several disorders, including ovarian cancer, endometrial cancer, ovarian cysts, pelvic inflammatory disease, benign breast disease.

7) A patient is prescribed ehtinyl estradiol and norelgestromin transdermal contraceptive patch. Which statement, If made by the patient, indicates an understanding of the use of this drug? ▪ “The patch prevents pregnancy by acting as barrier.” ▪ “I will experience minimal side effects because it is a progestin-only device.” ▪ “I will remove the patch each month and replace it with a new patch 1 week later.” ▪ “I will apply the patch in my vaginal area prior to having sexual intercourse.” 8) The NP at the immunization clinic is reviewing the list of patients who are scheduled to receive the varicella vaccination. The NP will cancel all of the following patients except: ▪ A 21-year old patient who is allergic to neomycin ▪ A 12-year old patient with an allergy to gelatin ▪ An 8-year old patient with asthma ▪ A patient who is pregnant 9) The recommended range for maintaining serum theophylline levels is: ▪ 20 to 25 ug/ml ▪ 30 to 40 ug/ml ▪ 0.05 to 2 ug/ml ▪ 10 to 20 ug/ml 10) For his asthma, a patient is prescribed albuterol in the form of an inhalant. The patient tells you the medication causes shakes and hand tremors. What is the best response? ▪ “I will contact the respiratory therapist about your problem.” ▪ “Tremors are the most common side effect of this inhalant and will usually fade over time.” ▪ “The tremors are probably not related to the medication.” ▪ “ I will contact your provider about your problem.” 11) A patient with COPD is acutely hypercapneic. Which respiratory therapy should you prescribe to lower the patient’s carbon dioxide concentration? ▪ Salmeterol ▪ Oxygen via a nasal cannula 2L/minute ▪ Fluticasone propionate ▪ Albuterol nebulizer 12) A patient has been diagnosed with reflux esophagitis (GERD). What instruction by the NP is most appropriate? ▪ Exercise soon after eating to increase gastric emptying ▪ You need to schedule an upper GI endoscopy soon. ▪ Try these proton-pump inhibitors for 2 weeks. ▪ Over-the- counter antiemetics work well for this condition

13) A patient with peptic ulcers report pain in the stomach. A gastric tissue biopsy reveals the presence of Helicobacter pylori infection. What should be the first-line treatment for the patient? ▪ Cimetidine combined with Metronidazole and Ketoconazole ▪ Omeprazole combined with metronidazole and clarithromycin ▪ Cimetidine combined with sucralfate and clarithromycin ▪ Omeprazole combined with clarithromycin and sucralfate 14) Metoclopramide (Reglan) carries a black box warning that it can cause tardive dyskinesia with long-term therapy. ▪ True ▪ False 15) A patient with gastroesophageal reflux disease (GERD) receives a prescription for a proton pump inhibitor (PPI). What information will the provider include when teaching the patient about this drug? ▪ “The FDA has determined that there is a gastric cancer risk with this drug.” ▪ “This drug will be given on a long-term basis only.” ▪ “You should report any fever and cough to your provider.” ▪ “You may experience high magnesium levels when taking this drug.” 16) Which medication is the first-line drug for migraine prevention? ▪ Propranolol ▪ Topiramate ▪ Ergotamine ▪ Metoclopramide 17) Why should Sumatriptan be used with caution in a patient with angina? ▪ None of the answers are correct ▪ It can precipitate an anginal attack secondary to vasoconstriction of coronary arteries. ▪ It can cause vasoconstriction of the coronary arteries leading to severe hypotension and chest pain ▪ It can precipitate an angina attack secondary to vasospasm of coronary arteries. 18) A patient with a history of moderate to severe headache pain associated with nausea and vomiting is diagnosed with migraines. Which medication would the NP prescribe initially? ▪ Meperidine ▪ Butorphanol ▪ Aspirin ▪ Sumatriptan 19) A patient is taking Loracaserin (Belviq) for weight-loss. Which supplement taken by this patient would cause you to be alarmed? ▪ Garlic ▪ Ginseng ▪ St. John’s wort ▪ Ginkgo biloba

20) What are the adverse effects of Orlistat? Select all that apply. ▪ Fecal urgency ▪ Bloody stool ▪ Fatty stool ▪ Oily spotting ▪ Increased defecation ▪ Flatus with discharge ▪ Abdominal discomfort 21) Probiotics are recommended to be co-administered when what are prescribed? ▪ Antibiotics ▪ Antidiarrheals ▪ Antihistamines ▪ Antihypertensives ▪ Antacids 22) Which of the following is (are) true of Vitamin B-3? (select all the apply). ▪ Can be used to raise HDL levels. ▪ Administration of high doses may cause flushing ▪ A deficiency may result in beriberi ▪ Should be supplemented to patients on a long-term Isoniazid. ▪ Used to treat high cholesterol levels. 23) Which of the following is a false statement about medication therapy for gout? ▪ Colchicine is currently considered a first-line drug for gout. ▪ Colchicine is an anti-inflammatory agent used for gout. ▪ Colchicine can decrease the frequency of acute flare-ups ▪ Colchicine can relieve the pain of gout. 24) The anti-inflammatory effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is due to their ability to do which of the following? ▪ Inhibit the stimulation of the chemoreceptor trigger zone ▪ Reset the hypothalamic “setpoint” ▪ None of the answers are correct ▪ Inhibit prostaglandin synthesis 25) A patient who takes oral levothyroxine for hypothyroidism is admitted to the hospital. After the provider determines the patient has myxedema, what action will the provider take? ▪ Prescribe a B-blocker ▪ Increase the dose of levothyroxine ▪ Change to intravenous levothyroxine ▪ Prescribe methimazole

26) A pregnant patient recently began treatment for hypothyroidism. What response will the provider give when the patient shares that she does not want to take medications while she is pregnant? ▪ Your baby will likely be born with permanent neuropsychologic deficits if the condition is not treated ▪ Hypothyroidism is a normal effect of pregnancy and usually is of no consequence ▪ Treatment is required only when you are experiencing symptoms ▪ No danger to the fetus exists until the third trimester. 27) Thyroxine has recently been added to the routine medications for a patient who also uses insulin, warfarin, cholestyramine, and antacids daily. Which statement should be included in the patient’s medication education? ▪ You will need to avoid aluminum-containing antacids such as Maalox and Mylanta. ▪ The dosage of insulin that you take may need to be decreased ▪ Take your cholestyramine at least 4 hours apart from the levothyroxine ▪ Your dose of warfarin will have to be increased while you are taking this medication 28) A 38-year old female is seen in your office complaining of cold intolerance, fatigue, dry skin, weight gain, and heavy menstrual periods. Her physical exam showed a HR 58 bpm and a waxy sallow complexion and a firm goiter. Her TSH level is 34 Mu/L. What is the recommended treatment for this patient? ▪ Begin levothyroxine (synthroid) at 0.025 mg PO every morning and repeat TSH in 2 weeks. ▪ Administer an IV loading dose of levothyroxine and start with half replacement therapy. ▪ Initiate levothyroxine dose 0.1mg PO every morning and recheck her TSH in 6 weeks. ▪ Administer a loading dose of PO levothyroxine and start full replacement dose. 29) The reason that two MMR vaccines at least a month apart are recommended is: ▪ Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR. ▪ The second dose of MMR “boosts” the immunity built from the first dose. ▪ Two vaccines 1 month apart is the standard dosing for all live virus vaccines. ▪ If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine. 30) A patient is infected with a virus. What type of immunity will be engaged to stop the virus from reproducing? ▪ Humoral immunity ▪ Antibody immunity ▪ Hapten immunity ▪ Cell-mediated immunity

31) A 39-year old patient who has been taking a specific antibiotic for years without problems develops tachycardia, lowered blood pressure, wheezing, and urticaria when given this antibiotic in the clinic. The most likely explanation for this occurrence is that the patient: ▪ Has received the wrong medication ▪ Is experiencing an anaphylactic hypersensitivity reaction to the antibiotic. ▪ Has developed autoimmunity. ▪ Is experiencing a reaction to something other than the antibiotic.

32. Which of the following medications has the most potential to significantly impair the ability to drive an automobile? ▪ Ranitidine ▪ Levocetirizine ▪ Diphenhydramine ▪ Fexofenadine 33) Which of the following histamine receptor antagonists is known to enter the central nervous system readily and is known to be sedative? ▪ Desloratadine ▪ Hydroxyzine ▪ Cetirizine ▪ Loratadine ▪ Fexofenadine 34) What mechanism of action or pharmacological action is best associated with memantine? ▪ GABA analog ▪ Increases GABA concentration ▪ NMDA receptor antagonist ▪ NMDA receptor agonist 35) During your assessment of a patient taking gabapentin which of the following side effects is most likely to be seen? ▪ SLE like syndrome ▪ Hypohidrosis ▪ Hypotension ▪ Hypertension ▪ Sedation 36) Which of the following is most appropriate to communicate to a patient receiving specific brands for thyroid hormone replacement? ▪ Disulfiram like reaction with alcohol ▪ Increased risk of endometrial cancer ▪ Contraindicated in pregnancy ▪ No switching brands

37) Metformin most likely causes which of the following? ▪ Increased gluconeogenesis ▪ Increased insulin sensitivity ▪ Decreased GI glucose absorption ▪ Increased pancreatic insulin release 38) Primary hypothyroidism may be suspected in what scenario? ▪ If T3 high and T4 low ▪ If TSH high ▪ If TSH low ▪ If T3 high 39) Which mechanism of action or pharmacological action is best associated with sitagliptin (januvia) and saxagliptin (onglyza)? ▪ Binds PPAR-Gamma ▪ Decreases insulin resistance ▪ Increases insulin sensitivity ▪ DDP-4 inhibitor 40) Which of the following hormones is primarily released by the thyroid gland? ▪ Calcitonin ▪ TRH ▪ Free T4 (FT4) ▪ TSH 41) Which of the following medications is associated with rapid acting insulin? ▪ Insulin glulisine (Apidra) ▪ Determir (Levemir) ▪ Regular insulin (Humulin R) ▪ Insulin glitter 42) Which of the following diseases or disorders is most likely an indication for the use of levodopa/carbidopa? ▪ Addison’s disease ▪ Alzheimer’s disease ▪ Dent’s disease ▪ Parkinson’s disease 43) During your assessment of a patient taking serotonin norepinephrine reuptake inhibitors (SNRIs), which of the following side effects is most likely to be seen? ▪ Ophthalmoplegia ▪ Hyperthyroidism ▪ Decreased libido ▪ Muscle wasting

44) Which of the following is most likely an indication for serotonin norepinephrine reuptake inhibitors (SNRIs)? ▪ CHF ▪ Acute pancreatitis ▪ Depression ▪ Autism ▪ Schizotypal personality disorder 45) Which of the following medications is associated with long acting insulin? ▪ Isophane NPH (Humalin N) ▪ Insulin glulisine (Apidra) ▪ Insulin Aspart (Novolog) ▪ Glargine (Lantus) ▪ Insulin lispro (Humalog) 46) What mechanism of action or pharmacological action is best associated with pramlintide (Symlin)? ▪ Blocks renin angiotensin-aldosterone system ▪ Blocks glycine and GABA release ▪ NMDA receptor antagonist ▪ Synthetic amylin analog 47) Which of the following medications is associated with managing gout? ▪ Colesevelam ▪ Vitamin A ▪ Aminocarproic acid ▪ NSAIDs 48) Which of the following is an important consideration when taking glyburide or glipizide? ▪ NSAIDs reduce effect ▪ Statins reduce effects ▪ Beta blockers reduce effects ▪ ACE inhibitors reduce effects 49) Bethanechol: ▪ It lowers the LDL cholesterol by 30-40% ▪ Increases detrusor muscle tone to empty the bladder ▪ Reduces bronchial airway constriction to treat asthma ▪ Decreases gastric acid section to treat PUD 50) A patient who recently begun hormone replacement therapy with estrogen asks you how the hormone will affect her non-reproductive tissues. Which response(s) are appropriate? ▪ All the answers are correct ▪ It reduces low-density lipoproteins ▪ It suppresses bone resorption ▪ It promotes and suppresses coagulation

51) A patient who has recently begun hormone replacement therapy with estrogen asks the NP how the hormone will affect her nonreproductive tissues. Which response(s) by the NP are appropriate? (select all that apply) ▪ It suppresses bone resorption ▪ It reduces low-density lipoproteins (LDLs) ▪ It reduces fat deposits in the liver ▪ It promotes and suppresses coagulation ▪ It improves glomerular filtration rates 52) Modest improvement in the memory of patients with alzheimer’s disease may occur with drugs that increase transmission at which of the following receptors? ▪ Adrenergic ▪ Cholinergic ▪ GABAergic ▪ Dopaminergic 53) Patches are sometimes prescribed to patients. Understanding how often patches are applied, when to remove them, correct location of patch placement, frequency of dosing, and correct way to dispose are important counseling points when discussing with your patients. Match the following medications with the correct frequency of dosing: ▪ Exelon once daily ▪ Lidoderm once weekly ▪ All are incorrect frequencies of dosing ▪ Fentanly patch once daily 54) Patients with Alzheimer’s disease, which factors are associated with the pathophysiology of this disease? Select all that apply. ▪ Neuronal degeneration and decreased acetylcholine ▪ Autoimmune changes in the myelin sheath ▪ Beta-amyloid and neuritic plaques ▪ Neurofibrillary tangles and tau ▪ Firing of hyper-excitable neurons throughout the brain 55) The NP is teaching an NP student about medication for ADHD. Which statement by the NP student indicates understanding of the teaching? ▪ I may dispense these medications to nursing staff if needed ▪ If I notice side effects of these medications, I should stop giving the drug immediately and notify the provider. ▪ It is permissible to crush extended-release medications for patients who have difficulty swallowing pills. ▪ Patients taking stimulant drugs for ADHD may lose weight

56) The pharmacological properties of which one of the following medications is similar to Amphetamine? ▪ Methylphenidate ▪ Atomoxetine ▪ Lithium ▪ Haldol 57) A 57-year old patient presents to your office complaining about poor appetite, anhedonia, persistent depressed mood and increased sleep latency. He reports chronic neuropathic pain in the feet unrelieved by analgesics. Which of the following medications may address the patient’s symptoms of poor sleep, depressed mood, poor appetite and neuropathic pain? ▪ Lorazipam ▪ Amitriptyline ▪ Trazadone ▪ Escitalopram 58) Which statements are true about Modafinil? ▪ Physical withdrawal has not been reported ▪ Physical dependence has not been reported ▪ All the answers are correct ▪ Modafinil has many off-the label uses, such as for the treatment of jet lat and ADHD. 59) Which benzodiazepines are commonly used as sleep aids? Select all that apply. ▪ Temazepam ▪ Flurazepam ▪ Chlordiazepoxide ▪ Triazolam 60) A patient has been prescribed Citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: ▪ 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. ▪ Appetite and concentration improve in the first 1 to 2 weeks. ▪ His dysphoric mood will improve in 1 to 2 weeks. 61) You examine a male patient and find an enlarged prostate on a digital rectal examination. He complained of having difficulty with erectile dysfunction and urine flow. What appropriate treatment would be prescribed? ▪ Oral tadalafil as needed ▪ A daily low dose of oral tadalafil ▪ A daily oral dose of Sildenafil ▪ Topical minoxidil

62) A patient receiving doxazosin presents for a routine evaluation. Which assessment finding related to the medication therapy would be most concerning to the provider? ▪ Dizziness when supine ▪ Increased nasal congestion ▪ Blood pressure 80/45 mmHG ▪ Diminished ejaculate volume 63) A patient who receives haloperidol is noted to be shifting in the chair, rocking back and forth, and tapping both feet constantly. What is the most accurate term to document these findings? ▪ Akathisia ▪ Parkinsonism ▪ Dystonia ▪ Tardive dyskinesia 64) Which of the following statement is true regarding the treatment of Parkinson’s Disease? ▪ Deep brain stimulation is an option used to wean off patients completely from taking Levodopa. ▪ The combination of Levodopa and Carbidopa is the most effective treatment for the motor symptoms of Parkinson’s disease. ▪ It is best to use Amantadine as a monotherapy as soon as possible. ▪ Dopamine is very effective than Levodopa, and they can be used as a monotherapy. 65) Which inhibitory neurotransmitter is involved in Parkinson’s disease? ▪ Dopamine ▪ Oxytocin ▪ Acetylcholine ▪ Adrenalline