The Nurse Practitioner is preparing to Prescribe a medication regimen for her patient. He or she recognizes that criteria for choosing an effective drug for any disorder include:
The Nurse Practitioner is preparing to Prescribe a medication regimen for her patient. He or she recognizes that criteria for choosing an effective drug for any disorder include:
Consulting nationally recognized guidelines for disease management
Asking the patient what drug they think would work best for them
Prescribing medications that are available as samples before writing a prescription
Following U.S. Drug Enforcement Administration guidelines for prescribing
Question 2
NP is a 66-year-old male that is on Omeprazole for GERD and Clopidogrel for TIA prophylaxis. The pharmacist calls to tell you the Omeprazole should be switched due to a drug-drug interaction. This interaction is:
Clopidogrel increases protein binding of Omeprazole, thus decreasing effectiveness of the Omeprazole
Clopidogrel decreases clearance of Omeprazole, thus increasing the concentration and side effects of Omeprazole
Omeprazole decreases hepatic CYP2C19, thus decreasing Clopidogrel effectiveness
Omeprazole increases production of platelets and decreases Clopidogrel efficacy requiring larger doses
Question 3
The Family nurse practitioner prescribed losartan 50 mg PO daily for a hypertensive patient. This medication promotes vasodilation by:
Blocking the action of angiotensin II
Promoting the synthesis of prostaglandins
Inhibiting calcium influx into smooth muscle cells
Promoting the release of aldosterone
uestion 4
Proton Pump Inhibitors such as Protonix and Omeprazole are very effective at suppressing gastric acid but are associated with the risk of which of the conditions:
Rhinitis
Migraines
Clostridium difficile
Otitis Media
Question 5
An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client’s lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient’s pulmonary edema?
Furosemide
Hydrochlorothiazide
Mannitol
Triamterene
Question 6
Which of the following does not come in an oral formulation for asthma?
albuterol
theophylline
zafirlukast
ipratropium
Singulair
Question 7
A Nurse Practitioner is providing discharge instructions to a patient who will be taking fludrocortisone at home. The Nurse Practitioner will encourage the patient to eat a diet that is
low in sodium and potassium.
low in sodium, high in potassium.
high in iron.
low in proteins.
Question 8
KS is a 45-year-old female with current lipid levels of: TC: 282; HDL: 61; LDL: 122; TG: 163. What is the best initial treatment for KS if she has an ASCVD risk of 38%?
Atorvastatin 20 mg daily
Simvastatin 80 mg daily
Tricor 45 mg daily
Zetia 10 mg daily
Question 9
You are treating a patient for C. Diff and are discharging them on a course of Metronidazole. The main counseling point you need to address is:
Avoid alcohol
Take on an empty stomach
Separate by 2 hours from all other meds
Do not crush or chew
Question 10
A Nurse Practitioner is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following?
The amount of the drug that must be given to produce a particular response
How well a drug produces its desired effect
A drug’s strength of attraction for a receptor site
A drug’s ability to stimulate its receptor
Question 11
Destiny presents with a history of depression. Her parents believe she took an overdose of an antidepressant medication. Her temperature is 40.1 degrees C. On exam, her pupils are dilated and she has hyperreflexia. Which of the following symptoms would not be expected?
Agitation
Bradycardia
Confusion
Diarrhea
Question 12
Drugs that use CYP 3A4 isoenzymes for metabolism may:
A. Induce the metabolism of another drug
B. Inhibit the metabolism of another drug
C. Both 1 and 2
D. Neither 1 nor 2
Question 13
NP is a 72-year-ol female with Parkinson’s x 3 years. She has been controlled on Amantadine until recently when she has been having more rigidity. You decide to put her on a dopamine agonist. Counseling on the new dopamine agonist would include:
• i. Delusions and hallucinations are common
• ii. The medication can slow disease progression
• iii. Doses should be tapered slowly if discontinuing
• iv. Dyskinesias are common
• v. Sleep attacks are a possible side effect
i only
i and iii only
ii and iv only
i, iii and v only
All of the above
Question 14
What is the main difference between a first- and second-generation antihistamine drug?
First generation antihistamines cause less drowsiness
First generation antihistamines case more dry mouth
Second generation antihistamines cause more dry eyes
Second generation antihistamines cause less headaches
Question 15
A patient on valproic acid may experience which of the following symptoms?
Weight gain
Nausea
Constipation
All of the above
Question 16
Which laxative when used may cause aspiration pneumonia especially in the elderly:
Bisacodyl
Glycerin Suppository
Polyethylene Glycol
Mineral Oil
Question 17
A physician has ordered subcutaneous injections of morphine, a narcotic, every 4 hours as needed for pain for a motor vehicle accident victim. The nurse is aware that there is a high abuse potential for this drug and that it is categorized as a
C-I drug.
C-II drug.
C-III drug.
C-IV drug.
Question 18
A female patient has been taking zafirlukast for a week and is experiencing diarrhea. The nurse should instruct her to do which of the following?
Take nonnarcotic analgesics
Schedule blood tests
Drink plenty of fluids
Take the drug with food
Question 19
Which of the following is a 5HT3 receptor blocker for use in nausea/vomiting?
Ondansetron
Metoclopramide
Promethazine
Dicyclomine
Question 20
What is the primary source of histamine in the body during an allergic reaction?
Mast cells
T-lymphocytes
White blood cells
B-cells
A 46-year-old white American has been prescribed a drug that binds to acid glycoproteins. The nurse understands that white Americans usually receive
a higher-than-normal dose of drugs that bind to acid glycoproteins.
a lower-than-normal dose of drugs that bind to acid glycoproteins.
the recommended normal dose of drugs that bind to acid glycoproteins.
one half the recommended dose of drugs that bind to acid glycoproteins.
Question 22
NP is a 72-year-ol female with Parkinson’s x 3 years. She has been controlled on Amantadine until recently when she has been having more rigidity. You decide to put her on a dopamine agonist. You know the following are dopamine agonists except:
Carbidopa/Levodopa
Ropinirole
Pramipexole
Bromocriptine
Question 23
A 22-year-old male college senior has lived with a diagnosis of Crohn’s disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn’s disease?
Tositumomab plus 131I (Bexxar)
Muromonab-CD3 (Orthoclone OKT3)
Infliximab (Remicade)
Eculizumab (Soliris)
Question 24
A nurse practitioner understands when prescribing a medication that there are certain questions to address. Check all that apply.
Is there a need for the drug in treating the presenting problem?
Is this the best drug for the presenting problem?
Can the patient take the prescribed drug?
None of the above.
Question 25
You are discharging a patient home after postoperative DVT. They ask you why they have to use Lovenox and Warfarin at the same time. You answer:
Warfarin onset is delayed
Warfarin affects platelets
LMWH has a longer half life
LMWH has few side effects than Warfarin
Question 26
Laxatives help to do all of the following except:
Softening the stool
Decrease the amount of strain needed to defecate
Increase the presence of impaction of stool the colon
Reduce the painful elimination that may be associated with hemorrhoids
Question 27
A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells?
Giving the drug with food in order to delay absorption
Administering the drug in small, frequent doses
Limiting the patient’s protein intake and encouraging fluids
Administering the drug intravenously rather than orally
Question 28
A patient with a known history of benign prostatic hyperplasia (BPH) presents to the clinic 4 days after developing a cold. He tells you he began experiencing a sore throat and nasal congestion and began to take an over the counter decongestant. Today, he complains of not urinating over the last 12 hours. He also has suprapubic fullness on exam. Which of the following medications are most likely responsible for this patient’s urinary retention?
Tamsulosin
Phenylephriine
Clonazepam
Finasteride
1 points
Question 29
The American Geriatric Society provides the Beers Criteria to aid providers in knowing
Dosage adjustments necessary in chronic renal disease
Potentially inappropriate medications that should be avoided in the geriatric population
Medications that cannot be crushed
Medications that are safe to use in the pediatric population
Question 30
A high school student was diagnosed with asthma when he was in elementary school and has become accustomed to carrying and using his “puffers”. In recent months, he has become more involved in sports and has developed a habit of administering albuterol up to 10 times daily. The nurse should teach the student that overuse of albuterol can lead to
permanent liver damage.
rebound bronchoconstriction.
community-acquired pneumonia.
severe anticholinergic effects.
Question 31
Drugs have a high potential for abuse. There is no routine therapeutic use for these drugs and they are not available for regular use. They may be obtained for “investigational use only” by applying to the U.S. Drug Enforcement Agency. Examples include heroin and LSD. Which scheduled drug is this?
Schedule 1
Schedule 2
Schedule 3
Schedule 4
Question 32
A Nurse Practitioner is providing patient education to a 35-year-old man who has been prescribed clonidine (Catapres) as part of step 2 antihypertensive therapy. The Nurse Practitioner should anticipate that the drug will be administered
intravenously.
subcutaneously.
transdermally.
orally.
Question 33
A female patient has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of prednisone to avoid
hypokalemia.
gastrointestinal problems.
adrenal insufficiency.
menstrual irregularities.
Question 34
After a recent history of shortness of breath that has become increasingly severe, a woman has been prescribed ipratropium by MDI while she undergoes a diagnostic workup. What patient teaching should the nurse provide to this patient?
“Make sure that you take this at the scheduled times, regardless of whether you feel short of breath.”
“Most people find that ipratropium cures their lung disease within a few months.”
“You should think of this as an ’emergency drug’, and it should only be used when you experience symptoms.”
“It’s important that you perform deep breathing exercises before and after taking ipratropium.”
Question 35
JJ is a 62-year-old male who has hypertension. He currently takes HCTZ 25 mg daily, Amlodipine 5 mg daily and Lisinopril 10 mg daily. He has developed a dry cough that has persisted. Which med could this potentially be due to and what is an acceptable alternative?
HCTZ; change to Diltiazem
Lisinopril; change to Spironolactone
Amlodipine; stop Amlodipine
Lisinopril; change to Losartan
Question 36
The hypersecretion of gastric acid and development of peptic ulcers is a characterization of what condition:
Cystic Fibrosis
Huntington’s Disease
Sickle Cell Anemia
Zollinger-Ellison Syndrome
Question 37
A patient is taking cholestyramine. The Nurse Practitioner will assess for which of the following common adverse effects of the drug?
Abdominal pain
Headache
Constipation
Indigestion
Question 38
Phenytoin acts to reduce seizures by:
Blocking K+ channels that open and close at low frequencies
Blocking K+ channels that open and close at high frequencies
Blocking Na+ channels that open and close at low frequencies
Blocking Na+ channels that open and close at high frequencies
Question 39
Which of the following affects drug distribution throughout the body?
Presence of food in the gastrointestinal tract
Increase in hepatic enzymes
Protein binding
High blood levels
Question 40
A 72-year-old man is prescribed theophylline for symptomatic relief of bronchial asthma. Which of the following findings would alert the nurse to the need for close monitoring?
Enlarged prostate gland
Need for additional bronchodilation
Signs of an active lung infection
Hypersensitivity to povidone
Question 41
A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to
crush the tablet before swallowing.
swallow the tablet whole.
swallow the tablet with milk or food.
avoid drinking milk for 3 hours after swallowing the tablet.
Question 42
A female patient is taking 0.125 mg of digoxin daily for heart failure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. The nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is concerned that the additional weight will necessitate an increase in the medication. Which of the following is an appropriate response by the nurse?
“Yes, the drug dosage will probably have to be increased.”
“No, the drug dosage will likely stay the same.”
“No, the drug dosage will have to be decreased.”
“I don’t know; I will have to ask your physician.”
Question 43
A patient will begin three new medications as part of her treatment plan. The nurse practitioner understands that proper disposal of medications is key when the nurse practitioner states
Many medications can be potentially harmful if taken by someone other than the person the medication was prescribed.
Consult with several pharmacists to determine the cost of each drug.
educate the patient to discard syringes in recycle bin
consult with the physician concerning choice of medications for the patient.
uestion 44
A 66-year-old female recently diagnosed with hyperthyroidism and was started on therapy. 6 weeks later her lab results showed: RBC of 4.6, WBC of 0.9 and Platelets of 456. Which of the following would be the most likely cause?
Iodine
Levothyroxine
Methimazole
Cytomel
Question 45
Which of the following medications is an analog of meperidine and treats diarrhea by suppressing both bowel motility and fluid secretion in the intestinal lumen:
Loperamide
Diphenoxylate
Bismuth Subsalicylate
Difenoxin
Question 62
Which combination of drugs is considered first line therapy in the treatment of nausea and vomiting in pregnancy:
Lorazepam and Scopolamine
Dronabinol and Diphenhydramine
Doxylamine and Vitamin B6
Metoclopramide and Vitamin B6
1 points
uestion 63
A Nurse Practitioner is providing care for a 71-year-old woman who was sponsored to emigrate from Mexico to the United States 6 months ago. Earlier this week, the woman slipped while getting off a bus and fractured her hip. How should the woman’s nurse best exemplify cultural competence in the care of this patient?
Ensure that the woman receives care solely from Spanish-speaking caregivers.
Consider dimensions of the woman’s cultural background when planning care.
Integrate teaching about American culture when interacting with the patient.
Address the woman’s children first when explaining her care and changes in her health status.
Question 64
Which antihypertensive has been shown to have mild uricosuric effects in gout patients?
Losartan
Lisinopril
Atenolol
Amlodipine
Question 65
A 48-year-old woman who works as an office manager is prescribed metoclopramide (Reglan) for diabetic gastroparesis. The nurse will be sure to assess the patient for
tachycardia.
depression.
hypotension.
anemia.
uestion 66
A man who smokes one pack of cigarettes daily has been diagnosed with chronic bronchitis. He has been prescribed theophylline by his family doctor. What effect will the patient’s smoking status have on the therapeutic use of theophylline?
Theophylline may be contraindicated due to the risk of an anaphylactoid reaction
The patient may require higher doses of theophylline than a nonsmoker
The patient may require administration of an inhaled bronchodilator before each dose of theophylline
The patient will require serial blood testing to ensure a safe serum level of theophylline
uestion 67
A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is
headache.
irritability.
dry mouth.
heart palpitations.
s Question 73
The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son’s medication regimen by the nurse. The nurse is currently teaching the parent’s about the appropriate use of a “rescue drug” for acute exacerbations of their son’s asthma. What drug should the nurse suggests the parents to use in these situations?
Theophylline
Albuterol
Beclomethasone
Acetylcysteine
Question 74
A Native American man who lives a traditional lifestyle is scheduled to have heart surgery. The tribal chief has requested that the tribe’s medicine man perform a ritual before the patient goes to surgery. The nurse’s response to this request should be
“I’m sorry, but that will not be possible.”
“I will need to inform the doctor and see if he will allow this.”
“As long as the ritual does not interfere with the patient’s preoperative care, it will be okay.”
“I don’t think that will help, but you have the right to perform the ritual.”
Question 75
Ms. Simpson has a known history of asthma. She is on Theophylline daily. The NP contemplates giving her an antibiotic for her respiratory infection. The NP knows that which choice below could elevate theophylline levels?
Augmentin
Amoxicillin
Ciprofloxacin
Mucinex
ss Question 76
JM is a 72-year-old male who has been diagnosed with gout and started on Allopurinol. What lab test are you most concerns with when starting the medication?
LFTs
Blood glucose
GFR
Serum Calcium
Question 77
John is a newly diagnosed diabetic that contacts the office with complaints of severe nausea and vomiting. What instructions should the APRN provide related to his insulin doses?
Monitor your blood sugar every 4 hours and take regular insulin based on the blood sugar reading.
Stop your insulin while you are not eating and restart it at half strength when you can keep liquids down.
There is no need to change your insulin dosage while sick. Continue your regular doses
I will call in a prescription for metformin for you to take in place of your insulin.
Question 77
John is a newly diagnosed diabetic that contacts the office with complaints of severe nausea and vomiting. What instructions should the APRN provide related to his insulin doses?
Monitor your blood sugar every 4 hours and take regular insulin based on the blood sugar reading.
Stop your insulin while you are not eating and restart it at half strength when you can keep liquids down.
There is no need to change your insulin dosage while sick. Continue your regular doses
I will call in a prescription for metformin for you to take in place of your insulin.
Question 78
A Nurse Practitioner is caring for a female patient who has developed atelectasis because of thick mucus secretions. The Nurse Practitioner is monitoring IV administration of acetylcysteine (Mucomyst) and notices that the patient’s face is flushed. The appropriate nursing action would be to
stop the administration of acetylcysteine.
slow the administration of acetylcysteine and administer diphenhydramine if ordered.
remove any residual drug from the patient’s face.
dilute the acetylcysteine solution.
Question 79
According to the American College of Gastroenterology, the recommended course that should be employed to treat H.Pylori is:
3 days
14 days
28 days
7 days
Question 80
Your patient is on Warfarin 2.5 mg daily. Which statement would be most concerning?
“I take my Warfarin on an empty stomach.”
“I eat a salad every day for lunch.”
“I take an Excedrin for Migraine one day a week.”
“I drink 8 glasses of water a day.”
“I am going out of town next week.”
Question 81
A Nurse Practitioner is teaching a patient about his newly prescribed drug, colchicine, for gout. The Nurse Practitioner will instruct the patient to avoid which of the following foods?
Green beans
Shrimp
Eggs
Milk
Question 81
A Nurse Practitioner is teaching a patient about his newly prescribed drug, colchicine, for gout. The Nurse Practitioner will instruct the patient to avoid which of the following foods?
Green beans
Shrimp
Eggs
Milk
Question 88
Bioavailability is best described as:
Amount of drug give that is metabolized
Extent and rate which a drug enters the circulation
Amount of drug that facilitates effects in the body
Amount of time drug is present in the body
uestion 89
Which of the following medications is not included on Beers Criteria?
diphenhydramine
naproxen
glyburide
metformin
amitriptyline
1 points
Question 90
It is determined that a patient, who is in a hepatic coma, needs a laxative. Lactulose is prescribed. Which of the following should the nurse monitor to assess the efficacy of the lactulose therapy?
Water levels in the colon
Oncotic pressure in the colon
Blood ammonia levels
Relief from symptoms
Question 91
Mr. Contreras is a 64-year-old patient with Type 2 diabetes. He has recently been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes?
Diuretics
Beta Blocker
Calcium Channel Blocker
ACE Inhibitor
1 points
Question 92
Corticosteroids in asthma do what?
Increase responsiveness to beta agonists
Relax pulmonary smooth muscle
Decrease airway obstruction in acute asthma
Inhibit the inflammatory response
Question 93
Gentamicin is a highly water-soluble drug with a large volume of distribution. This would distribute into:
Adipose tissue
Total body water
Plasma only
Plasma, blood, interstitial fluid
ss Question 94
Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient’s angina?
Ranolazine confers protection from myocardial infarction but does not relieve symptoms of angina.
Amlodipine will now be contraindicated in the treatment of Mr. Penny’s angina.
Mr. Penny will need to be taught to monitor his blood pressure and heart rate.
Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker.
ss Question 95
A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction?
Call the prescriber immediately regarding her allergic reactions
Hold the medication for her muscle spasms until she can be treated for a possible allergic reaction
Post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient’s record
Call the dietary staff and make sure that the patient is not served eggs for breakfast
Question 96
A patient with a history of bronchial asthma is seen in the clinic for increased episodes of difficulty breathing. He has been taking theophylline 100 mg PO tid. He is 40 years old and obese with an 16-pack-year history of cigarette smoking and excessive intake of coffee daily. He eats a low-carbohydrate, high-protein diet. Which identified factors decrease the therapeutic effects of the theophylline?
Age and gender
Coffee intake and weight
Age and weight
Smoking history and diet
s Question 97
The following are all categories of drugs used to treat Hypertension except:
Diuretics
ACE inhibitors
Dipeptyl peptidase-IV inhibitors
Calcium channel blockers
Question 98
What information would the Nurse Practitioner include in teaching a patient about the treatment of vitamin B12 deficiency following a total gastrectomy?
The patient will be taking vitamin B12 tablets twice daily for 1 year.
The patient will be taking oral folic acid supplements daily for life.
The patient will receive monthly cyanocobalamin (vitamin B12) injections for life (after being given daily weekly injections for the first month).
The patient will require iron supplementation and monthly blood transfusions until the deficiency is corrected.
Question 99
All of the following are considered major groups in treating ulcers except:
Proton Pump Inhibitors
Antibiotics
NSAIDS
Mucosal Protectants
Question 100
During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse’s assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives
may cause nutrient deficiencies.
may counter the therapeutic effect of other drugs.
causes acidic urine and urinary tract infections.
inhibits biotransformation of drugs.
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