Pharmacology Exam 1: Questions and Answers for 2023/2024, Exams of Pharmacology

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Pharm- Exam 1 2023/2024 WITH

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(1) Nurse practitioner prescriptive authority is regulated by: - ANSWER>>The State Board of Nursing for each state

(1) The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: - ANSWER>>Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care.

(1) Clinical judgment in prescribing includes: - ANSWER>>Factoring in the cost to the patient of the medication prescribed

(1) Criteria for choosing an effective drug for a disorder include: - ANSWER>>Consulting nationally recognized guidelines for disease management

(1) Nurse practitioner practice may thrive under health-care reform because of: - ANSWER>>The demonstrated ability of nurse practitioners to control costs and improve patient outcomes

(2) A patient's nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because: - ANSWER>>Distribution of drugs to target tissue may be affected.

(2) Drugs that have a significant first-pass effect: - ANSWER>>Are rapidly metabolized by the liver and may have little if any desired action

(2) The route of excretion of a volatile drug will likely be the: - ANSWER>>Lungs

(2) Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs: - ANSWER>>Increase the length of time a drug is available and active

(2) The NP chooses to give cephalexin every 8 hours based on knowledge of the drug's: - ANSWER>>Biological half-life

(2) Azithromycin dosing requires that the first day's dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:

• ANSWER>>Rapidly achieves drug levels in the therapeutic range

(2) The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: - ANSWER>>Onset of action

(2) Phenytoin requires that a trough level be drawn. Peak and trough levels are done: - ANSWER>>To determine if a drug is in the therapeutic range

(2) A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: - ANSWER>>Concentration will produce an adverse response

(2) Drugs that are receptor agonists may demonstrate what property? - ANSWER>>Desensitization or downregulation with continuous use

(2) Drugs that are receptor antagonists, such as beta blockers, may cause: - ANSWER>>An exaggerated response if abruptly discontinued

(2) Factors that affect gastric drug absorption include: - ANSWER>>Lipid solubility of the drug

(2) Drugs administered via IV: - ANSWER>>Begin distribution into the body immediately

(2) When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: - ANSWER>>Greater than the sum of the effects of each drug individually

(2) Which of the following statements about bioavailability is true? - ANSWER>>Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms.

(2) Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? - ANSWER>>The blood-brain barrier slows the entry of many drugs into and from brain cells.

(2) Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: - ANSWER>>Change drug molecules to a form that an excretory organ can excrete

(2) Once they have been metabolized by the liver, the metabolites may be: - ANSWER>>a. More active than the parent drug b. Less active than the parent drug c. Totally "deactivated" so they are excreted without any effect [[d. All of the above]]

(2) All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: - ANSWER>>Unbinding a nonvolatile drug from plasma proteins

(2) Steady state is: - ANSWER>>When the amount of drug in the body remains constant

(2) Two different pain medications are given together for pain relief. The drug— drug interaction is: - ANSWER>>Additive

(2) Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT: - ANSWER>>Prescribing a third drug to counteract the adverse reaction of the combination

(2) The time required for the amount of drug in the body to decrease by 50% is called: - ANSWER>>Half-life

(2) An agonist activates a receptor and stimulates a response. When given frequently over time, the body may: - ANSWER>>Downregulate the numbers of that specific receptor

(2) Drug antagonism is best defined as an effect of a drug that: - ANSWER>>Is modified by the concurrent administration of another drug

(2) Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? - ANSWER>>"To achieve best effect, take the tablet with at least 8 ounces of fluid."

(2) The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: - ANSWER>>Toxicity

(2) Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? - ANSWER>>Sodium bicarbonate

(2) Which of the following variables is a factor in drug absorption? - ANSWER>>A rich blood supply to the area of absorption leads to better absorption.

(2) An advantage of prescribing a sublingual medication is that the medication is: - ANSWER>>Absorbed rapidly

(2) Drugs that use CYP 3A4 isoenzymes for metabolism may: - ANSWER>>a. Induce the metabolism of another drug

b. Inhibit the metabolism of another drug [[c. Both a and b]]

(2) Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: - ANSWER>>After four to five half-lives

(2) Upregulation or hypersensitization may lead to: - ANSWER>>An exaggerated response if the drug is withdrawn

(3) An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because: - ANSWER>>A 6-year-old child may have problems swallowing a pill.

(3) In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it: - ANSWER>>Will be taken twice daily and will be taken at home

(3). 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? - ANSWER>>Percentage of fat differs between genders.

(3) The first step in the prescribing process according to the World Health Organization is: - ANSWER>>Diagnosing the patient's problem

(3) Treatment goals in prescribing should: - ANSWER>>Be patient-centered

(3) The therapeutic goals when prescribing include(s): - ANSWER>>a. Curative b. Palliative c. Preventive [[d. All of the above]]

(3) When determining drug treatment the NP prescriber should: - ANSWER>>Individualize the drug choice for the specific patient

(3) Patient education regarding prescribed medication includes: - ANSWER>>Discussion of expected adverse drug reactions

(3) Passive monitoring of drug effectiveness includes: - ANSWER>>Instructing the patient to report if the drug is not effective

(3) Pharmacokinetic factors that affect prescribing include: - ANSWER>>Bioavailability

(3) Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute of Medicine: - ANSWER>>Conflicts of interest and financial relationships should be disclosed by those providing education.

(3) Under new U.S. Food and Drug Administration labeling, Pregnancy Categories will be: - ANSWER>>Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label

(4) The U.S. Food and Drug Administration regulates: - ANSWER>>The official labeling for all prescription and over-the-counter drugs

(4) The U.S. Food and Drug Administration approval is required for: - ANSWER>>Medical devices, including artificial joints

(4) An Investigational New Drug is filed with the U.S. Food and Drug Administration: - ANSWER>>Prior to human testing of any new drug entity

(4) Phase IV clinical trials in the United States are also known as: - ANSWER>>Postmarketing research

(4) Off-label prescribing is: - ANSWER>>Legal if there is scientific evidence for the use

(4) The U.S. Drug Enforcement Administration: - ANSWER>>Registers manufacturers and prescribers of controlled substances

(4) Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration: - ANSWER>>May not be refilled; a new prescription must be written

(4) Precautions that should be taken when prescribing controlled substances include: - ANSWER>>Using tamper-proof paper for all prescriptions written for controlled drugs

(4) Strategies prescribers can use to prevent misuse of controlled prescription drugs include: - ANSWER>>a. Use of chemical dependency screening tools b. Firm limit-setting regarding prescribing controlled substances c. Practicing "just say no" to deal with patients who are pushing the provider to prescribe controlled substances [[d. All of the above]]

(4) Behaviors predictive of addiction to controlled substances include: - ANSWER>>Stealing or borrowing another patient's drugs

(4) Medication agreements or "Pain Medication Contracts" are recommended to be used: - ANSWER>>Universally for all prescribing for chronic pain

(4) A prescription needs to be written for: - ANSWER>>a. Legend drugs b. Most controlled drugs c. Medical devices [[d. All of the above]]

(5) Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs): - ANSWER>>A 3-month-old female

(5) Infants and young children are at higher risk of ADRs due to: - ANSWER>>Lack of safety and efficacy studies in the pediatric population

(5) The elderly are at high risk of ADRs due to: - ANSWER>>Age-related decrease in renal function

(5) The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic doses is type: - ANSWER>>B

(5) Digoxin may cause a type A adverse drug reaction due to: - ANSWER>>Its narrow therapeutic index

(5) Sarah developed a rash after using a topical medication. This is a type ____ allergic drug reaction. - ANSWER>>IV (4)

(5) A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n): - ANSWER>>Cytotoxic hypersensitivity reaction

(5) Anaphylactic shock is a: - ANSWER>>Type I reaction, called immediate hypersensitivity reaction

(5) James has hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a corticosteroid) use. He is at risk for what type of adverse drug reaction? - ANSWER>>Type C

(5). Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D reaction because they are known: - ANSWER>>Carcinogens

(5)A 24-year-old male received multiple fractures in - ANSWER>>Late

(5) An example of a first-dose reaction that may occur includes: - ANSWER>>Orthostatic hypotension that does not occur with repeated doses

(5) Drugs that are prone to cause adverse drug effects include: - ANSWER>>Insulins

(5) The U.S. Food and Drug Administration MedWatch system is activated when: - ANSWER>>An adverse event or serious problem occurs with a medication that is not already identified on the label.

(5) The Vaccine Adverse Events Reporting System is: - ANSWER>>A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events

(6) Pharmacoeconomics is: - ANSWER>>The analysis of the costs and consequences of any health-care-related treatment or service

(6) The direct costs of drug therapy include: - ANSWER>>Pain and suffering due to inadequate drug therapy

(6) Indirect costs associated with drug therapy include: - ANSWER>>Loss of wages while undergoing drug therapy

(6) The intangible costs of drug therapy include: - ANSWER>>Inconvenience, pain, and suffering incurred with therapy

(6) When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as: - ANSWER>>Cost-minimization analysis

(6) Cost-effectiveness analysis compares two or more treatments or programs that are: - ANSWER>>Not necessarily therapeutically equivalent

(6) When the costs of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as: - ANSWER>>Cost-benefit analysis

(6) Mary has a two-tiered prescription benefit plan, which means: - ANSWER>>She pays a higher copay for brand-name drugs than for generic drugs.

(6) Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists: - ANSWER>>Increases compliance by reducing the financial burden of drug costs to the patient

(6) James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be: - ANSWER>>Refer him to the Medicare specialist in his insurance plan to explain the benefit to him.

(6) The "donut hole" in Medicare Part D: - ANSWER>>Refers to the period between when the annual individual drug costs are $2,970 and $4,750 and the patient pays 52.5% of the costs of brand name drugs (2013)

(6)Research has shown that when patients who are covered by Medicare Part D reach the "donut hole" in coverage they: - ANSWER>>Fill their prescriptions less frequently, including critical medications such as warfarin or a statin

(9) Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to: - ANSWER>>Serve as content experts in developing, implementing, and evaluating information systems

(9) You are going to prescribe a drug and the electronic health record (EHR) alerts you that there is a potential drug-drug interaction. The alert is generated by: - ANSWER>>The EHR clinical decision support system

(9) Which of the following is a primary benefit of the use of computerized provider order entry for patient medications? - ANSWER>>Decreases prescribing and transcription errors

(9) A number of barriers and concerns exist before the goals of a safe and efficient information technology (IT) system can be realized. Which of the following is NOT a barrier to adoption and use of IT in prescribing drugs? - ANSWER>>Access to highly skilled experts

(9) EHRs: - ANSWER>>Allow for all patient data to be centralized in one location for access by multiple providers

(9) Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include: - ANSWER>>Designing software so that only those who need the information can gain access

(9) Decision support systems often provide medication alerts that tell the prescriber: - ANSWER>>Potential drug-to-drug interactions with other medications the patient is taking

(9) Prescribers have been shown to override a medication alert about a patient's allergies when: - ANSWER>>a. The history showed that the patient had tolerated the medication in the past b. The benefit outweighed the risk c. The medication was therapeutically appropriate and needed [[d. All of the above]]

(9) The use of information technology for quality improvement in pharmacotherapeutics includes: - ANSWER>>Tracking data trends within the practice via the electronic health record database

(9) The advantage of using information technology for patient education includes:

• ANSWER>>Standardized and individualized patient education that is simultaneously recorded into the patient record

(9) One barrier to use of the Internet for both prescribing and for patient teaching is: - ANSWER>>Web pages and hyperlinks may change, be deleted, or be replaced

(9) Information technology can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to: - ANSWER>>Prioritize what is needed information and avoid spending time reading "interesting" information not central to the problem at hand

(9) Data in the electronic health record that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review: - ANSWER>>a. The patient's current diagnosis and history b. Drugs the patient is currently taking c. Any recent previous encounter for the same problem as this visit and what was done [[d. All of the above]]

(9) Information technology (IT) can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true? - ANSWER>>Collecting data between encounters via IT may mean a more efficient face-to-face encounter.

(9) Discharge summaries using information technology have several advantages. They can: - ANSWER>>Be filed with the patient's chart to document patient teaching

(9) Information technology can also be used for patient teaching during the encounter and after it. The provider can help patients and their families become savvy consumers of health-care information by: - ANSWER>>Teaching them how to identify high-quality Web sites and "red flags" signaling inaccurate content

Incorporating information technology (IT) into a patient encounter takes skill and tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by: - ANSWER>>a. Turning the screen around so the patient can see material being recorded b. Not placing the computer screen between the provider and the patient c. Both a and b

(11) Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it: - ANSWER>>Relaxes smooth muscle in the bladder neck

(11) To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT: - ANSWER>>Monitor their blood pressure and skip a dose if the pressure is less than 120/

(11) John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should: - ANSWER>>Not miss a dose or stop taking the drug because of potential rebound hypertension

(11) Clonidine has several off-label uses, including: - ANSWER>>a. Alcohol and nicotine withdrawal b. Post-herpetic neuralgia [[c. Both a and b]]

(11) Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by: - ANSWER>>Reducing vascular smooth muscle tone

(11) Which of the following adverse effects are less likely in a beta1-selective blocker? - ANSWER>>Impaired insulin release

(11) Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take related to his nadolol? - ANSWER>>Extend the dosage interval.

(11) Beta blockers are the drugs of choice for exertional angina because they: - ANSWER>>Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance

(11) Adherence to beta blocker therapy may be affected by their: - ANSWER>>Effects on the male genitalia, which may produce impotence

(11) Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: - ANSWER>>Left ventricular dysfunction is diagnosed

(11) Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with: - ANSWER>>a. Angina b. Coronary artery disease [[c. Both 1 and 2]]

(11) To prevent life-threatening events from rapid withdrawal of a beta blocker: - ANSWER>>The dosage should be decreased by one-half every 4 days.

(11) Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose? - ANSWER>>Diaphoresis

(11) Combined alpha-beta antagonists are used to reduce the progression of heart failure because they: - ANSWER>>Vasodilate the peripheral vasculature

(11) Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes? - ANSWER>>a. Histamine 2 blockers b. Quinolones c. Serotonin re-uptake inhibitors [[d. All of the above]]

(11) Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? - ANSWER>>African American

(11) Bethanechol: - ANSWER>>Increases detrusor muscle tone to empty the bladder

(11) Clinical dosing of Bethanechol: - ANSWER>>Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved

(11) Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects? - ANSWER>>Diphenhydramine

(11) Anticholinesterase inhibitors are used to treat: - ANSWER>>Myasthenia gravis

(11) Which of the following drugs used to treat Alzheimer's disease is not an anticholinergic? - ANSWER>>Memantine

(11) Taking which drug with food maximizes it bioavailability? - ANSWER>>Rivastigmine

(11) Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women? - ANSWER>>Pyridostigmine

(11) There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include: - ANSWER>>Fasciculations of voluntary muscles

(11) Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily? - ANSWER>>Donepezil

(11) Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine? - ANSWER>>Vasodilation and decreased heart rate

(11) Nicotine gum products are: - ANSWER>>Bound to exchange resins so the nicotine is only released during chewing

(11) Nicotine replacement therapy (NRT): - ANSWER>>Delays healing of esophagitis and peptic ulcers

(11) Success rates for smoking cessation using NRT: - ANSWER>>Vary from 40% to 50% at 12 months

(11) Cholinergic blockers are used to: - ANSWER>>a. Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines b. Control tremors and relax smooth muscle in Parkinson's disease c. Inhibit the muscarinic action of ACh on bladder muscle

[[d. All of the above]]

(11) Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? - ANSWER>>Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.

(11) Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to: - ANSWER>>Swallow the tablet 1 hour before traveling where motion sickness is possible.

(11) You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is: - ANSWER>>Discontinue the tamsulosin and start doxazosin.

(11) You are treating a patient with a diagnosis of Alzheimer's disease. The patient's wife mentions difficulty with transportation to the clinic. Which medication is the best choice? - ANSWER>>Donepezil

(11) A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause? - ANSWER>>Bethanechol

(11) Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications? - ANSWER>>Carvedilol

(11) Activation of central alpha2 receptors results in inhibition of cardioacceleration and _______ centers in the brain. - ANSWER>>Vasoconstriction

(12) Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

• ANSWER>>Anorexiants may cause tolerance and should only be prescribed for 6 months

(12) Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John's wort due to: - ANSWER>>The risk of serotonin syndrome

(12) Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for _______ episode of status epilepticus. - ANSWER>>Rectal diazepam (Diastat)

(12) Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: - ANSWER>>For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment

(12) Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: - ANSWER>>Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.

(12) Carbamazepine has a Black Box Warning due to life-threatening: - ANSWER>>Dermatologic reaction, including Steven's Johnson and toxic epidermal necrolysis

(12) Long-term monitoring of patients who are taking carbamazepine includes: - ANSWER>>Complete blood count every 3 to 4 months

(12) 6-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: - ANSWER>>Blood dyscrasias, which are uncommon but possible

(12) 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: - ANSWER>>Assess for suicidal ideation

(12) 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:

• ANSWER>>Consult with a neurologist, as this is not a common adverse effect of topiramate.

(12) Monitoring of a patient on gabapentin to treat seizures includes: - ANSWER>>Recording seizure frequency, duration, and severity

(12) Scott's seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes: - ANSWER>>He should monitor his temperature and ability to sweat in the heat while playing

(12) Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: - ANSWER>>To not abruptly discontinue levetiracetam due to risk for withdrawal seizures

(12) Levetiracetam has known drug interactions with: - ANSWER>>Few, if any, drugs

(12) Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: - ANSWER>>Ruling out a hypersensitivity reaction that may lead to multi-organ failure

(12) Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause: - ANSWER>>Reduced lamotrigine levels, requiring doubling the dose of lamotrigine

(12) The tricyclic antidepressants should be prescribed cautiously in patients with:

• ANSWER>>Heart disease

(12) A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs): - ANSWER>>a. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) b. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce c. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment [[d. All of the above]]

(12) Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is: - ANSWER>>Fluoxetine

(12) Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes: - ANSWER>>SSRIs may take 2 to 6 weeks before she will have maximum drug effects.

(12) 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: - ANSWER>>Duloxetine (Cymbalta)

(12) Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long- acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider: - ANSWER>>With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)

(12) Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: - ANSWER>>Potentiate the effects of the drug

(12) Patients who are prescribed olanzapine (Zyprexa) should be monitored for: - ANSWER>>Insomnia

(12) A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including: - ANSWER>>Bradykinesia, akathisia, and agitation

(12) In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is: - ANSWER>>Alprazolam (Xanax)

(12) A patient with anxiety and depression may respond to: - ANSWER>>Buspirone (Buspar) and an SSRI combined

(12) When prescribing temazepam (Restoril) for insomnia, patient education includes: - ANSWER>>Temazepam should not be used more than three times a week for less than 3 months.

(12) Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: - ANSWER>>Zolpidem should be taken just before going to bed.

(12) One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as: - ANSWER>>Drowsiness and nausea

(12) Tom is taking lithium for bipolar disorder. He should be taught to: - ANSWER>>Eat a diet with consistent levels of salt (sodium)

(12) Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her? - ANSWER>>Valproate is a known teratogen, but may be taken after the first trimester if necessary.

(12) When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include: - ANSWER>>a. The medication may cause sedation and they should not drive. b. Constipation is a common side effect and they should increase fluids and fiber. c. Patients should not take any other acetaminophen-containing medications at the same time. [[d. All of the above]]

(12) Kirk sprained his ankle and is asking for pain medication for his mild-to- moderate pain. The appropriate first-line medication would be: - ANSWER>>Ibuprofen (Advil)

(12) Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be: - ANSWER>>Acetaminophen with hydrocodone (Vicodin)

(12) Jack, age 8, 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: - ANSWER>>Insomnia and decreased appetite

(12) Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes: - ANSWER>>a. ADHD symptoms b. Routine height and weight checks c. Amount of methylphenidate being used [[d. All of the above]]

(12) When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: - ANSWER>>Blood pressure

(30) Common mistakes practitioners make in treating anxiety disorders include: - ANSWER>>Thinking a partial response to medication is acceptable

(30) An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: - ANSWER>>Buspirone (Buspar)

(30) An appropriate drug to initially treat panic disorder is: - ANSWER>>Diazepam (Valium)

(30) Prior to starting antidepressants, patients should have laboratory testing to rule out: - ANSWER>>Hypothyroidism

(30) David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David's education regarding his medication would include: - ANSWER>>He may experience sexual dysfunction beginning a month after he starts therapy.

(30) Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be: - ANSWER>>Appetite and concentration improve in the first 1 to 2 weeks.

(30) An appropriate drug for the treatment of depression with anxiety would be: - ANSWER>>Escitalopram (Lexapro)

(30) An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: - ANSWER>>Venlafaxine (Effexor)

(30) The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is: - ANSWER>>There is no laboratory monitoring required

(30) Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants? - ANSWER>>Reduce dose by 50% for 3 to 4 days

(30) The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason? - ANSWER>>They have become tolerant of the medication, which is characterized by the need for higher and higher doses.

(30) What "onset of action" symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor? - ANSWER>>They can feel a bit of nausea, but this resolves in a week.

(30) Which of the following should not be taken with a selective serotonin reuptake inhibitor? - ANSWER>>Alcohol

(30) Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)? - ANSWER>>It has a shorter half-life and withdrawal syndrome has a faster onset without taper.

(30) The patient shares with the provider that he is taking his Prozac at night before going to bed. What is best response? - ANSWER>>Have you noticed that you are having more sleep issues since you started that?

(37) Paige has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventive medication includes: - ANSWER>>The goal of treatment is to reduce migraine occurrence by 50%.

(37) A first-line drug for abortive therapy in simple migraine is: - ANSWER>>Naproxen (Aleve)

(37) Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her? - ANSWER>>Assess how often she is using Fiorinal and refill her medication.

(37) When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include: - ANSWER>>They may need premedication with an antinausea medication.

(37) Migraines in pregnancy may be safely treated with: - ANSWER>>Acetaminophen with codeine (Tylenol #3)

(37) Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be: - ANSWER>>Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

(37) Kelly is a 14-year-old patient who presents to the clinic with a classic migraine. She says she is having a headache two to three times a month. The