Pharmacology MSN 571 PHARM Midterm Exam 1 Questions and Answers- United States University
1. Why are most statins recommended to be taken in the
... [Show More] evening?
Can cause insomnia
Decreases stomach upset
Cholesterol synthesis increases during the night
Cholesterol synthesis decreases during the night
2. What is the mechanism of action of ezetimibe?
It inhibits the absorption of bile, thus causing the liver to produce bile
from cholesterol.*
It decreases the adhesion of cholesterol on the arterial walls.
It inhibits absorption of dietary and biliary cholesterol in the small
intestine.
(option cutoff)
3. Which of the following is not an expected adverse effect of Niacin?
Arthralgias
Hyperglycemia
Itching
Flushing
4. Which adverse effects would you monitor for a patient receiving a statin to
manage cholesterol levels. Select all that apply.
Gallstone development
Increased serum transaminase levels
Unexplained muscle pain or tenderness *
Nonalcoholic fatty liver disease *
Elevated creatinine kinase (CK) level with muscle pain *
5. Which of the following drug classes should be avoided in peptic ulcer
disease?
Avoid diuretics
Avoid NSAIDS
Avoid proton pump inhibitors
Avoid antibiotics
6. Which of the following groups of antibiotics is notable for side effects such
as nephrotoxicity and ototoxicity?
Cephalosporins
Beta-lactams
Aminoglycoside
Tetracyclines
7. Which of the following is most likely an intervention for otitis media?
Corticosteroids
Aspirin
Immunoglobulins
Amoxicillin
8. Which of the following medications is a fluoroquinolone antibiotic?
Penicillin
Azithromycin
Amikacin
Ciprofloxacin
9. Which of the following best classifieds aminoglycosides, macrolides, and
clindamycin?
mycolic acid synthesis inhibitors
protein synthesis inhibitors
cell wall inhibitors
folic acid synthesis inhibitors
10. Which of the following groups of antibiotics binds to the 50S subunit of
the bacterial ribosome and includes drugs such as erythromycin and
azithromycin?
macrolides
fluoroquinolones
aminoglycosides
tetracyclines
11. Which of the following groups of people are at risk for early
hypertension?
African American
Adolescents or young adults
Mexican American Culture
Old females
12. Which of the following drug treatment strategies is associated with peptic
ulcer disease?
Opioids
Two antibiotics
Corticosteroids
Hormonal therapy
13. Which of the following medications or drug classes is commonly indicated
for managing gestational hypertension?
Spironolactone (Aldactone)
Loop diuretics
Calcium channel blockers
Dobutamine
Calcium gluconate
14. Which antibiotic class disrupts folate metabolism in bacteria and is often
combined with trimethoprim?
cephalosporins
fluoroquinolones
Aminoglycosides
Sulfonamides
macrolides
15. Convert 15 lbs 8 oz to kilograms. Round to the nearest 100th.
7.00
34.10
33.00
7.03
16. A patient receiving intravenous gentamicin has a toxic serum drug level.
The prescriber confirms that the dosing is correct. Which possible cause of
the situation will the provider explore?
Whether patient is taking a medication that binds to serum albumin
Whether a loading dose was administered
If the ordered dose frequency is longer than the gentamicin half-life
If the drug was completely dissolved in the IV solution
17. The therapeutic index is a measure of drug:
Absorption rate
Safety profile
Bioavailability status
Effectiveness
18. Which science provides primary healthcare providers the opportunity to
individualize drug therapy based on a patient's genetic makeup?
Pharmacogenetics
Pharmacogenomics *
Pharmacodynamics
Pharmacokinetics
19. Which of the following is the most appropriate choice to describe age
associated changes that can affect pharmacokinetics in older patients?
Increase in total body water
Decrease in creatinine clearance
(option cutoff)
(option cutoff)
20. Drugs that use CYP 3A4 enzymes for metabolism may:
None of the answers are correct
Induce the metabolism of another drug
Inhibit the metabolism of another drug *
Both induce and inhibit the metabolism of another drug.
21. An example of a first-dose reaction that may occur includes:
Orthostatic hypotension that does not occur with repeated doses
Hemolytic anemia from Ceftriaxone use
Contact dermatitis from neomycin use *
Purple glove syndrome with phenytoin use
22. Your patient is diagnosed with Psoriasis. You can prescribe all except:
Methotrexate
Vitamin E Analogs
Tars *
Glucocorticoids
23. Isotretinoin (Accutane) is a drug employed in the treatment of severe
recalcitrant cystic acne. Which one of the following is not an adverse effect
associated with its use?
Conjunctivitis
Fetal abnormalities
Hyponatremia *
Hypertriglyceridemia
24. A 14-year-old patient has moderate acne that has not responded to
topical Which treatment choice will the NP discuss with the patient and
parents?
Doxycycline (vibramycin) *
Combination oral contraceptive medication
Spironolactone
Isotretinoin (Accutane)
25. The renin-angiotensin-aldosterone system plays an important role in
maintaining blood pressure. Which compound in this system is most powerful
at raising blood pressure?
Angiotensin III
Angiotensin II *
Angiotensin I
Renin
26. A patient who developed hypertension at 28 weeks gestation age. What
medication do you anticipate giving?
Any one of these medications listed here may be prescribed to a
pregnant *
Methyldopa
Nifedipine
Labetalol
27. A patient has been prescribing furosemide for pulmonary edema
secondary to congestive heart failure. What should be included in patient
teaching instructions?
Rise Slowly from sitting or reclining positions.
Report any irregular heartbeat, muscle weakness, or cramping.
Report any tenderness or swelling of the joints to your healthcare
provider.
All are true *
28. Which calcium channel blocker would be ideally used to treat a
dysrhythmia?
Nifedipine
Verapamil *
Amlodipine
Nicardipine
29. A patient has been taking hydrochlorothiazide and lisinopril (Prinzide,
Zestoretic) for moderate hypertension. On the following the following signs
and symptoms would be most concerned related to this condition?
Fatigue, weakness, dyspnea when supine
Anorexia, mild fever, dark urine
Fatigue, unexplained weight loss, polydipsia
Dull abdominal pain, anorexia, weight loss *
30. The Nurse Practitioner is teaching the NP student about acetaminophen.
Which of the following would be included when teaching the student?
All of the answers are correct *
The antidote to acetaminophen overdose is acetylcysteine
Patients need to watch over-the-counter medications for
acetaminophen in the product to prevent overdose
Patients with normal kidney and liver function should not take more
than 4000mg per day.
31. _________ is an example of an agonist-antagonist opioid.
Morphine
Buprenorphine
Naloxone *
Diprenorphine
32. A 76-year-old female with renal insufficiency presents to the clinic with
severe pain secondary to a compression fracture in the lumbar spine. She
reports that the pain has been uncontrolled with tramadol, and it is decided
to start treatment with an opioid. Which of the following is the best opioid for
this patient?
Fentanyl transdermal patch
Hydrocodone *
Meperidine
Morphine
33. A patient with opioid use disorder has undergone detoxification with
buprenorphine.
(option cutoff)
(option cutoff)
“The combination drug contains more buprenorphine”
“Buprenorphine causes more respiratory depression”
34. What are the most important characteristics that any drug can have?
Selectivity
All the answers are correct *
Effectiveness
Safety
35. Which of the following is not consistent with the rules for geriatric
prescribing:
Steady state is reached more quickly in the older adult
Adverse drug responses present atypically in the older adult
Reduce the number of drugs in the patient's regimen whenever
possible *
Half-life will be longer in older adults
36. The 4th to the 10th week of gestation is the period of time when there is
the greatest concern about drug-induced:
Fetal hemorrhage
Fetal cardiac arrest
Fetal malformations *
Labor
37. A pediatric client is prescribed amoxicillin 25mg/kg/day divided in two
daily doses. The medication is available as 125mg/5ml. The client weighs 25
pounds. What is the total daily dose for the client? Round answer to the
nearest tenth __________mg.
205 mg
280 mg *
190 mg
300 mg
38. What changes in drug distribution with aging would influence prescribing
a medication in a 90-year old patient?
Decreased plasma proteins *
Increased volume of distribution
Increased muscle-to-fat-ratio
Decreased lipid solubility
39. A patient is diagnosed with otitis externa. Comorbidities include diabetes
mellitus, hypertension, and advanced multiple sclerosis. Which type of
education regarding medication administration would you provide?
The oral administration of a prescription for
hydrocortisone/neomycin/polymyxin B combination solution
The administration of topical combination medications for a
prescription of fluoroquinolones/glucocorticoid com *
The oral administration of a prescription for fluoroquinolone
The administration of topical medications for a prescription of alcohol
plus acetic acid solution.
40. A 6-year-old child presents with crying due to ear pain. Tympanic
membranes are erythematous, bulging, and immobile, but intact. In addition
to antibiotic therapy, what will the provider recommend for pain
management?
Prednisone
A tympanostomy to relieve pressure in the middle ear
Low dose aspirin
Lidocaine ear drops *
41. The patient asks if there is any other option besides antibiotics to treat
acute otitis media. How will you respond?
“Pain management is only necessary when antibiotics are prescribed.”
“Pain management is also part of the treatment plan for otitis media.*
“Antibiotics are the way to cure otitis media.”
“Pain management is reserved for use when the tympanic membrane
is burst.”
42. Which drug would most likely be used to treat candidiasis?
Terconazole
Amphotericin B
Tioconazole
Nystatin *
43. A 19-year-old female comes to your clinic with a greenish, malodorous
discharge. Vulvar pruritus is also present. On pelvic exam, vaginal mucosa is
erythematous. Wet mount of discharge shows a motile organism. The patient
is started on an appropriate therapy. Later that evening, the patient develops
flushing, nausea and vomiting after eating dinner with a glass of wine. The
patient was most likely treated with which of the following medications?
Metronidazole *
Ceftriaxone
Fluconazole
Azithromycin
44. A patient with genital herpes simplex becomes pregnant. What
statement made by the patient concerning her prescribed acyclovir would
indicate that teaching was effective?
“I should only take this medication during an active outbreak of my
herpes,”
“I need to switch to the topical formulation of this medication now that
I am pregnant.”
It is best to discontinue the use of this medication until I deliver the
baby.”
“I may continue the acyclovir throughout the course of my pregnancy.”
*
45. Which of the following is a common case of iron deficiency in patients in
the United States?
Chronic blood loss through the gastrointestinal tract *
Rapid growth during adolescence
Vegetarian eating patterns
Decreased intestinal uptake of iron
46. Anemia of chronic renal failure is caused by the lack of:
parathyroid hormone
adrenaline
thyroid hormone
Erythropoietin *
47. A 75-year-old woman with hypertension is being treated with a thiazide.
Her blood pressure responds well and reads at 120/76mmHg. After several
months on the medication, she complains of being tired and weak. An
analysis of the blood indicates values for which of the following?
Potassium *
Sodium
Calcium
Glucose
48. The patient is receiving anticoagulant therapy. The INR value for the
patient today is 1.5. In response to this, what will you do?
The level cannot be interpreted without knowing the prothrombin time
and the international normalized ratio (INR).
The level is outside the expected target therapeutic level of
anticoagulation; it is too high.
The level is within the expected target therapeutic level of
anticoagulation.
The level is outside the expected target therapeutic level of
anticoagulation; it is too low. *
49. A patient with hypercholesterolemia who is taking 20mg of simvastatin
as prescribed. After a few days, the patient’s urinalysis reports indicated the
presence of myoglobin. How would you manage this patient?
Instruct the patient to take the simvastatin before meals.
Instruct the patient to decrease his dose to 10mg of simvastatin daily.
Instruct the patient to drink 250 mL of water with the simvastatin.
Instruct the patient to discontinue the simvastatin. *
50. Which of the following may cause a detrimental potentiate drug
interaction?
Propranolol and albuterol
Isoniazid and rifampin
Aspirin and warfarin *
Sulbactam and ampicillin
1. A patient is started on warfarin therapy while also receiving intravenous
heparin. The patient is concerned about the risk for bleeding. What would
you tell the patient?
“Because of your valve replacement, it is especially important for you
to be given anticoagulant therapy. The heparin and warfarin together
are more effective than one alone”
“Your concern is valid. I will call the doctor to discontinue the heparin.”
“Because you are now up and walking, you have a higher risk of blood
clots and therefore need to be on both medications.”
“It usually takes about 3 days to achieve a therapeutic effect for
warfarin, so the heparin is continued until the warfarin is therapeutic.”
*
52. The patient is receiving anticoagulant therapy. The INR value for the
patient today is 1.5. In response to this, what will you do?
Hold the nest dose of warfarin
Prescribe protamine sulfate
Increase the heparin drip rate
Prescribe an additional dose of warfarin. *
53. Which of the following is most true of nurse practitioner prescribers?
Prescriptive authority is under the full control of the Board of Nursing in
all states. *
All states allow nurse practitioners to prescribe controlled substances
All states allow some level of prescription writing by nurse
practitioners.
None of the answer choices are correct.
54. Which prescriber action will have the greatest impact on the patient’s
commitment to adherence to any medication therapy?
Assuring that the medication prescription will be covered by the
patient's insurance
Providing mediation education that the patient can easily understand*
Scheduling once a day administration
Prescribing the medication in oral form whenever possible
55. The selection of antibiotics for the treatment of infection is based on
which understanding of selective toxicity?
The ability to avoid injuring host cells.
The ability to act against a specific microbe.
The ability to suppress bacterial resistance. *
The ability to transfer DNA coding.
56. When planning care for a patient receiving a sulfonamide antibiotic,
which is the appropriate intervention?
Force fluids to at least 2000 mL/day *
Encourage liquids that produce acidic urine.
Insert a Foley catheter for accurate input and output measurement.
Encourage a diet that causes an alkaline ash.
57. A patient presents to your clinic with symptoms of a potentially serious
gram-negative infection. You decide to give a cephalosporin antibiotic now
while awaiting laboratory results. You choose:
None of the answers are correct. *
1st generation cephalosporin
3rd generation cephalosporin
2nd generation cephalosporin
58. Acute Bacterial Rhinosinusitis Syndrome (ABRS)
Acinetobacter, Enterococcus Faecalis, Campylobacter
Escherichia Coli, klebsiella pneumoniae, proteus Mirabilis
Legionella pneumoniae, Mycoplasma pneumoniae, Chlamydia
pneumoniae
Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus,
Influenza*
59. The NP explains to the NP students about penicillin. Which is true about
penicillin? Select all that apply.
They are known as beta-lactam antibiotics. *
They cause bacteria to take up excess amounts of water and sodium.
They are considered one of the safest antibiotics.
They are active only against bacteria that are growing and dividing. *
60. The patient is taking daptomycin. The NP should obtain a creatine
phosphokinase (CPK) level when the patient shows which symptom?
Abdominal bloating and diarrhea
Muscle pain and weakness *
Headache and visual disturbances
Increased urination and urinary urgency
61. Risk factors for extended spectrum Beta Lactamase producing organisms
include all except:
Use of corticosteroids
(option cutoff)
They are considered one of the safest antibiotics
They are active only against bacteria that are growing and dividing *
62. Treatment to eradicate nasal MRSA is mupirocin. Patient education
regarding nasal MRSA includes:
Nasal MRSA eradication requires at least 4 weeks of therapy, with up to
8 weeks needed in some patients.*
Alternate treating one nare in the morning and the other in the
evening.
Take the oral medication exactly as prescribed.
Insert one-half of the dose in each nostril twice a day.
63. A patient suspected of having influenza comes to the urgent care for
treatment. Which information will the NP need before prescribing
oseltamivir?
Allergies to antibiotics
Length of time since onset of symptoms *
Over-the-counter medications taken in the last 48 hours
Immunization history
64. What is the treatment option for a patient who reported small, vesicular
lesions on his genitals that lasted between 10 and 20 days?
Acyclovir (Zovirax) *
Three injections of penicillin
Test of cure
One time dose of azithromycin
65. A provider is about to prescribe prednisone to a patient for tendonitis.
What item in the patient’s medical history would cause the provider to
reconsider that action?
Systemic fungal infection *
Seborrheic dermatitis
Allergic rhinitis
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