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Advanced pharmacology for NP Exam
Questions with Answers | Latest 2023/
Ray has been diagnosed with hypertension and it is determined that an angiotensin-converting enzyme inhibitor is needed. Prior to prescribing this drug, the nurse practitioner (NP) should assess for: - ANSWER>>Decreased renal function
Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hypertension in diabetic patients because they: - ANSWER>>All of the above: Improve insulin sensitivity Improve renal hemodynamics Reduce the production of angiotensin II
A potentially life-threatening adverse response to an ACE inhibitor is angioedema. Which of the following statements is true about this adverse response? - ANSWER>>Swelling of the tongue and hoarseness are the most common symptoms.
ACE inhibitors are useful in a variety of disorders. Which of the following statements is true about both their usefulness in a particular disorder and the reason for their use? - ANSWER>>Both 1 and 2 are true:
- They are useful to prevent stable angina because they decrease the thickening of vascular walls due to decreased modified release.
- They are useful to prevent heart failure because they reduce remodeling of injured myocardial tissues.
Despite good blood pressure control, an NP might change a patient's drug from an ACE inhibitor to an angiotensin II receptor blocker (ARB) because the ARB: - ANSWER>>Does not produce a dry, hacking cough
While taking an ARB, patients need to avoid certain over-the-counter drugs without irst consulting the provider because: - ANSWER>>Both 1 and 2:
- Cimetidine is metabolized by the CYP3A4 isoenzymes
- Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels
Laboratory monitoring for patients on ACE inhibitors or ARBs should include: - ANSWER>>Serum creatinine levels with the drug dosage reduced for values greater than 2.5 mg/dL
Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it: - ANSWER>>Decreases the amount of calcium inside the cell
Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker? - ANSWER>>Edema of the hands and feet
Patient teaching related to amlodipine includes: - ANSWER>>Avoid grapefruit juice as it affects the metabolism of this drug.
Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her should be: - ANSWER>>Started at about half the usual dosage
Larry has heart failure, which is being treated with digoxin because it exhibits: - ANSWER>>Negative inotropism
Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes: - ANSWER>>Serum potassium
Which of the following create a higher risk for digoxin toxicity? Both the cause and the reason for it must be correct. - ANSWER>>Administration to older adults because of reduced renal function
Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: - ANSWER>>Report muscle weakness or tenderness and dark urine to his provider immediately.
Which of the following diagnostic results would NOT indicate a problem related to a reductase inhibitor? - ANSWER>>Increased white blood cell count
Because of the pattern of cholesterol synthesis, reductase inhibitors are given - ANSWER>>In the evening in a single daily dose
Niaspan, an extended-release form of niacin, was previously prescribed to treat a patient's hypertriglycerides. However, the FDA withdrew its approval of the drug. Which of the following drugs with research efficacy should be substituted? - ANSWER>>1 or 2:
- Statins
- Fibrates
Niaspan is less likely to cause which side effect that is common to niacin? - ANSWER>>Cutaneous flushing
Dulcea has type 2 diabetes and a high triglyceride level. She has been prescribed gemfibrozil to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? - ANSWER>>Gallbladder disease
Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the ANSWER to be correct. - ANSWER>>Reductase inhibitors, due to an increased risk for rhabdomyolysis
Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other antilipidemics, this drug: - ANSWER>>Exchanges chloride ions for negatively charged acids in the bowel
Because of their site of action, bile acid sequestering resins: - ANSWER>>Should be administered separately from other drugs by at least four hours
Colestipol comes in a powdered form. The patient is taught to: - ANSWER>>Mix the powder with four to six ounces of milk or fruit juice
The choice of diuretic to use in treating hypertension is based on: - ANSWER>>Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40 mL/min range
Direct renin inhibitors have the following properties. They: - ANSWER>>"Shut down" the entire RAAS cycle
When comparing ACE and ARB medications, which of the following holds true? - ANSWER>>Both contribute to some retention of potassium
How is diabetic renal protection affected by ACE medications? Diabetes mellitus patients: - ANSWER>>Have a reduced rate of renal progression, but ACE medications still need to be discontinued when advanced renal issues are present
What dermatological issue is linked to Amiodarone use? - ANSWER>>Progressive change of skin tone toward a blue spectrum
Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why? - ANSWER>>Profound hypotension
Which formulation of nitrate is appropriate for acute anginal pain? - ANSWER>>Sublingual
Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol margarine daily for the past three months. Her LDL is 135 mg/dL. An appropriate treatment for her would be: - ANSWER>>Determined by her risk factors
Phil is a 54-year-old male with multiple risk factors who has been on a high-dose statin for three months to treat his high LDL level. His LDL is still higher than his goal and his triglycerides are elevated. A reasonable change in therapy would be to: - ANSWER>>Continue the statin and add in ezetimibe.
Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman? - ANSWER>>Bile acid-binding resins
Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112 mg/dL and he has not tolerated statins. He warrants a trial of a: - ANSWER>>Fibric acid derivative
Jose is a 12-year-old overweight child with a total cholesterol of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include ____________ with a re- evaluation in six months. - ANSWER>>Sterols
Monitoring of a patient who is on a lipid-lowering drug includes: - ANSWER>>Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in six weeks
Before starting therapy with a statin, the following baseline laboratory values should be evaluated: - ANSWER>>Liver function [alanine aminotransferase/aspartate aminotransferase (ALT/AST)] and creatine kinase
When starting a patient on a statin, education would include: - ANSWER>>All of the above:
- If they stop the medication their lipid levels will return to pretreatment levels.
- Medication is a supplement to diet therapy and exercise.
- If they have any muscle aches or pain, they should contact their provider.
Omega-3 fatty acids are best used to help treat: - ANSWER>>High triglycerides
When are statins traditionally ordered to be taken? - ANSWER>>With the evening meal
Which of the following patients should not have a statin medication ordered? - ANSWER>>Someone with three first- or second-degree family members with history of muscle issues when started on statins
Fiber supplements are great options for elderly patients who have the concurrent problem of: - ANSWER>>Long-term issues of constipation
What is considered the order of statin strength from lowest effect to highest? - ANSWER>>Lovastatin, Simvastatin, Rosuvastatin
The most recent treatment guidelines strongly recommend dosing primarily based on: - ANSWER>>Personal CV risk
Which statins are most associated with soft plaque regression? - ANSWER>>Rosuvastatin and atorvastatin
The first step in responding to a patient who complains of muscular pain with statins - ANSWER>>Review the history and characteristics of the pain.
Omega-3 supplements can come from animal or plant sources. Which of the following is correct? - ANSWER>>Fish sources have potential contamination with mercury.
Why has nonfasting lipid testing become popular? - ANSWER>>All of the above:
Based on clinical trials, compelling indications for an ACE inhibitor as treatment for hypertension include: - ANSWER>>Renal parenchymal disease
An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? - ANSWER>>Nondihydropyridine calcium channel blockers
If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents? - ANSWER>>Diuretics
Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true? - ANSWER>>Few antihypertensive drugs come in generic formulations.
Caffeine, exercise, and smoking should be avoided for at least how many minutes before blood pressure measurement? - ANSWER>>
Blood pressure checks in children: - ANSWER>>Should be done during every health-care visit after three years of age
Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include: - ANSWER>>All of the above:
- Lifestyle changes are difficult to achieve and maintain.
- Adverse drug reactions.
- Costs of drugs and monitoring with laboratory tests can be expensive.
Lifestyle modifications for patients with early hypertension include: - ANSWER>>Adopt the dietary approaches to stop hypertension (DASH) diet.
Which diuretic agents typically do not need potassium supplementation? - ANSWER>>Aldosterone inhibitors
Aldactone family medications are frequently used when the hypertensive patient also has: - ANSWER>>Advancing liver dysfunction
Hypertensive African Americans are typically listed as not being as responsive to which drug groups? - ANSWER>>ACE inhibitors
What educational point concerning fluid intake must be covered with diuretic prescriptions? - ANSWER>>Fluid intake should remain near normal for optimal performance.
What is a common side-effect concern with hypertensive medications and all individuals, but especially the elderly? - ANSWER>>Risk of falls
Which drug class is recommended for first-line treatment of hypertension in African Americans? - ANSWER>>Calcium channel blockers
Current guidelines for blood pressure treatment in geriatric patients include: - ANSWER>>Loosen strict adherence to reduction below 160 systolic.
Which antihypertensive is safe during pregnancy? - ANSWER>>Beta blocker
Potassium excess risk is highest with which combination of medications: - ANSWER>>An ARB and an aldosterone antagonist
Once-daily diuretics are typically suggested to be taken: - ANSWER>>Upon awakening
A patient is taking warfarin and is asking about what they can take for minor aches and pains. The best recommendation is: - ANSWER>>Acetaminophen, not to exceed 4 grams per day
A patient had a deep vein thrombosis (DVT) and was on heparin and warfarin in the hospital and discharged home on warfarin. She asks her primary care nurse
Patients receiving heparin therapy require monitoring of: - ANSWER>>Platelets every two to three days for thrombocytopenia that may occur on day four of therapy
The routine monitoring recommended for low-molecular-weight heparin is - ANSWER>>Factor Xa levels if the patient is pregnant
When writing a prescription for warfarin it is common to write _________ on the prescription. - ANSWER>>The brand name of warfarin and "do not substitute"
Education of patients who are taking warfarin includes discussing their diet. Instructions include: - ANSWER>>Avoid foods high in vitamin K.
Patients who are being treated with epoetin alfa need to be monitored for the development of: - ANSWER>>Thrombocytopenia
If a patient is taking darbepoetin alfa (Aranesp), their blood counts should be monitored to determine if a dosage adjustment is needed. How soon should this be done after starting the drug? - ANSWER>>Six weeks if they are a cancer patient
A patient is having hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alfa he should also be prescribed: - ANSWER>>Iron, to start when the epogen starts
Monitoring for a patient prescribed iron for iron deficiency anemia includes: - ANSWER>>Reticulocyte count one week after therapy is started
Patient education regarding taking iron replacements includes: - ANSWER>>Iron is best taken on an empty stomach with juice.
Patients with pernicious anemia require treatment with: - ANSWER>>Vitamin B
The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is: - ANSWER>>Hemoglobin levels return to normal.
Patients who are beginning therapy with vitamin B12 need to be monitored for: - ANSWER>>Leukopenia that occurs at one to three weeks of therapy
A patient taking carbamazepine needs to be started on a direct factor Xa inhibitor for antithrombotic therapy. Which of the direct factor Xa inhibitors should be avoided due to drug interactions? - ANSWER>>Rivaroxaban
Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first? - ANSWER>>Patients with kidney stones
Patients taking antacids should be educated regarding these drugs, including letting them know that: - ANSWER>>All of the above:
- They may cause constipation or diarrhea.
- Many are high in sodium.
- They should separate antacids from other medications by one hour.
A patient has diarrhea and is wondering if they can take loperamide (Imodium). Loperamide: - ANSWER>>Slows gastric motility and reduces fluid and electrolyte loss from diarrhea
Bismuth subsalicylate (Pepto-Bismol) is a common over-the-counter (OTC) remedy for gastrointestinal complaints. Bismuth subsalicylate: - ANSWER>>May cause stools to turn reddish color
A young adult will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes following normal food and water precautions as well as taking: - ANSWER>>Bismuth subsalicylate before each meal and at bedtime
Pernicious anemia is treated with: - ANSWER>>Vitamin B
Premature infants require iron supplementation with: - ANSWER>>2 mg/kg per day until age 12 months
Breastfed infants should receive iron supplementation of: - ANSWER>>1 mg/kg per day
An adult female presents to the clinic with menorrhagia. Her hemoglobin is 10. and her ferritin is 15 ng/mL. Initial treatment for her anemia is: - ANSWER>> mg ferrous sulfate tid
A 15-month-old male has a screening hemoglobin of 10.4 g/dL. Treatment for anemia in toddlers is: - ANSWER>>6 mg/kg per day of elemental iron
Monitoring for a patient taking iron to treat iron deficiency anemia includes: - ANSWER>>Hemoglobin, hematocrit, and ferritin four weeks after treatment is started
An adult female has been prescribed iron to treat her anemia. Education of patients prescribed iron would include: - ANSWER>>Increase fluids and fiber to treat constipation.
A patient has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy? - ANSWER>>600 mcg/day
A patient with Crohn's disease has a documented folate deficiency. Drug therapy for folate deficiency anemia is: - ANSWER>>Oral folic acid 1 to 2 mg per day
Patients who are being treated for folate deficiency require monitoring of: - ANSWER>>Hematocrit and hemoglobin at one week and then at eight weeks
The treatment of vitamin B12 deficiency is: - ANSWER>>1,000 mcg daily of oral cobalamin
The dosage of Vitamin B12 to initially treat pernicious anemia is: - ANSWER>>Vitamin B12 1,000 mcg IM daily for one week then 1,000 mg IM weekly for a month
Before beginning IM vitamin B12 therapy, which laboratory values should be obtained? - ANSWER>>All of above:
- Reticulocyte count, hemoglobin, and hematocrit
- Iron
- Vitamin B
________ should be monitored when vitamin B12 therapy is started. - ANSWER>>Serum potassium
Anemia due to chronic renal failure is treated with: - ANSWER>>Epoetin alfa (Epogen)
Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: - ANSWER>>Estrogen
Lifestyle changes are the first step in treatment of GERD. Food or drink that may aggravate GERD include: - ANSWER>>Caffeine
Metoclopramide improves GERD symptoms by: - ANSWER>>Increasing lower esophageal tone
Antacids treat GERD by: - ANSWER>>Increasing gastric pH
What would be the appropriate treatment for H. pylori in a patient who recently took azithromycin for "bronchitis"? - ANSWER>>Quadruple therapy with a PPI, bismuth, tetracycline, and metronidazole for 10 to 14 days
When given subcutaneously, how long until neutral protamine Hagedorn (NPH) insulin begins to take effect (onset of action) after administration? - ANSWER>>Sixty to ninety minutes
Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include: - ANSWER>>Dizziness, confusion, diaphoresis, and tachycardia
Nonselective beta blockers and alcohol create serious drug interactions with insulin because they: - ANSWER>>Mask the signs and symptoms of altered glucose levels
Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true? - ANSWER>>Duration of action is increased when the dose is increased.
The decision may be made to switch from twice daily NPH insulin to insulin glargine to improve glycemia control throughout the day. If this is done: - ANSWER>>The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
When blood glucose levels are difficult to control in type 2 diabetes, some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research? - ANSWER>>Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: - ANSWER>>Decreases glycogenolysis by the liver
Prior to prescribing metformin, the provider should: - ANSWER>>Draw a serum creatinine to assess renal function
The action of gliptins is different from other antidiabetic agents because they: - ANSWER>>Act on the incretin system to indirectly increase insulin production
Sitagliptin has been approved for: - ANSWER>>Both 1 and 2
- Monotherapy in once-daily doses
- Combination therapy with metformin
GLP-1 agonists - ANSWER>>Directly bind to a receptor in the pancreatic beta cell
Avoid concurrent administration of exenatide with which of the following drugs? - ANSWER>>All of the above:
- Digoxin
- Warfarin
- Lovastatin
Administration of exenatide is by subcutaneous injection: - ANSWER>>Sixty minutes prior to the morning and evening meal
When is metformin typically initiated for glucose metabolism issues? - ANSWER>>When the patient is diagnosed with prediabetes
Which characteristic of metformin makes it a popular selection for diabetes care?
- ANSWER>>Only rarely causes hypoglycemia
All of the following are options for insulin injections when each dose is close to 100 units except: - ANSWER>>Stop injectable insulin and change to oral methods only
Long-term injection site skin changes are called: - ANSWER>>Lipodystrophy
