LATEST ADVANCED PHARMACOLOGY MIDTERM EXAM 2023

 

Question 1 : The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the

Minimum adverse effect level                        peak of action

therapeutic range                     onset of action

 

Question 2 : The Nurse Practitioner is following up on a patient who is experiencing acute asthma problems. Albuterol (Proventil) by metered-dose inhaler (MDI) has been ordered as treatment. Which patient response would indicate to the family nurse practitioner that the patient understands how to take the medication?

“I will take 1 puff of the medication and then wait a minute before taking the second puff.”

“I will take 2 puffs of the medication every 4 hours, even if I am not short of breath.”

“It is important for me to take this medication on a regular cycle to prevent future attacks.”

“I will take 2 puffs, one right after the other, whenever I begin to get short of breath.”

 

Question 3 : A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?

Bradycardia                Diarrhea

                        Nausea                        Slight headache

 

Question 4 : A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

crush the tablet before swallowing.

swallow the tablet whole.

                        swallow the tablet with milk or food.

avoid drinking milk for 3 hours after swallowing the tablet.

 

Question 5 : A patient with a history of bronchial asthma is seen in the clinic for increased episodes of difficulty breathing. He has been taking theophylline 100 mg PO tid. He is 40 years old and obese with an 16-pack-year history of cigarette smoking and excessive intake of coffee daily. He eats a low-carbohydrate, high-protein diet. Which identified factors decrease the therapeutic effects of the theophylline?

Age and gender                       Coffee intake and weight

Age and weight                       Smoking history and diet

 

Question 6 : A female patient calls the clinic and reports that since she has been taking dextromethorphan (Robitussin), she has been extremely drowsy and dizzy. The nurse will question the patient about which of the following?

The amount of tea or soft drinks she has during the day

                        The amount of grapefruit or orange juice she has during the day

The number of cups of coffee she has during the day

The amount of water she drinks every day

Question 7: An expected outcome for a patient who has just taken sublingual nitroglycerin should be

increased heart rate and decreased blood pressure.

decreased heart rate and decreased blood pressure.

increased heart rate and increased blood pressure.

decreased heart rate and increased blood pressure.

Question 8 : A Nurse Practitioner explains to a patient that nitroglycerin patches should be applied in the morning and removed in the evening. This medication schedule reduces the potential for

adverse effects.                       nitrate dependence.

                        nitrate tolerance.        toxic effects.

Question 9 : A patient with mild low back pain has been advised to take acetaminophen. The nurse will inform him that excessive intake of acetaminophen may result in

gastrointestinal distress.          acute renal failure.

cognitive deficits.                   liver damage.

 

Question 10: Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient’s age will have what effect on her use of nitroglycerin?

The woman may experience paradoxical vasoconstriction when taking nitroglycerin.

Decreased saliva production will inhibit the absorption of the drug in her mucosa.

The woman will need to allow more time between doses in order to facilitate absorption.

                        The woman will be more susceptible to hypotension than a younger patient.

Question 11: A Nurse Practitioner is providing patient education to a 35-year-old man who has been prescribed clonidine (Catapres) as part of step 2 antihypertensive therapy. The Nurse Practitioner should anticipate that the drug will be administered

Intravenously  intravenously.  subcutaneously.          transdermally.

orally.

 

Question 12 : The APRN is treating a 56 year old male with diagnosed atrial fibrillation.  He is complaining of being light headed.    His vital signs are BP 100/68  HR 144  RR 22.   The best choice of medication to treat this patient is:

ACE-Inhibitor such as Lisinopril (Zestril®)              Diuretic such as HCTZ

Cardiac glycoside such as Digoxin                 Beta blocker such as Metoprolol

Either 2 or 4 would be appropriate

 

Question 13 : A 65-year-old male presents with a history of worsening urinary urgency, frequency, and hesitancy. He also tells you that he has to “push really hard” to urinate and that his urine dribbles a little after he is done urinating. What medication should be avoided

paroxetine       ipratropium inhaler    omeprazole**              clonidine

 

Question 14: A Nurse Practitioner is providing care for a 71-year-old woman who was sponsored to emigrate from Mexico to the United States 6 months ago. Earlier this week, the woman slipped while getting off a bus and fractured her hip. How should the woman’s nurse best exemplify cultural competence in the care of this patient?

Ensure that the woman receives care solely from Spanish-speaking caregivers.

                        Consider dimensions of the woman’s cultural background when planning care.

Integrate teaching about American culture when interacting with the patient.

Address the woman’s children first when explaining her care and changes in her health status.

 

Question 15 : Which effect does the Nurse Practitioner expect may occur when using cholinergic agonists?

dry mouth        tachycardia      increased bladder tone                       pupil dilation

 

Question 16 : A Nurse Practitioner is caring for a 70-year-old patient who is taking desmopressin (DDAVP). The patient has a history of cardiovascular disease. The nurse will prioritize the assessment of which of the following?

Weight            Electrolyte levels         Dehydration                Body temperature

 

Question 17 : A Nurse Practitioner is discussing with a patient the efficacy of a drug that his physician has suggested, and he begin taking. Efficacy of a drug means which of the following?

The amount of the drug that must be given to produce a particular response

                        How well a drug produces its desired effect

A drug’s strength of attraction for a receptor site

A drug’s ability to stimulate its receptor

 

Question 18 : A Nurse Practitioner who provides care in a long-term care facility is documenting a new resident’s medication regimen on the resident’s intake admission. The Nurse Practitioner is documenting the generic, rather than proprietary, names of the resident’s current drugs because

There is a potential for confusion and miscommunication if proprietary names are used.

proprietary names of drugs can vary from state to state.

documentation of trade names for drugs requires permission from the manufacturer.

drugs with generic names are prescribed and used differently than proprietary drugs.

 

Question 19: Which statement is FALSE regarding the treatment of hyperthyroidism?

Long-acting beta-blocking agents are given as adjunctive therapy until Propulthiouracil (PTU) or methimazole (Tapazole) restores the patient to euthyroid

Propylthiouracil (PTU) reduces peripheral conversion of T4 to the more potent T3

                        Methimazole (Tapazole) is the drug of choice for pregnant or lactating females.

Since methimazole (Tapazole) is stronger than Propylthiouracil (PTU), Methimazole should be initiated at 15 mg/day compared to 300 mg/day for Propylthiouracil for treatment of mild disease

 

Question 20 :The APRN would use what class of medication to manage COPD?

Mucolytic agents                    Methylxanthine derivatives

                        Short-acting and long acting inhaled beta2 agonists                       Anticholinergic agents

 

Question 21 : Typical adverse reactions to oral calcium-channel blockers include:

dyspnea           edema              fatigue            cough

 

Question 22 : A patient with unstable angina pectoris who is NOT controlled with a nitrate would likely benefit most from the addition of:

Sodium channel blocker              Beta blocker                Cardiac glycoside              Either 1 or 2

 

Question 23 : Which type of antihistamines are used to inhibit the secretion of gastric acid in patients with gastrointestinal disorders?

                        H1       H2       H3       H4

 

Question 24 : A 39 y/o female is diagnosed with Graves disease.  She also has a small goiter =.  Her symptoms are not deemed to be severe and propylthiouracil is prescribed.  Where is the most serious potential adverse effect of this medication?

Hypocalcemia Renal Failure   Agranulocytosis          Hematouria

 

 

Question 25: Typical adverse reactions to oral calcium-channel blockers include:

dyspnea           edema             fatigue             cough

 

Question 26 : A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of

                        seizure disorders.                    low blood pressure.

increased intraocular pressure.                        diabetic hyperlipidemia.

 

Question 27 : A 75-year-old woman is prescribed magnesium hydroxide for constipation. The nurse’s assessment reveals that the patient is being treated for rheumatoid arthritis and hypertension. The patient lives in assisted living and is on a low-sodium diet. Before the magnesium hydroxide therapy begins, it will be most important for the nurse to assess the patient’s

home environment.                 diet.

activity level.               medication history.

 

Question 28 : A teenage boy has undergone a diagnostic workup following several months of persistent, bloody diarrhea that appears to lack an infectious etiology. The boy has also experienced intermittent abdominal pain and has lost almost 15 pounds this year. Which of the following medications is most likely to treat this boy’s diagnosis?

Lubiprostone               Mesalamine

Docusate                     Bismuth subsalicylate

 

Question 29 : A Nurse Practitioner is caring for a patient who has recently moved from Vermont to south Florida. The patient has been on the same antihypertensive drug for 6 years and has had stable blood pressures and no adverse effects. Since her move, however, she reports “dizzy spells and weakness” and feels that the drug is no longer effective. The Nurse Practitioner suspects that the change in the effectiveness of the drug is related to

the impact of the placebo effect on the patient’s response.

the accumulative effect of the drug if it has been taken for many years.

                        the impact of the warmer climate on the patient’s physical state.

problems with patient compliance with the drug regimen due to the move.

 

Question 30: Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse’s first suggestion?

Bismuth subsalicylate             A bulk-forming (fiber) laxative

A stimulant laxative                A hyperosmotic laxative

 

Question 31 : A Native American man who lives a traditional lifestyle is scheduled to have heart surgery. The tribal chief has requested that the tribe’s medicine man perform a ritual before the patient goes to surgery. The nurse’s response to this request should be

“I’m sorry, but that will not be possible.”

“I will need to inform the doctor and see if he will allow this.”

“As long as the ritual does not interfere with the patient’s preoperative care, it will be okay.”

“I don’t think that will help, but you have the right to perform the ritual.”

 

Question 32 : A 72-year-old man is taking Adderall XR for the treatment of narcolepsy. He is currently having problems with not being able to swallow large tablets or capsules. The man also wears dentures, which makes it even more difficult for him to swallow medication. He is in the clinic to talk to the nurse about his problem. The nurse will instruct him to

swallow the capsule with 8 ounces of water.

ask his physician to prescribe an alternative drug.

                        open the capsule and sprinkle the beads in applesauce.

open the capsule and crush the beads.

 

Question 33: Which of the following is TRUE about long-acting beta agonist use in asthma patients?

It is effective to use in acute exacerbations

It may be used as solo treatment in step 2 of asthma treatment

It is useful in exercise induced asthma

                        It can be combined with an inhaled corticosteroid to improve asthma control

 

 

Question 34: A Nurse Practitioner is providing a patient with a list of drugs as a part of the patient’s plan of care. Which of the following drug nomenclatures should the Nurse Practitioner use to list the drugs?

The drugs’ chemical names                 The drugs’ generic names

The drugs’ trade names                       The drugs’ biologic names

 

Question 35: A Nurse Practitioner is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the Nurse Practitioner to monitor for

hepatic encephalopathy.          ototoxicity.       vascular thrombosis.   dehydration.

 

Question 36 : A woman has a long history of seasonal allergies that are typically accompanied by rhinorrhea, red eyes, and frequent sneezing. Sneezes are a result of

                        a CNS reflex that is initiated by receptors in the nasal cavities.

a reflex that is caused when irritants come into contact with cilia.

elevated CO2 levels that are detected by chemoreceptors in the large vessels.

stimulation of goblet cells and mast cells by the presence of microorganisms.

 

Question 37: A female patient is taking 0.125 mg of digoxin daily for heart failure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. The nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is concerned that the additional weight will necessitate an increase in the medication. Which of the following is an appropriate response by the nurse?

“Yes, the drug dosage will probably have to be increased.”

                        “No, the drug dosage will likely stay the same.”

“No, the drug dosage will have to be decreased.”

“I don’t know; I will have to ask your physician.”

 

Question 38 : Biguanides control hyperglycemia in type 2 diabetes primarily by acting at which organ?

Brain               Liver                Pancreas                      Spleen

 

Question 39 : A 67-year-old man is admitted to the hospital with pneumonia. He reports to the nurse that he has chronic arthritis and circulation problems. Further assessment by the nurse reveals that the patient has a history of mild hypertension. He explains that he owns a business and lives alone. The nurse determines that he is within the normal weight range for his height and age but has a fondness for spicy foods and sweets. Which of the mentioned patient variables will have the greatest impact on the effectiveness of the patient’s drug therapy?

                        Vascular impairment             Mild hypertension

Dietary habits              Chronic arthritis

 

Question 40 : A patient comes to primary clinic for strep throat. A throat swab culture is sent to lab. What information is required for the nurse practitioner to disclose on lab transmittal?

                        National Provider Identification (NPI)

Centers for Medicare & Medicaid Services (CMS)

Health Insurance Portability and Accountability Act of 1996 (HIPPA)

None of the above

 

Question 41: A patient is in the clinic for seasonal allergic rhinitis. Loratadine (Claritin) is prescribed. Which of the following statements will the nurse include when providing patient education concerning this drug?

“Be sure to take this medication on a full stomach.”

                        “Determine if the drug is going to make you drowsy before you drive.”

“You should take the medication twice a day.”

“This drug has to be taken every 4 to 6 hours.”

 

Question 42 : An unconscious patient has been brought to the hospital, and the Nurse Practitioner has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be the most appropriate for the nurse to use when administering the medication?

                        Intravenous infusion.

Subcutaneous administration.

Intrathecal administration.

Intramuscular administration.

 

Question 43: Ms. Simpson has a known history of asthma. She is on Theophylline daily.  The NP contemplates giving her an antibiotic for her respiratory infection. The NP knows that which choice below could elevate theophylline levels?

Augmentin                  Amoxicillin

                        Ciprofloxacin              Mucinex

 

Question 44: The first drugs typically used to treat the symptoms of an allergic reaction or allergic rhinitis are:

                        oral H1 antihistamines.                     intranasal H1 antihistamines.

H2 antihistamines.                 H3 antihistamines

 

Question 45 : A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states, “I take it as soon as I feel heartburn coming on, but it doesn’t seem to help at all.” How should the nurse best respond to this patient’s statement?

“It could be that Prilosec isn’t the right drug for you, so it would be best to talk this over with your care provider.”

“Prilosec won’t really decrease the sensation of heartburn, but it is still minimizing the damage to your throat and stomach that can be caused by the problem.”

“Prilosec will help your heartburn but it’s not designed to provide immediate relief of specific episodes of heartburn.”

“A better strategy is to take a dose of Prilosec 15 to 30 minutes before meals or drinks that cause you to get heartburn.”

 

Question 46 : A patient with a known history of benign prostatic hyperplasia (BPH) presents to the clinic 4 days after developing a cold. He tells you he began experiencing a sore throat and nasal congestion and began to take an over the counter decongestant.  Today, he complains of not urinating over the last 12 hours.  He also has suprapubic fullness on exam.  Which of the following medications are most likely responsible for this patient’s urinary retention?

Tamsulosin                  Phenylephrine

Clonazepam                Finasteri

 

Question 47: A clinic Nurse Practitioner has been assigned a 49-year-old female patient who has a history of diabetes. A recent diagnosis of hypertension has been made, and the patient has been prescribed a thiazide diuretic and labetalol. The patient will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the Nurse Practitioner will be to

question the patient about her dietary intake.

                        monitor the patient’s blood pressure.

weigh the patient.

monitor the patient’s respiratory rate.

 

Question 48 : A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments?

                        Blood pressure                        Urinary output

Heart rate                    Blood urea nitrogen (BUN)

 

Question 49 : A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman’s medication regimen. The nurse should consequently assess for signs and symptoms of

atrial fibrillation.                     thrombophlebitis.

                        hyperkalemia.             leukocytosis.

 

Question 50: A 58-year-old man is admitted to the emergency department. A diagnosis of severe digoxin toxicity is made. Bradycardia is present, and an electrocardiogram (ECG) confirms toxicity. The nurse will administer which of the following drugs?

Furosemide                 Digoxin immune fab

Captopril                     Dopamine

 

Question 51 : A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells?

Giving the drug with food in order to delay absorption

Administering the drug in small, frequent doses

Limiting the patient’s protein intake and encouraging fluids

                        Administering the drug intravenously rather than orally

 

Question 52 : Which of the following statements accurately describes digoxin?

It is widely used to augment cardiac output.

                        It blocks the Na-K ATPase pump. 

It is broken down by the liver.

It increases ventricular contraction by activating the AV node.

 

Question 53: Ginger, a 25-year old female presents at the clinic with known history of depression.  She reports taking an SSRI with only partial relief.  Which of the following drugs can be used safely at any dose in conjunction with an SSRI?

MAOI (MAO Inhibitor)                      TCA (Tricyclic Antidepressant)

Theophylline               None of the above

 

Question 54: A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?

Call the physician                    Ask the patient to lie back and try to relax

Have the patient swallow a tablet every 5 minutes for 15 minutes

Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

 

Question 55 : Mesalamine (Asacol) is prescribed for a 22-year-old woman with Crohn disease. The nurse will discuss with the patient the possibility for which of the following adverse effects related to the new drug therapy?

Hair loss          Metallic taste              Fatigue           Increased appetite

 

Question 56: A Nurse Practitioner is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a patient who has just been admitted. What is the most likely goal of this intervention?

To treat sinus bradycardia accompanied by hypotension

To resolve the patient’s uncompensated heart failure

To treat the patient’s ventricular tachycardia

                        To convert the patient’s atrial fibrillation to normal sinus rhythm

 

Question 57: A Nurse Practitioner is teaching an older adult patient about polypharmacy. Which of the following statements best describe this term?

Taking more than one drug when the patient deems it necessary

                        Taking several drugs simultaneously

Increasing the dosage of a drug by the patient

Taking one drug one day and another drug the next day

 

Question 58 : A 70-year-old woman has experienced peripheral edema and decreasing stamina in recent months and has sought care from her primary care provider. The patient’s subsequent diagnostic workup has resulted in a diagnosis of chronic heart failure. The woman has been prescribed digoxin and the nurse has begun patient education. What should the nurse teach the patient about her new medication?

“By reducing the amount of fluid that your body contains, digoxin will make it easier for your heart to pump.”

“This will lessen the workload of your heart by reducing your blood pressure.”

“Most patients see their heart failure resolve in 2 to 4 months after they begin taking digoxin.”

“This drug won’t cure your disease, but it will help you be able to exercise more and be more comfortable.”

 

Question 59: A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be

liquid.              lozenge.           tablet.              suppository.

 

Question 60 : Which antihypertensive agent is associated with hair growth?

Prazosin           Minoxidil        Metoprolol      Diltiazem

 

Question 61 : An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client’s lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient’s pulmonary edema?

Furosemide    Hydrochlorothiazide   Mannitol          Triamterene

 

Question 62: A Nurse Practitioner is administering drugs to a 70-year-old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the Nurse Practitioner will also be careful to observe for

possible drug toxicity.             decreased therapeutic effects.

altered drug absorption.          increased drug metabolism.

 

Question 63 : The anticoagulant drug that acts as a vitamin K antagonist is:

heparin                        coumadin        dabigatran       apixaban

 

Question 64:  The NP is examining a 34-year-old obese man with a body mass index (BMI) of 35 who complains of almost daily indigestion and heartburn for the past year with a strong acid taste in the mouth about an hour after meals, and frequent belching and awakening at night with choking. The history is negative for chronic illnesses and alarm symptoms. A diagnosis of gastroesophageal reflux disease (GERD) is made. What is the best initial treatment for the patient?

                        Omeprazole (Prilosec) 20 mg every morning 30 minutes before breakfast.

Hyoscyamine (Levsin) 0.125 mg tid 15 minutes before eating

Omeprazole (Prilosec) 20 mg after breakfast daily.

Ranitidine (Zantac) 150 mg bid.

 

Question 65: A Nurse Practitioner is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which of the following instructions?

Eat a high-protein diet

Decrease the dosage if any adverse effect is experienced

                        Wear appropriate clothing and sunscreen whenever he is in direct sunlight

Have a complete blood cell count done weekly

 

Question 66: Mr. Johnson is an 80 year old male who  is on Digoxin therapy. The Nurse Practitioner knows they should monitor the older adult patient for which of the most common adverse reactions of digoxin?

confusion        blurred vision              diarrhea           eating disorder

 

Question 67 :  77-year-old man’s chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?

The man’s glomerular filtration rate and creatinine levels are within reference ranges.

The man’s heart rate is between 60 and 70 beats per minute with a regular rhythm.

The man’s potassium and sodium levels remain with reference ranges.

                        The man’s chest sounds are clear and his ankle edema is lessened.

 

Question 68 : A patient will begin three new medications as part of her treatment plan. The nurse practitioner understands that proper disposal of medications is key when the nurse practitioner states

Many medications can be potentially harmful if taken by someone other than the person the medication was prescribed.

Consult with several pharmacists to determine the cost of each drug.

educate the patient to discard syringes in recycle bin

consult with the physician concerning choice of medications for the patient.

 

Question 69: Susie is a 40 year old female with Type 2 Diabetes.  She reports that over the last several days, she has been having some hypoglycemic episodes and feels it is related to medication.  Her medication list is as follows: Which medication most likely is contributing to her hypoglycemic episodes

Victoza (liraglutide) 1.8 mg SC daily Metformin 500mg p.o. Twice a Day

Glyburide 5 mg p.o. Twice a day       Lisinopril 10mg p.o. daily

 

Question 70 : A Nurse Practitioner is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for which of the following?

Decrease in plasma concentration of lovastatin

Increase in the statin tolerance level

Decrease in LDL

                        Increase in plasma concentration of lovastatin

 

Question 71 : Acetazolamide is categorized as which of the following?

Alpha-adrenergic                    Beta-adrenergic b

Carbonic anhydrase               Miotic

 

Question 72 : Which of the following can block the action of heparin?

Phytomenadione                     Vitamin K

Idarucizumab              Protamine sulfate

 

Question 73 : When prescribing an antihypertensive medication for a type 2 diabetic patient, the drug classifications that would tend to reduce insulin sensitivity are:

Diuretics and calcium channel blockers.

                        Diuretics and beta blockers.

Calcium channel blockers and ACE inhibitors.

Alpha blockers and ACE inhibitors.

 

Question 74 : A 53-year-old man has been treated for severe asthma for several years with prednisone. Recently, his physician initiated alternate-day therapy for him. The patient tells the nurse that he would rather take the medication every day to prevent confusion. Which of the following would be the best response by the nurse?

“This schedule will be more convenient for you.”

“This schedule will enable you to lose weight.”

“This schedule will decrease the cost of your medication.”

“This schedule allows rest periods so that adverse effects are decreased but the anti-inflammatory effects continue.”

 

Question 75: The Nurse Practitioner is conducting a medication reconciliation of a new resident of a long-term care facility. The Nurse Practitioner notes that the resident takes allopurinol on a daily basis for the treatment of gout. What is the primary purpose of this drug?

                        To balance urate concentration and prevent gout attacks

To promote the remodeling of damaged synovium

To potentiate the metabolism of dietary purines

To achieve pain relief in joints affected by gout

 

Question 76: John is a newly diagnosed diabetic that contacts the office  with complaints of severe nausea and vomiting.  What instructions should the APRN provide related to his insulin doses?

Stop your insulin while you are not eating and restart it at half strength when you can keep liquids down.

There is no need to change your insulin dosage while sick.  Continue your regular doses

I will call in a prescription for metformin for you to take in place of your insulin.

Monitor your blood sugar every 4  hours and take regular insulin based on the blood sugar reading.

 

Question 77 : The Elderly are at high risk of  Adverse Drug Reactions due to:

having greater muscle mass than younger adults, leading to higher volume of distribution

the extensive studies that have been conducted on drug safety in this age group

                        age related decrease in renal function

the blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effects

 

Question 78 : Metformin (Glucophage) acts by:

Enhancing insulin secretion

Decreasing hepatic glucose production with  minor effects on insulin sensitivity in both liver and peripheral tissues

Increasing sensitivity in the muscle and liver

Suppressing glucagon producrtion

 

Question 79 : A 68-year-old man complains of a chronic, nonproductive cough. He states that he has to have relief, that he has been coughing every 2 to 3 minutes, and he is worn out. Dextromethorphan is prescribed for him. Before he leaves the clinic he asks how long it will take for the medicine to work. The nurse will advise him that he should experience therapeutic effects in

5 minutes.        10 minutes.      15 to 30 minutes.        60 minutes.

 

Question 80 : A 72-year-old man is prescribed theophylline for symptomatic relief of bronchial asthma. Which of the following findings would alert the nurse to the need for close monitoring?

Enlarged prostate gland                    Need for additional bronchodilation

Signs of an active lung infection                    Hypersensitivity to povidone

 

Question 81: A home health Nurse Practitioner is performing a home visit to an elderly client who has early-stage dementia. The Nurse Practitioner observes that some of the client’s pill bottles are empty, even though the client is not due for refills for 2 weeks. What nursing diagnosis should the Nurse Practitioner prioritize when planning this client’s care?

Impaired Home Maintenance Management               Ineffective Coping

Knowledge Deficit                 Ineffective Therapeutic Regimen Management

 

Question 82: Mr. Contreras is a 64-year-old patient with Type 2 diabetes. He has recently been diagnosed with hypertension. Which antihypertensive drug is the recommended choice to treat hypertension in patients with diabetes?

Diuretics          Beta Blocker   Calcium Channel Blocker       ACE Inhibitor

 

Question 83: Which of the following is a potential adverse side effect of autonomic-anticholinergic agents?

Reduced GI motility   Bradycardia

Increased symptoms of benign prostatic hypertrophy            Photosensitivity

 

Question 84: Decongestants are recommended to use in which of the following patients?

patients with otitis media       patients with coronary artery disease

patients with hypertension      patients taking monoamine oxidase inhibitors

 

Question 85: A 55-year-old man’s hypertension has not responded adequately to his current medication regimen consisting or an ACE inhibitor, a beta-blocker and a thiazide diuretic. As a result, he will soon begin taking hydralazine (Apresoline) in addition to his existing antihypertensives. The addition of this medication to his regimen means that the nurse must prioritize which of the following nursing actions?

Close monitoring of the patient’s electrolyte levels

Supervision of the patient when performing activities of daily living

                        Frequent assessment of the patient’s cardiac status

Checking the patient’s blood glucose levels before each meal and at bedtime

 

Question 86: A Nurse Practitioner has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The Nurse Practitioner notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to

passive diffusion.    active transport.    glomerular filtration.     first-pass effect.

 

Question 87: The APRN’s ability to prescribe controlled substances is regulated by:

FDA    DEA    State Law        All of the above

 

Question 88: A Nurse Practitioner is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for which of the following?

History of taking anticoagulant drugs                      Allergy to seafood

Hirsutism                     The patient’s age

 

Question 89: A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient’s compromised renal function will likely

                        increase the half-life of medications that are metabolized by the kidneys.

decrease the first-pass effect of medications that the patient is given.

necessitate intravenous, rather than oral, medications.

make the antiseizure medications less effective than in the past.

 

Question 90: A Nurse Practitioner who provides care for older adults is aware of the high incidence of drug interactions in this population. When educating a group of seniors about the prevention of drug interactions, the Nurse Practitioner should encourage them to

take their medications with food unless otherwise instructed.

                        consult their care provider before taking new over-the-counter medications.

maintain a healthy, high-fluid diet, and high levels of physical activity.

ensure that there is at least 90 minutes between doses of different drugs.

 

Question 91: To maximize the therapeutic effect of diphenoxylate HCl with atropine sulfate, the nurse will instruct the patient to take the medication

once a day.      twice a day.     every 2 hours. four times a day.

 

Question 92: A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which of the following common adverse effects of the drug?

Headache        Dyspepsia        Throat irritation          Muscle cramps

 

Question 93: Advanced practice nurse prescribing of scheduled medications is affected most by:

Combined state medical / pharmacy  / nursing prescribing board regulations

FDA

Individual states laws regarding scheduled medications that can be prescribed and for how long                

DEA

 

Question 94: A 34-year-old male patient is prescribed methimazole (MMI). The Nurse Practitioner will advise him to report which of the following immediately?

Vertigo                        Intolerance to cold     Loss of appetite                      Epigastric distress

 

Question 95: A patient with seasonal allergies is exasperated by her recent nasal congestion and has expressed her desire to treat it by using pseudoephedrine. The nurse should inform the patient that

Under the Combat Methamphetamine Abuse Act, pseudoephedrine now requires a prescription.

Drugs containing pseudoephedrine are available without a prescription but are kept off pharmacy shelves.

She must be prepared to show identification when buying a drug that contains pseudoephedrine.

Pseudoephedrine is being phased out of the marketplace in order to combat illegal use.

Question 96: In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient’s hypertension?

The adverse effects of each drug may cancel each other out.

Using two drugs for a health problem tends to increase patient compliance with the drug regimen.

Using lower doses of two separate drugs may lessen the risk of adverse reactions.

                        Using the two drugs to treat a health problem may create a synergistic effect.

 

Question 97: A common side effect of metformin (Glucophage) therapy is:

weight gain                 lactic acidosis              Hypoglycemia             diarrhea

 

Question 98: Autonomic drugs have little effect when administered:

orally               intramuscularly                        intravenously               by inhalation

 

Question 99: Drugs that use CYP 3A4 isoenzymes for metabolism may:

Induce the metabolism of another drug                      Inhibit the metabolism of another drug

Both 1 and 2               Neither 1 nor 2

 

Question 100: The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son’s medication regimen by the nurse. The nurse is currently teaching the parent’s about the appropriate use of a “rescue drug” for acute exacerbations of their son’s asthma. What drug should the nurse suggests the parents to use in these situations?

Theophylline   Albuterol         Beclomethasone          Acetylcysteine

-2-

 

Question 1 : What critical piece of information is missing from the following medication order: Amoxicillin 250 mg every 8 hours?

Dose                Route              Frequency                   Trade name of the drug

 

Question 2 : Which of the following is a side effect or precaution associated with ACE inhibitors?

Hypokalemia               Angioedema               Productive cough

Contraindicated in diabetic patients

 

Question 4 : Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient’s angina?

Ranolazine confers protection from myocardial infarction but does not relieve symptoms of angina.

Amlodipine will now be contraindicated in the treatment of Mr. Penny’s angina.

Mr. Penny will need to be taught to monitor his blood pressure and heart rate.

Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker.

 

Question 5: The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the

Minimum adverse effect level            peak of action therapeutic range     onset of action

 

Question 6 : What is a serious side effect of ibuprofen in the older adult patient?

rebound headaches      Impairment of renal function            neuropathy

pancreatic failure

 

Question 7 : A patient who is a steroid-dependent asthmatic is started on a beclomethasone inhaler. Which should be part of patient education?

Use the inhaler when an asthmatic attack begins

Keep the inhaler refrigerated at all times

Adjust the number of puffs daily as needed

                        Rinse the mouth well after each use

 

Question 8 : All of the following agents are used to control the inflammatory changes seen in the lungs of asthmatics except:

Albuterol inhaler (proventil)  Triamcinolone (Azmacort)

Montelukast (Singulair)                      Cromolyn sodium inhaler (Intal)

 

Question 9 : A male patient is to begin treatment for pneumonia with an albuterol (Ventolin) inhaler. The nurse will advise the patient that he will most likely experience which of the following common adverse effects of the drug?

Headache        Dyspepsia        Throat irritation                      Muscle cramps

 

Question 10 : A 24-year-old factory worker has been prescribed guaifenesin for the first time. Which of the following will be a priority assessment by the nurse before the patient’s first dose?

The amount of salt intake                   The amount of alcohol consumption

The amount of fatty foods eaten daily            The number of cigarettes smoked per day

Question 11 : When prescribing an antihypertensive medication for a type 2 diabetic patient, the drug classifications that would tend to reduce insulin sensitivity are:

Diuretics and calcium channel blockers.       Diuretics and beta blockers.

Calcium channel blockers and ACE inhibitors.          Alpha blockers and ACE inhibitors.

Question 12 : A Nurse Practitioner working for a drug company is involved in phase III drug evaluation studies. Which of the following might the Nurse Practitioner be responsible for during this stage of drug development?

Working with animals who are given experimental drugs

Monitoring drug effects in patients who are selected to participate in a study, who have the disease that the drug is meant to treat

                        Administering investigational drugs to patients

Informing healthy, young volunteer participants of possible risks that could occur from taking an experimental drug

Question 13 : Classes of medications typically used to treat hyperthyroid conditions include:

Antibiotics and corticosteroids.

ACE inhibitors, anxiolytics, and antithyroid medications.

ACE inhibitors, anxiolytics, and antithyroid medications.

                        Calcium channel blockers and corticosteroids.

Question 14: The Nurse Practitioner’s assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this?

“I tend to get sick in the stomach when I take antibiotics.”

“I’ve been told that aspirin might have caused my stomach bleed a few years back.”

                        “I broke out in hives and got terribly itchy when I started a new prescription last year.”

“When I fell last year, the doctor said that it might have been because of my blood pressure pills.”

Question 15: A Nurse Practitioner who provides care in a long-term care facility is documenting a new resident’s medication regimen on the resident’s intake admission. The Nurse Practitioner is documenting the generic, rather than proprietary, names of the resident’s current drugs because

there is a potential for confusion and miscommunication if proprietary names are used.

proprietary names of drugs can vary from state to state.

documentation of trade names for drugs requires permission from the manufacturer.

drugs with generic names are prescribed and used differently than proprietary drugs.

Question 16 : A Nurse Practitioner is providing a patient with a list of drugs as a part of the patient’s plan of care. Which of the following drug nomenclatures should the Nurse Practitioner use to list the drugs?

The drugs’ chemical names                 The drugs’ generic names

The drugs’ trade names                       The drugs’ biologic name

Question 17 : A Nurse Practitioner who is responsible for administering medications should understand that the goals of the MedWatch program are to (Select all that apply.)

provide regular feedback about product safety issues.

accredit new medical facilities and hospitals.

facilitate the reporting of adverse reactions of drugs.

increase awareness of serious reactions caused by drugs or medical devices.

report medication errors that occur in hospitals.

Question 18: A 70-year-old woman has a complex medical and a current drug regimen that includes calcium and vitamin D supplements for osteoporosis, metformin (Glucophage) for type 2 diabetes, phenelzine (Nardil) for depression, and metoprolol (Lopressor) and furosemide (Lasix) for hypertension. The woman is requesting dextromethorphan for the treatment of a recurrent cough. What component of her drug regimen contraindicates the use of dextromethorphan?

Calcium supplements              Metformin (Glucophage)

Phenelzine (Nardil)                Metoprolol (Lopressor)

Question 19 : Which of the following is a potential adverse side effect of autonomic-anticholinergic agents?

Reduced GI motility               Bradycardia

Increased symptoms of benign prostatic hypertrophy                        Photosensitivity

Question 20 : A patient has been prescribed an oral drug that is known to have a high first-pass effect. Which of the following measures has the potential to increase the amount of the free drug that is available to body cells?

Giving the drug with food in order to delay absorption

Administering the drug in small, frequent doses

Limiting the patient’s protein intake and encouraging fluids

                        Administering the drug intravenously rather than orally

Question 21 : A 22-year-old male college senior has lived with a diagnosis of Crohn’s disease for several years and has undergone several courses of treatment with limited benefit. Which of the following targeted therapies has the potential to alleviate the symptoms of Crohn’s disease?

Tositumomab plus 131I (Bexxar)                   Muromonab-CD3 (Orthoclone OKT3)

Infliximab (Remicade)                                   Eculizumab (Soliris)

Question 22 : Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?

                        A man who is in cardiogenic shock following a myocardial infarction

A man who has a diagnosis of primary hypertension

A woman who has been admitted with a suspected ischemic stroke

A woman who is in labor and may require a caesarean section

Question 23: A patient with type 1 diabetes has been admitted to the hospital for orthopedic surgery and the care team anticipates some disruptions to the patient’s blood glucose levels in the days following surgery. Which of the following insulin regimens is most likely to achieve adequate glycemic control?

Small doses of long-acting insulin administered four to five times daily

                        Doses of basal insulin twice daily with regular insulin before each meal

Large doses of rapid-acting insulin combined with long-acting insulin each morning and evening

Divided doses of intermediate-acting insulin every 2 hours, around the clock

Question 24: A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion. Which of the following lab values would be a priority for the nurse to assess before administration?

Blood glucose levels               Serum potassium levels

Serum sodium levels               Triglyceride levels

Question 25 : The APRN should educate a diabetic patient that beta blockers may mask the signs and symptoms of

insulin sensitivity        hyperglycemia       hypoglycemia          insulin resistance

Question 26 : A 72-year-old female patient is prescribed ipratropium aerosol for pulmonary emphysema. The nurse will instruct her to “test spray” the new metered-dose inhaler (MDI) three times before using it to prevent which of the following?

Anaphylactoid reaction                       Asymptomatic elevated hepatic enzymes levels

Paradoxic acute bronchospasm                    Symptomatic hepatitis with hyperbilirubinemia

Question 27 : A Nurse Practitioner is caring for a patient who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed for her. Which of the following should the Nurse Practitioner assess before beginning drug therapy?

Serum calcium levels              Serum potassium levels

Blood glucose levels               Serum magnesium levels

Question 28 : Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse’s first suggestion?

Bismuth subsalicylate             A bulk-forming (fiber) laxative

A stimulant laxative                A hyperosmotic laxative

Question 29 : A patient is bothered with nighttime episodes of bronchoconstriction related to asthma. Which of the following medications can be administered to decrease the nighttime episodes and prevent asthma attacks?

Anticholinergics                      Beta2-adrenergic agonists

Xanthines                    Leukotriene modifiers

Question 30 : A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?

Call the physician

Ask the patient to lie back and try to relax

Have the patient swallow a tablet every 5 minutes for 15 minutes

Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

Question 31 : Which of the following serves to protect the public by ensuring the purity of a drug and its contents?

American Pharmaceutical Association                       United States Adopted Names Council

Nursing drug guides               Federal legislation

Question 32 : What is associated with chronic overtreatment with levothyroxine (Synthroid)?

Tachycardia     Osteoporosis   Insomnia         Sweating

Question 33 : A Nurse Practitioner is providing discharge instructions to a patient who will be taking fludrocortisone at home. The Nurse Practitioner will encourage the patient to eat a diet that is

low in sodium and potassium.            low in sodium, high in potassium.

high in iron.                 low in proteins.

Question 34 : The anticoagulant drug that acts as a vitamin K antagonist is:

Heparin                       coumadin        dabigatran                   apixaban

Question 35 : A physician has ordered subcutaneous injections of morphine, a narcotic, every 4 hours as needed for pain for a motor vehicle accident victim. The nurse is aware that there is a high abuse potential for this drug and that it is categorized as a

C-I drug.         C-II drug.       C-III drug.      C-IV drug.

Question 36 : A Nurse Practitioner has been following a male patient who is taking hydralazine, clonidine, and a diuretic for hypertension. After 2 weeks of medication therapy, the patient begins to complain of numbness and tingling in his hands and feet. The Nurse Practitioner suspects that these signs or symptoms are

a result of new onset diabetes.                        an adverse effect of the diuretic.

signs of peripheral neuritis.               an idiosyncratic reaction to clonidine.

Question 37: Which effect does the Nurse Practitioner expect may occur when using cholinergic agonists?

dry mouth        tachycardia      increased bladder tone                       pupil dilation

Question 38 : What information would the Nurse Practitioner include in teaching a patient about the treatment of vitamin B12 deficiency following a total gastrectomy?

The patient will be taking vitamin B12 tablets twice daily for 1 year.

The patient will be taking oral folic acid supplements daily for life.

The patient will receive monthly cyanocobalamin (vitamin B12) injections for life (after being given daily weekly injections for the first month).

The patient will require iron supplementation and monthly blood transfusions until the deficiency is corrected.

Question 39 Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine?

The resident has not eaten breakfast because of a recent loss of appetite

                        The resident’s apical heart rate is 112 beats/minute with a regular rhythm

The resident had a fall during the night while transferring from her bed to her bathroom

The resident received her annual influenza vaccination the previous day

Question 40 A patient will begin three new medications as part of her treatment plan. The nurse practitioner understands that proper disposal of medications is key when the nurse practitioner states

Many medications can be potentially harmful if taken by someone other than the person the medication was prescribed.

Consult with several pharmacists to determine the cost of each drug.

educate the patient to discard syringes in recycle bin

consult with the physician concerning choice of medications for the patient.

Question 41 : Which of the following patients should be advised by the Nurse Practitioner to avoid over-the-counter cold and allergy preparations that contain phenylephrine?

                        A 47-year-old female with hypertension

A 52-year-old male with adult-onset diabetes

A 17-year-old female with symptoms of an upper respiratory infection

A 62-year-old male with gout

Question 42 : The Nurse Practitioner  is following up on a patient who is experiencing acute asthma problems. Albuterol (Proventil) by metered-dose inhaler (MDI) has been ordered as treatment. Which patient response would indicate to the family nurse practitioner that the patient understands how to take the medication?

“I will take 1 puff of the medication and then wait a minute before taking the second puff.”

“I will take 2 puffs of the medication every 4 hours, even if I am not short of breath.”

“It is important for me to take this medication on a regular cycle to prevent future attacks.”

“I will take 2 puffs, one right after the other, whenever I begin to get short of breath.”

Question 43 : Which type of antihistamines are used to inhibit the secretion of gastric acid in patients with gastrointestinal disorders?

H1       H2       H3       H4

Question 44: The APRN would use what class of medication to manage COPD?

Mucolytic agents                    Methylxanthine derivatives

Anticholinergic agents                        Short-acting and long acting inhaled beta2 agonists

Question 45 : Susie is a 40 year old female with Type 2 Diabetes.  She reports that over the last several days, she has been having some hypoglycemic episodes and feels it is related to medication.  Her medication list is as follows:

Victoza (liraglutide) 1.8 mg SC daily Metformin 500mg p.o. Twice a Day

Glyburide 5 mg p.o. Twice a day       Lisinopril 10mg p.o. dailo

Question 46 : A patient on valproic acid may experience which of the following symptoms?

Weight gain     Nausea                 Constipation                All of the above

Question 47 : A patient with seasonal allergies is exasperated by her recent nasal congestion and has expressed her desire to treat it by using pseudoephedrine. The nurse should inform the patient that

under the Combat Methamphetamine Abuse Act, pseudoephedrine now requires a prescription.

drugs containing pseudoephedrine are available without a prescription but are kept off pharmacy shelves.

she must be prepared to show identification when buying a drug that contains pseudoephedrine.

pseudoephedrine is being phased out of the marketplace in order to combat illegal use.

Question 48 : A Nurse Practitioner is administering drugs to a 70-year-old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the Nurse Practitioner will also be careful to observe for

possible drug toxicity.             decreased therapeutic effects.

altered drug absorption.          increased drug metabolism.

Question 49 : A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.)

Respiratory rate          Oxygen saturation       Temperature    Heart rate

Blood pressure

Question 50: A patient is taking gabapentin (Neurontin) for spasticity associated with multiple sclerosis. Which of the following should be the priority for monitoring?

Question 51 : A patient with diabetes has had a cough for 1 week and has been prescribed a cough syrup (an expectorant). What special instructions should the nurse include in the patient teaching for this situation?

Wash hands before and after taking the medicine

Keep track of any gastrointestinal tract infections

                        Monitor glucose levels closely

Note the time the medicine is taken each day

Question 52: A patient has a history of tonic-clonic seizures that have been successfully treated with phenytoin (Dilantin) for several years. Phenytoin achieves a therapeutic effect by

                        decreasing the influx of sodium into neurons.

increasing the levels of available glutamate.

simultaneously potentiating the effects of GABA and inhibiting reuptake.

by slowing the function of calcium channels within the neurological system.

Question 53: A 62-year-old woman has been prescribed a fentanyl transdermal patch for chronic cancer pain. The patient asks the nurse how long it will take for her to experience pain relief. The nurse will instruct the patient that she should feel pain relief in approximately

6 hours.           12 hours.         24 hours.        32 hours.

103: Which of the following affects drug distribution throughout the body?

Presence of food in the gastrointestinal tract             Increase in hepatic enzymes

Protein binding                      High blood levels

Question 55 : The APRN is treating a patient with type 2 diabetes.  The patient is on the maximum dose of metformin and glucotrol.  Current weight  212  pounds.    Labs from this morning indicate a fasting blood sugar of 312 and HbA1C of 9.   The APRN wants to start the patient on Lantus 0.2 unit/kg.  What dose and instructions should the APRN provide?

                        Give 19 units of Lantus subcutaneously prior to bedtime.

Give 24 units of Lantus subcutaneously prior to dinner

Give 2 units of Lantus subcutaneously prior to lunch every day

Give 42 units of Lantus subcutaneously prior to bedtime.

Question 56 : A 62-year-old man has been prescribed lovastatin. The Nurse Practitioner will instruct the patient to take the medication

at bedtime.      in the early morning.   in the evening.             in the afternoon.

Question 57 : A patient has been started on a treatment regimen that includes levothyroxine. Select the dosage regimen that is most appropriate for a mean replacement dosage.

                        1.2 mcg/kg of body weight per day

1.4 mcg/kg of body weight per day

1.5 mcg/kg of body weight per day

1.7 mcg/kg of body weight per day

 

Question 59 : A 22 year old patient is transitioning from oral agents to insulin.  He will be taking 20 units of lantus at bedtime and regular insulin before meals.  What instructions should the NP provide about the timing and dose of regular insulin?

Take 1 unit of regular insulin for each 5 grams of carbohydrate to be consumed 30 minutes before each meal.

Take 1 unit of regular insulin for each 10 grams of carbohydrate to be consumed 15 minutes before each meal

Take 5 units of regular insulin for each 15 grams of carbohydrate consumed immediately after each meal.

Take 5 units of regular insulin immediately after each meal

Question 60 :  What drug class will decrease the facial flushing that occurs with niacin?

Vasopressors       Antihistamines             Acne products                    NSAIDS

 

Question 61: Successful treatment for an adult patient with Helicobacter pylori (H. pylori)-induced peptic ulcer disease requires therapy with which regimen?

                         Clarithromycin, amoxicillin, and omeprazole (Prilosec).

Bismuth (Pepto-Bismol), cephalexin (Keflex), and metronidazole (Flagyl).

Amoxicillin, bismuth (Pepto-Bismol), metronidazole (Flagyl), and cimetidine (Tagamet).

Clarithromycin, cephalexin (Keflex), and lansoprazole.

Question 62 : Typical adverse reactions to oral calcium-channel blockers include:

dyspnea           edema             fatigue             cough

 

Question 63 : A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of

an adrenergic antagonist.      an adrenergic agonist.

a cardiotonic.                          a neurotransmitter.

 

Question 64 : A Nurse Practitioner has been administering a drug to a patient intramuscularly (IM). The physician discontinued the IM dose and wrote an order for the drug to be given orally. The Nurse Practitioner notices that the oral dosage is considerably higher than the parenteral dose and understands that this due to

passive diffusion.                    active transport.

glomerular filtration.               first-pass effect.

 

Question 65 : Which of the following oral medications is the safest to use during pregnancy?

Losartan                      Methyldopa

Amlodipine                 Lisinopri

 

Question 66 : Mr. Johnson is an 80 year old male who  is on Digoxin therapy. The Nurse Practitioner knows they should monitor the older adult patient for which of the most common adverse reactions of digoxin?

confusion        blurred vision              diarrhea                       eating disorder

 

Question 67 : Which of the following statements accurately describes digoxin?

It is widely used to augment cardiac output.

                        It blocks the Na-K ATPase pump. 

It is broken down by the liver.

It increases ventricular contraction by activating the AV node.

Question 68 : A patient with bronchial asthma is prescribed a sustained-release preparation of theophylline. To help minimize the adverse effects of the drug, which of the following should the nurse suggest?

                        Take it on an empty stomach, 1 hour before or 2 hours after meals

Take it with a meal

Take it with foods containing xanthines, such as caffeine

Increase the drug dosage up to 50%

 

Question 69: A woman with numerous chronic health problems has been diagnosed with a benign gastric ulcer has begun treatment with ranitidine (Zantac). Which of the following teaching points should the nurse provide to this patient?

“Quitting smoking will significantly increase the chance that this drug will heal your ulcer.”

“This drug will help to eliminate the bacteria in your stomach that caused your ulcer.”

“You should eat several small meals each day rather than three larger meals.”

“Take each dose of ranitidine with an antacid of your choice.”

 

Question 70 : A clinic Nurse Practitioner has been assigned a 49-year-old female patient who has a history of diabetes. A recent diagnosis of hypertension has been made, and the patient has been prescribed a thiazide diuretic and labetalol. The patient will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the Nurse Practitioner will be to

question the patient about her dietary intake.

                        monitor the patient’s blood pressure.

weigh the patient.

monitor the patient’s respiratory rate.

 

Question 71: Biguanides control hyperglycemia in type 2 diabetes primarily by acting at which organ?

Brain               Liver                Pancreas                      Spleen

 

Question 72 : A common side effect of metformin (Glucophage) therapy is:

weight gain     lactic acidosis  Hypoglycemia             diarrhea

 

Question 73 : A Nurse Practitioner is instructing a patient in the administration of regular insulin by the subcutaneous route. Which of the following strategies would the Nurse Practitioner suggest if the goal is to promote absorption of the regular insulin?

Rotate injection sites by using the arm one day, the stomach the next day, and the thigh the day after and then repeating the cycle.

Select one injection site for regular insulin injections and use it exclusively.

Administer the medication 30 to 60 minutes after a meal.

Select one anatomic area for regular insulin injections and then use serial locations within that area.

 

Question 74 : You are seeing a 65 year old  male with a long history of COPD who has recently developed hypertension. Which class of antihypertensive agents should the Nurse Practitioner avoid for this patient?

Beta-Blockers             Calcium Channel Blockers

ACE inhibitors                        Diuretics

 

Question 75 : A 20-year-old woman calls the clinic at 5 PM and reports to the Nurse Practitioner that she forgot to take her morning dose of fexofenadine (Allegra). She usually takes her evening dose at 8 PM. She wants to know what she should do. The Nurse Practitioner will instruct her to

double her evening dose.

skip the evening dose and start back in the morning.

                        forget about the morning dose and take the evening dose.

take the morning dose now and the evening dose at the regular time.

 

Question 76 : A patient taking Metformin (Glucophage) is scheduled for a cardiac cath. The patient asks why he can’t take his metformin the day of the test. What is the most appropriate reply?

The combination of metformin and the dye stimulates the liver to release insulin causing hypoglycemia.  You can restart the metformin 48 hours after the test.

Dye is a cytochrome system inducer that affects metformin.   You should wait 3 days before restarting the metform so you don’t develop a toxic level of the drug.

Metformin interacts with the dye used in the test.  You can take the Metformin starting the day after the test.

You can develop lactic acidosis if you take metformin and are given dye.  You should have a serum creatinine drawn before restarting the medication.

 

Question 77 : A 79-year-old woman with a medical history that includes osteoporosis has recently moved to a long-term care facility. Medication reconciliation indicates that the woman has been taking calcitonin, salmon for several years. The nurse should recognize that the most likely route for the administration of this drug is

subcutaneous.      intramuscular.          intravenous.                 intranasal.

 

Question 78 : A 42-year-old man is being treated for a peptic ulcer with ranitidine (Zantac) taken PO at bedtime. Even though few adverse effects are associated with this drug, one common adverse effect that can be severe is

headache.       irritability.       dry mouth.       heart palpitations.

 

Question 79 : Which of the following can block the action of heparin?

Phytomenadione         Vitamin K       Idarucizumab              Protamine sulfate

 

Question 80 : A patient has been admitted to the ICU because of multiple traumas due to a motor vehicle accident. The physician has ordered propofol (Diprivan) to be used for maintenance of sedation. Before administration of propofol, a priority assessment by the nurse would be to check for a history of

seizure disorders.        low blood pressure.     increased intraocular pressure.

diabetic hyperlipidemia.

 

Question 81 : You decide to start your pt, Ms. Rodrigues, on spironolactone (Aldactone) 50 mg PO daily.  As the NP, you will instruct the patient to call the clinic if which symptoms are experienced?

                        Muscle twitching, numbness, tingling, burning sensations of the limbs, and diarrhea

Increased irritability, abdominal cramping, and lower extremity weakness.

Decreased reflex response, nausea, and vomiting.

Weight gain, excessive thirst, and fever.

 

Question 82 : A teenage boy has undergone a diagnostic workup following several months of persistent, bloody diarrhea that appears to lack an infectious etiology. The boy has also experienced intermittent abdominal pain and has lost almost 15 pounds this year. Which of the following medications is most likely to treat this boy’s diagnosis?

Lubiprostone   Mesalamine    Docusate         Bismuth subsalicylate

Question 83 : A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to

use over-the-counter (OTC) drugs to treat any muscle cramps or pain.

drink moderate amounts of alcohol.

                        avoid prolonged exposure to sunlight.

change to another similar drug if lovastatin proves to be ineffective.

 

Question 84 : A 39 y/o female is diagnosed with Graves disease.  She also has a small goiter.  Her symptoms are not deemed to be severe and propylthiouracil is prescribed.  Where is the most serious potential adverse effect of this medication?

Hypocalcemia Renal Failure   Agranulocytosis          Hematouria

 

Question 85 : A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction?

Call the prescriber immediately regarding her allergic reactions

Hold the medication for her muscle spasms until she can be treated for a possible allergic reaction

Post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient’s record

Call the dietary staff and make sure that the patient is not served eggs for breakfast

Question 86 : The APRN is prescribing a medication that is known to induce hepatic enzymes. What effect should you anticipate?

Induction decreases the rate of metabolism, thereby increasing serum levels of drug

Induction increases the drug’s pharmacologic effect

                        Induction increases the rate of metabolism, thereby decreasing serum levels of drug

Induction increases the chance for drug toxicity

Question 87 : A 66-year-old woman has a complex medical history that includes poorly-controlled type 1 diabetes, renal failure as a result of diabetic nephropathy and chronic heart failure (CHF). Her care provider has recently added spironolactone (Aldactone) to the woman’s medication regimen. The nurse should consequently assess for signs and symptoms of

atrial fibrillation.         thrombophlebitis.        hyperkalemia.             leukocytosis.

Question 88 : Several months of treatment with a statin accompanied by lifestyle modifications have failed to appreciably improve a patient’s cholesterol levels. Consequently, the patient has been prescribed cholestyramine. The nurse should recognize that this drugs achieves its therapeutic effect by

binding LDL to HDL.

mitigating the harmful effects of atherosclerosis by promoting vasodilation.

inhibiting the synthesis of cholesterol.

                        oxidizing cholesterol to bile acids.

Question 89 : An elderly patient with a history of congestive heart failure has been admitted to hospital with failure to thrive and admission blood work reveals a hemoglobin level of 6.9 g/dL. The care team has consequently administered two units of packed red blood cells, but auscultation of the client’s lungs now reveals diffuse crackles. Administration of what drug is likely to resolve the patient’s pulmonary edema?

Furosemide    Hydrochlorothiazide   Mannitol          Triamterene

Question 90 : A Nurse Practitioner is caring for a 78-year-old patient with renal insufficiency and chronic heart failure who is receiving rapid infusions of high-dose furosemide. It will be a priority for the Nurse Practitioner to monitor for

hepatic encephalopathy.          ototoxicity.       vascular thrombosis.

dehydration.

 

Question 91 : Ms. Neely was placed on fluoxetine about 8 weeks ago and is doing well on the medication.  When initially prescribed the medication, she asks you about the common side effects of this type of medication.  Which choice below is correct?

Cough             loss of taste                 weight loss                  weight gain

 

Question 92 : Which statement is FALSE regarding the treatment of hyperthyroidism?

Propylthiouracil (PTU) reduces peripheral conversion of T4 to the more potent T3

Since methimazole (Tapazole) is stronger than Propylthiouracil (PTU), Methimazole should be initiated at 15 mg/day compared to 300 mg/day for Propylthiouracil for treatment of mild disease

Long-acting beta-blocking agents are given as adjunctive therapy until

 

Propulthiouracil (PTU) or methimazole (Tapazole) restores the patient to euthyroid

                        Methimazole (Tapazole) is the drug of choice for pregnant or lactating females.

 

Question 93 :Which antihypertensive agent is associated with hair growth?

Prazosin           Minoxidil        Metoprolol                  Diltiazem

 

Question 94 : A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to

crush the tablet before swallowing.

swallow the tablet whole.

                        swallow the tablet with milk or food.

avoid drinking milk for 3 hours after swallowing the tablet.

 

Question 95 : The most effective therapy for a patient who is H. pylori positive with a gastric ulcer is:

                        Bismuth, Metronidazole, Omeprazole, and Tetracycline

Cephalexin, Bismuth, Omeprazole, and Ranitidine

Amoxicillin, Metronidazole, and Bismuth

Amoxicillin, Cefzil, and omeprazole

 

Question 96: A patient has been prescribed a drug that can be self-administered at home. Which of the following would be the most important information for the nurse to relate to the patient concerning self-administration of a drug?

Where to purchase the medication

The cost of the drug

                        The therapeutic effects and possible adverse effects

The pharmacokinetics of the drug

 

Question 97 : A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following?

Bradycardia                Diarrhea          Nausea                        Slight headache

 

Question 98 : The APRN is seeing Mrs. Smith, age 77, who is here for follow up of hypertension, dyslipidemia, and depression.  What should you consider during her follow-up?

                        Age-related changes in renal function are the main cause of adverse drug reactions

No alteration in dosing is required with low albumin levels and protein bound drugs

Changes in lean body mass and fluids have little effect on drug serum concentrations

The effects of cardiovascular and CNS medications are predictable in older ad

 

Question 99 : A Nurse Practitioner is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a patient who has just been admitted. What is the most likely goal of this intervention?

To treat sinus bradycardia accompanied by hypotension

To resolve the patient’s uncompensated heart failure

To treat the patient’s ventricular tachycardia

                        To convert the patient’s atrial fibrillation to normal sinus rhythm

 

Question 100 : In which of the following patients would a Nurse Practitioner expect to experience alterations in drug metabolism?

A 35-year-old woman with cervical cancer

A 41-year-old man with kidney stones

                        A 50-year-old man with cirrhosis of the liver

A 62-year-old woman in acute renal failure

 

Question 2:  A man who smokes one pack of cigarettes daily has been diagnosed with chronic bronchitis. He has been prescribed theophylline by his family doctor. What effect will the patient’s smoking status have on the therapeutic use of theophylline?   The patient may require higher doses of theophylline than a non-smoker

 

Question 3: The APRN is caring for a patient taking a calcium channel blockers for hypertension.  The APRN should monitor the patient for what common side effects of this medication? peripheral edema, constipation, dizziness

 

Question 4: A Nurse Practitioner is providing a patient with a list of drugs as a part of the patient’s plan of care. Which of the following drug nomenclatures should the Nurse Practitioner use to list the drugs? The drugs’ generic names

 

Question 5: A 73-year-old woman has scheduled an appointment with her nurse practitioner to discuss her recurrent constipation. The woman states that she experiences constipation despite the fact that she takes docusate on a daily basis and performs cleansing enemas several times weekly. How should the nurse best respond to this patient’s statements? Taking too many laxatives can make your bowels dependent on them, making you more susceptible to constipation.”

Question 6: You are seeing a 55 year old patient recently diagnosed with a bleeding ulcer. What should be the initial treatment choice for this patient? A Proton Pump Inhibitor

Question 10:  72-year-old female patient is prescribed ipratropium aerosol for pulmonary emphysema. The nurse will instruct her to “test spray” the new metered-dose inhaler (MDI) three times before using it to prevent which of the following? Paradoxic acute bronchospasm

Question 11: A Nurse Practitioner is caring for a patient who is diabetic and has been diagnosed with hypertension. An angiotensin-converting enzyme inhibitor, captopril, has been prescribed for her. Which of the following should the Nurse Practitioner assess before beginning drug therapy? Serum potassium levels

Question 12:  A female patient has been taking zafirlukast for a week and is experiencing diarrhea. The nurse should instruct her to do which of the following?      Drink plenty of fluids

Question 16: A 79-year-old woman who takes several medications for a variety of chronic health problems has been prescribed an oral antiplatelet aggregator that is to be taken once daily. The nurse has encouraged the woman to take the pill at the same time of day that she takes some of her other medications. What is the most likely rationale for the nurse’s advice?  Integrating the new drug into the patient’s existing schedule promotes adherence.

Question 17:  Decongestants are recommended to use in which of the following patients? patients with otitis media

Question 18: A Native American man who lives a traditional lifestyle is scheduled to have heart surgery. The tribal chief has requested that the tribe’s medicine man perform a ritual before the patient goes to surgery. The nurse’s response to this request should be      “As long as the ritual does not interfere with the patient’s preoperative care, it will be okay.”

Question 23: A patient has been prescribed lovastatin for a high cholesterol level. The nurse’s teaching plan will include a basic explanation of how the drug produces its therapeutic effect. The nurse will explain that lovastatin lowers cholesterol levels because it inhibits cholesterol syntheses.

Question 24:  After a recent history of shortness of breath that has become increasingly severe, a woman has been prescribed ipratropium by MDI while she undergoes a diagnostic workup. What patient teaching should the nurse provide to this patient? “Make sure that you take this at the scheduled times, regardless of whether you feel short of breath.”

 

Question 25: A 62-year-old woman has been prescribed a fentanyl transdermal patch for chronic cancer pain. The patient asks the nurse how long it will take for her to experience pain relief. The nurse will instruct the patient that she should feel pain relief in approximately  24 hours.

 

Question 26: A Nurse Practitioner is administering drugs to a 70-year-old patient who has a reduced plasma albumin level. When assessing the patient for therapeutic outcomes of drug therapy, the Nurse Practitioner will also be careful to observe for      possible drug toxicity.

Question 27: A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of   an adrenergic antagonist.

 

Question 29: A 45-year-old man who is a construction worker has been diagnosed with hyperlipidemia and has been prescribed lovastatin. The nurse will advise the patient to  avoid prolonged exposure to sunlight.

Question 30: An unconscious patient has been brought to the hospital, and the Nurse Practitioner has prescribed a life-saving drug to be administered parenterally. Which of the following methods would be the most appropriate for the nurse to use when administering the medication?  Intravenous infusion.

 

Question 31: A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion. Which of the following lab values would be a priority for the nurse to assess before administration? Triglyceride levels

 

Question 32: A 24-year-old factory worker has been prescribed guaifenesin for the first time. Which of the following will be a priority assessment by the nurse before the patient’s first dose? The amount of alcohol consumption.

 

Question 33: The lower respiratory system utilizes a number of different mechanisms that confer protection and maintain homeostasis. Which of the following physiological processes protects the lower respiratory system?

Cilia sweep foreign material and mucus upward toward the trachea and larynx where they can then be swallowed.

 

Question 34: Following an assessment by her primary care provider, a 70-year-old resident of an assisted living facility has begun taking daily oral doses of levothyroxine. Which of the following assessment findings should prompt the nurse to withhold a scheduled dose of levothyroxine? The resident’s apical heart rate is 112 beats/minute with a regular rhythm

Question 35     A 77-year-old man’s chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?          The man’s chest sounds are clear and his ankle edema is lessened.

 

Question 36     The APRN is seeing Mrs. Smith, age 77, who is here for follow up of hypertension, dyslipidemia, and depression.  What should you consider during her follow-up? ge-related changes in renal function are the main cause of adverse drug reactions

Question 37: A Nurse Practitioner is caring for a patient who has been diagnosed with hypothyroidism. Levothyroxine (Synthroid) has been prescribed. Before the drug therapy is started, the nurse will assess for which of the following? History of taking anticoagulant drugs

Question 38: In which of the following patients would a Nurse Practitioner expect to experience alterations in drug metabolism?        A 50-year-old man with cirrhosis of the liver

Question 40: During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse’s assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives    may cause nutrient deficiencies.

Question 41     A patient is taking gabapentin (Neurontin) for spasticity associated with multiple sclerosis. Which of the following should be the priority for monitoring?         Renal function

Question 42     Topical inhaled alpha adrenergic blocking agents or nasal vasoconstricting decongestants should not be used chronically (>5 days) because they can cause     rebound rhinitis/congestion

Question 43     The parents of a 7-year-old boy who has just been diagnosed with allergic asthma are being taught about their son’s medication regimen by the nurse. The nurse is currently teaching the parent’s about the appropriate use of a “rescue drug” for acute exacerbations of their son’s asthma. What drug should the nurse suggests the parents to use in these situations? Albuterol

Question 44     A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction? Post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient’s record

 

Question 45     A Nurse Practitioner who provides care in a busy clinic is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics in many patients. Treatment of high cholesterol using statins would be contraindicated in which of the following patients? An obese male client who is a heavy alcohol user and who has cirrhosis of the liver                    

 

Question 49     Mr. Penny, age 67, was diagnosed with chronic angina several months ago and has been unable to experience adequate relief of his symptoms. As a result, his physician has prescribed ranolazine (Ranexa). Which of the following statements is true regarding the use of ranolazine for the treatment of this patient’s angina? Mr. Penny requires concurrent treatment with a beta blocker, nitrate, or a calcium channel blocker.

 

Question 50: A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by       inhibiting the movement of calcium ions across the cardiac muscle cell membrane.

 

Question 51     A patient comes to the clinic asking for help to quit drinking alcohol. She has a 21-year history of heavy drinking and is worried about developing cirrhosis of the liver. The patient agrees to take disulfiram (Antabuse). The nurse will teach the patient that the combination of alcohol and Antabuse will cause which of the following? Nausea

Question 52     A mother brings her 4-year-old child, who is vomiting and has a temperature of 103°F into the emergency department (ED). The ED physician orders acetaminophen (Tylenol) for the fever. The best form of Tylenol to give the child, considering her presentation, would be suppository.

 

Question 53     A patient receives 25 units of NPH insulin at 7.AM. At what time of day should the nurse advise the patient to be most alert for a potential hypoglycemic reaction? Late afternoon

Question 54     A patient is being treated for respiratory infection. He is a recovering alcoholic and has impaired liver function. The nurse will instruct the patient to be especially cautious when taking  an elixir.

 

Question 55     A Nurse Practitioner who provides care in a long-term care facility is documenting a new resident’s medication regimen on the resident’s intake admission. The Nurse Practitioner is documenting the generic, rather than proprietary, names of the resident’s current drugs because there is a potential for confusion and miscommunication if proprietary names are used.

 

Question 56     A 46-year-old white American has been prescribed a drug that binds to acid glycoproteins. The nurse understands that white Americans usually receive a higher-than-normal dose of drugs that bind to acid glycoproteins.

 

Question 59     A 47-year-old woman has been diagnosed with open-angle glaucoma. Pilocarpine drops are prescribed. The nurse’s assessment reveals that the patient has worn soft contact lenses for 15 years. The nurse will instruct the patient to       remove the contact lenses before applying the drops.

 

Question 60     A female patient is taking 0.125 mg of digoxin daily for heart failure. At a recent clinic visit she reports that since she has been on the drug, she can breathe better and her heart rate has been around 74 beats per minute. The nurse weighs the patient and notices that she has gained 10 pounds since the digoxin therapy was started. The patient is concerned that the additional weight will necessitate an increase in the medication. Which of the following is an appropriate response by the nurse?          “No, the drug dosage will likely stay the same.”

Question 61     A 60-year-old man has scheduled a follow-up appointment with his primary care provider stating that the omeprazole (Prilosec) which he was recently prescribed is ineffective. The patient states, “I take it as soon as I feel heartburn coming on, but it doesn’t seem to help at all.” How should the nurse best respond to this patient’s statement?    “Prilosec will help your heartburn but it’s not designed to provide immediate relief of specific episodes of heartburn.”

Question 62     A normal maintenance dose for digoxin is 0.125 to 0.5 mg/day. In which of the following patients would the nurse most likely administer a lower-than-normal maintenance dose of digoxin? A 79-year-old male with cardiomegaly.

 

Question 63     Frequent episodes of exercise-related chest pain have caused a 79-year-old woman to use her prescribed nitroglycerin spray several times in recent weeks. This patient’s age will have what effect on her use of nitroglycerin? The woman will be more susceptible to hypotension than a younger patient.

 

Question 64     A 70-year-old woman has a complex medical and a current drug regimen that includes calcium and vitamin D supplements for osteoporosis, metformin (Glucophage) for type 2 diabetes, phenelzine (Nardil) for depression, and metoprolol (Lopressor) and furosemide (Lasix) for hypertension. The woman is requesting dextromethorphan for the treatment of a recurrent cough. What component of her drug regimen contraindicates the use of dextromethorphan?                       Phenelzine (Nardil)

 

Question 65     In order to promote therapeutic drug effects, the Nurse Practitioner should always encourage patients to       take their medication at the prescribed times.

 

Question 66     A female patient, age 36, is prescribed inhaled corticosteroid (ICS) for daily use. Which of the following adverse effects should the nurse closely monitor for in this patient? Oropharyngeal Candida albicans infection

Question 68     A patient is admitted to the emergency department with severe chest pain. The emergency department physician orders intravenous nitroglycerin 5 mcg/min, titrate dose by 5 mcg/min every 3 to 5 minutes per infusion pump as needed. Before administering the nitroglycerin, the nurse should prioritize which of the following assessments? Blood pressure

Question 69     In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient’s hypertension? Using the two drugs to treat a health problem may create a synergistic effect.

 

Question 70     Mr. Tan is a 69-year-old man who prides himself in maintaining an active lifestyle and a healthy diet that includes adequate fluid intake. However, Mr. Tan states that he has experienced occasional constipation in recent months. What remedy should be the nurse’s first suggestion?            A bulk-forming (fiber) laxative

 

Question 71     Which of the following patients is most likely to benefit from the administration of an adrenergic agonist?     A woman who is in labor and may require a caesarean section

Question 72     A 49-year-old woman has been diagnosed with myalgia. The physician has recommended aspirin. The patient is concerned that the aspirin will upset her stomach. The nurse will encourage the patient to         swallow the tablet with milk or food.

 

Question 73 A 77-year-old patient has a long-standing history of hypertension, a health problem that is being treated with metoprolol and a thiazide diuretic. Before administering the 8 AM dose of these medications, what assessments should the nurse perform and document? (Select all that apply.) Heart rate, Blood Pressure.

 

Question 74     A patient has been prescribed a drug that can be self-administered at home. Which of the following would be the most important information for the nurse to relate to the patient concerning self-administration of a drug?        The therapeutic effects and possible adverse effects

 

Question 75     A patient with a recent diagnosis of acute renal failure has a long-standing seizure disorder which has been successfully controlled for several years with antiseizure medications. The nurse should recognize that the patient’s compromised renal function will likely  increase the half-life of medications that are metabolized by the kidneys.

 

Question 97     Which of the following statements best defines how a chemical becomes termed a drug?  A chemical must have a proven therapeutic value or efficacy without severe toxicity or damaging properties to become a drug.

 

Question 98     A diabetic patient being treated for obesity tells the Nurse Practitioner that he is having adverse effects from his drug therapy. The patient has been taking dextroamphetamine for 2 weeks as adjunct therapy. Which of the following adverse effects would need the Nurse Practitioner’s immediate attention? Increased blood glucose

Question 99     A 53-year-old man has been treated for severe asthma for several years with prednisone. Recently, his physician initiated alternate-day therapy for him. The patient tells the nurse that he would rather take the medication every day to prevent confusion. Which of the following would be the best response by the nurse? “This schedule allows rest periods so that adverse effects are decreased but the anti-inflammatory effects continue.”

 

Question 100   A 58-year-old man is prescribed dicyclomine (Bentyl) for irritable bowel syndrome. In which of the following conditions is dicyclomine therapy contraindicated?Glaucoma

 

NEW ADDITIONAL QUESTIONS

 

Question 1

A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor) to manage his hypertension. The nurse would be sure to instruct the patient to

Understand the signs and symptoms of hypoglycemia.

Question 2

The recommended range for maintaining serum theophylline levels is:

 

10 to 20 μg/mL.

Question 3

A child with sinusitis has been on antibiotics for seven days and his symptoms are not improving. All of the following are options to prescribe for the patient now EXCEPT:

Azithromycin (Zithromycin) Question 4   A male patient is to begin glyburide (Diabeta) for type 2 diabetes. Before the drug therapy begins, a priority action by the nurse will be to assess the patient’s Use of alcohol

 

Question 5

A Nurse Practitioner is caring for a patient who is taking digoxin and a loop diuretic. Which of the following would be most important for the Nurse Practitioner to monitor?

Potassium levels

Question 6

An older adult who lives in a long-term care facility has recently begun taking losartan (Cozaar) for the treatment of hypertension. The nurse who provides care for this resident should recognize that this change in the resident’s medication regimen make create a risk for

Falls

 

Question 7

A child is prescribed an inhaled corticosteroid agent to decrease respiratory inflammation related to exposure to an animal. The patient’s parent administers a higher than prescribe dose of the medication for 5 days. What should the APRN monitor the child for?

Adrenal insufficiency

Question 8

A 48-year-old woman who works as an office manager is prescribed metoclopramide (Reglan) for diabetic gastroparesis. The nurse will be sure to assess the patient for

 Depression

Question 9

A Nurse Practitioner is caring for a 61-year-old man who has had a severe attack of gout while in the hospital for food poisoning. The Nurse Practitioner administers colchicine intravenously in order to

avoid aggravating the gastrointestinal tract.

Question 10

How does cholestyramine lowers blood cholesterol?

Sequestering bile salts and thus decreasing absorption and increasing catabolism

Question 11

A patient has been prescribed a histamine-2 (H2) receptor antagonist for the treatment of GERD. Why are H2RAs more effective than H1 receptor antagonists in the treatment of diseases of the upper GI tract?
The parietal cells of the stomach have H2 receptors but not H1 receptors.

Question 12

A Nurse Practitioner is providing care for a patient who suffered extensive burns to his extremities during a recent industrial accident. Topical lidocaine gel has been ordered to be applied to the surfaces of all his burns in order to achieve adequate pain control. When considering this order, the Nurse Practitioner should be aware that. there is a risk of systemic absorption of the lidocaine through the patient’s traumatized skin.

Question 13

 

Mr. Lastinger was prescribed warfarin sodium (Coumadin).  You advise him to avoid eating large amounts of leafy green vegetables because:
The vitamins in the vegetables will bind with, and inactivate the Coumadin

Question 14

A 62 year old male who had a myocardial infarction one year ago is being seen for hypertension. Which medication has the best evidence in mortality reduction? Couldn’t get an answer

Question 15

 

The Nurse Practitioner is prescribing Salmeterol (Serevent) inhaler for a patient with asthma.  What instructions would be correct to provide the patient?

“This is a long acting medication for your asthma and should be used once every 12 hours”

 

 

Question 16

 

A 76-year-old woman has a complex medical history that includes emphysema, osteoporosis, malnutrition, and hypothyroidism. Recently, the woman fell outside her home as a result of weakness and suffered a fracture to her femoral head. The woman’s subsequent hip-replacement surgery has been scheduled and the care team recognizes that the use of isoflurane will be most significantly influenced by history of her emphysema

Question 17

Which of the following will a Nurse Practitioner inform the patient is one of the most common adverse effects of guaifenesin (Robitussin)?

Gastrointestinal distress

Question 18

How does cholestyramine lowers blood cholesterol?

Sequestering bile salts and thus decreasing absorption and increasing catabolism

Question 19

Which of the following would be an expected outcome in a patient who has been given atropine during a medical emergency? Restoration of normal sinus rhythm

Question 20

The Nurse Practitioner is teaching a patient about the role of medications in the treatment of asthma. Which statement by the patient would require further teaching?

I do not need to use a spacer with my MDI

Question 21

A Nurse Practitioner is caring for a female patient who has developed atelectasis because of thick mucus secretions. The Nurse Practitioner is monitoring IV administration of acetylcysteine (Mucomyst) and notices that the patient’s face is flushed. The appropriate nursing action would be to

slow the administration of acetylcysteine and administer diphenhydramine if ordered.

Question 22

Which of the following conditions is a contraindication for pioglitazone (Actos).

Severe congestive heart failure

Question 23

Following an endoscopy, a 66-year-old man has been diagnosed with a duodenal ulcer resulting from Helicobacter pylori infection. Which of the following medications will likely be used in an attempt to eradicate the patient’s H. pylori infection? (Select all that apply.)

		Antibiotics
		A PPI

Question 24

A clinic Nurse Practitioner is planning care for a 68-year-old man who has been on omeprazole (Prilosec) therapy for heartburn for some time. Regarding the patient’s safety, which of the following would be a priority nursing action?

Coordinate bone density testing for the patient.

Question 25

The side effects of antihistamines are mostly due to their:

sedating effects

Question 94

 

A patient has been started on a treatment regimen that includes levothyroxine. Select the dosage regimen that is most appropriate for a mean replacement dosage. The patient has been started on a treatment regimen that includes levothyroxine. Select the dosage regimen that is most appropriate for a mean replacement dosage.  1.5 mcg/kg of body weight per da

 

 

Question 91

A patient with a long history of alcohol abuse has been admitted to an acute medical unit with signs and symptoms of hepatic encephalopathy. His current medication orders include QID doses of oral lactulose. What desired outcomes should the nurse associate with this drug order? Patient will have three to four loose bowel movements each day.

 

Question 88

 

Shirley, age 58, has been diabetic for 7 years. Her blood pressure for the last three office visits have been 154/100, 144/94, and 144/90. What would you prescribe today during her routine office visit? An ACE-Inhibitor

 

 

Question 87

 

Glargine (Lantus) is an insulin analog that essentially has no peak and is usually administered: once a day

 

Question 78

Mr. Nguyen, age 71, will soon be discharged home from the hospital after a successful coronary artery bypass graft (CABG). During patient education about his drug regimen, Mr. Nguyen’s nurse should prioritize teach about. potential adverse effects of the drugs that Mr. Nguyen will be taking

 

 

 

Question 76

 

A Nurse Practitioner is conducting an assessment of a patient who has recently had several changes made to her drug regimen. What assessment question most directly addresses the safety implications of the patient’s drug regimen? Do you take any herbal supplements or alternative medications?”

 

Question 65

 

A homeless man who is well known to care providers at the local hospital has been admitted to the emergency department after having a seizure outside a mall. The man is known to be a heavy alcohol user and is malnourished with a very low body mass index. How are this patient’s characteristics likely to influence possible treatment with phenytoin?

The patient’s protein deficit will likely increase the levels of the free drug in his blood

Question 66

An adult male comes to the clinic with complaints that he is experiencing increased difficulty breathing over the past few days. He has a history of asthma and coronary artery disease. He was recently diagnosed with hypertension. Examination reveals no jugular vein distention and no productive cough. Breath sounds are present, but expiratory wheezes are noted bilaterally, and he denies any chest pain. His vital signs are pulse of 74 beats/min, respirations of 32 breaths/min, and BP of 160/100 mm Hg. His current medications are albuterol (Proventil) inhaler 2 puffs every 4 hours prn for wheezing, nitroglycerin transdermal patch, and propranolol (Inderal) 60 mg PO bid. What is the best treatment for this patient?

Discontinue propranolol and begin verapamil (Calan) 80 mg PO tid qd.

Question 55

A Nurse Practitioner is a member of a research team that is exploring unique differences in responses to drugs that each individual possesses, based on genetic make-up. This area of study is called pharmacogenomics.

Question 50

Which mechanism of platelet inhibition is exhibited by aspirin?
Cyclooxygenase (COX) inhibition

Question 42

A Nurse Practitioner is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The Nurse Practitioner will question the patient about her intake of which of the following? coffee

Question 37

A female patient has been taking prednisone for her asthma for 1 month. The nurse will teach her to gradually decrease her dose of prednisone to avoid. adrenal insufficiency.

Question 30

A Nurse Practitioner is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which of the following actions should the Nurse Practitioner take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment? Carefully assess the patient for infections.

 

Question 29

A Nurse Practitioner is teaching a patient about his newly prescribed drug, colchicine, for gout. The Nurse Practitioner will instruct the patient to avoid which of the following foods? Shrimp

Question 27

 

Drugs have a high potential for abuse. There is no routine therapeutic use for these drugs and they are not available for regular use. They may be obtained for “investigational use only” by applying to the U.S. Drug Enforcement Agency. Examples include heroin and LSD. Which scheduled drug is this? schedule I drugs

 

 

Question 12

An elderly postsurgical patient has developed postoperative pneumonia in the days following abdominal surgery and is being treated with a number of medications. Which of the following medications that the nurse will administer has the slowest absorption? An oral antidepressant that the patient has been taking daily for several years

 

Question 11

The nurse practitioner orders Amoxicillin 500 mg tid? What is the total amount of medication patient will take per day? 1500MG

Question 6

A resident of a long-term care facility receives 12.5 mg metoprolol (Lopressor) at 8 AM and 8 PM daily. Before administering this drug, the nurse should perform and document what assessments? Heart rate and blood pressure

Question 2

Destiny presents with a history of depression.  Her parents believe she took an overdose of an antidepressant medication.  Her temperature is 40.1 degrees C.  On exam, her pupils are dilated and she has hyperreflexia. Which of the following symptoms would not be expected?

Agitation

Question 94

Which medication class is recognized for the treatment of moderate to severe dementia?

	CC	Cholinesterase inhibitors.
		NMDA receptor antagonists.
		SSRIs.
		Central alpha2 agonists.

 

Question 10

A patient has GERD and is taking ranitidine (Zantac). She continues to have gastric discomfort and asks whether she can take an antacid. Which of the following is an appropriate response by the nurse?

		“Sure, you may take an antacid with ranitidine.”
		“No, the two drugs will work against each other.”
		“Yes, but be sure to wait at least 2 hours to take the antacid after you take the ranitidine.”
		“I wouldn’t advise it. You may experience severe constipation.”

 

Question 12

The  Family nurse practitioner prescribed losartan 50 mg PO daily for a hypertensive patient. This medication promotes vasodilation by:

		Blocking the action of angiotensin II
		Promoting the synthesis of prostaglandins
		Inhibiting calcium influx into smooth muscle cells
		Promoting the release of aldosterone

Question 54

A possible side effect from the use of nifedipine (Procardia XL) is:

		Hypokalemia
		Hyperkalemia and tetany
		Dry hacking cough and hyperuricemia
		Edema of the ankles and headaches

 

Question 55

It is determined that a patient, who is in a hepatic coma, needs a laxative. Lactulose is prescribed. Which of the following should the nurse monitor to assess the efficacy of the lactulose therapy?

		Water levels in the colon
		Oncotic pressure in the colon
		Blood ammonia levels
		Relief from symptoms

 

Question 96

A Nurse Practitioner who provides care on an acute medicine unit has frequently recommended the use of nicotine replacement gum for patients who express a willingness to quit smoking during their admission or following their discharge. For which of the following patients would nicotine gum be contraindicated?

		A patient who received treatment for kidney failure due to an overdose of acetaminophen
		A patient whose pulmonary embolism was treated with a heparin infusion
		A patient with a history of angina who experienced a non-ST wave myocardial infarction
		A patient whose stage III pressure ulcer required intravenous antibiotics and a vacuum dressing

Question 57

Jillian is a Nurse Practitioner.  She recognizes that Nurse Practitioner prescriptive  authority Is regulated by:

		The U.S.  Drug Enforcement Administration
		The State board of pharmacy
		The state board of nursing for each state
		The national Council of state boards of nursing

Question 20

A 60-year-old African-American man lives with a number of chronic health problems. Genetic factors are likely to influence his etiology and/or treatment of

		hypertension.
		low bone density.
		a seizure disorder.
		cardiac arrhythmias.

Question 36

A 29-year-old female patient has been prescribed orlistat (Xenical) for morbid obesity. The nurse is providing patient education concerning the drug. An important instruction to the patient would be to

		omit the dose if the meal does not contain fat.
		take orlistat and multivitamins together.
		take orlistat in one dose at breakfast.
		omit the dose if the meal does not contain protein.

A 70-year-old man who enjoys good health began taking low-dose aspirin several months ago based on recommendations that he read in a magazine article. During the man’s most recent visit to his care provider, routine blood work was ordered and the results indicated an unprecedented rise in the man’s serum creatinine and blood urea nitrogen (BUN) levels. How should a nurse best interpret these findings?

 

The man may be experiencing a paradoxical effect of aspirin

The man may be allergic to aspirin

The man may be experiencing liver toxicity from the aspirin

The man may be experiencing nephrotoxic effects of aspirin

Question 76

Mr. Lacuna is an 83-year-old resident of a long-term care facility who has a diagnosis of moderate Alzheimer disease. Mr. Lacuna’s physician recently prescribed oral rivastigmine, but he was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should

		teach Mr. Lacuna about the importance of rotating sites when he applies the patch.
		teach Mr. Lacuna’s family to apply a second patch if they notice an acute exacerbation of his confusion.
		apply the patch to Mr. Lacuna’s back to reduce the chance that he will remove it.
		apply the patch to a mucous membrane to facilitate complete absorption.

                                           

 Question 5

You order an ECG on a patient that c/o feeling heart palpitations, chest pain, shortness of breath. Your ECG shows irregular heart rate and you determine that you need to call EMS immediately because this rhythm can cause death. What rhythm would you suspect the ECG is showing?

		Atrial Fibrillation
		Ventricular Fibrillation
		Asystole
		Ventricular Tachycardia

 

 

Question 10

Adrian Thompson is a 19-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that Andrian, apart from occasional sinus infections, Andrian is not prone to respiratory problems. What potential risk factor is most important to assess with regards to Adrian’s current problem?

		Anorexia symptoms
		Last menses
		Covid-19 contact
		Cocaine use

Question 20

The Denver II is a tool used to determine:

		a child’s mood.
		a child’s IQ.
		whether a child is developing as expected.
		whether a child is educable.

Question 45

Functional assessment is most important during the examination of a(n):

		older adult.
		young adult.
		infant.
		adolescent.

Question 84

A 62 year old female presents to the clinic with complains of chest pain and heart palpitations that started 3 days ago. Patient states she is healthy and only has a history of hypertension and tachycardia. Patient is currently taking Norvasc 10mg daily and Coreg 6.25 mg BID. You order an EKG and it shows heart rate above 200 beats/min and the ECG may look like a sawtooth cog.

What is the most likely diagnosis of this patient?

 

		Atrial Flutter
		Supraventricular Tachycardia
		NSR
		Afib with Right Ventricular Response

Question 28

A 25 yo AA female has come to the clinic because she has missed her menstrual period this month and 2 months before. She says her cycles are irregular and she wants to be on birth control to help regulate them.  She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is to:

		suggest a pregnancy test
		instruct her that this is a side effect of birth control injection therapy.
		schedule an appointment with a surgeon.
		refer her to a gynecologist for pap smear

Question 34

Darian is a 14-year-old adolescent who states his right testicle has a soft swollen mass. The testicle is not painful upon palpation. The right inguinal canal is without masses. The mass does transilluminate with a penlight. This collection of symptoms is consistent with:

		testicular cancer
		rectocele.
		hydrocele
		scrotal hernia.

Question 52

Which condition is considered progressive rather than reversible?

		Depression
		Delirium
		Dementia
		Anxiety

Question 96

A 56-year-old male presents to the clinic to see the nurse practitioner with complaints of shortness of breath for 1 months, 15-pound weight gain and lower extremity edema.  Vitals are as follows: HR: 120, Respirations 30, Blood Pressure: 138/90, BMI: 40; Oxygen saturation of 90%. On examination patient is noted to have jugular venous distention, enlarged liver, and crackles are noted on examination. A chest x-ray is completed and shows findings consistent with which diagnosis? Based on this scenario and imaging what is the most likely diagnosis?

 

		Right Sided Congestive Heart Failure
		Left Sided Congestive Heart Failure
		Pneumonia
		Emphysema

Question 84

A 62 year old female presents to the clinic with complains of chest pain and heart palpitations that started 3 days ago. Patient states she is healthy and only has a history of hypertension and tachycardia. Patient is currently taking Norvasc 10mg daily and Coreg 6.25 mg BID. You order an EKG and it shows heart rate above 200 beats/min and the ECG may look like a sawtooth cog.

What is the most likely diagnosis of this patient?

 

		Atrial Flutter
		Supraventricular Tachycardia
		NSR
		Afib with Right Ventricular Response

 

 

Question 72

Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:

		hepatic dysfunction.
		uremia.
		diabetic ketoacidosis.
		tuberculosis.

Question 77

You are reviewing an ECG of a 43 year old new patient. The patient has a history of second-degree heart block. The ECG shows the PR interval is increases with each beat until a QRS is dropped. What is this type of block called?

		Second degree heart block, type 2: Mobitz 2
		First degree heart block
		Second degree heart block, type 1: Wenckebach/Mobitz 1
		Third degree-complete heart block

Question 5

You order an ECG on a patient that c/o feeling heart palpitations, chest pain, shortness of breath. Your ECG shows irregular heart rate and you determine that you need to call EMS immediately because this rhythm can cause death. What rhythm would you suspect the ECG is showing?

		Atrial Fibrillation
		Ventricular Fibrillation
		Asystole
		Ventricular Tachycardia

 

Question 2

A 66-year-old female recently diagnosed with hyperthyroidism and was started on therapy. 6 weeks later her lab results showed: RBC of 4.6, WBC of 0.9 and Platelets of 456. Which of the following would be the most likely cause?

		Iodine
		Levothyroxine
		Methimazole
		Cytomel

Question 3

A Nurse Practitioner has administered a medication to a patient with hypertension. The prescribed drug is supposed to decrease cardiac output. A decrease in cardiac output would most likely

		increase the serum creatinine level.
		decrease drug absorption in the blood.
		decrease the amount of circulating blood sent through the kidneys.
		increase the synergistic effect of the drug.

Question 4

Laxatives help to do all of the following except:

		Softening the stool
		Decrease the amount of strain needed to defecate
		Increase the presence of impaction of stool the colon
		Reduce the painful elimination that may be associated with hemorrhoids

Question 5

The Nurse Practitioner is performing patient education for a woman who will soon begin treatment of hyperlipidemia with simvastatin (Zocor). The patient has asked the Nurse Practitioner if there are any “bad side effects” that she should be aware of. Which of the following statements should underlie the nurse’s response?

		Many patients experience gastrointestinal upset with statins, which can be partially alleviated by taking the drug with food.
		The patient may experience a dry cough, especially at night, for the first few weeks after starting to take the simvastatin.
		The patient will have to schedule regular blood work to closely monitor her kidney function for the duration of treatment.
		Most patients tolerate statins well, with minor muscle aches being among the most common adverse effects.

Question 6

Some first generation antihistamines are used:

		as stimulants
		to prevent motion sickness
		as laxatives
		as anticonvulsants

Question 10

You are discharging a patient home after postoperative DVT. They ask you why they have to use Lovenox and Warfarin at the same time. You answer:

		Warfarin onset is delayed
		Warfarin affects platelets
		LMWH has a longer half life
		LMWH has few side effects than Warfarin

Question 8

When using radioactive iodine for thyrotoxicosis the following are true:

		Avoid in nursing patients
		Hair loss
		Rapidly absorbed
		All of the above

Question 11

PS is a 54-year-old female who is diagnosed with a LE DVT on the right side due to HRT. The indicated treatment length is:

		1 month
		3 months
		6 months
		12 months

Question 12

A male patient who is hypertensive takes Hydrochlorothiazide for his blood pressure . He  presents with red, painful swelling of the great toe. In addition to treating gout, you recognize that you may need to:

		Increase his HCTZ
		Order laboratory studies for diabetes
		Change his thiazide antihypertensive medication
		Advise him to lose weight

Question 14

Destiny presents with a history of depression.  Her parents believe she took an overdose of an antidepressant medication.  Her temperature is 40.1 degrees C.  On exam, her pupils are dilated and she has hyperreflexia. Which of the following symptoms would not be expected?

		Agitation
		Bradycardia
		Confusion
		Diarrhea

Question 15

Which antihypertensive has been shown to have mild uricosuric effects in gout patients?

		Losartan
		Lisinopril
		Atenolol
		Amlodipine

Question 18

The hypersecretion of gastric acid and development of peptic ulcers is a characterization of what condition:

		Cystic Fibrosis
		Huntington’s Disease
		Sickle Cell Anemia
		Zollinger-Ellison Syndrome

Question 23

KS is a 45-year-old female with current lipid levels of: TC: 282; HDL: 61; LDL: 122; TG: 163. What is the best initial treatment for KS if she has an ASCVD risk of 38%?

		Atorvastatin 20 mg daily
		Simvastatin 80 mg daily
		Tricor 45 mg daily
		Zetia 10 mg daily

 

Question 24

A Nurse Practitioner is overseeing the care of a young man whose ulcerative colitis is being treated with oral prednisone. Which of the following actions should the Nurse Practitioner take in order to minimize the potential for adverse drug effects and risks associated with prednisone treatment?

		Avoid OTC antacids for the duration of treatment
		Advocate for intravenous, rather than oral, administration
		Teach the patient strategies for dealing with headaches
		Carefully assess the patient for infections

 

Question 28

NP is a 72-year-ol female with Parkinson’s x 3 years. She has been controlled on Amantadine until recently when she has been having more rigidity. You decide to put her on a dopamine agonist. Counseling on the new dopamine agonist would include:

• i. Delusions and hallucinations are common
• ii. The medication can slow disease progression
• iii. Doses should be tapered slowly if discontinuing
• iv. Dyskinesias are common
• v. Sleep attacks are a possible side effect

		i only
		i and iii only
		ii and iv only
		i, iii and v only
		All of the above

Question 31

It is determined that a patient, who is in a hepatic coma, needs a laxative. Lactulose is prescribed. Which of the following should the nurse monitor to assess the efficacy of the lactulose therapy?

		Water levels in the colon
		Oncotic pressure in the colon
		Blood ammonia levels
		Relief from symptoms

Question 32

You are asked to explain the mechanism of action of Acyclovir. The simplest answer is:

		Viral shedding of protein coat
		Competition for viral receptors
		Disruption of virus RNA and DNA production
		Viral trapping and degradation

 

Question 36

A nurse practitioner understands when prescribing a medication that there are certain questions to address. Check all that apply.

		Is there a need for the drug in treating the presenting problem?
		Is this the best drug for the presenting problem?
		Can the patient take the prescribed drug?
		None of the above.

All of the above

Question 36

A nurse practitioner understands when prescribing a medication that there are certain questions to address. Check all that apply.

		Is there a need for the drug in treating the presenting problem?
		Is this the best drug for the presenting problem?
		Can the patient take the prescribed drug?
		None of the above.

Question 37

A 41-year-old African-American male is 30 pounds overweight and has been diagnosed with hypertension. The most likely initial drug therapy for this patient will be

		Calcium channel blocker
		Statin
		ACE inhibitor
		ARB
		Beta blocker

Question 39

One of the main causes of airway narrowing in Asthma and COPD is the pathological constriction of the smooth muscle. Which of the following class of drug targets treating and resolving this issue?

		Antihistamines
		Inhaled beta-2 adrenergic agonists
		Antiemetics
		Acetylcholinesterase inhibitors

Question 40

Non-dihydropyridine calcium channel blockers include:

• i. Amlodipine
• ii. Nifedipine
• iii. Diltiazem
• iv. Verapamil

		i and ii only
		i, ii and iii only
		iii only
		iii and iv only
		All of the above
		None of the above

Question 41

Jillian is a Nurse Practitioner. She recognizes that Nurse Practitioner prescriptive  authority Is regulated by:

		The U.S. Drug Enforcement Administration
		The State board of pharmacy
		The state board of nursing for each state
		The national Council of state boards of nursing

Question 43

Once a patient is started on a medication for thyroid replacement, what is the typical amount of time to wait to repeat lab tests?

		14-16 weeks
		3-4 weeks
		10-12 weeks
		6-8 weeks

Question 49

A patient has been prescribed rabeprazole (Aciphex). It will be important for the nurse to assess the patient’s drug history to determine if the patient is taking which of the following drugs?

		Levodopa
		Morphine
		Digoxin
		Dicyclomine hydrochloride

Question 50

Your patient in the hospital is scheduled to take their dose of Humulin R at 1100. The medication gets administered at 1130. When would you expect peak levels of the medication?

		1230
		1630
		1330
		1200

Question 51

You are giving a presentation to medical students and one of them asks you to explain the mechanism of action of Jardiance. You tell them:

		The medication stimulate beta cells to increase insulin production
		The medication decreases gluconeogenesis in the liver
		The medication increases uptake of glucose into muscle cells for use and storage
		The medication decreases glucose reabsorption in the renal tubule

Question 52

Which of the following medications also comes in a topical dosage form -ointment- that can be used to topically treat herpes genitalis:

		Valcyclovir
		Remdisivir
		Ganciclovir
		Acyclovir

 

Question 53

A Nurse Practitioner is caring for a male patient who has a diagnosis of coronary artery disease (CAD). His drug therapy includes lovastatin. Because the patient has a history of severe renal disease, the nurse will assess for which of the following?

		Decrease in plasma concentration of lovastatin
		Increase in the statin tolerance level
		Decrease in LDL
		Increase in plasma concentration of lovastatin

Question 55

Which of the following laxatives is available in both a tablet and suppository dosage form:

		Mineral Oil
		Bisacodyl
		Senna
		Docusate

Question 58

First Generation Anticholinergics are listed on the Beers Criteria and their use should be avoided in the geriatric population for the following reasons except:

		Constipation
		Risk of confusion
		Edema
		Dry mouth

Question 59

The most effective therapy for a patient  who is H. pylori positive with a gastric ulcer is:

		Amoxicillin, Cefzil, and omeprazole
		Amoxicillin, Metronidazole, and Bismuth
		Cephalexin, Bismuth, Omeprazole, and Ranitidine
		Bismuth, Metronidazole, Omeprazole, and Tetracycline

 

Question 60

An elderly postsurgical patient has developed postoperative pneumonia in the days following abdominal surgery and is being treated with a number of medications. Which of the following medications that the nurse will administer has the slowest absorption?

		A sublingual benzodiazepine that has been prescribed to help the patient sleep
		An intravenous (IV) antibiotic that is being administered by IV piggyback at 150 mL/hour
		An oral antidepressant that the patient has been taking daily for several years
		An intramuscular (IM) injection of an opioid analgesic

Question 65

Which mechanism of platelet inhibition is exhibited by aspirin?

		Adenosine diphosphate (ADP) antagonism
		Cyclooxygenase (COX) inhibition
		Phosphodiesterase inhibition
		Glycoprotein (GP) IIb/IIIa inhibition

Question 67

After IV administration, drugs are distributed quickest to:

		Liver, kidney, brain
		Brain, skin, fat
		Kidney, liver, skin
		Kidney, GI, brain

Question 69

A patient asks you what the mechanism of action is of Tizanidine. You tell them:

		It increases inhibition of motor neurons
		The actual mechanism is unknown
		It reduces somatic motor activity in gamma and alpha neurons
		It decreases communication between nerves in the CNS

 

Question 74

Your patient is on Atorvastatin 40 mg daily, and presents for their routine follow up appointment. They complain of extreme fatigue, muscle aches, and dark colored urine. What is your best course of action given presentation?

		Decrease the dose of atorvastatin
		Collect a 24 hour urine
		Obtain a liver function test
		Discontinue the pravastatin and order a liver function profile test

Question 75

When adding Spironolactone to a patient’s regimen, the side effect to be most careful of is:

		Hypokalemia
		Urticaria
		Gynecomastia
		Hyponatremia

Question 77

NP is a 66-year-old male that is on Omeprazole for GERD and Clopidogrel for TIA prophylaxis. The pharmacist calls to tell you the Omeprazole should be switched due to a drug-drug interaction. What is the safest PPI alternative to change NP to?

		Esomeprazole
		Pantoprazole
		Rabeprazole
		Lansoprazole

Question 78

Your patient presents with complaints of nausea/vomiting and states their friend has used Marinol in the past with great results and relief. You explain this may not be a first choice for acute nausea/vomiting due to:

		Usually, medication is used for chemotherapy patients
		Usually, medication is used in patients who need to gain weight
		Side effects of the medication are worse than other agents
		All of the above

Question 79

A patient with a variety of chronic health problems is being seen by her nurse practitioner, who is currently reviewing the patient’s medication regimen. Which of the patient’s medications should prompt the nurse to teach her to avoid drinking grapefruit juice?

		Atorvastatin (Lipitor)
		Rabeprazole (Aciphex)
		Vitamin D
		Citalopram (Celexa)

Question 80

Glargine (Lantus) is an insulin analog that essentially has no peak and is usually administered:

		before meals
		With lispro insulin (Humalog) in one injection.
		Before breakfast and dinner.
		Once a day.

Question 80

Glargine (Lantus) is an insulin analog that essentially has no peak and is usually administered:

		before meals
		With lispro insulin (Humalog) in one injection.
		Before breakfast and dinner.
		Once a day.

Question 81

A Nurse Practitioner receives an order to administer a critically ill patient two drugs immediately (stat). The Nurse Practitioner begins the process by

		washing his or her hands before handling the medications.
		consulting a drug guide for compatibility.
		questioning the patient concerning allergies.
		identifying the patient by checking the armband and asking the patient to state his name.

Question 86

The mechanism of action for Carbamazepine on the CNS neurons is:

		Inhibition of K+ conductance
		Enhancement of long-term potentiation
		Inhibition of postsynaptic excitatory potentials
		Posttetanic potentiation inhibition

 

Question 87

A primary therapy for patients with mild ulcerative colitis is:

		Metronidazole (Flagyl).
		Mesalamine (Pentasa).
		Ciprofloxacin (Cipro).
		Prednisone (Deltasone).

 

Question 88

Which of the following is considered a bulk-forming laxative that can cause water absorption, softening of the fecal mass and promotes peristalsis:

		Psyllium
		Docusate
		Senna
		Castor Oil

Question 94

Atenolol has a half-life of 6 hours. If a patient takes 50 mg at 10 am, what will the blood level be at 10 am the next day?

		25 mg
		12.5 mg
		8 mg
		6.25 mg
		3.125 mg

 

Question 15

Which family of drugs do the following medications belong: Amiodarone, Propafenone and Flecainide?

		Antiarrhythmics
		Beta blockers
		Diuretics
		Calcium channel blockers

Question 17

A patient is being discharged home on Lantus Solostar insulin pens. You counsel the patient:

		Prime the pen with 2 units at each dose to insure proper insulin dose
		Prime the pen with 5 units at each dose to insure proper insulin dose
		Use the same injection site each time medication is given
		Time of injection each day is irrelevant

 

1 points   

Question 20

The majority of cytochrome P450 (CYP) enzymes are located where?

		heart
		kidney
		small intestine
		brain
		liver

 

Question 24

A 77-year-old man’s chronic heart failure is being treated with a regimen of quinapril (Accupril) and furosemide (Lasix). Which of the following assessment findings would suggest that the loop diuretic is contributing to a therapeutic effect?

		The man’s glomerular filtration rate and creatinine levels are within reference ranges.
		The man’s heart rate is between 60 and 70 beats per minute with a regular rhythm.
		The man’s potassium and sodium levels remain with reference ranges.
		The man’s chest sounds are clear and his ankle edema is lessened.

 

Question 26

The drug of choice for hyperthyroidism in pregnancy is:

		Propylthiouracil
		Levothyroxine
		Liothyronine
		Methimazole

Question 29

All of the following are considered major groups in treating ulcers except:

		Proton Pump Inhibitors
		Antibiotics
		NSAIDS
		Mucosal Protectants

Question 30

Based on the following patient comments, which statement does not show the patient’s understanding of their medication regimen?

		I take my HCTZ in the morning.
		I inject my Lantus at bedtime.
		I take my statin before bedtime.
		I inject my Novolog 10 minutes before I eat dinner.
		I inject my Humira once weekly.

Question 32

Serotonin Receptor Antagonists such as Ondansetron has the association of which side effect that may be considered life-threatening:

		Gastrointestinal Bleed
		QT Prolongation
		Hematoma
		Asthenia

Question 33

The mechanism of action of Simvastatin is:

		Bile acid binding resin
		Triglyceride binding
		HMG-CoA reductase inhibitor
		NPC1L1/Cholesterol complex inhibitor

Question 35

Which of the following antidiarrheal agents may blacken stools and the tongue and this side effect should be discussed with your patient:

		Loperamide
		Diphenoxylate
		Bismuth Subsalicylate
		Difenoxin

Question 38

Nitrofurantoin is listed on the Beers Criteria and recommended to avoid in the elderly population for the following reason:

	A.	Orthostatic Hypotension
	B.	Hypoglycemic Episodes
	C.	Pulmonary Toxicity
	D.	Purple Toe Syndrome

Question 39

Which of the following is a not a risk associated with the use of Proton Pump Inhibitors:

		Pneumonia
		Hypokalemia
		Fractures
		Hypomagnesemia

 

Question 44

The Nurse Practitioner is preparing to Prescribe a medication regimen for her patient. He or she recognizes that criteria for choosing an effective drug for any disorder include:

		Consulting nationally recognized guidelines for disease management
		Asking the patient what drug they think would work best for them
		Prescribing medications that are available as samples before writing a prescription
		Following U.S. Drug Enforcement Administration guidelines for prescribing

Question 47

A 62-year-old man is admitted to the hospital with a diagnosis of chest pain. He has an order for 0.3 mg of sublingual nitroglycerin prn for chest pain. Which of the following actions should the nurse do first when he complains of chest pain?

		Call the physician
		Ask the patient to lie back and try to relax
		Have the patient swallow a tablet every 5 minutes for 15 minutes
		Administer a tablet under his tongue and repeat the action in 5 and 10 minutes if the pain has not subsided

Question 49

The Elderly are at high risk of Adverse Drug Reactions due to:

		having greater muscle mass than younger adults, leading to higher volume of distribution
		the extensive studies that have been conducted on drug safety in this age group
		age related decrease in renal function
		the blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effects

Question 50

Which medication is least likely to cause hypoglycemia?

		glyburide
		repaglinide
		Glucovance
		metformin
		insulin

 

Question 54

Absorption of medications is a variable process that is dependent upon all of the following except

		Blood flow
		pH
		Creatine clearance
		Surface area

 

Question 58

A patient is going on a cruise but is very worried about getting sea sick. The best recommendation would be:

		Scopolamine patch: 1 patch behind ear and change after 72 hours
		Benadryl 50 mg: 50 mg every 4 hours while on cruise
		Cimetidine 200 mg: 200 mg twice daily x 10 days
		Metoclopramide 10 mg: 10 mg four times daily during cruise

 

Question 99

The IV administration of drugs:

		Undergoes first pass metabolism
		Are rapidly absorbed
		Are 100% bioavailable
		Are rapidly renally excreted

Question 97

Chronic use or abuse of laxatives may cause all of the following conditions except:

		Dehydration
		Colitis
		Ulcer
		Electrolyte Imbalance

 

Question 96

You know from your studies that the following is a synthetic opioid.

		Methadone
		Hydrocodone
		Oxycodone
		Codeine

Question 93

Which medication class is recognized for the treatment of moderate to severe dementia?

		Cholinesterase inhibitors.
		NMDA receptor antagonists.
		SSRIs.
		Central alpha2 agonists.

Question 91

Which of the following brand-generic combinations is incorrectly matched?

		enalapril-Vasotec
		amlodipine-Norvasc
		rosuvastatin-Crestor
		verapamil-Diovan
		nifedipine-Procardia

Question 89

A patient comes to your clinic and has a blood glucose of 420. The medication most likely responsible would be:

		Amitriptyline
		Prednisone
		Bactrim
		Lisinopril

Question 85

Which laxative when used may cause aspiration pneumonia especially in the elderly:

		Bisacodyl
		Glycerin Suppository
		Polyethylene Glycol
		Mineral Oil

Question 84

A patient is taking cholestyramine. The Nurse Practitioner will assess for which of the following common adverse effects of the drug?

		Abdominal pain
		Headache
		Constipation
		Indigestion

Question 67

Which can elevate theophylline levels?

		Concomitant treatment with cimetidine (Tagamet).
		Intravenous ampicillin.
		Heavy smoking.
		History of seizure disorder.

 

Question 39

Which of the following is a not a risk associated with the use of Proton Pump Inhibitors:

		Pneumonia
		Hypokalemia
		Fractures
		Hypomagnesemia

The Nurse Practitioner is preparing to Prescribe a medication regimen for her patient. He or she recognizes that criteria for choosing an effective drug for any disorder include:

		Consulting nationally recognized guidelines for disease management
		Asking the patient what drug they think would work best for them
		Prescribing medications that are available as samples before writing a prescription
		Following U.S. Drug Enforcement Administration guidelines for prescribing

Question 64

Some medications can cause a release of histamine from mast cells. An example of one of these medications is:

		Keflex
		Ranitidine
		Amoxicillin
		Morphine

Question 76

Which antiviral medication would primarily work by blocking neuraminidase, the enzyme that blocks the release of viral particles?

		Oseltamivir
		Ribavirin
		Acyclovir
		Amantadine

Question 9

Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the assisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston?

		The importance of having required laboratory work performed on time
		The need to take the medication at the same time each day regardless of her heart rate
		The correct technique for using a home blood pressure cuff
		Timing household activities to coincide with the administration times of her digoxin

Question 74

Which of the following muscle relaxants are safe to use in the elderly?

• i. Baclofen
• ii. Cyclobenzaprine
• iii. Methocarbamol
• iv. Tizanidine

		i only
		i and iii only
		ii and iv only
		i and iv only

Question 66

Dronabinol is a cannabinoid used as an antiemetic to treat chemotherapy-induced nausea and vomiting. There is concerns of its abuse potential and was once classified as a Schedule II drug.  The classification was later changed to Schedule III because of the following reasons:

		Dronabinol has a slow onset and does not produce the same effects that a person would get from smoking marijuana.
		Dronabinol, since its release on the market, has very little to no interest and does not pose a concern as a street drug.
		Both A and B
		None of the above

Question 61

Which of the following is a contraindication for antimuscarinic drugs?

		Overactive bladder
		nausea and vomiting
		Parkinson disease
		pyloric stenosis