05 Feb 3. Determine if the

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

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