PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSE PRESCRIBERS QUESTIONS WITH ANSWERS, Exams of Nursing

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PHARMACOTHERAPEUTICS FOR ADVANCED

PRACTICE NURSE PRESCRIBERS QUESTIONS WITH

ANSWERS

1.Patricia has been prescribed doxycycline for a chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Patricia's education would include:

1. Use a back-up method of birth control (condom) until her next menses.
2. Doxycycline may cause tendonitis and she should report any joint pain.
3. Her partner will need treatment if her infection doesn't clear with the doxy- cycline.
4. Doxycycline is used for one-dose treatment of STIs; take the whole prescrip- tion at once.: 1 2.When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include:
5. Metronidazole is safe in the first trimester of pregnancy.
6. Consuming alcohol in any form may cause a severe reaction.
7. Sexual partners need concurrent therapy.
8. Headaches are a sign of a serious adverse reaction and need immediate evaluation.: 2 3.The treatment goals when treating urinary tract infection (UTI) include:
9. Eradication of infecting organism
10. Relief of symptoms
11. Prevention of recurrence of the UTI
12. All of the above: 4 4.Sally is a 16-year-old female with a urinary tract infection. She is healthy, afebrile, with no use of antibiotics in the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be:
13. Azithromycin
14. Trimethoprim/sulfamethoxazole

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3. Ceftriaxone
4. Levofloxacin: 2 5.Jamie is a 24-year-old female with a urinary tract infection. She is healthy, afebrile, and her only drug allergy is sulfa, which gives her a rash. An appro- priate first-line antibiotic choice for her would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Ceftriaxone 4. Ciprofloxacin: 4 6.Juanita is a 28-year-old pregnant woman at 38 weeks' gestation who is diagnosed with a lower urinary tract infection (UTI). She is healthy with no drug allergies. Appropriate first-line therapy for her UTI would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Amoxicillin 4. Ciprofloxacin: 3 7.Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection? 1. Juanita, a 28-year-old pregnant woman 2. Sally, a 16-year-old healthy adolescent 3. Jamie, a 24-year-old female 4. Suzie, a 26-year-old diabetic: 3 8.Nicole is a 4-year-old female with a febrile urinary tract infection (UTI). She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Ceftriaxone 4. Ciprofloxacin: 3 9.Monitoring for a healthy, nonpregnant adult patient being treated for a urinary tract infection is:

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1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. "Test of cure" urinary analysis at completion of therapy 4. Follow-up urine culture 2 months after completion of therapy: 1 10.Monitoring for a child who has had a urinary tract infection is: 1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. "Test of cure" urinary analysis at completion of therapy 4. Follow-up urine culture 2 months after completion of therapy: 2 11.Monitoring for a pregnant woman who has had a urinary tract infection is: 1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. "Test of cure" urinary analysis at completion of therapy 4. Follow-up urine culture every 2 weeks until delivery: 4 12.Along with an antibiotic prescription, lifestyle education for a nonpregnant adult female who has had a urinary tract infection includes: 1. Increasing her intake of vitamin C-containing orange juice 2. Voiding 10 to 15 minutes after intercourse 3. Avoiding ingesting urinary irritants, such as asparagus 4. All of the above: 2 13.Lisa is a healthy nonpregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be: 1. Sixteen ounces per day of cranberry juice cocktail will prevent UTIs. 2. 100% cranberry juice or cranberry juice extract may decrease UTIs in some patients. 3. There is no evidence that cranberry juice helps prevent UTIs. 4. Cranberry juice only works to prevent UTIs in children.: 2 14.When Sam used clotrimazole (Lotrimin AF) for athlete's foot he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete's foot again. What would be a good choice of antifungal for Sam? 1. Miconazole (Micatin) powder 2. Ketoconazole (Nizoral) cream

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3. Terbinafine (Lamisil) cream 4. Griseofulvin (Grifulvin V) suspension: 3 15.When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include: 1. Spread penciclovir liberally all over lips and area surrounding lips. 2. Penciclovir therapy is started at the first sign of a cold sore outbreak. 3. Skin irritation is normal with penciclovir and it should resolve.

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4. The penciclovir should be used a minimum of 2 weeks to prevent recur- rence.: 2 16.Topical diphenhydramine (Benadryl) is available OTC to treat itching. Pa- tients or parents should be instructed regarding the use of topical diphenhy- dramine that: 1. For maximum effectiveness in treating itching, combine topical with oral diphenhydramine. 2. Topical diphenhydramine is the treatment of choice in treating poison ivy or poison oak. 3. Topical diphenhydramine should not be used in children younger than age 2 years. 4. When applying topical diphenhydramine, apply the cream liberally to all areas that itch.: 3 17.Absolute contraindications to estrogen therapy include: 1. History of any type of cancer 2. Clotting disorders 3. History of tension headaches 4. Orthostatic hypotension: 2 18.Women who have migraines with an aura should not be prescribed estro- gen because of: 1. The interaction between triptans and estrogen, limiting migraine therapy choices 2. An increased incidence of migraines with the use of estrogen 3. An increased risk of stroke occurring with estrogen use 4. Patients with migraines may be prescribed estrogen without any concerns- : 3

19. A 19-year-old female is a nasal Staph aureus carrier and is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contra- ceptives. What education should she receive regarding her medications? 1. Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour. 2. Both medications are best tolerated if taken on an empty stomach. 3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack. 4. If she gets nauseated with the medications she should call the office for an antiemetic prescription.: 3

6 / 18 20.A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be pre- scribed:

1. Low-dose oral estrogen 2. A low-dose estrogen/progesterone combination 3. A vaginal estradiol ring 4. Vaginal progesterone cream: 3 21.The goals of treatment when prescribing for sexually transmitted infec- tions include: 1. Treatment of infection 2. Prevention of disease spread 3. Prevention of long-term sequelae from the infection 4. All of the above: 4 22.The drug of choice for treatment of primary or secondary syphilis is: 1. Ceftriaxone IM 2. Benzathine penicillin G IM 3. Oral azithromycin 4. Oral ciprofloxacin: 2 23.The drug of choice for treatment of early latent or tertiary syphilis is: 1. Ceftriaxone IM 2. Benzathine penicillin G IM 3. Oral azithromycin 4. Oral ciprofloxacin: 2 24.Demione is a 24-year-old patient who is 32 weeks pregnant and has tested positive for syphilis. The best treatment for her would be: 1. IM ceftriaxone 2. IM benzathine penicillin G 3. Oral azithromycin 4. Any of the above: 2 25.Treatment for suspected gonorrhea is: 1. Ceftriaxone 250 mg IM x 1 2. Ceftriaxone 2 grams IM x 1 3. Ciprofloxacin 500 mg PO x 1

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4. Doxycycline 100 mg bid x 7 days: 1 26.When treating suspected gonorrhea in a nonpregnant patient, the patient should be concurrently treated for chlamydia with: 1. Azithromycin 1 gram PO x 1 2. Amoxicillin 500 mg PO x 1 3. Ciprofloxacin 500 mg PO x 1 4. Penicillin G 2.4 million units IM x 1: 1 27.Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened for gonorrhea and chlamydia in: 1. 4 weeks 2. 3 to 6 weeks 3. 3 to 6 months 4. 1 year: 3 28.A test of cure is recommended after treating chlamydia in which patient population? 1. Men who have sex with men 2. Adolescent females 3. Pregnant patients 4. All of the above: 3 29.Treatment for chancroid in a nonpregnant patient would be: 1. Oral azithromycin 2. IM ceftriaxone 3. Oral ciprofloxacin 4. Any of the above: 4 30.Jamie was treated for chancroid. Follow-up testing after treatment of chan- croid would be: 1. Syphilis and HIV testing at 3-month intervals 2. Chancroid-specific antigen test every 3 months

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3. Urine testing for Haemophilus ducreyi in 3 to 6 months for test of cure 4. Annual HIV testing if engaging in high-risk sexual behavior: 1 31.Helima presents with a complaint of vaginal discharge that when tested meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in nonpregnant symptomatic women would be: 1. Metronidazole 500 mg PO bid x 7 days 2. Doxycycline 100 mg PO bid x 7 days 3. Intravaginal tinidazole daily x 5 days 4. Metronidazole 2 grams PO x 1 dose: 1 32.Besides prescribing antimicrobial therapy, patients with bacterial vagi- nosis require education regarding the fact that: 1. The most recent partners in the past 60 days should also be treated. 2. Alcohol should not be consumed during and for 1 day after metronidazole is taken. 3. Condoms should be used during intercourse if intravaginal clindamycin cream is used. 4. Co-treatment for chlamydia is necessary.: 2 33.Sydney presents to the clinic with vulvovaginal candidiasis. Appropriate treatment for her would be: 1. OTC intravaginal clotrimazole 2. OTC intravaginal miconazole 3. Oral fluconazole one-time dose 4. Any of the above: 4 34.If a woman presents with recurrent vulvovaginal candidiasis she may be treated with: 1. Weekly intravaginal butoconazole for 3 months 2. Fluconazole 150 mg PO daily x 7 doses then monthly for 6 months 3. Weekly fluconazole 150 mg PO x 6 months 4. Intravaginal tioconazole x 14 days: 3 35.Zoe presents with genital warts present on her labia. Patient-applied topi- cal therapy for warts includes: 1. Podofilox 0.5% gel 2. Podophyllin 10% resin

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3. Trichloracetic acid 4. Any of the above: 1 36.Sophie presents to the clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include: 1. Metronidazole 2 grams PO x 1 dose 2. Topical intravaginal metronidazole daily x 7 days 3. Intravaginal clindamycin daily x 7 days 4. Azithromycin 2 grams PO x 1 dose: 1 37.In addition to antimicrobial therapy, patients treated for Trichomonas infec- tion should be educated regarding: 1. Necessity of treating sexual partner simultaneously 2. Abstaining from intercourse until both partners are treated 3. Need for retesting in 3 months due to high reinfection rate 4. All of the above: 4 38.Prescribing for women during their childbearing years requires constant awareness of the possibility of: 1. Pregnancy unless the women is on birth control 2. Risk for silent bacterial or viral infections of the genitalia 3. High risk for developmental disorders in their infants 4. Decreased risk for abuse during this time: 2 39.Intimate partner violence is a serious public health problem. It should be screened for: 1. At every encounter within the health-care system 2. When a women is being seen for symptoms of depression 3. Throughout pregnancy 4. If a sexually transmitted disease is diagnosed: 1 40.Paige has a history of chronic migraines and would benefit from pre- ventative medication. Education regarding migraine preventive medication includes: 1. Medication is taken at the beginning of the headache to prevent it from getting worse. 2. Medication alone is the best preventative against migraines occurring. 3. Medication should not be used more than four times a month.

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4. The goal of treatment is to reduce migraine occurrence by 50%.: 4 41.A first-line drug for abortive therapy in simple migraine is: 1. Sumatriptan (Imitrex) 2. Naproxen (Aleve) 3. Butorphanol nasal spray (Stadol NS) 4. Butalbital and acetaminophen (Fioricet): 2 42.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? 1. Switch her to sumatriptan (Imitrex) to treat her migraines. 2. Assess how often she is using Fiorinal and refill her medication. 3. Switch her to a beta blocker such as propranolol to prevent her migraine. 4. Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines.: 2 43.When prescribing ergotamine suppositories (Wigraine) to treat acute mi- graine, patient education would include: 1. Ergotamine will briefly make the migraine worse before the migraine re- solves. 2. The patient may experience bradycardia and dizziness. 3. They may need premedication with an antinausea medication. 4. Ergotamine works best if the patient starts off with a full suppository to get the full effect.: 3 44.Migraines in pregnancy may be safely treated with: 1. Acetaminophen with codeine (Tylenol #3) 2. Sumatriptan (Imitrex) 3. Ergotamine tablets (Ergostat) 4. Dihydroergotamine (DHE): 1 45.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:

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1. Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use. 2. Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose. 3. Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital). 4. Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.: 2 46.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 initial plan would be: 1. Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers. 2. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relax- ation therapy to reduce her stress. 3. Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine. 4. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic.: 1 47.Jayla is a 9-year-old patient who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate? 1. Prescribe amitriptyline (Elavil) daily, start at a low dose and increase dosage slowly every 2 weeks until it's effective in eliminating migraines. 2. Encourage her mother to give her Excedrin Migraine (aspirin, aceta- minophen, and caffeine) at the first sign of a headache to abort the headache.

3. Prescribe propranolol (Inderal) to be taken daily for at least 3 months. 4. Explain that it is rare for a 9-year-old child to get migraines and she needs an MRI to rule out a brain tumor.: 3 48.Amber is a 24-year-old patient who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber's naratriptan, educa- tion would include: 1. Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and St John's wort, and she should inform any providers she sees that she has migraines. 2. Continue to monitor her headaches, if the migraine is consistently happen- ing around her menses there is preventive therapy available. 3. Pregnancy is contraindicated when taking a triptan. 4. All of the above: 4 49.When prescribing for migraines, patient education includes: 1. Triptans are safe to be used as often as needed as long as the patient is healthy. 2. Use triptan before trying OTC meds such as acetaminophen or naproxen. 3. Stress reduction and regular sleep are integral to migraine treatment. 4. If migraines worsen they are to increase their medication.: 3 50.Juanita presents to the clinic with a complaint of headaches off and on for months. She reports they feel 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: 1. Sumatriptan (Imitrex) 2. Naproxen (Aleve) 3. Ergotamine (Ergostat) 4. Tylenol with codeine (Tylenol #3): 2 51.Nonpharmacologic therapy for tension headaches includes: 1. Biofeedback 2. Stress management 3. Massage therapy 4. All of the above: 4 52.James has been diagnosed with cluster headaches. Appropriate acute therapy would be:

1. Butalbital and aspirin (Fiorinal) 2. Meperidine IM (Demerol) 3. Oxygen 100% for 15 to 30 minutes 4. Indomethacin (Indocin): 3 53.Preventative therapy for cluster headaches includes: 1. Massage or relaxation therapy 2. Ergotamine nightly before bed 3. Intranasal lidocaine four times a day during "clusters" of headaches 4. Propranolol (Inderal) daily: 2 54.When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. A clinical characteristic of medication-overuse headaches is that they: 1. Are increasing in frequency 2. Are increasing in intensity 3. Recur when medication wears off 4. Begin to "cluster" into a pattern: 3 55.The goals of treatment when prescribing antiretroviral medication to pa- tients with HIV include: 1. Prevent vertical HIV transmission 2. Improve quality of life 3. Prolong survival 4. All of the above: 4 56.A challenge faced with antiretroviral therapy (ART) is: 1. Patients abusing ART 2. Drug-resistant mutations of HIV 3. Reduction of transmissibility of HIV 4. Lack of efficacy data: 2 57.Predictors for successful treatment with antiretroviral therapy (ART) in HIV- positive patients include: 1. They respond to a low-potency treatment regimen 2. They have demonstrated resistance in the past and should respond to newer ART drugs

3. The patient is strictly adherent to the ART treatment regimen 4. Lower baseline CD4 T-cell count at baseline: 3 58.The goal of antiretroviral therapy in HIV-positive patients is: 1. Maximum suppression of HIV replication 2. Eradication of HIV virus from the body 3. Determining a treatment regimen that is free of adverse effects 4. Suppression of CD4 T-cell count: 1 59.Pregnant women who are HIV positive: 1. Are treated with AZT alone to prevent birth defects 2. Are treated with a combination antiretroviral therapy (ART) regimen 3. Should not be treated with ART due to teratogenicity of the drugs 4. Are at high risk of developing resistance to ART drugs: 2 60.Antiretroviral therapy is recommended for HIV-positive patients with: 1. A history of AIDS-defining illness 2. Pregnant women 3. Hepatitis B co-infection 4. All of the above: 4 61.If considering starting a patient on the nucleoside reverse transcriptase inhibitor abacavir, the following testing is recommended prior to prescribing: 1. Renal function 2. HLA B*5701 testing 3. Pancreatic enzyme levels 4. CYP 450 enzyme activity: 2 62.Suzanne is pregnant and has tested HIV positive. Which antiretroviral drug should be avoided in women who are pregnant? 1. Lopinavir/r 2. Zidovudine 3. Ritonavir 4. Lopinavir/ritonavir: 1 63.The cost of HIV treatment can be prohibitive for any patient. Patients can receive assistance from the:

1. Best Pharmaceuticals for HIV/AIDS Patient Act 2. Ryan White HIV/AIDS Treatment Modernization Act 3. National Institute of Health HIV/AIDS Assistance Fund 4. Centers for Disease Control HIV/AIDS Treatment Fund: 2 64.Resistance to antiretroviral therapy (ART) is measured by: 1. Measuring the DNA viral load in the serum 2. Determining plasma viral RNA on two successive measurements 3. Phenotype assays of the combination of ART the patient is on 4. Elevation of T4 counts: 2 65.Phenotype assays are used to measure of antiretroviral therapy. 1. Effectiveness 2. Genotype 3. Sensitivity 4. Hypersensitivity susceptibility: 3 66.Patient factors that contribute to antiretroviral therapy (ART) failure in- clude: 1. Being a male who has sex with males 2. HIV diagnosis in pregnancy 3. Good compliance with the ART treatment regimen 4. ART adverse effects: 4 67.Patients who are taking antiretroviral therapy need to have the following monitored: 1. Lipid levels 2. Sexual functioning 3. Platelet count 4. All of the above: 1 68.Successful antiretroviral therapy (ART) in an HIV-positive patient is deter- mined by: 1. Being able to stop ART therapy due to HIV virus eradication 2. Lowering HIV viral load to unmeasurable amounts 3. Individual measures of success based on their personal situation 4. Normal blood hematologic factors: 3 69.The overall goal of treating hyperlipidemia is:

1. Maintain an LDL level of less than 160 mg/dL 2. To reduce atherogenesis 3. Lowering apo B, one of the apoliproteins 4. All of the above: 2 70.When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment? 1. Total LDL 2. Fasting HDL 3. Coronary artery disease risk level 4. Fasting total cholesterol: 3 71.John is a 4-week-old infant who has been diagnosed with chlamydial pneumonia. An appropriate treatment for his pneumonia would be: 1. Levofloxacin 2. Amoxicillin 3. Erythromycin 4. Cephalexin: 3 72.Wing-Sing is a 4-year-old patient who has suspected bacterial pneumonia. He has a temperature of 102°F, oxygen saturation level of 95%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumo- nia? 1. Ceftriaxone 2. Azithromycin 3. Cephalexin 4. Levofloxacin: 1 73.Giselle is a 14-year-old patient who presents to the clinic with symptoms consistent with mycoplasma pneumonia. What is the treatment for suspected mycoplasma pneumonia in an adolescent? 1. Ceftriaxone 2. Azithromycin 3. Ciprofloxacin 4. Levofloxacin: 2 74.Leonard is completing a 6-month regimen to treat tuberculosis (TB). Mon- itoring of a patient on TB therapy includes:

1. Monthly sputum cultures

2. Monthly chest x-ray 3. Bronchoscopy every 3 months 4. All of the above: 1 75.Compliance with directly observed therapy can be increased by: 1. Convenient clinic times 2. Incentives such as food, clothing, and transportation costs 3. Offering gifts for compliance 4. All of the above: 4