Pharmacotherapeutics for Advanced Practice Nurse Prescribers 4th Moser Woo-Test Bank

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Pharmacotherapeutics for Advanced Practice Nurse Prescribers 4th Moser Woo-Test Bank

Chapter 2. Review of Basic Principles of Pharmacology

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because:

1. Distribution of drugs to target tissue may be affected.
2. The solubility of the drug will not match the site of absorption.
3. There will be less free drug available to generate an effect.
4. Drugs bound to albumin are readily excreted by the kidneys.

 

 

____    2.   Drugs that have a significant first-pass effect:

1. Must be given by the enteral (oral) route only
2. Bypass the hepatic circulation
3. Are rapidly metabolized by the liver and may have little if any desired action
4. Are converted by the liver to more active and fat-soluble forms

 

 

____    3.   The route of excretion of a volatile drug will likely be the:

1. Kidneys
2. Lungs
3. Bile and feces
4. Skin

 

 

____    4.   Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs:

1. Assure that the drug will reach its intended target tissue
2. Are the reason for giving loading doses
3. Increase the length of time a drug is available and active
4. Are most common in collagen tissues

 

 

____    5.   The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:

1. Propensity to go to the target receptor
2. Biological half-life
3. Pharmacodynamics
4. Safety and side effects

 

 

____    6.   Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:

1. Rapidly achieves drug levels in the therapeutic range
2. Requires four- to five-half-lives to attain
3. Is influenced by renal function
4. Is directly related to the drug circulating to the target tissues

 

 

____    7.   The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:

1. Minimum adverse effect level
2. Peak of action
3. Onset of action
4. Therapeutic range

 

 

____    8.   Phenytoin requires that a trough level be drawn. Peak and trough levels are done:

1. When the drug has a wide therapeutic range
2. When the drug will be administered for a short time only
3. When there is a high correlation between the dose and saturation of receptor sites
4. To determine if a drug is in the therapeutic range

 

 

____    9.   A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the:

1. Concentration will produce therapeutic effects
2. Concentration will produce an adverse response
3. Time between doses must be shortened
4. Duration of action of the drug is too long

 

 

____  10.   Drugs that are receptor agonists may demonstrate what property?

1. Irreversible binding to the drug receptor site
2. Upregulation with chronic use
3. Desensitization or downregulation with continuous use
4. Inverse relationship between drug concentration and drug action

 

 

____  11.   Drugs that are receptor antagonists, such as beta blockers, may cause:

1. Downregulation of the drug receptor
2. An exaggerated response if abruptly discontinued
3. Partial blockade of the effects of agonist drugs
4. An exaggerated response to competitive drug agonists

 

 

____  12.   Factors that affect gastric drug absorption include:

1. Liver enzyme activity
2. Protein-binding properties of the drug molecule
3. Lipid solubility of the drug
4. Ability to chew and swallow

 

 

____  13.   Drugs administered via IV:

1. Need to be lipid soluble in order to be easily absorbed
2. Begin distribution into the body immediately
3. Are easily absorbed if they are nonionized
4. May use pinocytosis to be absorbed

 

 

____  14.   When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:

1. The sum of the effects of each drug individually
2. Greater than the sum of the effects of each drug individually
3. Less than the effect of each drug individually
4. Not predictable, as it varies with each individual

 

 

____  15.   Which of the following statements about bioavailability is true?

1. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms.
2. All brands of a drug have the same bioavailability.
3. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily.
4. Combining an active drug with an inert substance does not affect bioavailability.

 

 

____  16.   Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?

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

 

 

____  17.   Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to:

1. Inactivate prodrugs before they can be activated by target tissues
2. Change the drugs so they can cross plasma membranes
3. Change drug molecules to a form that an excretory organ can excrete
4. Make these drugs more ionized and polar to facilitate excretion

 

 

____  18.   Once they have been metabolized by the liver, the metabolites may be:

1. More active than the parent drug
2. Less active than the parent drug
3. Totally “deactivated” so they are excreted without any effect
4. All of the above

 

 

____  19.   All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by:

1. Reduced circulation and perfusion of the kidney
2. Chronic renal disease
3. Competition for a transport site by another drug
4. Unbinding a nonvolatile drug from plasma proteins

 

 

____  20.   Steady state is:

1. The point on the drug concentration curve when absorption exceeds excretion
2. When the amount of drug in the body remains constant
3. When the amount of drug in the body stays below the minimum toxic concentration
4. All of the above

 

 

____  21.   Two different pain medications are given together for pain relief. The drug—drug interaction is:

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

 

 

____  22.   Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:

1. Reducing the dosage of one of the drugs
2. Scheduling their administration at different times
3. Prescribing a third drug to counteract the adverse reaction of the combination
4. Reducing the dosage of both drugs

 

 

____  23.   Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?

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

 

 

____  24.   The time required for the amount of drug in the body to decrease by 50% is called:

1. Steady state
2. Half-life
3. Phase II metabolism
4. Reduced bioavailability time

 

 

____  25.   An agonist activates a receptor and stimulates a response. When given frequently over time, the body may:

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

 

 

____  26.   Drug antagonism is best defined as an effect of a drug that:

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

 

 

____  27.   Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements?

1. “Avoid any other oral medicines while taking this drug.”
2. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”
3. “The tablet may be crushed if you have any difficulty taking it.”
4. “To achieve best effect, take the tablet with at least 8 ounces of fluid.”

 

 

____  28.   The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in:

1. Disintegration
2. Toxicity
3. Malabsorption
4. Deterioration

 

 

____  29.   Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach?

1. Sodium bicarbonate
2. Ascorbic acid
3. Salicylic acid
4. Glucose

 

 

____  30.   Which of the following variables is a factor in drug absorption?

1. The smaller the surface area for absorption, the more rapidly the drug is absorbed.
2. A rich blood supply to the area of absorption leads to better absorption.
3. The less soluble the drug, the more easily it is absorbed.
4. Ionized drugs are easily absorbed across the cell membrane.

 

 

____  31.   An advantage of prescribing a sublingual medication is that the medication is:

1. Absorbed rapidly
2. Excreted rapidly
3. Metabolized minimally
4. Distributed equally

 

 

____  32.   Drugs that use CYP 3A4 isoenzymes for metabolism may:

1. Induce the metabolism of another drug
2. Inhibit the metabolism of another drug
3. Both 1 and 2
4. Neither 1 nor 2

 

 

____  33.   Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:

1. After the second dose
2. After four to five half-lives
3. When the patient feels the full effect of the drug
4. One hour after IV administration

 

 

____  34.   Upregulation or hypersensitization may lead to:

1. Increased response to a drug
2. Decreased response to a drug
3. An exaggerated response if the drug is withdrawn
4. Refractoriness or complete lack of response

 

Chapter 2. Review of Basic Principles of Pharmacology

Answer Section

 

MULTIPLE CHOICE

 

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  2. Chapter 14. Drugs Affecting the Autonomic Nervous System 

    Multiple Choice

    Identify the choice that best completes the statement or answers the question.

     

    ____    1.   Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia. Doxazosin has been chosen to treat his hypertension because it:

    1. Increases peripheral vasoconstriction
    2. Decreases detrusor muscle contractility
    3. Lowers supine blood pressure more than standing pressure
    4. Relaxes smooth muscle in the bladder neck

     

     

    ____    2.   To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do all of the following EXCEPT:

    1. Take the dose at bedtime
    2. Sit up slowly and dangle their feet before standing
    3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80
    4. Weigh daily and report weight gain of greater than 2 pounds in one day

     

     

    ____    3.   John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should:

    1. Not miss a dose or stop taking the drug because of potential rebound hypertension
    2. Increase fiber in the diet to treat any diarrhea that may occur
    3. Reduce fluid intake to less than 2 liters per day to prevent fluid retention
    4. Avoid sitting for long periods, as this can lead to deep vein thrombosis

     

     

    ____    4.   Clonidine has several off-label uses, including:

    1. Alcohol and nicotine withdrawal
    2. Post-herpetic neuralgia
    3. Both 1 and 2
    4. Neither 1 nor 2

     

     

    ____    5.   Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:

    1. Increasing heart rate to improve cardiac output
    2. Reducing vascular smooth muscle tone
    3. Increasing aldosterone-mediated volume activity
    4. Reducing aqueous humor production

     

     

    ____    6.   Which of the following adverse effects are less likely in a beta1-selective blocker?

    1. Dysrhythmias
    2. Impaired insulin release
    3. Reflex orthostatic changes
    4. Decreased triglycerides and cholesterol

     

     

    ____    7.   Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol. You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take related to his nadolol?

    1. Extend the dosage interval.
    2. Decrease the dose by 75%.
    3. Take no action because this value is expected in the older adult.
    4. Schedule a serum creatinine level to validate the CrCl value.

     

     

    ____    8.   Beta blockers are the drugs of choice for exertional angina because they:

    1. Improve myocardial oxygen supply by vasodilating the coronary arteries
    2. Decrease myocardial oxygen demand by decreasing heart rate and vascular resistance
    3. Both 1 and 2
    4. Neither 1 nor 2

     

     

    ____    9.   Adherence to beta blocker therapy may be affected by their:

    1. Short half-lives requiring twice daily dosing
    2. Tendency to elevate lipid levels
    3. Effects on the male genitalia, which may produce impotence
    4. None of the above

     

     

    ____  10.   Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the:

    1. Symptoms are severe
    2. Patient has not responded to other therapies
    3. Patient has concurrent hypertension
    4. Left ventricular dysfunction is diagnosed

     

     

    ____  11.   Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:

    1. Angina
    2. Coronary artery disease
    3. Both 1 and 2
    4. Neither 1 nor 2

     

     

    ____  12.   To prevent life-threatening events from rapid withdrawal of a beta blocker:

    1. The dosage interval should be increased by 1 hour each day.
    2. An alpha blocker should be added to the treatment regimen before withdrawal.
    3. The dosage should be tapered over a period of weeks.
    4. The dosage should be decreased by one-half every 4 days.

     

     

    ____  13.   Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose?

    1. Dizziness
    2. Increased heart rate
    3. Nervousness and shakiness
    4. Diaphoresis

     

     

    ____  14.   Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:

    1. Vasodilate the peripheral vasculature
    2. Decrease cardiac output
    3. Increase renal vascular resistance
    4. Reduce atherosclerosis secondary to elevated serum lipoproteins

     

     

    ____  15.   Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?

    1. Histamine 2 blockers
    2. Quinolones
    3. Serotonin re-uptake inhibitors
    4. All of the above

     

     

    ____  16.   Alpha-beta blockers are especially effective to treat hypertension for which ethnic group?

    1. White
    2. Asian
    3. African American
    4. Native American

     

     

    ____  17.   Bethanechol:

    1. Increases detrusor muscle tone to empty the bladder
    2. Decreases gastric acid secretion to treat peptic ulcer disease
    3. Stimulates voluntary muscle tone to improve strength
    4. Reduces bronchial airway constriction to treat asthma

     

     

    ____  18.   Clinical dosing of Bethanechol:

    1. Begins at the highest effective dose to obtain a rapid response
    2. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved
    3. Requires dosing only once daily
    4. Is the same for both the oral and parenteral route

     

     

    ____  19.   Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?

    1. Levothyroxine
    2. Prilosec
    3. Dulcolax
    4. Diphenhydramine

     

     

    ____  20.   Anticholinesterase inhibitors are used to treat:

    1. Peptic ulcer disease
    2. Myasthenia gravis
    3. Both 1 and 2
    4. Neither 1 nor 2

     

     

    ____  21.   Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?

    1. Donepezil
    2. Memantine
    3. Rivastigmine
    4. Galantamine

     

     

    ____  22.   Taking which drug with food maximizes it bioavailability?

    1. Donepezil
    2. Galantamine
    3. Rivastigmine
    4. Memantine

     

     

    ____  23.   Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women?

    1. Memantine
    2. Pyridostigmine
    3. Galantamine
    4. Rivastigmine

     

     

    ____  24.   There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include:

    1. Dizziness and headache
    2. Nausea
    3. Decreased salivation
    4. Fasciculations of voluntary muscles

     

     

    ____  25.   Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily?

    1. Tacrine
    2. Donepezil
    3. Memantine
    4. Pyridostigmine

     

     

    ____  26.   Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine?

    1. Vasodilation and decreased heart rate
    2. Increased secretion of gastric acid and motility of the GI smooth muscle
    3. Release of dopamine at the pleasure center
    4. Stimulation of the locus coeruleus

     

     

    ____  27.   Nicotine gum products are:

    1. Chewed to release the nicotine and then swallowed for a systemic effect
    2. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine release
    3. Bound to exchange resins so the nicotine is only released during chewing
    4. Approximately the same in nicotine content as smoking two cigarettes

     

     

    ____  28.   Nicotine replacement therapy (NRT):

    1. Is widely distributed in the body only when the gum products are used
    2. Does not cross the placenta and so is safe for pregnant women
    3. Delays healing of esophagitis and peptic ulcers
    4. Has no drug interactions when a transdermal patch is used

     

     

    ____  29.   Success rates for smoking cessation using NRT:

    1. Are about the same regardless of the method chosen
    2. Vary from 40% to 50% at 12 months
    3. Both 1 and 2
    4. Neither 1 nor 2

     

     

    ____  30.   Cholinergic blockers are used to:

    1. Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines
    2. Control tremors and relax smooth muscle in Parkinson’s disease
    3. Inhibit the muscarinic action of ACh on bladder muscle
    4. All of the above

     

     

    ____  31.   Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?

    1. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.
    2. Additive antimuscarinic effects may occur with antihistamines.
    3. Cholinergic blockers may decrease the sedative effects of hypnotics.
    4. Cholinergic blockers are contraindicated with antipsychotics.

     

     

    ____  32.   Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to:

    1. Apply the transdermal disk at least 4 hours before the antiemetic effect is desired.
    2. Swallow the tablet 1 hour before traveling where motion sickness is possible.
    3. Place the tablet under the tongue and allow it to dissolve.
    4. Change the transdermal disk daily for maximal effect.

     

     

    ____  33.   You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is:

    1. Continue the tamsulosin because the side effect will resolve with continued treatment.
    2. Discontinue the tamsulosin and start doxazosin.
    3. Have him double his fluid intake and stand more slowly.
    4. Prescribe meclizine as needed for the dizziness.

     

     

    ____  34.   You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice?

    1. Donepezil
    2. Tacrine
    3. Doxazosin
    4. Verapamil

     

     

    ____  35.   A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause?

    1. Acetaminophen
    2. Estradiol
    3. Donepezil
    4. Bethanechol

     

     

    ____  36.   Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications?

    1. Carvedilol
    2. Donepezil
    3. Bethanechol
    4. Tacrine

     

     

    ____  37.   Activation of central alpha2 receptors results in inhibition of cardioacceleration and ______________ centers in the brain.

    1. Vasodilation
    2. Vasoconstriction
    3. Cardiovascular
    4. Respiratory

    Chapter 14. Drugs Affecting the Autonomic Nervous System

    Answer Section

     

    MULTIPLE CHOICE

     

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Chapter 28. Chronic Stable Angina and Low-Risk Unstable Angina

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?

1. Calcium channel blockers
2. Beta blockers
3. Angiotensin-converting-enzyme (ACE) inhibitors
4. Aspirin

 

 

____    2.   Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:

1. Pulmonary embolism
2. Pneumonia
3. Gastroesophageal reflux
4. All of the above

 

 

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

1. I
2. II
3. III
4. IV

 

 

____    4.   Patients at high risk for developing significant coronary heart disease are those with:

1. LDL values between 100 and 130
2. Systolic blood pressure between 120 and 130
3. Class III angina
4. Obesity

 

 

____    5.   To reduce mortality, all patients with angina, regardless of class, should be on:

1. Aspirin 81 to 325 mg/d
2. Nitroglycerin sublingually for chest pain
3. ACE inhibitors or angiotensin receptor blockers
4. Digoxin

 

 

____    6.   Patients who have angina, regardless of class, who are also diabetic, should be on:

1. Nitrates
2. Beta blockers
3. ACE inhibitors
4. Calcium channel blockers

 

 

____    7.   Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct.

1. Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload.
2. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload.
3. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply.
4. Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function.

 

 

____    8.   Nitrates are especially helpful for patients with angina who also have:

1. Heart failure
2. Hypertension
3. Both 1 and 2
4. Neither 1 nor 2

 

 

____    9.   Beta blockers are especially helpful for patients with exertional angina who also have:

1. Arrhythmias
2. Hypothyroidism
3. Hyperlipidemia
4. Atherosclerosis

 

 

____  10.   Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?

1. These drugs are useful for immediate symptom relief when the patient is certain it is angina.
2. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away.
3. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than two doses. If chest pain is still not relieved, call 911.
4. All of the above

 

 

____  11.   Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7 a.m. and 2 p.m. because:

1. Long-acting forms have a higher risk for toxicity.
2. Orthostatic hypotension is a common adverse effect.
3. It must be taken with milk or food.
4. Nitrate tolerance can develop.

 

 

____  12.   Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because:

1. Nitrates increase MOS and beta blockers increase MOD.
2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out.
3. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease.
4. All of the above

 

 

____  13.   Drug choices to treat angina in older adults differ from those of younger adults only in:

1. Consideration of risk factors for diseases associated with and increased in aging
2. The placement of drug therapy as a treatment choice before lifestyle changes are tried
3. The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult
4. Those with higher risk for silent myocardial infarction

 

 

____  14.   Which of the following drugs has been associated with increased risk for myocardial infarction in women?

1. Aspirin
2. Beta blockers
3. Estrogen replacement
4. Lipid-lowering agents

 

 

____  15.   Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:

1. Patients often require multiple drugs
2. A large number of angina patients are older adults on fixed incomes
3. Generic formulations may be cheaper but are rarely bioequivalent
4. Lack of drug selectivity may result in increased adverse reactions

 

 

____  16.   Situations that suggest referral to a specialist is appropriate include:

1. When chronic stable angina becomes unpredictable in its characteristics and precipitating factors
2. When a post-myocardial infarction patient develops new-onset angina
3. When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina
4. All of the above

 

 

____  17.   The rationale for prescribing calcium blockers for angina can be based on the need for:

1. Increased inotropic effect in the heart
2. Increasing peripheral perfusion
3. Keeping heart rates high enough to ensure perfusion of coronary arteries
4. Help with rate control

 

 

____  18.   Medications are typically started for angina patients when:

1. The first permanent EKG changes occur
2. The start of class I or II symptoms
3. The events trigger a trip to the emergency department
4. When troponin levels become altered

 

 

____  19.   The most common cause of angina is:

1. Vasospasm of the coronary arteries
2. Atherosclerosis
3. Platelet aggregation
4. Low systemic oxygen

 

 

____  20.   Ranolazine is used in angina patients to:

1. Dilate plaque-filled arteries
2. Inhibit platelet aggregation
3. Restrict late sodium flow in the myocytes
4. Induce vasoconstriction in the periphery to open coronary vessels

 

 

____  21.   When is aspirin (ASA) used in angina patients?

1. All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons.
2. ASA should only be used in men.
3. ASA has no role in angina, but is useful in MI prevention.
4. The impact of ASA is best at the time of an angina attack.

 

Chapter 28. Chronic Stable Angina and Low-Risk Unstable Angina

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  3                    PTS:   1

 

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  1. ANS:  3                    PTS:   1

 

  1. ANS:  1                    PTS:   1

 

  1. ANS:  3                    PTS:   1

 

  1. ANS:  4                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  1                    PTS:   1

 

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  1. ANS:  3                    PTS:   1

 

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  1. ANS:  4                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  3                    PTS:   1

 

  1. ANS:  1                    PTS:   1

Chapter 42. Pneumonia

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   The most common bacterial pathogen in community-acquired pneumonia is:

1. Haemophilus influenzae
2. Staphylococcus aureus
3. Mycoplasma pneumoniae
4. Streptococcus pneumoniae

 

 

____    2.   The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be:

1. Ciprofloxacin
2. Azithromycin
3. Amoxicillin
4. Doxycycline

 

 

____    3.   The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed who has pneumonia and can be treated as an outpatient would be:

1. Levofloxacin
2. Amoxicillin
3. Ciprofloxacin
4. Cephalexin

 

 

____    4.   If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be:

1. IV or IM gentamicin
2. IV or IM ceftriaxone
3. IV amoxicillin
4. IV ciprofloxacin

 

 

____    5.   Samantha is 34 weeks pregnant and has been diagnosed with pneumonia. She is stable enough to be treated as an outpatient. What would be an appropriate antibiotic to prescribe?

1. Levofloxacin
2. Azithromycin
3. Amoxicillin
4. Doxycycline

 

 

____    6.   Adults with pneumonia who are responding to antimicrobial therapy should show improvement in their clinical status in:

1. 12 to 24 hours
2. 24 to 36 hours
3. 48 to 72 hours
4. 4 or 5 days

 

 

____    7.   Along with prescribing antibiotics, adults with pneumonia should be instructed on lifestyle modifications to improve outcomes, including:

1. Adequate fluid intake
2. Increased fiber intake
3. Bedrest for the first 24 hours
4. All of the above

 

 

____    8.   John is a 4-week-old infant who has been diagnosed with chlamydial pneumonia. An appropriate treatment for his pneumonia would be:

1. Levofloxacin
2. Amoxicillin
3. Erythromycin
4. Cephalexin

 

 

____    9.   Wing-Sing is a 4-year-old patient who has suspected bacterial pneumonia. He has a temperature of 102°F, oxygen saturation level of 95%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumonia?

1. Ceftriaxone
2. Azithromycin
3. Cephalexin
4. Levofloxacin

 

 

____  10.   Giselle is a 14-year-old patient who presents to the clinic with symptoms consistent with mycoplasma pneumonia. What is the treatment for suspected mycoplasma pneumonia in an adolescent?

1. Ceftriaxone
2. Azithromycin
3. Ciprofloxacin
4. Levofloxacin

 

Chapter 42. Pneumonia

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  4                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  1                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  3                    PTS:   1

 

  1. ANS:  1                    PTS:   1

 

  1. ANS:  3                    PTS:   1

 

  1. ANS:  1                    PTS:   1

 

  1. ANS:  2                    PTS:   1

Chapter 52. Pain Management: Acute and Chronic Pain

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the:

1. Sensory aspects of pain
2. Discriminative aspects of pain
3. Motivational aspects of pain
4. Cognitive aspects of pain

 

 

____    2.   Patients need to be questioned about all pain sites because:

1. Patients tend to report the most severe or important in their perception.
2. Pain tolerance generally decreases with repeated exposure.
3. The reported pain site is usually the most important to treat.
4. Pain may be referred from a different site to the one reported.

 

 

____    3.   The chemicals that promote the spread of pain locally include:

1. Serotonin
2. Norepinephrine
3. Enkephalin
4. Neurokinin A

 

 

____    4.   Narcotics are exogenous opiates. They act by:

1. Inhibiting pain transmission in the spinal cord
2. Attaching to receptors in the afferent neuron to inhibit the release of substance P
3. Blocking neurotransmitters in the midbrain
4. Increasing beta-lipoprotein excretion from the pituitary gland

 

 

____    5.   Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true?

1. Preterm and newborn infants do not yet have functional pain pathways.
2. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child.
3. Increases in the pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness.
4. Decreases in pain tolerance are evident in older adults.

 

 

____    6.   Which of the following statements is true about acute pain?

1. Somatic pain comes from body surfaces and is only sharp and well-localized.
2. Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates.
3. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.
4. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area.

 

 

____    7.   One of the main drug classes used to treat acute pain is NSAIDs. They are used because:

1. They have less risk for liver damage than acetaminophen.
2. Inflammation is a common cause of acute pain.
3. They have minimal GI irritation.
4. Regulation of blood flow to the kidney is not affected by these drugs.

 

 

____    8.   Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?

1. All opiates are scheduled drugs which require a DEA license to prescribe.
2. Opiates stimulate only mu receptors for the control of pain.
3. Most of the adverse effects of opiates are related to mu receptor stimulation.
4. Naloxone is an antagonist to opiates.

 

 

____    9.   If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use?

1. NSAIDs, opiates, corticosteroids
2. Low-dose opiates, salicylates, increased dose of opiates
3. Opiates, non-opiates, increased dose of non-opiate
4. Non-opiate, increased dose of non-opiate, opiate

 

 

____  10.   The goal of treatment of acute pain is:

1. Pain at a tolerable level where the patient may return to activities of daily living
2. Reduction of pain with a minimum of drug adverse effects
3. Reduction or elimination of pain with minimum adverse reactions
4. Adequate pain relief without constipation or nausea from the drugs

 

 

____  11.   Which of the following statements is true about age and pain?

1. Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.
2. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.
3. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.
4. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

 

 

____  12.   Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to:

1. Determine if the diagnosis of source of pain is correct
2. Determine if the current regimen is adequate or different combinations of drugs and non-drug therapy are required
3. Determine if the patient is willing and able to be an active participant in his or her pain management
4. All of the above

 

 

____  13.   Pathological similarities and differences between acute pain and chronic pain include:

1. Both have decreased levels of endorphins.
2. Chronic pain has a predominance of C-neuron stimulation.
3. Acute pain is most commonly associated with irritation of peripheral nerves.
4. Acute pain is diffuse and hard to localize.

 

 

____  14.   A treatment plan for management of chronic pain should include:

1. Negotiation with the patient to set personal goals for pain management
2. Discussion of ways to improve sleep and stress
3. An exercise program to improve function and fitness
4. All of the above

 

 

____  15.   Chronic pain is a complex problem. Some specific strategies to deal with it include:

1. Telling the patient to “let pain be your guide” to using treatment therapies
2. Prescribing pain medication on a “PRN” basis to keep down the amount used
3. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment
4. All of the above

 

 

____  16.   Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?

1. Use of more than one drug to treat the pain
2. Multiple times when prescriptions are lost with requests to refill
3. Preferences for treatments that include alternative medicines
4. Presence of a family member who has abused drugs

 

 

____  17.   The Pain Management Contract is appropriate for:

1. Patients with cancer who are taking morphine
2. Patients with chronic pain who will require long-term use of opiates
3. Patients who have a complex drug regimen
4. Patients who see multiple providers for pain control

 

Chapter 52. Pain Management: Acute and Chronic Pain

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  3                    PTS:   1

 

  1. ANS:  1                    PTS:   1

 

  1. ANS:  4                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  1                    PTS:   1

 

  1. ANS:  3                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  4                    PTS:   1

 

  1. ANS:  3                    PTS:   1

 

  1. ANS:  4                    PTS:   1

 

  1. ANS:  4                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  4                    PTS:   1

 

  1. ANS:  3                    PTS:   1

 

  1. ANS:  2                    PTS:   1

 

  1. ANS:  2                    PTS:   1

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