Final

Question 1

Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?

1. Water soluble and ionized drugs cross these barriers rapidly.
2. The blood-brain barrier slows the entry of many drugs into and from brain cells.
3. The fetal-placental barrier protects the fetus from drugs taken by the mother.
4. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women.

Answer 1

2. The blood-brain barrier slows the entry of many drugs into and from brain cells

Question 2

Two different pain medications are given together for pain relief. The drug—drug interaction is:

1. Synergistic
2. Antagonistic
3. Potentiative
4. Additive

Answer 2

4. Additive

Question 3

Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?

1. Protein malnutrition
2. Iron-deficiency anemia
3. Both 1 and 2
4. Neither 1 nor 2

Answer 3

4. Neither 1 nor 2

Question 4

An agonist activates a receptor and stimulates a response. When given frequently over time, the body may:

1. Upregulate the total number of receptors
2. Block the receptor with a partial agonist
3. Alter the drug’s metabolism
4. Downregulate the numbers of that specific receptor

Answer 4

4. Downregulate the numbers of that specific receptor

Question 5

Drug antagonism is best defined as an effect of a drug that:

1. Leads to major physiological and psychological dependence
2. Is modified by the concurrent administration of another drug
3. Cannot be metabolized before another dose is administered
4. Leads to a decreased physiological response when combined with another drug

Answer 5

2. Is modified by the concurrent administration of another drug

Question 6

In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it:

1. Has serious side effects and it is not being used for a life-threatening condition
2. Will be taken twice daily and will be taken at home
3. Is expensive, but covered by health insurance
4. None of these are important in choosing a drug

Answer 6

2. Will be taken twice daily and will be taken at home

Question 7

When determining drug treatment the NP prescriber should:

1. Always use evidence-based guidelines
2. Individualize the drug choice for the specific patient
3. Rely on his or her experience when prescribing for complex patients
4. Use the newest drug on the market for the condition being treated

Answer 7

2. Individualize the drug choice for the specific patient

Question 8

The U.S. Food and Drug Administration regulates:

1. Prescribing of drugs by MDs and NPs
2. The official labeling for all prescription and over-the-counter drugs
3. Off-label recommendations for prescribing
4. Pharmaceutical educational offerings

Answer 8

2. The official labeling for all prescription and over-the-counter drugs

Question 9

An Investigational New Drug is filed with the U.S. Food and Drug Administration:

1. When the manufacturer has completed phase III trials
2. When a new drug is discovered
3. Prior to animal testing of any new drug entity
4. Prior to human testing of any new drug entity

Answer 9

4. Prior to human testing of any new drug entity

Question 10

Off-label prescribing is:

1. Regulated by the U.S. Food and Drug Administration
2. Illegal by NPs in all states (provinces)
3. Legal if there is scientific evidence for the use
4. Regulated by the Drug Enforcement Administration

Answer 10

3. Legal if there is scientific evidence for the use

Question 11

4. The type of adverse drug reaction that is the result of an unwanted but otherwise normal pharmacological action of a drug given in the usual therapeutic doses is
A. Type A
B. Type B
C. Type C
D. Type D

Answer 11

A. Type A

Question 12

7. According to the World Health Organization Classification, Type B adverse reactions are:
A. When a drug is a teratogen
B. When a drug is carcinogenic
C. A delayed ADR, such as renal failure
D. An allergic or idiosyncratic response

Answer 12

D. An allergic or idiosyncratic response

Question 13

8. Sarah developed a rash after using a topical medication. This is a Type \_\_ allergic drug reaction.
A. I
B. II
C. III
D. IV

Answer 13

D. IV

Question 14

10. Anaphylactic shock is a:
    A. Type I reaction, called immediate hypersensitivity reaction
    B. Type II reaction, called cytotoxic hypersensitivity reaction
    C. Type III allergic reaction, called immune complex hypersensitivity
    D. Type IV allergic reaction, called delayed hypersensitivity reaction

Answer 14

A. Type I reaction, called immediate hypersensitivity reaction

Question 15

Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:

1. With a longer half-life so that missed doses produce a longer taper on the drug curve
2. In oral formulations that are more easily taken
3. That do not require frequent monitoring
4. Combined with patient education

Answer 15

1. With a longer half-life so that missed doses produce a longer taper on the drug curve

Question 16

Ethnic differences have been found in drug:

1. Absorption
2. Hepatic metabolism
3. Filtration at the glomerulus
4. Passive tubular reabsorption

Answer 16

2. Hepatic metabolism

Question 17

Tetracycline needs to be given on an empty stomach because it chelates with:

1. Calcium
2. Magnesium
3. Iron
4. All of the above

Answer 17

4. All of the above

Question 18

Fasting for an extended period can:

1. Increase drug absorption due to lack of competition between food and the drug
2. Alter the pH of the gastrointestinal tract, affecting absorption
3. Cause vasoconstriction, leading to decreased drug absorption
4. Shrink the stomach, causing decreased surface area for drug absorption

Answer 18

3. Cause vasoconstriction, leading to decreased drug absorption

Question 19

A low-carbohydrate, high-protein diet may:

1. Increase drug-metabolizing enzymes
2. Decrease drug absorption from the GI tract
3. Alter drug binding to plasma proteins
4. Enhance drug elimination

Answer 19

1. Increase drug-metabolizing enzymes

Question 20

Cruciferous vegetables may alter drug pharmacokinetics by:

1. Enhancing absorption of weakly acidic drugs
2. Altering CYP 3A4 activity, leading to elevated levels of drugs, such as the statins
3. Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by CYP 1A2
4. Decreasing first-pass metabolism of drugs

Answer 20

3. Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by CYP 1A2

Question 21

Phenytoin decreases folic acid absorption by:

1. Altering the pH of the stomach
2. Increasing gastric emptying time
3. Inhibiting intestinal enzymes required for folic acid absorption
4. Chelation of the folic acid into inactive ingredients

Answer 21

3. Inhibiting intestinal enzymes required for folic acid absorption

Question 22

Which of the following vitamin or mineral supplements may by teratogenic if a pregnant woman takes more than the recommended amount?

1. Iron
2. Vitamin A
3. Vitamin B6
4. Vitamin C

Answer 22

2. Vitamin A

Question 23

Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B6 (pyridoxine) to prevent:

1. Beriberi
2. Peripheral neuropathy
3. Rickets
4. Megaloblastic anemia

Answer 23

2. Peripheral neuropathy

Question 24

Vitamin B12 deficiency may lead to:

1. Hair loss
2. Insomnia
3. Dry scales on the scalp
4. Numbness and tingling of the hands

Answer 24

4. Numbness and tingling of the hands

Question 25

There is strong evidence to support that adequate vitamin C intake prevents: 1. The common cold 2. Breast cancer 3. Scurvy 4. All of the above

Answer 25

3. Scurvy

Question 26

Adequate vitamin D is needed for: 1. Absorption of calcium from the gastrointestinal tract 2. Regulation of serum calcium levels 3. Regulation of serum phosphate levels 4. All of the above

Answer 26

4. All of the above

Question 27

Symptoms of folate deficiency include: 1. Thinning of the hair 2. Bruising easily 3. Glossitis 4. Numbness and tingling of the hands and feet

Answer 27

3. Glossitis

Question 28

28. Patients with iron deficiency will develop: 1. Hemolytic anemia 2. Megaloblastic anemia 3. Macrocytic-hypochromic anemia 4. Microcytic-hypochromic anemia

Answer 28

4. Microcytic-hypochromic anemia

Question 29

There is evidence that dietary supplementation or adequate intake of fish oils and omega-3 fatty acids have well-documented: 1. Concern for developing cardiac dysrhythmias 2. Anti-inflammatory effects 3. Total cholesterol-lowering effects 4. Effects on fasting blood sugar

Answer 29

2. Anti-inflammatory effects

Question 30

There is enough preliminary evidence to recommend that children with autism receive which supplemental nutrient? 1. Vitamin B1 (thiamine) 2. Vitamin B2 (riboflavin) 3. Calcium 4. Omega-3 fatty acids

Answer 30

4. Omega-3 fatty acids

Question 31

Vitamin B2 (riboflavin) may be prescribed to: 1. Decrease the incidence of beriberi 2. Reduce headaches and migraines 3. Prevent pernicious anemia 4. Treat hyperlipidemia

Answer 31

1. Decrease the incidence of beriberi

Question 32

1. Pharmacoeconomics is: 1. The study of the part of the U.S. economy devoted to drug use 2. The study of the impact of prescription drug costs on the overall economy 3. The analysis of the costs and consequences of any health-care-related treatment or service 4. The analysis of the clinical efficacy of the drug

Answer 32

3. The analysis of the costs and consequences of any health-care-related treatment or service

Question 33

5. 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: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis

Answer 33

1. Cost-minimization analysis

Question 34

2. The direct costs of drug therapy include: 1. The actual cost of acquiring the medication 2. The loss of income due to illness 3. Pain and suffering due to inadequate drug therapy 4. The cost of a funeral associated with premature death

Answer 34

3. Pain and suffering due to inadequate drug therapy

Question 35

10. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be: 1. Order cognitive testing to determine the source of his confusion. 2. Sit down with him and explain the whole Medicare Part D process. 3. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him. 4. Request his son come to the next

Answer 35

4. Request his son come to the next appointment so you can explain the benefit to him.

Question 36

5. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be: 1. Penicillin VK, because his rash does not sound like a serious rash 2. Amoxicillin 3. Cefadroxil (Duricef) 4. Azithromycin

Answer 36

4. Azithromycin

Question 37

2. Infants and young children are at higher risk of developing antibiotic-resistant infections due to: 1. Developmental differences in pharmacokinetics of the antibiotics in children 2. The fact that children this age are more likely to be in daycare and exposed to pathogens from other children 3. Parents of young children insisting on preventive antibiotics so they don’t miss work when their child is sick 4. Immunosuppression from the multiple vaccines they receive in the first 2 years of life

Answer 37

2. The fact that children this age are more likely to be in daycare and exposed to pathogens from other children

Question 38

8. Lauren is a 13-year-old child who comes to clinic with a 4-day history of cough, low-grade fever, and rhinorrhea. When she blows her nose or coughs the mucous is greenish-yellow. The appropriate antibiotic to prescribe would be: 1. Amoxicillin 2. Amoxicillin/clavulanate 3. TMP/SMZ (Septra) 4. None

Answer 38

4. None

Question 39

3. Providers should use an antibiogram when prescribing. An antibiogram is: 1. The other name for the Centers for Disease Control guidelines for prescribing antibiotics 2. An algorithm used for prescribing antibiotics for certain infections 3. The reference also known as the Pink Book, published by the Centers for Disease Control 4. A chart of the local resistance patterns to antibiotics developed by laboratories

Answer 39

4. A chart of the local resistance patterns to antibiotics developed by laboratories

Question 40

12. Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her? 1. Encourage increased fluids and fiber. 2. Assess her for pseudomembranous colitis. 3. Advise her to eat yogurt daily to help restore her gut bacteria. 4. Start her on an antidiarrheal medication.

Answer 40

2. Assess her for pseudomembranous colitis.

Question 41

13. Keng has chronic hepatitis that has led to mildly impaired liver function. He has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction? 1. Azithromycin (Zithromax) 2. Clarithromycin (Biaxin) 3. Erythromycin (E-mycin) 4. None of the above

Answer 41

3. Erythromycin (E-mycin)

Question 42

6. Sarah is a 25-year-old female who is 8 weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her? 1. Ciprofloxacin (Cipro) 2. Amoxicillin (Trimox) 3. Doxycycline 4. Trimethoprim-sulfamethoxazole (Septra)

Answer 42

2. Amoxicillin (Trimox)

Question 43

15. If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to: 1. Loop diuretics 2. Sulfonylureas 3. Thiazide diuretics 4. All of the above

Answer 43

4. All of the above

Question 44

24. Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: 1. Platelet count 2. BUN and creatinine 3. White blood cell count 4. AST, ALT, alkaline phosphatase, and bilirubin

Answer 44

4. AST, ALT, alkaline phosphatase, and bilirubin

Question 45

25. When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include: 1. Metronidazole is safe in the first trimester of pregnancy. 2. Consuming alcohol in any form may cause a severe reaction. 3. Sexual partners need concurrent therapy. 4. Headaches are a sign of a serious adverse reaction and need immediate evaluation.

Answer 45

2. Consuming alcohol in any form may cause a severe reaction

Question 46

20. To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed: 1. Niacin (vitamin B3) 2. Pyridoxine (vitamin B6) 3. Riboflavin (vitamin B2) 4. Thiamine (vitamin B1)

Answer 46

2. Pyridoxine (vitamin B6)

Question 47

16. Tetracyclines such as minocycline are safe to use in: 1. Pregnant women 2. Adolescents 3. Patients with renal dysfunction 4. Patients with hepatic dysfunction

Answer 47

2. Adolescents

Question 48

1. Men who use transdermal testosterone gel (AndroGel) should be advised to avoid: 1. Washing their hands after applying the gel 2. Wearing occlusive clothing while using the gel 3. Exposure to estrogens while using the gel 4. Skin-to-skin contact with pregnant women while using the gel

Answer 48

4. Skin-to-skin contact with pregnant women while using the gel

Question 49

2. Education when prescribing androgens to male patients includes advising that: 1. Short-term use places the patient at risk for hepatocellular carcinoma. 2. Cholestatic hepatitis and jaundice may occur with low doses of androgens. 3. Gynecomastia is a rare occurrence with the use of androgens. 4. Low sperm levels only occur with long-term use of androgens.

Answer 49

2. Cholestatic hepatitis and jaundice may occur with low doses of androgens.

Question 50

4. The U.S. Food and Drug Administration warns that androgens may cause: 1. Peliosis hepatis 2. Orthostatic hypotension 3. Menstrual irregularities 4. Acne

Answer 50

1. Peliosis hepatis

Question 51

6. Male patients require ______________________ before and during androgen therapy. 1. A digital prostate exam 2. A Doppler exam of testicular blood flow 3. Urine analysis for proteinuria 4. Serial orthostatic blood pressures

Answer 51

1. A digital prostate exam

Question 52

8. Postmenopausal women with an intact uterus should not be prescribed: 1. Estrogen/progesterone combination 2. IM medroxyprogesterone (Depo Provera) 3. Estrogen alone 4. Androgens

Answer 52

3. Estrogen alone

Question 53

12. A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed: 1. Low-dose oral estrogen 2. A low-dose estrogen/progesterone combination 3. A vaginal estradiol ring 4. Vaginal progesterone cream

Answer 53

3. A vaginal estradiol ring

Question 54

15. The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to: 1. The potential development of significant hypertension 2. Increased risk of strokes 3. Decreased bone density 4. The risk of a life-threatening rash such as Stevens-Johnson

Answer 54

3. Decreased bone density

Question 55

2. Education when prescribing androgens to male patients includes advising that: 1. Short-term use places the patient at risk for hepatocellular carcinoma. 2. Cholestatic hepatitis and jaundice may occur with low doses of androgens. 3. Gynecomastia is a rare occurrence with the use of androgens. 4. Low sperm levels only occur with long-term use of androgens.

Answer 55

2. Cholestatic hepatitis and jaundice may occur with low doses of androgens.

Question 56

22. Effects of estrogen include: 1. Regulation of the menstrual cycle 2. Maintenance of bone density by increasing bone reabsorption 3. Maintenance of the normal structure of the skin and blood vessels 4. A and C 5. All of the above

Answer 56

4. A and C

Question 57

23. Absolute contraindications that clinicians must consider when initiating estrogen therapy include: 1. Undiagnosed dysfunctional uterine bleeding 2. Deep vein or arterial thromboemboli within the prior year 3. Endometriosis 4. 1 and 2 5. All of the above

Answer 57

4. 1 and 2

Question 58

24. Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent: 1. Nausea 2. Breakthrough bleeding 3. Breast tenderness 4. Pregnancy

Answer 58

2. Breakthrough bleeding

Question 59

1. Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of: 1. Hemoglobin 2. Serum calcium 3. White blood count 4. Serum potassium

Answer 59

4. Serum potassium

Question 60

5. Obese women may have increased risk of failure with which contraceptive method? 1. Combined oral contraceptives 2. Progestin-only oral contraceptive pill 3. Injectable progestin 4. Combined topical patch

Answer 60

4. Combined topical patch

Question 61

7. When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is: 1. Immediate protection against pregnancy the first week of using the pill 2. No back-up method is needed when starting 3. Menses occur during the week 4. They can start the pill on the Sunday after the office visit

Answer 61

3. Menses occur during the week

Question 62

11. An advantage of using the NuvaRing vaginal ring for contraception is: 1. It does not require fitting and is easy to insert. 2. It is inserted once a week, eliminating the need to remember to take a daily pill. 3. Patients get a level of estrogen and progestin equal to combined oral contraceptives. 4. It also provides protection against vaginal infections.

Answer 62

1. It does not require fitting and is easy to insert.

Question 63

5. Which of the following drug classes is associated with significant differences in metabolism based on gender? 1. Beta blockers 2. Antibiotics 3. Serotonin reuptake inhibitors 4. Angiotensin-converting-enzyme (ACE) inhibitors

Answer 63

3. Serotonin reuptake inhibitors

Question 64

7. Hot flashes are often a concern during menopause. Which of the following may help in reducing them? 1. Drink one caffeinated liquid per day 2. Take progesterone supplementation 3. Exercise 20-40 minutes/day 4. Increase intake of carrots, yams, and soy products

Answer 64

4. Increase intake of carrots, yams, and soy products

Question 65

8. Factors common in women that can affect adherence to a treatment regimen include all of the following EXCEPT: 1. Number of drugs taken: Women tend to take fewer drugs over longer periods of time 2. Fear that medications can cause disease: Information obtained from social networks may be inaccurate for a specific woman 3. Nutritional status: Worries about possible weight gain from a given drug may result in nonadherence 4. Religious differences: A patient’s belief system that is not congruent with the treatment regimen presents high risk for nonadherence

Answer 65

1. Number of drugs taken: Women tend to take fewer drugs over longer periods of time

Question 66

9. Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is: 1. Oral contraceptive pills 2. Caffeine 3. NSAIDs 4. Aspirin

Answer 66

3. NSAIDs

Question 67

11. Treatment of PMDD that affects all or most of the symptoms includes: 1. Tryptophan up to 6 g/d 2. Vitamin E 200-400 mg/d 3. Evening primrose oil 500 mg/d 4. Fluoxetine 20 mg/d

Answer 67

4. Fluoxetine 20 mg/d

Question 68

13. Maternal-to-child transmission of HIV infection during pregnancy may be prevented by: 1. Use of antiviral drugs such as zidovudine 2. Use of condoms during intercourse 3. Both 1 and 2 4. Neither 1 nor 2

Answer 68

1. Use of antiviral drugs such as zidovudine

Question 69

15. Which of the following holds true for the pharmacokinetics of women? 1. Gastric emptying is faster than that of men. 2. Organ blood flow is the same as that of men. 3. Evidence is strong concerning renal differences in elimination. 4. Medications that involve binding globulins are impacted by estrogen levels.

Answer 69

4. Medications that involve binding globulins are impacted by estrogen levels.

Question 70

16. The metabolism of drugs in women is primarily impacted by: 1. Hepatic blow flow 2. Enzymes of the CYP450 system differences with men 3. The amount of gastric secretions 4. Whether they are pre- or postmenopausal

Answer 70

2. Enzymes of the CYP450 system differences with men

Question 71

17. The interpretation of DEXA scores in the rare cases of adolescent osteoporosis in teens: 1. Use the same T scores that are established for women 2. Cannot be done because of less-than-mature bones 3. Must use special Z-scores developed for this reason 4. Can only be done if bisphosphonates have already been started

Answer 71

3. Must use special Z-scores developed for this reason

Question 72

18. The timing of NSAIDS for best control of severe menstrual cramps includes: 1. Taking them for 2-3 days prior to the start of bleeding 2. Taking them 2-3 times a day during the first 2 days 3. Taking them every 2-3 hours 4. They have not been found to be helpful at all

Answer 72

1. Taking them for 2-3 days prior to the start of bleeding

Question 73

19. Which of the following is true concerning lesbian health concerns? 1. They cannot contract an STI from another woman. 2. Pap smears are not required to screen for cervical cancer. 3. Lesbian women have a tendency to be frequent clinic visitors. 4. The health risks associated with smoking, alcohol, and depression are higher than in the heterosexual population.

Answer 73

4. The health risks associated with smoking, alcohol, and depression are higher than in the heterosexual population.

Question 74

4. Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of the following statements are true about both its usefulness in the disorder and the reason for its use? 1. Stable angina because it decreases the thickening of vascular walls due to decreased modified release. 2. Heart failure because it reduces remodeling of injured myocardial tissues. 3. Both 1 and 2 are true and the reasons are correct. 4. Both 1 and 2 are true but the reasons are wrong. 5. Neither 1 nor 2 are true.

Answer 74

3. Both 1 and 2 are true and the reasons are correct.

Question 75

6. While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-counter drugs without first consulting the provider because: 1. Cimetidine is metabolized by the CYP 3A4 isoenzymes 2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels 3. Both 1 and 2 4. Neither 1 nor 2

Answer 75

3. Both 1 and 2

Question 76

13. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes: 1. Hemoglobin 2. Serum potassium 3. Blood urea nitrogen 4. Serum glucose

Answer 76

2. Serum potassium

Question 77

15. Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: 1. Within 6 hours of the last dose 2. Because a reference point is needed in adjusting a dose 3. After three half-lives from the starting of the drug 4. When a patient has stable renal function

Answer 77

2. Because a reference point is needed in adjusting a dose

Question 78

17. Which of the following is true about procainamide and its dosing schedule? 1. It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen. 2. Gastrointestinal adverse effects are common so the drug should be taken with food. 3. Adherence can be improved by using a sustained release formulation that can be given once daily. 4. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Answer 78

4. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Question 79

10. Patient teaching related to amlodipine includes: 1. Increase calcium intake to prevent osteoporosis from a calcium blockade. 2. Do not crush the tablet; it must be given in liquid form if the patient has trouble swallowing it. 3. Avoid grapefruit juice as it affects the metabolism of this drug. 4. Rise slowly from a supine position to reduce orthostatic hypotension.

Answer 79

3. Avoid grapefruit juice as it affects the metabolism of this drug.

Question 80

12. Larry has heart failure, which is being treated with digoxin because it exhibits: 1. Negative inotropism 2. Positive chronotropism 3. Both 1 and 2 4. Neither 1 nor 2

Answer 80

4. Neither 1 nor 2

Question 81

24. Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor? 1. Elevated serum transaminase 2. Increased serum creatinine 3. Elevated creatinine kinase 4. Increased white blood cell counts

Answer 81

4. Increased white blood cell counts

Question 82

25. Because of the pattern of cholesterol synthesis, reductase inhibitors are given: 1. In the evening in a single daily dose 2. Twice daily in the morning and the evening 3. With each meal and at bedtime 4. In the morning before eating

Answer 82

1. In the evening in a single daily dose

Question 83

28. Dulcea has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? 1. Reactive airway disease/asthma 2. Inflammatory bowel disease 3. Allergy to aspirin 4. Gallbladder disease

Answer 83

4. Gallbladder disease

Question 84

29. Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. 1. Reductase inhibitors, due to an increased risk for rhabdomyolysis 2. Bile-acid sequestering resins, due to interference with folic acid absorption 3. Grapefruit juice, due to interference with metabolism 4. Niacin, due to decreased gemfibrozil activity

Answer 84

1. Reductase inhibitors, due to an increased risk for rhabdomyolysis

Question 85

31. Because of their site of action, bile acid sequestering resins: 1. Should be administered separately from other drugs by at least 4 hours 2. May increase the risk for bleeding 3. Both 1 and 2 4. Neither 1 nor 2

Answer 85

1. Should be administered separately from other drugs by at least 4 hours

Question 86

32. Colestipol comes in a powdered form. The patient is taught to: 1. Take the powder dry and follow it with at least 8 ounces of water 2. Take it with a meal to enhance its action on fatty food 3. Mix the powder with 4 to 6 ounces of milk or fruit juice 4. Take after the evening meal to coincide with cholesterol synthesis

Answer 86

3. Mix the powder with 4 to 6 ounces of milk or fruit juice

Question 87

34. Direct renin inhibitors have the following properties. They: 1. Are primarily generic drugs 2. Are a renin-angiotensin-aldosterone system (RAAS) medication that is safe during pregnancy 3. Can be used with an angiotensin-converting enzyme and angiotensin II receptor blocker medications for stronger impact 4. “Shut down” the entire RAAS cycle

Answer 87

4. “Shut down” the entire RAAS cycle

Question 88

35. When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true? 1. Both have major issues with a dry, irritating cough 2. Both contribute to some retention of potassium 3. ARBs have a stronger impact on hypertension control than ACE medications 4. ARBs have stronger diabetes mellitus renal protection properties than ACE medications

Answer 88

2. Both contribute to some retention of potassium

Question 89

3. Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: 1. Can be given to patients of all ages, including infants and children, for viral gastroenteritis 2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea 3. Is the treatment of choice for the diarrhea associated with E. coli 0157 4. May be used in pregnancy and by lactating women

Answer 89

2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea

Question 90

5. Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food and water precautions as well as taking: 1. Loperamide four times a day throughout the trip 2. Bismuth subsalicylate with each meal and at bedtime 3. A prescription for diphenoxylate with atropine to use if she gets diarrhea 4. None of the above

Answer 90

2. Bismuth subsalicylate with each meal and at bedtime

Question 91

6. Josie is a 5-year-old patient who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? 1. Prochlorperazine (Compazine) 2. Meclizine (Antivert) 3. Promethazine (Phenergan) 4. Ondansetron (Zofran)

Answer 91

4. Ondansetron (Zofran)

Question 92

7. Jim presents with complaints of “heartburn” that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be: 1. Omeprazole (Prilosec) twice a day 2. Ranitidine (Zantac) twice a day 3. Famotidine (Pepcid) once a day 4. Metoclopramide (Reglan) four times a day

Answer 92

2. Ranitidine (Zantac) twice a day

Question 93

8. Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: 1. Iron deficiency anemia, vitamin B12 and calcium deficiency 2. Folate and magnesium deficiency 3. Elevated uric acid levels leading to gout 4. Hypokalemia and hypocalcemia

Answer 93

1. Iron deficiency anemia, vitamin B12 and calcium deficiency

Question 94

9. Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: 1. Megaloblastic anemia 2. Osteoporosis 3. Hypertension 4. Strokes

Answer 94

1. Megaloblastic anemia

Question 95

10. Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be: 1. PEG 3350 (Miralax) 2. Bisacodyl (Dulcolax) suppository 3. Docusate (Colace) suppository 4. Polyethylene glycol electrolyte solution

Answer 95

2. Bisacodyl (Dulcolax) suppository

Question 96

11. Methylnaltrexone is used to treat constipation in: 1. Patients with functional constipation 2. Patients with irritable bowel syndrome-associated constipation 3. Children with encopresis 4. Opioid-associated constipation

Answer 96

4. Opioid-associated constipation

Question 97

12. An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include: 1. Electrolytes, including potassium and chloride 2. Bone mineral density for osteoporosis 3. Magnesium level 4. Liver function

Answer 97

1. Electrolytes, including potassium and chloride

Question 98

1. Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS? 1. Calcium channel blockers 2. Beta blockers 3. Angiotensin-converting-enzyme (ACE) inhibitors 4. Aspirin

Answer 98

3. Angiotensin-converting-enzyme (ACE) inhibitors

Question 99

3. The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class: 1. I 2. II 3. III 4. IV

Answer 99

2. II

Question 100

4. Patients at high risk for developing significant coronary heart disease are those with: 1. LDL values between 100 and 130 2. Systolic blood pressure between 120 and 130 3. Class III angina 4. Obesity

Answer 100

3. Class III angina

Question 101

9. Beta blockers are especially helpful for patients with exertional angina who also have: 1. Arrhythmias 2. Hypothyroidism 3. Hyperlipidemia 4. Atherosclerosis

Answer 101

1. Arrhythmias

Question 102

12. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because: 1. Nitrates increase MOS and beta blockers increase MOD. 2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out. 3. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease. 4. All of the above

Answer 102

2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out.

Question 103

15. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT: 1. Patients often require multiple drugs 2. A large number of angina patients are older adults on fixed incomes 3. Generic formulations may be cheaper but are rarely bioequivalent 4. Lack of drug selectivity may result in increased adverse reactions

Answer 103

3. Generic formulations may be cheaper but are rarely bioequivalent

Question 104

17. The rationale for prescribing calcium blockers for angina can be based on the need for: 1. Increased inotropic effect in the heart 2. Increasing peripheral perfusion 3. Keeping heart rates high enough to ensure perfusion of coronary arteries 4. Help with rate control

Answer 104

4. Help with rate control

Question 105

20. Ranolazine is used in angina patients to: 1. Dilate plaque-filled arteries 2. Inhibit platelet aggregation 3. Restrict late sodium flow in the myocytes 4. Induce vasoconstriction in the periphery to open coronary vessels

Answer 105

3. Restrict late sodium flow in the myocytes