Chapter 41. Hyperthyroidism & Hypothyroidism
1. When methimazole is started for
hyperthyroidism it may take to see a
total reversal of hyperthyroid symptoms.
1. 2 to 4
weeks
2. 1 to 2
months
3. 3 to 4
months
4. 6 to 12
months
2. In addition to methimazole, a
symptomatic patient with hyperthyroidism may need a prescription for:
1. A calcium
channel blocker
2. A beta
blocker
3. Liothyronine
4. An alpha
blocker
3. After starting a patient with
Grave’s disease on an antithyroid agent such as methimazole, patient monitoring
includes TSH & free T4 every:
1. 1 to 2
weeks
2. 3 to 4
weeks
3. 2 to 3
months
4. 6 to 9
months
4. A woman who is pregnant & has
hyperthyroidism is best managed by a specialty team who will most likely treat
her with:
1. Methimazole
2. Propylthiouracil
(PTU)
3. Radioactive
iodine
4. Nothing,
treatment is best delayed until after her pregnancy ends
5. Goals when treating hypothyroidism
with thyroid replacement include:
1. Normal
TSH & free T4 levels
2. Resolution
of fatigue
3. Weight
loss to baseline
4. All of
the above
6. When starting a patient on
levothyroxine for hypothyroidism the patient will need follow-up measurement of
thyroid function in:
1. 2 weeks
2. 4 weeks
3. 2 months
4. 6 months
7. Once a patient who is being treated
for hypothyroidism returns to euthyroid with normal TSH levels, he or she
should be monitored with TSH & free T4 levels every:
1. 2 weeks
2. 4 weeks
3. 2 months
4. 6 months
8. Treatment of a patient with
hypothyroidism & cardiovascular disease consists of:
1. Levothyroxine
2. Liothyronine
3. Liotrix
4. Methimazole
9. Infants with congenital
hypothyroidism are treated with:
1. Levothyroxine
2. Liothyronine
3. Liotrix
4. Methimazole
10. When starting a patient with
hypothyroidism on thyroid replacement hormones patient education would include:
1. They
should feel symptomatic improvement in 1 to 2 weeks.
2. Drug
adverse effects such as lethargy & dry skin may occur.
3. It may
take 4 to 8 weeks to get to euthyroid symptomatically & by laboratory
testing.
4. Because
of its short half-life, levothyroxine doses should not be missed.
11. In hyperthyroid states, what organ
system other than CV must be evaluated to establish potential adverse issues?
1. The liver
2. The nails
& skin
3. The eye
4. The ear
12. Why are “natural” thyroid products not
readily prescribed for most patients?
1. There is
no reliability for the amount of hormone per dose.
2. There is
higher incidence of allergic reactions.
3. There is
a more reliable dose of T3 to T4 per batch.
4. All of
the above
13. What is the desired mixed of T3 to T4
drug levels in newly diagnosed endocrine patients?
1. 99% of T3
& the rest is T4 to get rapid resolution.
2. Most
needs to be T4 to mimic natural ratios of hormone.
3. The ratio
is unimportant.
4. The mix
needs to be 50-50 at first.
14. Laboratory values are actually different
for TSH when screening for thyroid issues & when used for medication
management. Which of the follow holds true?
1. Screening
TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to
remain above 5.0.
2. Screening
values are much narrower than the acceptable range used to keep a person stable
on hormone replacement.
3. Therapeutic
values are kept between 0.05 & 3.0 ideally. Screening values are considered
acceptable up to 10.
4. Screening
values are between 5 & 10, & therapeutic values are greater than 10.
15. What happens to the typical hormone
replacement dose when a woman becomes pregnant?
1. Most
women need less medication.
2. Most
women do not require a dose change.
3. The
average woman needs more medication during pregnancy.
4. The
average woman needs more medication only if carrying multiples.
Chapter 42. Pneumonia
1. The most common bacterial pathogen
in community-acquired pneumonia is:
1. Haemophilusinfluenzae
2. Staphylococcus
aureus
3. Mycoplasma
pneumoniae
4. Streptococcus
pneumoniae
2. The first-line drug choice for a
previously healthy adult patient diagnosed with community-acquired pneumonia
would be:
1. Ciprofloxacin
2. Azithromycin
3. Amoxicillin
4. Doxycycline
3. The first-line antibiotic choice for
a patient with comorbidities or who is immunosuppressed who has pneumonia &
can be treated as an outpatient would be:
1. Levofloxacin
2. Amoxicillin
3. Ciprofloxacin
4. Cephalexin
4. If an adult patient with
comorbidities cannot reliably take oral antibiotics to treat pneumonia, an
appropriate initial treatment option would be:
1. IV or IM
gentamicin
2. IV or IM
ceftriaxone
3. IV
amoxicillin
4. IV
ciprofloxacin
5. Samantha is 34 weeks pregnant &
has been diagnosed with pneumonia. She is stable enough to be treated as an
outpatient. What would be an appropriate antibiotic to prescribe?
1. Levofloxacin
2. Azithromycin
3. Amoxicillin
4. Doxycycline
6. Adults with pneumonia who are
responding to antimicrobial therapy should show improvement in their clinical
status in:
1. 12 to 24
hours
2. 24 to 36
hours
3. 48 to 72
hours
4. 4 or 5
days
7. Along with prescribing antibiotics,
adults with pneumonia should be instructed on lifestyle modifications to
improve outcomes, including:
1. Adequate
fluid intake
2. Increased
fiber intake
3. Bedrest
for the first 24 hours
4. All of
the above
8. 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
9. 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%, & is taking fluids adequately. What would be
appropriate initial treatment for his pneumonia?
1. Ceftriaxone
2. Azithromycin
3. Cephalexin
4. Levofloxacin
10. 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
Chapter 43. Smoking Cessation
1. Nicotine withdrawal symptoms
include:
1. Nervousness
2. Increased
appetite
3. Difficulty
concentrating
4. All of
the above
2. If a patient wants to quit smoking,
nicotine replacement therapy is recommended if the patient:
1. Smokes
more than 10 cigarettes a day
2. Smokes
within 30 minutes of awakening in the morning
3. Smokes
when drinking alcohol
4. All of
the above
3. Instructions for a patient who is
starting nicotine replacement therapy include:
1. Smoke
less than 10 cigarettes a day when starting nicotine replacement.
2. Nicotine
replacement will help with the withdrawal cravings associated with quitting
tobacco.
3. Nicotine
replacement can be used indefinitely.
4. Nicotine
replacement therapy is generally safe for all patients.
4. Nicotine replacement therapy should
not be used in which patients?
1. Pregnant
women
2. Patients
with worsening angina pectoris
3. Patients
who have just suffered an acute myocardial infarction
4. All of
the above
5. Instructions for the use of nicotine
gum include:
1. Chew the
gum quickly to get a peak effect.
2. The gum
should be “parked” in the buccal space between chewing.
3. Acidic
drinks such as coffee help with the absorption of the nicotine.
4. The
highest abstinence rates occur if the patient chews the gum when he or she is
having cravings.
6. Patients who choose the nicotine
lozenge to assist in quitting tobacco should be instructed:
1. Chew the
lozenge well.
2. Drink at
least 8 ounces of water after the lozenge dissolves.
3. Use one
lozenge every 1 to 2 hours (at least nine per day with a maximum of 20 per
day).
4. A
tingling sensation in the mouth should be reported to the provider.
7. Transdermal nicotine replacement
(the patch) is an effective choice in tobacco cessation because:
1. The patch
provides a steady level of nicotine without reinforcing oral aspects of
smoking.
2. There is
the ability to “fine tune” the amount of nicotine that is delivered to the
patient at any one time.
3. There is
less of a problem with nicotine toxicity than other forms of nicotine
replacement.
4. Transdermal
nicotine is safer in pregnancy.
8. The most common adverse effect of
the transdermal nicotine replacement patch is:
1. Nicotine
toxicity
2. Tingling
at the site of patch application
3. Skin
irritation under the patch site
4. Life-threatening
dysrhythmias
9. If a patient is exhibiting signs of
nicotine toxicity when using transdermal nicotine, they should remove the patch
&:
1. Wash the
area thoroughly with soap & water.
2. Flush the
area with clear water.
3. Reapply a
new patch in 8 hours.
4. Take
acetaminophen for the headache associated with toxicity.
10. When a patient is prescribed nicotine
nasal spray for tobacco cessation, instructions include:
1. Inhale
deeply with each dose to ensure deposition in the lungs.
2. The dose
is one to two sprays in each nostril per hour, not to exceed 40 sprays per day.
3. If they
have a sensation of “head rush” this indicates the medication is working well.
4. Nicotine
spray may be used for up to 12 continuous months.
11. If prescribing bupropion (Zyban) for
tobacco cessation, the instructions to the patient include:
1. Bupropion
(Zyban) is started 1 to 2 weeks before the quit date.
2. Nicotine
replacement products should not be used with bupropion.
3. If they
smoke when taking bupropion they may have increased anxiety & insomnia.
4. Because
they are not using bupropion as an antidepressant, they do not need to worry
about increased suicide ideation when starting therapy.
12. Varenicline (Chantix) may be
prescribed for tobacco cessation. Instructions to the patient who is starting
varenicline include:
1. The maximum
time varenicline can be used is 12 weeks.
2. Nausea is
a sign of varenicline toxicity & should be reported to the provider.
3. The
starting regimen for varenicline is start taking 1 mg twice a day a week before
the quit date.
4. Neuropsychiatric
symptoms may occur.
13. The most appropriate smoking cessation
prescription for pregnant women is:
1. A
nicotine replacement patch at the lowest dose available
2. Bupropion
(Zyban)
3. Varenicline
(Chantix)
4. Nonpharmacologic
measures
Chapter 44. Sexually Transmitted Infections & Vaginitis
1. The goals of treatment when
prescribing for sexually transmitted infections include:
1. Treatment
of infection
2. Prevention
of disease spread
3. Prevention
of long-term sequelae from the infection
4. All of
the above
2. 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
3. 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
4. Demione is a 24-year-old patient who
is 32 weeks pregnant & 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
5. 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
4. Doxycycline
100 mg bid x 7 days
6. 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
7. Ongoing monitoring is essential
after treating for gonorrhea. The patient should be rescreened for gonorrhea
& chlamydia in:
1. 4 weeks
2. 3 to 6
weeks
3. 3 to 6
months
4. 1 year
8. 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
9. Treatment for chancroid in a
nonpregnant patient would be:
1. Oral
azithromycin
2. IM
ceftriaxone
3. Oral
ciprofloxacin
4. Any of
the above
10. Jamie was treated for chancroid.
Follow-up testing after treatment of chancroid would be:
1. Syphilis
& HIV testing at 3-month intervals
2. Chancroid-specific
antigen test every 3 months
3. Urine
testing for Haemophilusducreyiin 3 to 6 months for test of cure
4. Annual
HIV testing if engaging in high-risk sexual behavior
11. 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
12. Besides prescribing antimicrobial
therapy, patients with bacterial vaginosis 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 & 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.
13. Sydney presents to the clinic with
vulvovaginal c&idiasis. 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
14. If a woman presents with recurrent
vulvovaginal c&idiasis 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
15. Zoe presents with genital warts
present on her labia. Patient-applied topical therapy for warts includes:
1. Podofilox
0.5% gel
2. Podophyllin
10% resin
3. Trichloracetic
acid
4. Any of
the above
16. Sophie presents to the clinic with a
malodorous vaginal discharge & 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
17. In addition to antimicrobial therapy,
patients treated for Trichomonas infection 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
Chapter 45. Tuberculosis
1. Drug resistant tuberculosis (TB) is
defined as TB that is resistant to:
1. Fluoroquinolones
2. Rifampin
& isoniazid
3. Amoxicillin
4. Ceftriaxone
2. Goals when treating tuberculosis
include:
1. Completion
of recommended therapy
2. Negative
purified protein derivative at the end of therapy
3. Completely
normal chest x-ray
4. All of
the above
3. The principles of drug therapy for
the treatment of tuberculosis include:
1. Patients
are treated with a drug to which M. tuberculosis is sensitive.
2. Drugs
need to be taken on a regular basis for a sufficient amount of time.
3. Treatment
continues until the patient’s purified protein derivative is negative.
4. All of
the above
4. Isabella has confirmed tuberculosis
& is placed on a 6-month treatment regimen. The 6-month regimen consists
of:
1. Two
months of four-drug therapy (INH, rifampin, pyrazinamide, & ethambutol)
followed by Four months of INH &
rifampin
2. Six
months of INH with daily pyridoxine throughout therapy
3. Six
months of INH, rifampin, pyrazinamide, & ethambutol
4. Any of
the above
5. Kaleb has extensively resistant
tuberculosis (TB). Treatment for extensively resistant TB would include:
1. INH,
rifampin, pyrazinamide, & ethambutol for at least 12 months
2. INH,
ethambutol, kanamycin, & rifampin
3. Treatment
with at least two drugs to which the TB is susceptible
4. Levofloxacin
6. Lila is 24 weeks pregnant & has
been diagnosed with tuberculosis (TB). Treatment regimens for a pregnant
patient with TB would include:
1. Streptomycin
2. Levofloxacin
3. Kanamycin
4. Pyridoxine
7. Bilal is a 5-year-old patient who
has been diagnosed with tuberculosis. His treatment would include:
1. Pyridoxine
2. Ethambutol
3. Levofloxacin
4. Rifabutin
8. Ezekiel is a 9-year-old patient who
lives in a household with a family member newly diagnosed with tuberculosis
(TB). To prevent Ezekiel from developing TB he should be treated with:
1. 6 months
of Isoniazid (INH) & rifampin
2. 2 months
of INH, rifampin, pyrazinamide, & ethambutol, followed by 4 months of INH
3. 9 months
of INH
4. 12 months
of INH
9. Leonard is completing a 6-month
regimen to treat tuberculosis (TB). Monitoring 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
10. Compliance with directly observed
therapy can be increased by:
1. Convenient
clinic times
2. Incentives
such as food, clothing, & transportation costs
3. Offering
gifts for compliance
4. All of
the above
Chapter 46. Upper Respiratory Infections, Otitis Media,
& Otitis Externa
1. Caleb is an adult with an upper
respiratory infection (URI). Treatment for his URI would include:
1. Amoxicillin
2. Diphenhydramine
3. Phenylpropanolamine
4. Topical
oxymetazoline
2. Rose is a 3-year-old patient with an
upper respiratory infection (URI). Treatment for her URI would include:
1. Amoxicillin
2. Diphenhydramine
3. Pseudoephedrine
4. Nasal
saline spray
3. Patients who should be cautious
about using decongestants for an upper respiratory infection (URI) include:
1. School-age
children
2. Patients
with asthma
3. Patients
with cardiac disease
4. Patients
with allergies
4. Jaheem is a 10-year-old low-risk
patient with sinusitis. Treatment for a child with sinusitis is:
1. Amoxicillin
2. Azithromycin
3. Cephalexin
4. Levofloxacin
5. Jacob has been diagnosed with
sinusitis. He is the parent of a child in daycare. Treatment for sinusitis in
an adult who has a child in daycare is:
1. Azithromycin
500 mg q day for 5 days
2. Amoxicillin-clavulanate
500 mg bid for 7 days
3. Ciprofloxacin
500 mg bid for 5 days
4. Cephalexin
500 mg qid for 5 days
6. The length of treatment for
sinusitis in a low-risk patient should be:
1. 5–7 days
2. 7–10 days
3. 14–21
days
4. 7 days
beyond when symptoms cease
7. Patient education for a patient who
is prescribed antibiotics for sinusitis includes:
1. Use of
nasal saline washes
2. Use of
inhaled corticosteroids
3. Avoiding
the use of ibuprofen while ill
4. Use of
laxatives to treat constipation
8. Myles is a 2-year-old patient who
has been diagnosed with acute otitis media. He is afebrile & has not been
treated with antibiotics recently. First-line treatment for his otitis media
would include:
1. Azithromycin
2. Amoxicillin
3. Ceftriaxone
4. Trimethoprim/sulfamethoxazole
9. Alyssa is a 15-month-old patient who
has been on amoxicillin for 2 days for acute otitis media. She is still febrile
& there is no change in her tympanic membrane examination. What would be
the plan of care for her?
1. Continue
the amoxicillin for the full 10 days.
2. Change
the antibiotic to azithromycin.
3. Change
the antibiotic to amoxicillin/clavulanate.
4. Change
the antibiotic to trimethoprim/sulfamethoxazole.
10. A child that may warrant “watchful
waiting” instead of prescribing an antibiotic for acute otitis media includes
patients who:
1. Are low
risk with temperature of less than 39oC or 102.2oF
2. Have
reliable parents with transportation
3. Are older
than age 2 years
4. All of
the above
11. Whether prescribing an antibiotic for
a child with acute otitis media or not, the parents should be educated about:
1. Using
decongestants to provide faster symptom relief
2. Providing
adequate pain relief for at least the first 24 hours
3. Using
complementary treatments for acute otitis media, such as garlic oil
4. Administering
an antihistamine/decongestant combination (Dimetapp) so the child can sleep
better
12. First-line therapy for a patient with
acute otitis externa (swimmer’s ear) & an intact tympanic membrane
includes:
1. Swim-Ear
drops
2. Ciprofloxacin
& hydrocortisone drops
3. Amoxicillin
4. Gentamicin
ophthalmic drops
Chapter 47. Urinary Tract Infections
1. The treatment goals when treating
urinary tract infection (UTI) include:
1. Eradication
of infecting organism
2. Relief of
symptoms
3. Prevention
of recurrence of the UTI
4. All of
the above
2. 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 & no drug allergies. An appropriate first-line
antibiotic choice for her would be:
1. Azithromycin
2. Trimethoprim/sulfamethoxazole
3. Ceftriaxone
4. Levofloxacin
3. Jamie is a 24-year-old female with a
urinary tract infection. She is healthy, afebrile, & her only drug allergy
is sulfa, which gives her a rash. An appropriate first-line antibiotic choice
for her would be:
1. Azithromycin
2. Trimethoprim/sulfamethoxazole
3. Ceftriaxone
4. Ciprofloxacin
4. 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
5. 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
6. Nicole is a 4-year-old female with a
febrile urinary tract infection (UTI). She is generally healthy & has no
drug allergies. Appropriate initial therapy for her UTI would be:
1. Azithromycin
2. Trimethoprim/sulfamethoxazole
3. Ceftriaxone
4. Ciprofloxacin
7. Monitoring for a healthy,
nonpregnant adult patient being treated for 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
8. 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
9. 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
10. 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
11. 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.
Chapter 48: Women as Patients
1. 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. 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
3. Because of their longer life
expectancy, women are more likely than men to experience a disabling condition.
Common conditions in older women that can produce disability include:
1. Depression
2. Panic
disorders
3. Dementia
4. All of
the above
4. Gender differences between men &
women in pharmacokinetics include:
1. More
rapid gastric emptying so that drugs absorbed in the stomach have less exposure
to absorption sites
2. Higher
proportion of body fat so that lipophilic drugs have relatively greater volumes
of distribution
3. Increased
levels of bile acids so that drugs metabolized in the intestine have higher
concentrations
4. Slower
organ blood flow rates so drugs tend to take longer to be excreted
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
6. Since 40% of bone accrual occurs
during adolescence, building bone during this time is critical. Ways to improve
bone accrual in adolescents include:
1. Use of
bisphosphonates early if dual energy X-ray absorptiometry(DEXA) scans show
limited bone accrual
2. Encouraging
a daily dietary intake of 1,300 mg of calcium & 400 IU of vitamin D
3. Avoiding
all birth control methods that include progesterone
4. Fostering
the intake of iron mainly in green & leafy vegetables
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, & soy products
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
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
10. Premenstrual dysphoric disorder (PMDD)
occurs in a fairly small number of patients. Theories of the pathology behind
PMDD that are supported in research include:
1. Altered
sensitivity in the serontonic system
2. Inhibition
of the cyclooxygenase system
3. Fluctuations
of the gonadal hormones
4. All of
these are theories supported by research
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
12. Women are now the fastest growing
population with HIV infection & AIDS. HIV-infected women:
1. Are less
likely to become pregnant or to carry a pregnancy to term
2. Have
higher rates of cervical dysplasia & HPV-concurrent infections
3. Are most
often over 35 years of age
4. Most
often come from Asian & Caucasian ethnic groups
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
& 2
4. Neither 1
nor 2
14. Erroneous information about LGBTQ
individuals can lead to failure to give accurate advice to them as patients.
Which of the following statements is true about lesbians:
1. Lesbians
cannot contract a sexually transmitted infection from their female partner.
2. Screening
for cervical cancer is not required.
3. Lesbians
as a group are less likely to have health-care insurance.
4. Like
women in general, lesbians are more likely than gay men to seek care for
health-related issues.
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.
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
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
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
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, & depression are higher than
in the heterosexual population.
Chapter 49. Men as Patients
1. The factor that has the greatest
effect on males developing male sexual characteristics is:
1. Cultural
beliefs
2. Effective
male role models
3. Adequate
intake of testosterone in the diet
4. &rogen
production
2. When assessing a male for
hypogonadism prior to prescribing testosterone replacement, serum testosterone
levels are drawn:
1. Without
regard to time of day
2. First
thing in the morning
3. Late
afternoon
4. In the
evening
3. Some research supports that
testosterone replacement therapy may be indicated in which of the following
diagnoses in men?
1. Age-related
decrease in cognitive functioning
2. Metabolic
syndrome
3. Decreased
muscle mass in aging men
4. All of
the above
4. The goal of testosterone replacement
therapy is:
1. Absence
of all hypogonadism symptoms
2. Testosterone
levels in the mid-normal range 1 week after an injection
3. Testosterone
levels in the mid-normal range just prior to the next injection
4. Avoidance
of high serum testosterone levels during therapy
5. While on testosterone replacement,
hemoglobin & hematocrit levels should be monitored. Levels suggestive of
excessive erythrocytosis or abuse are:
1. Hemoglobin
14 g/dl or hematocrit 39%
2. Hemoglobin
11.5 g/dl or hematocrit 31%
3. Hemoglobin
13 g/dl or hematocrit 38%
4. Hemoglobin
17.5 g/dl or hematocrit 54%
6. Monitoring of an older male patient
on testosterone replacement includes:
1. Oxygen
saturation levels at every visit
2. Serum
cholesterol & lipid profile every 3 to 6 months
3. Digital
rectal prostate screening exam at 3 & 6 months after starting therapy
4. Bone
mineral density at 3 months & 6 months after starting therapy
7. When prescribing phosphodiesterase
type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be
screened for use of:
1. Statins
2. Nitrates
3. Insulin
4. Opioids
8. Men who are prescribed
phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction should be
educated regarding the adverse effects of the drug which include:
1. Hearing
loss
2. Hypotension
3. Delayed
ejaculation
4. Dizziness
9. Male patients who should not be
prescribed phosphodiesterase type 5 (PDE-5) inhibitors include:
1. Diabetics
2. Those who
have had an acute myocardial infarction in the past 6 months
3. Patients
who are deaf
4. Patients
under age 60 years of age
10. Monitoring of male patients who are
using phosphodiesterase type 5 (PDE-5) inhibitors includes:
1. Serum
fasting glucose levels
2. Cholesterol
& lipid levels
3. Blood
pressure
4. Complete
blood count
Chapter 50. Children as Patients
1. The Pediatric Research Equity Acts
requires:
1. All
children be provided equal access to drug research trials
2. Children
to be included in the planning phase of new drug development
3. That
pediatric drug trials guarantee children of multiple ethnic groups are included
4. All
applications for new active ingredients, new indications, new dosage forms, or
new routes of administration require pediatric studies
2. The Best Pharmaceuticals for
Children Act:
1. Includes
a pediatric exclusivity rule which extends the patent on drugs studied in
children
2. Establishes
a committee that writes guidelines for pediatric prescribing
3. Provides
funding for new drug development aimed at children
4. Encourages
manufacturers specifically to develop pediatric formulations
3. The developmental variation in Phase
I enzymes has what impact on pediatric prescribing?
1. None,
Phase I enzymes are stable throughout childhood.
2. Children
should always be prescribed lower than adult doses per weight due to low enzyme
activity until puberty.
3. Children
should always be prescribed higher than adult doses per weight due to high
enzyme activity.
4. Prescribing
dosages will vary based on the developmental activity of each enzyme, at times
requiring lower than adult doses & other times higher than adult doses
based on the age of the child.
4. Developmental variation in renal
function has what impact on prescribing for infants & children?
1. Lower
doses of renally excreted drugs may be prescribed to infants younger than age 6
months.
2. Higher doses
of water soluble drugs may need to be prescribed because of increased renal
excretion.
3. Renal
excretion rates have no impact on prescribing.
4. Parents
need to be instructed on whether drugs are renally excreted or not.
5. Topical corticosteroids are
prescribed cautiously in young children because:
1. They may
cause an intense hypersensitivity reaction
2. Of
hypothalamic-pituitary-adrenal axis suppression
3. Corticosteroids
are less effective in young children
4. Young
children may accumulate corticosteroids, leading to toxic levels
6. Liza is breastfeeding her
2-month-old son & has an infection that requires an antibiotic. What drug
factors influence the effect of the drug on the infant?
1. Maternal
drug levels
2. Half-life
3. Lipid-solubility
4. All of
the above
7. Drugs that are absolutely
contraindicated in lactating women include:
1. Selective
serotonin reuptake inhibitors
2. Antiepileptic
drugs such as carbamazepine
3. Antineoplastic
drugs such as methotrexate
4. All of
the above
8. Zia is a 4-month-old patient with
otitis media. Education of his parents regarding administering oral antibiotics
to an infant includes:
1. How to
administer an oral drug using a medication syringe
2. Mixing
the medication with a couple of ounces of formula & putting it in a bottle
3. Discontinuing
the antibiotic if diarrhea occurs
4. Calling
for an antibiotic change if the infant chokes & sputters during
administration
9. To increase adherence in pediatric
patients a prescription medication should:
1. Have a
short half-life
2. Be the
best tasting of the effective drugs
3. Be the
least concentrated form of the medication
4. Be
administered 3 or 4 times a day
10. Janie is a 5-month-old breastfed
infant with a fever. Treatment for her fever may include:
1. “Baby”
aspirin
2. Acetaminophen
suppository
3. Ibuprofen
suppository
4. Alternating
acetaminophen & ibuprofen
Chapter 51. Geriatric Patients
1. Principles of prescribing for older
adults include:
1. Avoiding
prescribing any newer high-cost medications
2. Starting
at a low dose & increasing the dose slowly
3. Keeping
the total dose at a lower therapeutic range
4. All of
the above
2. Sadie is a 90-year-old patient who
requires a new prescription. What changes in drug distribution with aging would
influence prescribing for Sadie?
1. Increased
volume of distribution
2. Decreased
lipid solubility
3. Decreased
plasma proteins
4. Increased
muscle-to-fat ratio
3. Glen is an 82-year-old patient who
needs to be prescribed a new drug. What changes in elimination should be taken
into consideration when prescribing for Glen?
1. Increased
glomerular filtration rate(GFR) will require higher doses of some renally excreted
drugs.
2. Decreased
tubular secretion of medication will require dosage adjustments.
3. Thin skin
will cause increased elimination via sweat.
4. Decreased
lung capacity will lead to measurable decreases in lung excretion of drugs.
4. A medication review of an elderly
person’s medications involves:
1. Asking
the patient to bring a list of current prescription medications to the visit
2. Having
the patient bring all of their prescription, over-the-counter, & herbal
medications to the visit
3. Asking
what other providers are writing prescriptions for them
4. All of
the above
5. Steps to avoid polypharmacy include:
1. Prescribing
two or fewer drugs from each drug class
2. Reviewing
a complete drug history every 12 to 18 months
3. Encouraging
the elderly patient to coordinate their care with all of their providers
4. Evaluating
for duplications in drug therapy & discontinuing any duplications
6. Robert is a 72-year-old patient who
has hypertension & angina. He is at risk for common medication practices
seen in the elderly including:
1. Use of
another person’s medications
2. Hoarding
medications
3. Changing
his medication regimen without telling his provider
4. All of
the above
7. To improve positive outcomes when
prescribing for the elderly the nurse practitioner should:
1. Assess
cognitive functioning in the elder
2. Encourage
the patient to take a weekly “drug holiday” to keep drug costs down
3. Encourage
the patient to cut drugs in half with a knife to lower costs
4. All of
the above
8. When an elderly diabetic patient is
constipated the best treatment options include:
1. Mineral
oil
2. Bulk-forming
laxatives such as psyllium
3. Stimulant
laxatives such as senna
4. Stool
softeners such as docusate
9. Delta is an 88-year-old patient who
has mild low-back pain. What guidelines should be followed when prescribing
pain management for Delta?
1. Keep the
dose of oxycodone low to prevent development of tolerance.
2. Acetaminophen
is the first-line drug of choice.
3. Avoid
prescribing NSAIDs.
4. Add in a
short-acting benzodiazepine for a synergistic effect on pain.
10. Robert is complaining of poor sleep.
Medications that may contribute to sleep problems in the elderly include:
1. Diuretics
2. Trazodone
3. Clonazepam
4. Levodopa
11. The GFRs for a 91-year-old woman who
weighs 93 pounds & is 5'1" with a serum creatinine of 1.1, & for a
202-pound, 25-year-old male who is 5'9" with the same serum creatinine
according to the Cockcroft Gault formula are:
1. 25ml/ min
& 133 mL/min respectively
2. 25 mL/min
& 103 mL/min respectively
3. 22 ml/min
& 133 mL/min respectively
4. 22 ml/min
& 103 mL/min respectively
12. In geriatric patients, the percentage
of body fat is increased. What are the pharmacologic implications of this
physiologic change?
1. A
lipid-soluble medication will be eliminated more quickly & not work as
well.
2. A
lipid-soluble medication will accumulate in fat tissue & its duration of
action may be prolonged.
3. Absorption
of lipid-soluble drugs is impaired in older adults.
4. The
bioavailability of the lipid-soluble drug will be increased in older adults.
13. All of the following statements about
the Beer’s List are true except:
1. It is a
list of medications or medication classes that should generally be avoided in
persons 65 years or older because they are either ineffective or they pose
unnecessarily high risk for older persons & a safer alternative is
available.
2. It is
derived from the expert opinion of one geriatrician & is not
evidence-based.
3. These
criteria have been adopted by the Centers for Medicare & Medicaid Services
for regulation of long-term care facilities.
4. These
criteria are directed at the general population of patients over 65 years of
age & do not take disease states into consideration.
14. You are reviewing the data from
several meta-analyses that addressed the most common causes of adverse drug
reactions in the older adult. Which of the following would you find to be
decreased & the most common cause of these problems in older adults?
1. Body fat
content
2. Liver
function
3. Renal
function/clearance
4. Plasma
albumin levels
15. Which of the following is not consistent
with the rules for geriatric prescribing:
1. Half-life
will be longer in older adults
2. Steady
state is reached more quickly in the older adult
3. Reduce
the number of drugs in the patient's regimen whenever possible
4. Adverse
drug responses present atypically in the older adult
Chapter 52. Pain Management: Acute & Chronic Pain
1. Different areas of the brain are
involved in specific aspects of pain. The reticular & limbic systems in the
brain influence the:
1. Sensory
aspects of pain
2. Discriminative
aspects of pain
3. Motivational
aspects of pain
4. Cognitive
aspects of pain
2. Patients need to be questioned about
all pain sites because:
1. Patients
tend to report the most severe or important in their perception.
2. Pain
tolerance generally decreases with repeated exposure.
3. The
reported pain site is usually the most important to treat.
4. Pain may
be referred from a different site to the one reported.
3. The chemicals that promote the
spread of pain locally include:
1. Serotonin
2. Norepinephrine
3. Enkephalin
4. Neurokinin
A
4. Narcotics are exogenous opiates.
They act by:
1. Inhibiting
pain transmission in the spinal cord
2. Attaching
to receptors in the afferent neuron to inhibit the release of substance P
3. Blocking
neurotransmitters in the midbrain
4. Increasing
beta-lipoprotein excretion from the pituitary gl&
5. Age is a factor in different
responses to pain. Which of the following age-related statements about pain is
NOT true?
1. Preterm
& newborn infants do not yet have functional pain pathways.
2. Painful
experiences & prolonged exposure to analgesic drugs during pregnancy may
permanently alter neuronal organization in the child.
3. Increases
in the pain threshold in older adults may be related to peripheral neuropathies
& changes in skin thickness.
4. Decreases
in pain tolerance are evident in older adults.
6. Which of the following statements is
true about acute pain?
1. Somatic
pain comes from body surfaces & is only sharp & well-localized.
2. Visceral
pain comes from the internal organs & is most responsive to acetaminophen
& opiates.
3. Referred
pain is present in a distant site for the pain source & is based on
activation of the same spinal segment as the actual pain site.
4. Acute
neuropathic pain is caused by lack of blood supply to the nerves in a given
area.
7. One of the main drug classes used to
treat acute pain is NSAIDs. They are used because:
1. They have
less risk for liver damage than acetaminophen.
2. Inflammation
is a common cause of acute pain.
3. They have
minimal GI irritation.
4. Regulation
of blood flow to the kidney is not affected by these drugs.
8. Opiates are used mainly to treat
moderate to severe pain. Which of the following is NOT true about these drugs?
1. All
opiates are scheduled drugs which require a DEA license to prescribe.
2. Opiates
stimulate only mu receptors for the control of pain.
3. Most of
the adverse effects of opiates are related to mu receptor stimulation.
4. Naloxone
is an antagonist to opiates.
9. If interventions to resolve the
cause of pain (e.g., rest, ice, compression, & elevation) are insufficient,
pain medications are given based on the severity of pain. Drugs are given in
which order of use?
1. NSAIDs,
opiates, corticosteroids
2. Low-dose
opiates, salicylates, increased dose of opiates
3. Opiates,
non-opiates, increased dose of non-opiate
4. Non-opiate,
increased dose of non-opiate, opiate
10. The goal of treatment of acute pain
is:
1. Pain at a
tolerable level where the patient may return to activities of daily living
2. Reduction
of pain with a minimum of drug adverse effects
3. Reduction
or elimination of pain with minimum adverse reactions
4. Adequate
pain relief without constipation or nausea from the drugs
11. Which of the following statements is
true about age & pain?
1. Use of
drugs that depend heavily on the renal system for excretion may require dosage
adjustments in very young children.
2. Among the
NSAIDs, indomethacin is the preferred drug because of lower adverse effects
profiles than other NSAIDs.
3. Older
adults who have dementia probably do not experience much pain due to loss of
pain receptors in the brain.
4. Acetaminophen
is especially useful in both children & adults because it has no effect on
platelets & has fewer adverse effects than NSAIDs.
12. Pain assessment to determine adequacy
of pain management is important for all patients. This assessment is done to:
1. Determine
if the diagnosis of source of pain is correct
2. Determine
if the current regimen is adequate or different combinations of drugs &
non-drug therapy are required
3. Determine
if the patient is willing & able to be an active participant in his or her
pain management
4. All of
the above
13. Pathological similarities &
differences between acute pain & chronic pain include:
1. Both have
decreased levels of endorphins.
2. Chronic
pain has a predominance of C-neuron stimulation.
3. Acute
pain is most commonly associated with irritation of peripheral nerves.
4. Acute
pain is diffuse & hard to localize.
14. A treatment plan for management of
chronic pain should include:
1. Negotiation
with the patient to set personal goals for pain management
2. Discussion
of ways to improve sleep & stress
3. An
exercise program to improve function & fitness
4. All of
the above
15. Chronic pain is a complex problem.
Some specific strategies to deal with it include:
1. Telling
the patient to “let pain be your guide” to using treatment therapies
2. Prescribing
pain medication on a “PRN” basis to keep down the amount used
3. Scheduling
return visits on a regular basis rather than waiting for poor pain control to
drive the need for an appointment
4. All of
the above
16. Chemical dependency assessment is integral
to the initial assessment of chronic pain. Which of the following raises a “red
flag” about potential chemical dependency?
1. Use of
more than one drug to treat the pain
2. Multiple
times when prescriptions are lost with requests to refill
3. Preferences
for treatments that include alternative medicines
4. Presence
of a family member who has abused drugs
17. The Pain Management Contract is
appropriate for:
1. Patients
with cancer who are taking morphine
2. Patients
with chronic pain who will require long-term use of opiates
3. Patients
who have a complex drug regimen
4. Patients
who see multiple providers for pain control
