Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Test, Exams of Health sciences

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Pharmacotherapeutics for Advanced

Practice Nurse Prescribers 5th Edition Woo

Robinson Test Bank / (CHAPTERS 23 & 24,

complete questions and Correct answers)

2024-2025. Graded A

A 19-year-old patient was diagnosed with bacterial conjunctivitis. Which antibiotic would be most appropriate for this patient?

1. Cipro tablets
2. Ocuflox solution
3. Levaquin tablets
4. Cleocin solution - ANSOption 2: Ocuflox solution would be the eye drop antibiotic prescribed in this case. A 23-year-old female patient presents to the clinic with a 24-hour history of zoster outbreak. When would therapy with a nucleoside analog be initiated for greatest effect?
5. Within 3 days
6. Within 4 days
7. Within 2 days
8. Within 5 days - ANS3. Within 2 days Option 3: Therapy is most effective if initiated within 48 hours of the outbreak of the rash.

Rationales Option 1: Therapy with nucleoside analogues should be initiated within 3 days of the outbreak of the rash in herpes zoster. Option 2: Therapy would be losing effect after 4 days following outbreak of rash. A 23-year-old patient was diagnosed with Trichomonas vaginal infection. Which medication is most appropriate for this patient?

1. A single dose of 2 g metronidazole
2. A single dose of 1 g metronidazole
3. A single dose of 5 g tinidazole
4. A single dose of 500 mg tinidazole - ANS1. A single dose of 2 g metronidazole Option 1: One-day treatment with metronidazole is 2 g as a single dose or tinidazole 2 g orally in a single dose; 7-day treatment is 500 mg twice a day. Rationales Option 2: One-day treatment with metronidazole is more than 1 g as a single dose. Option 3: One-day treatment with tinidazole is less than 5 g orally in a single dose. Option 4: One-day treatment with tinidazole is more than 500 mg orally in a single dose.

A 24-year-old patient was diagnosed with bacterial vaginosis. Which medication dosage is most appropriate for this patient?

1. Tinidazole 2 g oral dose once daily for 2 days taken with food
2. Tinidazole 1 g oral dose once daily for 2 days taken with food
3. Tinidazole 1 g oral dose once daily for 7 days taken with food
4. Tinidazole 2 g oral dose once daily for 7 days taken with food - ANS1. Tinidazole 2 g oral dose once daily for 2 days taken with food Option 1: The recommended dose of tinidazole in nonpregnant females with bacterial vaginosis is a 2 g oral dose once daily for 2 days taken with food or a 1 g oral dose once daily for 5 days taken with food. A 33-year-old female has been diagnosed with genital herpes, and this is her first outbreak. Which recommended dose of antiviral will the APN prescribe to this patient?
5. Acyclovir 200 mg 5 times per day for 10 days
6. Acyclovir 500 mg 5 times per day for 10 days
7. Acyclovir 200 mg 3 times per day for 10 days
8. Acyclovir 500 mg 3 times per day for 10 days - ANS1. Acyclovir 200 mg 5 times per day for 10 days Option 1: Acyclovir 200 mg every 4 hours while awake, 5 times per day for 10 days is the recommended dose for treatment of the initial episode of genital herpes.

Rationales Option 2: The initial recommended dose of acyclovir is fewer than 200 mg. Option 3: An accepted off-label dose of acyclovir is 400 mg, not 200 mg, 3 times per day for 10 days. Option 4: An accepted off-label dose of acyclovir is 400 mg, not 500 mg, 3 times per day for 10 days. A 33-year-old female patient is diagnosed with vaginal candidiasis. Which medication and dosage are most appropriate for the APN to prescribe?

1. Itraconazole 100 mg as single PO dose
2. Fluconazole 150 mg as single PO dose
3. Fluconazole 100 mg as single PO dose
4. Itraconazole 150 mg as single PO dose - ANS2. Fluconazole 150 mg as single PO dose Option 2: Fluconazole 150 mg as single PO dose is the correct medication and dosage. Rationales Option 1: Itraconazole 100 mg as single PO dose is appropriate treatment for esophageal candidiasis but not vaginal candidiasis.

Option 3: This dose of fluconazole is too low. Option 4: Itraconazole 150 mg as single PO dose is appropriate treatment for esophageal candidiasis but not vaginal candidiasis. A 33-year-old pregnant female patient has developed community-acquired pneumonia (CAP). Which antibiotic is most appropriate for this patient?

Levaquin

Avelox

Noroxin

Zithromax - ANS4. Zithromax Option 4: Antibiotic therapy for the pregnant patient is similar to treatment of other adults with CAP: the macrolides erythromycin, azithromycin (Zithromax), and clarithromycin are safe during pregnancy, although erythromycin or azithromycin is the first choice because each is Pregnancy Category B, whereas clarithromycin is Pregnancy Category C. Quinolones are contraindicated in pregnancy due to the inhibition of fetal growth. Rationales

Option 1: Fluoroquinolones such as levofloxacin (Levaquin) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Option 2: Fluoroquinolones such as moxifloxacin (Avelox) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Option 3: Fluoroquinolones such as norfloxacin (Noroxin) are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. A 36-year-old patient is diagnosed with oral candidiasis. Which regimen of fluconazole is most appropriate for this patient?

Fluconazole 300 mg PO on first day, followed by 50 mg once daily for 2 weeks

Fluconazole 300 mg PO on first day, followed by 100 mg once daily for 2 weeks

Fluconazole 200 mg PO on first day, followed by 50 mg once daily for 2 weeks

Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks - ANS4. Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks Option 4: Fluconazole 200 mg PO on first day, followed by 100 mg once daily for 2 weeks is the proper medication and dosage to be prescribed with a patient with oral candidiasis. Rationales Option 1: Fluconazole 300 mg PO on first day is too high for an initial dose. Fluconazole 50 mg once daily for 2 weeks is too low of a continuing dose. Option 2: Fluconazole 300 mg PO on first day is too high for an initial dose. Option 3: Fluconazole 50 mg once daily for 2 weeks is too low of a continuing dose. A 42-year-old pregnant female patient comes to the clinic with an outbreak of herpes simplex to the lips. Which medication would be most appropriate for the patient?

Famciclovir

Acyclovir

Famvir

Valganciclovir - ANS2. Acyclovir Option 2: Acyclovir is Pregnancy Category B and safe to use in pregnancy. Rationales Option 1: There is inadequate human data on famciclovir to justify prescribing to a pregnant patient. Option 3: There is inadequate human data on Famvir to justify prescribing to a pregnant patient. Option 4: Valganciclovir is Pregnancy Category C and is most often used in treating cytomegalovirus disease in HIV patients. A 46-year-old patient is newly diagnosed with hepatitis C. The APN understands that hepatitis B serum will need to be drawn prior to starting any hepatitis C virus (HCV) medications for which reason?

Risk of hepatitis C reactivation

Risk of hepatitis A reactivation

Risk of hepatitis B reactivation

Risk of hepatitis D reactivation - ANSOption 3: There is a risk of reactivation of hepatitis B, and this would need to be covered. A 63-year-old healthy patient was diagnosed with community-acquired pneumonia. Which antibiotic would be most appropriate for this patient?

Levaquin

Penicillin

Macrobid

Keflex - ANS1. Levaquin Option 1: Levaquin is the most commonly used antibiotic for community-acquired pneumonia. Rationales Option 2: Although penicillin is commonly used for standard pneumonia, it is not the most common for treatment of community-acquired pneumonia. Option 3:

Macrobid is not used to treat community-acquired pneumonia. Option 4: Keflex is not used to treat community-acquired pneumonia. A 66-year-old patient with diabetes and chronic heart disease has been diagnosed with atypical pneumonia. Which antibiotic would be most appropriate for this patient?

Zithromax

Levaquin

Macrobid

Keflex - ANS2. Levaquin Option 1: Presence of comorbidities such as chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressant conditions or use of immunosuppressant drugs; use of antimicrobials within the previous 3 months; or other risk for drug-resistant Streptococcus pneumoniae (DRSP) infection requires a respiratory fluoroquinolone.

A 76-year-old patient was diagnosed with a first episode of herpes zoster. Which medication regimen is most appropriate for the APN to prescribe?

Acyclovir 800 mg 5 times per day for 7 to 10 days

Acyclovir 800 mg 5 times per day for 10 to 12 days

Acyclovir 800 mg 3 times per day for 7 to 10 days

Acyclovir 800 mg 3 times per day for 10 to 12 days - ANS1. Acyclovir 800 mg 5 times per day for 7 to 10 days Option 1: Oral acyclovir 800 mg taken every 4 hours while awake, 5 times per day for 7 to 10 days, is the recommended dose for initial episode of herpes zoster. Rationales Option 2: Acyclovir does not need to be taken for 10 to 12 days to treat herpes zoster. Option 3: Acyclovir needs to be taken more frequently than 3 times per day to treat herpes zoster. Option 4: Acyclovir needs to be taken more frequently than 3 times per day but for less than 10 to 12 days to treat herpes zoster.

A health-care provider was exposed to HIV by a needle stick. The APN understands that post-exposure prophylaxis (PEP) is effective only if the exposure occurred within which time frame?

72 hours

48 hours

24 hours

12 hours - ANSOption 1: PEP is effective only if the exposure occurred within 72 hours (or 3 days). A patient with HIV was prescribed an antibiotic, and 7 days later the patient developed an erythema multiforme rash. Which antibiotic is most consistent with this side effect?

Trimpex

Macrobid

Zithromax

Biaxin - ANS1. Trimpex Option 1:

Rashes and generalized skin eruptions are common adverse reactions for sulfonamides and trimethoprim (Trimpex). The incidence may be dose- related and is more prevalent in HIV-infected patients. Skin eruptions may include erythema multiforme, exfoliative dermatitis, toxic epidermal necrolysis, and Stevens-Johnson syndrome. Rationales Option 2: Nitrofurantoin monohydrate macrocrystals (Macrobid) should be used with caution in those predisposed to its adverse effects: older patients and patients with anemia, renal impairment, electrolyte imbalance, diabetes, vitamin B deficiency, and debilitating diseases. It does not commonly cause rash. Option 3: Rashes and generalized skin eruptions are not commonly noted with azithromycin (Zithromax), a macrolide. Option 4: Rashes and generalized skin eruptions are not commonly noted with clarithromycin (Biaxin), a macrolide. A pregnant 29-year-old patient has developed community-acquired pneumonia. The APN understands that a fluoroquinolone cannot be prescribed due to the risk of malformation of the fetus. Which regimen would be most appropriate?

A beta-lactam plus a carbapenem

A beta-lactam plus a macrolide

A beta-lactam plus a tetracycline

A beta-lactam plus a cephalosporin - ANS2. A beta-lactam plus a macrolide Option 2: Fluoroquinolones are avoided during pregnancy due to concerns for fetal malformations, based on animal studies. Women with comorbid conditions or recent antibiotics should be treated with a beta-lactam plus a macrolide. Rationales Option 1: Carbapenems are used to treat serious infections in the hospital. Option 3: Doxycycline, a tetracycline, is not used during pregnancy because it may cause discoloration of deciduous teeth in neonates. Option 4: A beta-lactam plus a cephalosporin is not the most appropriate regimen for this patient. An APN is prescribing oseltamivir for the onset of flu-like symptoms to a 44- year-old patient. Which dosage is appropriate for this patient?

75 mg PO bid for 5 days and start within 48 hours of symptoms

75 mg PO bid for 4 days and start within 48 hours of symptoms

75 mg PO bid for 3 days and start within 48 hours of symptoms

75 mg PO bid for 2 days and start within 48 hours of symptoms - ANS1. 75 mg PO bid for 5 days and start within 48 hours of symptoms Option 1: 75 mg PO bid for 5 days and start within 48 hours of symptoms is the correct dosage and time frame. An infant is diagnosed with chlamydial pneumonia. Which medication regimen adheres to the standard of treatment for this patient?

Clarithromycin 50 mg/kg daily for 14 days

Erythromycin 50 mg/kg daily for 14 days

Azithromycin 50 mg/kg daily for 14 days

Clindamycin 20 mg/kg daily for 14 days - ANS2. Erythromycin 50 mg/kg daily for 14 days Option 2: The standard treatment for infants with confirmed chlamydial pneumonia is erythromycin (EryPed) 50 mg/kg daily for 14 days or oral azithromycin (Zithromax) 20 mg/kg/d for 3 days.

Rationales Option 1: Clarithromycin is not the recommended medication for this patient. Option 3: Azithromycin can be used with infants; however, the standard treatment for infants with confirmed chlamydial pneumonia is oral azithromycin 20 mg/kg/d for 3 days. Option 4: Clindamycin is not the recommended medication for this patient. Current treatment of HIV infection functions through which mechanism of action?

Reduction in transmissibility

Pre-exposure prophylaxis

Eradication of infection

Viral suppression - ANS4. Viral suppression Option 4: Until there is a cure for HIV, the best treatment for HIV includes viral suppression with adherence to effective and safe antiretroviral therapy.

Rationales Option 1: Reducing transmissibility of HIV is a goal of treatment but is not the mechanism of action. Option 2: Pre-exposure prophylaxis is a method for preventing HIV infection but is not the mechanism of action of treatment. Option 3: Eradication of infection is currently not possible. Doxycycline is not used during pregnancy because it may cause which effect in neonates?

Growth stunt

Discoloration of deciduous teeth

Cardiac malformation

Decrease in lung surfactant - ANS2. Discoloration of deciduous teeth Option 2: Doxycycline, a tetracycline, is not used during pregnancy because it may cause discoloration of deciduous teeth in neonates. Rationales

Option 1: Doxycycline is not noted to cause growth stunt, cardiac malformations, or decreased lung surfactant in neonates. First-generation cephalosporins are active against which organisms?

Methicillin-resistant Staphylococcus Aureus

Gram-negative organisms

Methicillin-sensitive Staphylococcus Aureus

Enterococcus organisms - ANS3. Methicillin-sensitive Staphylococcus Aureus Option 3: First-generation cephalosporins are active against gram-positive cocci, including S. aureus and S. epidermidis (excluding methicillin-resistant strains), and most streptococci. Option 1: First-generation cephalosporins are active against gram-positive cocci, including S. aureus and S. epidermidis (excluding methicillin-resistant strains), and most streptococci. Option 2: First-generation cephalosporins are not active against gram-negative organisms.

Option 4: First-generation cephalosporins are resistant to enterococcus species. Fluoroquinolones are considered to be which type of agent?

Bacteriostatic

Bactericidal

Cytotoxic

Enteric - ANS2. Bactericidal Option 2: Fluoroquinolones are bactericidal through interference with enzymes required for the synthesis and repair of bacterial DNA. Rationales Option 1, 3, 4: Fluoroquinolones are not considered bacteriostatic, cytotoxic, or enteric agents Fluoroquinolones fall under which pregnancy category?

Category B

Category X

Category A

Category C - ANS4. Category C Option 4: Fluoroquinolones are Pregnancy Category C. Use is not recommended in pregnant women because there are no adequate, well-controlled studies in this population, and teratogenesis has been demonstrated in animals. Use during pregnancy only if there is a clear benefit that justifies the risk to the fetus. If a patient has not clinically improved within 72 hours of starting an antibiotic, then the APRN must consider which possibility?

The pathogen is not being treated appropriately.

The antibiotic should be discontinued.

Another antibiotic needs to be added.

A probiotic needs to be added. - ANS1. The pathogen is not being treated appropriately. Option 1: If no improvement in clinical status occurs within 72 hours, the practitioner needs to consider that the pathogen is not being treated appropriately. Two

possibilities exist. One is that the antibiotic chosen is not treating the pathogen. Another consideration is that the pathogen is resistant to the antibiotic chosen. Rationales Option 2: Discontinuing the antibiotic without using another may increase resistance. Option 3: Adding an antibiotic without discontinuing the current one may increase resistance. Option 4: Adding a probiotic would not help treatment. In which time frame would an APN expect to see signs of allergic reactions after an antibiotic is initiated?

From 20 minutes to 3 weeks

From 3 weeks to 6 months

From 6 months to 1 year

From 1 year to 18 months - ANS1. From 20 minutes to 3 weeks Option 1:

Signs of allergic reactions may occur from minutes to weeks after the antibiotic is initiated and even after the course of therapy is completed. Although immediate hypersensitivity reactions are more likely to be life threatening, delayed reactions can also be serious. Oral ribavirin, combined with interferon, is used to treat infection of which virus?

Influenza A

HIV-1

Respiratory syncytial virus (RSV)

Hepatitis C virus (HCV) - ANS4. Hepatitis C virus (HCV) Rationales Option 4: Oral ribavirin plays a key role when combined with interferon for the treatment of HCV. Option 1: Ribavirin is active against influenza A, but its oral form combined with interferon is not used to treat it. Option 2:

Ribavirin is active against H1V-1, but its oral form combined with interferon is not used to treat it. Option 3: Ribavirin is active against RSV, but its oral form combined with interferon is not used to treat it. Protease inhibitors are used to treat HIV and which other viral infection?

Herpes simplex

Hepatitis C

Herpes zoster

Cytomegalovirus - ANS2. Hepatitis C Option 2: Protease inhibitors are a class of medications used to treat or prevent viral infection such as HIV and hepatitis C. Rationales Option 1: Protease inhibitors are not used to treat herpes simplex. Option 3: Protease inhibitors are not used to treat herpes zoster. Option 4:

Protease inhibitors are not used to treat cytomegalovirus. Question 1. The 43-year-old patient comes into the clinic with flu-like symptoms. The patient's onset of symptoms is less than 48 hours. The APN will prescribe oseltamivir and understands that the half-life is which of the following?

20 to 24 hours

6 to 10 hours

2.5 to 5 hours

12 to 16 hours - ANS2. 6 to 10 hours Option 2: The half-life for oseltamivir is 6 to 10 hours. Rationales Option 1: The half-life for peramivir is 20 hours. Option 3: The half-life for zanamivir is 2.5 to 5.1 hours.

The 53-year-old patient just completed a 14-day course of antibiotic and developed Clostridium difficile colitis. Which antibiotic most likely caused this patient to have Clostridium difficile colitis?

Zithromax

Biaxin

Cleocin

Prilosec - ANS3. Cleocin Option 3: There is a high incidence of Clostridium difficile colitis associated with clindamycin (Cleocin). Rationales Option 1: An azalide such as Zithromax does not have the highest incidence of Clostridium difficile colitis. Option 2: A macrolide such as Biaxin does not have the highest incidence of Clostridium difficile colitis. Option 4: Prilosec is not an antibiotic but a proton pump inhibitor (PPI).