The CNP orders the patient a tetracycline antibiotic and instructs him to avoid taking the medication with foods, beverages, or drugs that contain calcium, iron, or magnesium.
Question 1The CNP orders the patient a tetracycline antibiotic and instructs him to avoid taking the medication with foods, beverages, or drugs that contain calcium, iron, or magnesium. The patient takes the antibiotic along with a daily multivitamin, not realizing that the vitamin contains iron. What effect may this have on the tetracycline?
Select one:
a.Decreased metabolism
b.Impaired excretion
c.Impaired absorption
d.Increased distribution
Question 2During completion of the exam and review of the patient’s most recent medical record notes, it is noted by the CNP that the patient has a malignant brain tumor. What pharmacokinetic phase may be affected by the presence of the tumor?
Select one:
a.Absorption
b.Metabolism
c.Excretion
d.Distribution
Question 3The patient requires a drug to be prescribed by the CNP that is known to be completely metabolized by the first-pass effect. During the prescribing process the CNP knows that due to this requirement:
Select one:
a.The drug must be given in a lipid-soluble form.
b.The drug must be given in higher doses.
c.The drug must be given by a non-oral route.
d.The drug must be given more frequently.
Question 4A patient with cirrhosis of the liver exhibits decreased metabolic activity. This will require the CNP to make what possible changes in the patient’s pharmacotherapeutic regimen? (Select all that apply.)
Select one or more:
a.A change in the timing of medication administration
b.Giving all prescribed drugs by intramuscular injection
c.More frequent monitoring for adverse drug effects
d.An increased dose of prescribed drugs
e.A reduction in the dosage of the drugs
Question 5A patient who is in renal failure may have a diminished capacity to excrete medications. During the course of drug therapy, the CNP must assess the patient more frequently for what development?
Select one:
a.Increased risk of allergy
b.Increased absorption of the drug from the intestines
c.Increased risk for drug toxicity
d.Decreased therapeutic drug effects
Progress Test 2
Question 1A 16-year-old adolescent is 6 weeks pregnant. The pregnancy has exacerbated her acne. She asks her CNM if she can resume taking her isotretinoin (Accutane) prescription, a category X drug, prescribed by her dermatologist. What is the most appropriate response by the CNM:
Select one:
a.“You should reduce the Accutane dosage by half during pregnancy.”
b.“Accutane is known to cause birth defects and should never be taken during pregnancy.”
c.“Since you have a prescription for Accutane, it is safe to resume using it.”
d.“You should consult with your dermatology provider at your next visit.”
Question 2To reduce the effect of a prescribed medication on the infant of a breastfeeding mother, how should the CNM teach the mother to take the medication?
Select one:
a.Immediately before the next feeding
b.At night
c.In divided doses at regular intervals around the clock
d.Immediately after breastfeeding
Question 3To reduce the chance of a duplicate medication order for the older patient who presents for his first outpatient visit with a CNP after a hospitalization, what action should the provider take? (Select all that apply.)
Select one or more:
a.Call in all prescriptions to the patient’s pharmacies rather than relying on paper copies of prescriptions.
b.Give all prescriptions to the patient’s family member.
c.Take a medication history, including all OTC and prescription medications and a pharmacy history.
d.Work with the patient’s other health care providers to limit the number of prescriptions.
e.Perform the process of medication reconciliation before sending the patient home.
Question 4Little human research has explored the safety or harmfulness of herbs in:
Select one:
a.pregnancy
b.lactation
c.Both a and b
d.Neither a nor b
Question 5According to a survey conducted by AARP and the NCCAM in 2006:
Select one:
a.50% of people 50 years of age or older do not talk to their doctors about their use of CAM.
b.69% of people 50 years of age or older do not talk to their doctors about their use of CAM.
c.25% of people 50 years of age or older do not talk to their doctors about their use of CAM.
d.10% of people 50 years of age or older do not talk to their doctors about their use of CAM.
Progress Test 3
Question 1A patient is prescribed NPH and regular insulin every morning by his CNP, who is verifying that the patient understands that there are two different peak times to be aware of for this insulin regimen. Why is this important for the provider to address?
Select one:
a.The risk for hypoglycemia is greatest around the peak of insulin activity.
b.It is best to plan exercise or other activities around peak insulin activity.
c.The client needs to plan the next insulin injection around the peak times.
d.Additional insulin may be needed at peak times to avoid hyperglycemia.
Question 2The CNP prescribes 5 units of Humalog and 25 units of NPH (Isophane) insulin prior to breakfast. The provider should tell the patient which of the following:
Select one:
a.Consume a high-carbohydrate snack in 6 hours.
b.Make sure your breakfast is available to eat before administering this insulin.
c.Administer the medications in two separate syringes.
d.Hold the insulin if your blood glucose level is greater than 100 mg/dL.
Question 3A 63- year-old client with type 2 diabetes is admitted with an infected foot ulcer. Despite previous good control on glyburide (Micronase), his blood glucose has been elevated the past several days and he now requires sliding-scale insulin. The CNP explains to the patient’s primary nurse that the most likely reason for the elevated glucose levels is:
Select one:
a.patients with diabetes who are admitted to the hospital are switched to insulin for safety and tighter control.
b.a temporary condition related to the stress response with increased glucose release.
c.the oral antidiabetic drug is no longer working for him.
d.the patient is converting to a type 1 diabetic.
Question 4Multiple studies, such as the Diabetes Mellitus Control and Complications Trial research group (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), continue to show that intensive glucose control may prevent and/or delay the onset of complications:
Select one:
a.at or below glycosylated hemoglobin (A1c) of 7%.
b.at or below glycosylated hemoglobin (A1c) of 12%.
c.at or below glycosylated hemoglobin (A1c) of 10%.
d.at or below glycosylated hemoglobin (A1c) of 15%.
Question 5Onset of type 1 diabetes may occur:
Select one:
a.suddenly as with the onset of diabetic ketoacidosis.
b.slowly with less risk of ketoacidosis as in the case of latent autoimmune diabetes of adults (LADA).
c.Both a and b
d.Neither a nor b
Progress Test 4
Question 1The Infectious Diseases Society of America released new guidelines advising providers against routine antibiotic treatment of sinusitis, because most cases are caused by viruses. When antibiotics are used, the guidelines suggest:
Select one:
a.amoxicillin alone.
b.amoxicillin-clavulanate instead of amoxicillin alone.
c.amoxicillin for one week followed by amoxicillin-clavulanate for one week
d.Either b or c.
Question 2Among the statements below, select the one which provides the best rationale for treatment with group A β-hemolytic streptococci:
Select one:
a.It is extremely easy to accurately diagnose a bacterial pharyngitis by history and physical alone. A throat culture is not necessary before treatment with group A β-hemolytic streptococci.
b.It is extremely difficult to accurately diagnose a bacterial pharyngitis by history and physical alone. A throat culture is optional but highly recommended before treatment with group A β-hemolytic streptococci.
c.It is extremely easy to accurately diagnose a bacterial pharyngitis by history and physical alone. A throat culture is optional before treatment with group A β-hemolytic streptococci.
d.It is extremely difficult to accurately diagnose a bacterial pharyngitis by history and physical alone. A throat culture is necessary before treatment with group A β-hemolytic streptococci.
Question 3 C. difficile is often associated with copious liquid diarrhea and is a consequence of treatment with all antibiotics. Among the following which are most likely to cause C. difficile infection:
Select one:
a.ampicillin
b.amoxicillin
c.cephalosporin
d.All of the above
Question 4Nonpharmacologic interventions for an uncomplicated UTI may include rest, hydration to flush the urinary tract, and short-term use of urinary analgesics with agents such as:
Select one:
a.Phenazopyridine
b.Urised
c.Both a and b
d.Neither a nor b
Question 5For patients with uncomplicated genital, rectal, and pharyngeal gonorrhea, the CDC recommendations call for combination therapy using:
Select one:
a.ceftriaxone 100 mg as a single IM dose, plus azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days.
b.ceftriaxone 250 mg as a single IM dose, plus either azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days.
c.ceftriaxone 250 mg as a single IM dose, plus azithromycin 1 g orally in a single dose or doxycycline 200 mg orally twice daily for 7 days.
d.ceftriaxone 50 mg as a single IM dose, plus azithromycin 1 g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days.
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