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Test bank pharmaco.docx NURSING NGR 5035 Chapter 26-35

Test bank NURSING NGR 5035 Chapter 26-35 Chapter 26: Drugs Used in Treating Eye and Ear Disorders Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The Centers for Disease Control recommends all newborn infants receive prophylactic administration of ____ within 1 hour of birth. A. Gentamicin ophthalmic ointment B. Ciprofloxacin ophthalmic drops C. Erythromycin oral suspension D. Erythromycin ophthalmic ointment ____ 2. Conjunctivitis in a child that is accompanied by acute otitis media is treated with: A. Sulfacetamide 10% ophthalmic solution (Bleph-10) B. Bacitracin/polymyxin B (Polysporin) ophthalmic drops C. Ciprofloxacin (Ciloxan) ophthalmic drops D. High-dose oral amoxicillin ____ 3. Twenty-year-old Annie comes to clinic complaining of copious yellow-green eye discharge. Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be: A. None; wait for the culture results to determine the course of treatment B. Ciprofloxacin (Ciloxan) ophthalmic drops C. IM ceftriaxone D. High-dose oral amoxicillin ____ 4. Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes: A. Throwing away eye makeup and purchasing new B. Redness and intense burning is normal with ophthalmic antibiotics C. When applying eye ointment, set the tip of the tube on the lower lid and squeeze in inch D. Use a cotton swab to apply ointment, spreading the ointment all over the lid and in the conjunctival sac ____ 5. Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers due to: A. There may be an antagonistic reaction between the two B. The additive effects may include bradycardia C. They may potentiate each other and cause respiratory depression D. The additive effects may cause metabolic acidosis ____ 6. David presents to clinic with symptoms of allergic conjunctivitis. He is prescribed cromolyn sodium (Opticrom) eye drops. The education regarding using cromolyn eye drops includes: A. He should not wear his soft contacts while using the cromolyn eye drops B. Cromolyn drops are instilled once a day to prevent allergy symptoms C. Long-term use may cause glaucoma D. He may experience bradycardia as an adverse effect ____ 7. Ciprofloxacin otic drops are contraindicated in: A. Children B. Patients with acute otitis externa C. Patients with a perforated tympanic membrane D. Swimmer’s ear ____ 8. ____ is prescribed to prevent swimmer’s ear. A. Ciprofloxacin otic drops (Ciloxan) B. Isopropyl ear drops (EarSol) C. Colistin (Coly-Mycin S Otic) D. Gentamicin otic drops ____ 9. Patient education regarding the use of ciprofloxacin-hydrocortisone (Cipro HC otic) ear drops includes: A. Fill the canal with the drops with each dose B. Some redness and itching around the ear canal is normal C. Warm the bottle of ear drops in his or her hand before administering D. Cipro HC otic may cause ototoxicity ____ 10. Janie presents to clinic with hard ear wax in both ear canals. Instructions regarding home removal of hard cerumen includes: A. Moisten a cotton swab (Q-tip) and swab ear canal twice daily B. Instill tap water in both ears while bathing C. Squirt hydrogen peroxide into ears with each bath D. Instill carbamide peroxide (Debrox) twice daily until canals are clear Chapter 27: Anemia Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Pernicious anemia is treated with: A. Folic acid supplement B. Thiamine supplement C. Vitamin B12 D. Iron ____ 2. Premature infants require iron supplementation with: A. 10 mg/day of iron B. 2 mg/kg per day until age 12 months C. 7 mg/day in diet D. 1 mg/kg per day until adequate intake of iron from foods ____ 3. Breastfed infants should receive iron supplementation of: A. 3 mg/kg per day B. 6 mg/kg per day C. 1 mg/kg per day D. Breastfed babies do not need iron supplementation ____ 4. Valerie presents to clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia would be: A. 18 mg/day of iron supplementation B. 6 mg/kg per day of iron supplementation C. 325 mg ferrous sulfate per day D. 325 mg ferrous sulfate TID ____ 5. Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be: A. 18 mg/day of iron supplementation B. 6 mg/kg per day of elemental iron C. 325 mg ferrous sulfate per day D. 325 mg ferrous sulfate TID ____ 6. Monitoring for a patient taking iron to treat iron deficiency anemia is: A. Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started B. Complete blood count every 4 weeks throughout treatment C. Annual complete blood count D. Reticulocyte count in 4 weeks ____ 7. Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include: A. Take the iron with milk if it upsets her stomach B. Antacids may help with the nausea and GI upset caused by iron C. Increase fluids and fiber to treat constipation D. Iron is best tolerated if it is taken at the same time as her other medications ____ 8. Allie has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy? A. 40 mcg/day B. 400 mcg/day C. 800 mcg/day D. 2 gm/day ____ 9. Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is: A. Oral folic acid 1 to 2 mg per day B. Oral folic acid 1 gram per day C. IM folate weekly for at least 6 months D. Oral folic acid 400 mcg daily ____ 10. Patients who are being treated for folate deficiency require monitoring of: A. Complete blood count every 4 weeks B. Hematocrit and hemoglobin at 1 week and then at 8 weeks C. Reticulocyte count at 1 week D. Folate levels every 4 weeks until hemoglobin stabilizes ____ 11. The treatment of vitamin B12 deficiency is: A. 1,000 mcg daily of oral cobalamin B. 2 gm per day of oral cobalamin C. 100 mcg/day Vitamin B12 IM D. 500 mcg/dose nasal cyanocobalamin 2 sprays once a week ____ 12. The dosage of Vitamin B12 to initially treat pernicious anemia is: A. Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month B. Vitamin B12 IM monthly C. Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg weekly for a month D. Oral cobalamin 1,000 mcg daily ____ 13. Before beginning IM Vitamin B12 therapy, which laboratory values should be obtained? A. Reticulocyte count, hemoglobin, and hematocrit B. Iron C. Vitamin B12 D. All of the above ____ 14. ____ should be monitored when Vitamin B12 therapy is started. A. Serum calcium B. Serum potassium C. Ferritin D. C-reactive protein ____ 15. Anemia due to chronic renal failure is treated with: A. Epoetin alfa (Epogen) B. Ferrous sulfate C. Vitamin B12 D. Hydroxyurea 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 oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS? A. Calcium channel blockers B. Beta blockers C. ACE inhibitors D. Aspirin ____ 2. Not all chest pain is caused by myocardial ischemia. Non-cardiac causes of chest pain include: A. Pulmonary embolism B. Pneumonia C. Gastroesophageal reflux D. 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: A. Class I B. Class II C. Class III D. Class IV ____ 4. Patients at high risk for developing significant coronary heart disease are those with: A. LDL values between 100 and 130 B. Systolic blood pressure between 120 and 130 C. Class III angina D. Obesity ____ 5. To reduce mortality, all patients with angina, regardless of Class, should be on: A. Aspirin 81 to 325 mg/d B. Nitroglycerin sublingually for chest pain C. ACE inhibitors or ARBs D. Digoxin ____ 6. Patients who have angina, regardless of Class, who are also diabetic, should be on: A. Nitrates B. Beta blockers C. ACE inhibitors D. 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. A. Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload. B. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload. C. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply. D. 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: A. Heart failure B. Hypertension C. Both A and B D. Neither A nor B ____ 9. Beta blockers are especially helpful for patients with exertional angina who also have: A. Arrhythmias B. Hypothyroidism C. Hyperlipidemia D. Atherosclerosis ____ 10. Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use? A. These drugs are useful for immediate symptom relief when the patient is certain it is angina. B. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away. C. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than three doses. If chest pain is still not relieved, go to the hospital. D. All of the above ____ 11. Isosorbide dinitrate is a long-acting nitrate given BID. The schedule for administration is 7 AM and 2 PM because: A. Long-acting forms have a higher risk for toxicity B. Orthostatic hypotension is a common adverse effect C. It must be taken with milk or food D. Nitrate tolerance can develop ____ 12. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because: A. Nitrates increase MOS and beta blockers increase MOD B. Their additive affects permit lower doses of both drugs and their adverse reactions cancel each other out. C. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease D. All of the above ____ 13. Although they are often described as helpful in the lay media, which of the following therapies have not been shown to be helpful based on clinical evidence? A. Vitamins C and E B. Co-enzyme Q10 C. Folic acid D. All of the above ____ 14. Drug choices to treat angina in older adults differ from those of younger adults only in: A. Consideration of risk factors for diseases associated with and increased in aging B. The placement of drug therapy as a treatment choice before lifestyle changes are tried C. The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult D. Those with higher risk for silent myocardial infarction (MI) ____ 15. Which of the following drugs has been associated with increased risk for myocardial infarction (MI) in women? A. Aspirin B. Beta blockers C. Estrogen replacement D. Lipid-lowering agents ____ 16. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT: A. Patients often require multiple drugs B. A large number of angina patients are older adults on fixed incomes C. Generic formulations may be cheaper but are rarely bioequivalent D. Lack of drug selectivity may result in increased adverse reactions ____ 17. Five questions should be asked during the follow up of any angina patient. They include: A. Have there been any changes in lab data since the last visit? B. Has the level of physical activity associated with the angina changed since the last visit? C. Have new risk factors come to light in producing the angina? D. Is the patient filling prescriptions and taking the drugs as prescribed? ____ 18. Situations that suggest referral to a specialist is appropriate include: A. When chronic stable angina becomes unpredictable in its characteristics and precipitating factors B. When a post-MI patient develops new-onset angina C. When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina D. All of the above Chapter 29: Anxiety and Depression Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Common mistakes practitioners make in treating anxiety disorders include: A. Switching medications after an 8- to 12-week trial B. Maximizing dosing of anti-anxiety medications C. Encouraging exercise and relaxation therapy before starting medication D. Thinking a partial response to medication is acceptable ____ 2. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: A. Alprazolam (Xanax) B. Diazepam (Valium) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ____ 3. An appropriate drug to initially treat panic disorder is: A. Alprazolam (Xanax) B. Diazepam (Valium) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ____ 4. Prior to starting antidepressants, patients should have laboratory testing to rule out: A. Hypothyroidism B. Anemia C. Diabetes mellitus D. Low estrogen levels ____ 5. David is a 34 year old who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include: A. Paroxetine may cause intermittent diarrhea B. He may experience sexual dysfunction beginning a month after he starts therapy C. He may have constipation and he should increase fluids and fiber D. Paroxetine has a long half-life so he may occasionally skip a dose ____ 6. Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly SSRI antidepressants work would be: A. Appetite and concentration improve in the first 1 to 2 weeks B. Sleep should improve almost immediately upon starting citalopram C. Full response to the SSRI may take 2 to 4 months after he reaches full therapeutic dose D. His dysphoric mood will improve in 1 to 2 weeks ____ 7. An appropriate drug for the treatment of depression with anxiety would be: A. Alprazolam (Xanax) B. Escitalopram (Lexapro) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ____ 8. An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: A. Venlafaxine (Effexor) B. Escitalopram (Lexapro) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ____ 9. The laboratory monitoring required when a patient is on an SSRI is: A. Complete blood count every 3 to 4 months B. Therapeutic blood levels every 6 months after steady state is achieved C. Blood glucose every 3 to 4 months D. There is no laboratory monitoring required ____ 10. Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the SSRI. What is the initial dosage adjustment when starting a taper off antidepressants? A. Change dose to every other day dosing for a week B. Reduce dose by 50% for 3 to 4 days C. Reduce dose by 50% every other day D. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life Chapter 29: Anxiety and Depression Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Common mistakes practitioners make in treating anxiety disorders include: A. Switching medications after an 8- to 12-week trial B. Maximizing dosing of anti-anxiety medications C. Encouraging exercise and relaxation therapy before starting medication D. Thinking a partial response to medication is acceptable ____ 2. An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be: A. Alprazolam (Xanax) B. Diazepam (Valium) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ____ 3. An appropriate drug to initially treat panic disorder is: A. Alprazolam (Xanax) B. Diazepam (Valium) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ____ 4. Prior to starting antidepressants, patients should have laboratory testing to rule out: A. Hypothyroidism B. Anemia C. Diabetes mellitus D. Low estrogen levels ____ 5. David is a 34 year old who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include: A. Paroxetine may cause intermittent diarrhea B. He may experience sexual dysfunction beginning a month after he starts therapy C. He may have constipation and he should increase fluids and fiber D. Paroxetine has a long half-life so he may occasionally skip a dose ____ 6. Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly SSRI antidepressants work would be: A. Appetite and concentration improve in the first 1 to 2 weeks B. Sleep should improve almost immediately upon starting citalopram C. Full response to the SSRI may take 2 to 4 months after he reaches full therapeutic dose D. His dysphoric mood will improve in 1 to 2 weeks ____ 7. An appropriate drug for the treatment of depression with anxiety would be: A. Alprazolam (Xanax) B. Escitalopram (Lexapro) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ____ 8. An appropriate first-line drug for the treatment of depression with fatigue and low energy would be: A. Venlafaxine (Effexor) B. Escitalopram (Lexapro) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ____ 9. The laboratory monitoring required when a patient is on an SSRI is: A. Complete blood count every 3 to 4 months B. Therapeutic blood levels every 6 months after steady state is achieved C. Blood glucose every 3 to 4 months D. There is no laboratory monitoring required ____ 10. Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the SSRI. What is the initial dosage adjustment when starting a taper off antidepressants? A. Change dose to every other day dosing for a week B. Reduce dose by 50% for 3 to 4 days C. Reduce dose by 50% every other day D. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life Chapter 31: Contraception Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of: A. Hemoglobin B. Serum calcium C. White blood count D. Serum potassium ____ 2. The mechanism of action of oral combined contraceptives which prevents pregnancy is: A. Estrogen prevents the LH surge necessary for ovulation B. Progestins thicken cervical mucous and slow tubal motility C. Estrogen thins the endometrium making implantation difficult D. Progestin suppresses FSH release ____ 3. To improve actual effectiveness of oral contraceptives women should be educated regarding: A. Use of a back-up method if they have vomiting or diarrhea during a pill packet B. Doubling pills if they have diarrhea during the middle of a pill pack C. They will have a normal menstrual cycle if they miss two pills D. Mid-cycle spotting is not normal and the provider should be contacted immediately ____ 4. A contraindication to the use of combined contraceptives is: A. Adolescence (not approved for this age) B. A history of clotting disorder C. Recent pregnancy D. Overweight ____ 5. Obese women may have increased risk of failure with which contraceptive method? A. Combined oral contraceptives B. Progestin-only oral contraceptive pill C. Injectable progestin D. Combined topical patch ____ 6. Ashley comes to clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be: A. Recommend she return to the clinic at the start of her next menses to get a Depo Provera shot B. Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first 7 days C. Prescribe oral contraceptives and have her start them the same day with a back-up method used for the first 7 days D. Discuss the advantages of using the topical birth control patch and recommend she consider using the patch ____ 7. When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is: A. Immediate protection against pregnancy the first week of using the pill B. No back-up method is needed when starting C. Menses occur during the week D. They can start the pill on the Sunday after the office visit ____ 8. The topical patch combined contraceptive (Ortho Evra) is: A. Started on the first day of the menstrual cycle B. Recommended for women over 200 pounds C. Is not as effective as oral combined contraceptives D. Has more adverse effects, such as nausea, than the oral combined contraceptives ____ 9. Progesterone-only pills are recommended for women who: A. Are breastfeeding B. Have a history of migraine C. Have a medical history that contradicts the use of estrogen D. All of the above ____ 10. Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects? A. Increased migraine headaches B. Increased risk of developing blood clots C. Irregular vaginal bleeding for the first few months D. Increased risk for hypercalcemia ____ 11. An advantage of using the NuvaRing vaginal ring for contraception is: A. It does not require fitting and is easy to insert B. It is inserted once a week, eliminating the need to remember to take a daily pill C. Patients get a level of estrogen and progestin equal to combined oral contraceptives D. All of the above ____ 12. Oral emergency contraception (Plan B) is contraindicated in women who: A. Had intercourse within the past 72 hours B. May be pregnant C. Are taking combined oral contraceptives D. Are using a diaphragm Chapter 32: Dermatologic Conditions Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be: A. Intermediate potency corticosteroid ointment (Kenalog) B. A combination of a corticosteroid and an antifungal (Lotrisone) C. A low potency corticosteroid cream applied sparingly (hydrocortisone 1%) D. A high potency corticosteroid cream (Diprolene AF) ____ 2. Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used for: A. Short-term or intermittent treatment of atopic dermatitis B. Topical treatment of fungal infections (Candida) C. Chronic, inflammatory seborrheic dermatitis D. Recalcitrant nodular acne ____ 3. Long-term treatment of moderate atopic dermatitis includes: A. Topical corticosteroids and emollients B. Topical corticosteroids alone C. Topical antipruritics D. Oral corticosteroids for exacerbations of atopic dermatitis ____ 4. Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with: A. Topical antipruritics B. Oral corticosteroids for 2 to 3 weeks C. Thickly applied topical intermediate-dose corticosteroids D. Isolation of the patient to prevent spread of the dermatitis ____ 5. When a patient has contact dermatitis, wet dressings with Domeboro solution are used for: A. Cleaning the weeping area of dermatitis B. Bathing the patient to prevent infection C. Relief of inflammation D. Providing a barrier layer to protect the surrounding skin ____ 6. Appropriate initial treatment for psoriasis would be: A. An immunomodulator (Protopic or Elidel) B. Wet soaks with Burrow’s or Domeboro solution C. Intermittent therapy with intermediate potency topical corticosteroids D. Anthralin (Drithocreme) ____ 7. Patient education when prescribing the Vitamin D3 derivative calcipotriene for psoriasis includes: A. Apply thickly to affected psoriatic areas two to three times a day B. A maximum of 100 grams per week may be applied C. Do not use calcipotriene in combination with their topical corticosteroids D. Calcipotriene may be augmented with the use of coal tar products ____ 8. Mild acne may be initially treated with: A. Topical combined antibiotic B. Minocycline C. Topical retinoid D. OTC benzoyl peroxide ____ 9. Tobie presents to clinic with moderate acne. He has been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education of Tobie would include: A. He should see an improvement in his acne within the first 2 weeks of treatment B. If there is no response in a week, double the daily application of adapalene (Differin) C. He may see an initial worsening of his acne that will improve in 6 to 8 weeks D. Adapalene may cause bleaching of clothing ____ 10. Josie has severe cystic acne and is requesting treatment with Accutane. The appropriate treatment for her would be: A. Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane) B. Order Accutane after educating her on the adverse effects C. Recommend she try oral antibiotics (minocycline) D. Refer her to a dermatologist for treatment ____ 11. The most cost-effective treatment for two or three impetigo lesions on the face is: A. Mupirocin ointment B. Retapamulin (Altabax) ointment C. Topical clindamycin solution D. Oral amoxicillin/clavulanate (Augmentin) ____ 12. Dwayne has classic tinea capitis. Treatment for tinea on the scalp is: A. Miconazole cream rubbed in well for 4 weeks B. Oral griseofulvin for 6 to 8 weeks C. Ketoconazole shampoo daily for 6 weeks D. Ciclopirox cream daily for 4 weeks ____ 13. Nicolas is a football player who presents to clinic with athlete’s foot. Patients with tinea pedis may be treated with: A. OTC miconazole cream for 4 weeks B. Oral ketoconazole for 6 weeks C. Mupirocin ointment for 2 weeks D. Nystatin cream for 2 weeks ____ 14. Jim presents with fungal infection of two of his toenails (onychomycosis). Treatment for fungal infections of the nail includes: A. Miconazole cream B. Ketoconazole cream C. Oral griseofulvin D. Mupirocin cream ____ 15. Scabies treatment for a 4-year-old child includes a prescription for: A. Permethrin 5% cream applied from the neck down B. Pyrethrin lotion C. Lindane 1% shampoo D. All of the above ____ 16. Vanessa has been diagnosed with scabies. Her education would include: A. She should apply the scabies treatment cream for an hour and wash it off B. Scabies may need to be retreated in a week after initial treatment C. All members of the household and close personal contacts should be treated D. Malathion is flammable and she should take care until the solution dries ____ 17. Catherine has head lice and her mother is asking about what products are available that are not neurotoxic. The only non-neurotoxin head lice treatment is: A. Permethrin 1% (Nix) B. Lindane shampoo C. Malathion (Ovide) D. Benzoyl alcohol (Ulesfia) ____ 18. Rick has male pattern baldness on the vertex of his head and has been using Rogaine for 2 months. He asks how effective minoxidil (Rogaine) is. Minoxidil: A. Provides a permanent solution to male pattern baldness if used for at least 4 months B. Will show results after 4 months of twice a day use C. May not work for Rick’s type of baldness D. Works better if he also uses hydrocortisone cream daily on his scalp Chapter 33: Diabetes Mellitus Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five to 90 percent of Type 1 diabetics have: A. Autoantibodies to two tyrosine phosphatases B. Mutation of the hepatic transcription factor on chromosome 12 C. A defective glucokinase molecule due to a defective gene on chromosome 7p D. Mutation of the insulin promoter factor ____ 2. Type 2 diabetes is a complex disorder involving: A. Absence of insulin production by the beta cells B. A suboptimal response of insulin-sensitive tissues in the liver C. Increased levels of glucagon-like peptide in the post-prandial period D. Too much fat uptake in the intestine ____ 3. Diagnostic criteria for diabetes include: A. Fasting blood glucose greater than 140 mg/dl on two occasions B. Post-prandial blood glucose greater than 140 mg/dl C. Fasting blood glucose 100 to 125 mg/dl on two occasions D. Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl ____ 4. Routine screening of asymptomatic adults for diabetes is appropriate for: A. Individuals who are older than 45 and have a BMI less than 25 kg/m2 B. Native Americans, African Americans, and Hispanics C. Persons with HDL cholesterol greater than 100 mg/dl D. Persons with pre-diabetes confirmed on at least two occasions ____ 5. Screening criteria for children who meet the following criteria should begin at age 10 and occur every 3 years thereafter: A. BMI above the 85th percentile for age and sex B. Family history of diabetes in first- or second-degree relative C. Hypertension based on criteria for children D. Any of the above ____ 6. Insulin is used to treat both types of diabetes. It acts by: A. Increasing beta cell response to low blood glucose levels B. Stimulating hepatic glucose production C. Increasing peripheral glucose uptake by skeletal muscle and fat D. Improving the circulation of free fatty acids ____ 7. Adam has Type 1 diabetes and plays tennis for his university. He exhibits a Knowledge deficit about his insulin and his diagnosis. He should be taught that: A. He should increase his CHO intake during times of exercise B. Each brand of insulin is equal in bioavailability, so buy the least expensive C. Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts D. If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes ____ 8. Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous inject. Which of the following insulin preparations has the shortest onset and duration of action? A. Insulin lispro B. Insulin glulisine C. Insulin glargine D. Insulin detemir ____ 9. The drug of choice for Type 2 diabetics is metformin. Metformin: A. Decreases glycogenolysis by the liver B. Increases the release of insulin from beta cells C. Increases intestinal uptake of glucose D. Prevents weight gain associated with hyperglycemia ____ 10. Before prescribing metformin, the provider should: A. Draw a serum creatinine level to assess renal function B. Try the patient on insulin C. Prescribe a thyroid preparation if the patient needs to lose weight D. All of the above ____ 11. Sulfonylureas may be added to a treatment regimen for Type 2 diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they: A. Increase endogenous insulin secretion B. Have a significant risk for hypoglycemia C. Address the insulin resistance found in Type 2 diabetics D. Improve insulin binding to receptors ____ 12. Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: A. Better reduction in glucose levels than other classes B. Less weight gain than sulfonylureas C. Low risk for hypoglycemia D. Can be given twice daily ____ 13. Control targets for patients with diabetes include: A. HbA1C between 7 and 8 B. Fasting blood glucose levels between 100 and 120 mg/dl C. Blood pressure less than 130/80 mm Hg D. LDL lipids less than 130 mg/dl ____ 14. Establishing glycemic targets is the first step in treatment of both types of diabetes. For Type 1 diabetes: A. Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily B. Tight control is acceptable for older adults if they are without complications C. Plasma glucose levels are the same for children as adults D. Conventional therapy has a fasting plasma glucose target between 120 and 150 mg/dl ____ 15. Treatment with insulin for Type 1 diabetics: A. Starts with a total daily dose of 0.2 to 0.4 units per kg of body weight B. Divides the total doses into three injections based on meal size C. Uses a total daily dose of insulin glargine given once daily with no other insulin required D. Is based on the level of blood glucose ____ 16. When the total daily insulin dose is split and given twice daily, which of the following rules may be followed? A. Give two-thirds of the total dose in the morning and one-third in the evening. B. Give 0.3 units per kg of premixed 70/30 insulin with one-third in the morning and two-thirds in the evening. C. Give 50% of an insulin glargine dose in the morning and 50% in the evening. D. Give long-acting insulin in the morning and short-acting insulin at bedtime. ____ 17. Studies have shown that control targets that reduce the HbA1C to less than 7% are associated with fewer long-term complications of diabetes. Patients who should have such a target include: A. Those with long-standing diabetes B. Older adults C. Those with no significant cardiovascular disease D. Young children who are early in their disease ____ 18. Prevention of conversion from pre-diabetes to diabetes in young children must take highest priority and should focus on: A. Aggressive dietary manipulation to prevent obesity B. Fostering LDL levels less than 100 mg/dl and total cholesterol less than 170 mg/dl to prevent cardiovascular disease C. Maintaining a blood pressure that is less than 80% based on weight and height to prevent hypertension D. All of the above ____ 19. The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are: A. Metformin and insulin B. Sulfonylureas and insulin glargine C. Split-mixed dose insulin and GPL-1 agonists D. Biguanides and insulin lispro ____ 20. Unlike most Type 2 diabetics where obesity is a major issue, older adults with low body weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is: A. Weight loss in previously overweight persons B. Involuntary loss of 10% of body weight in less than 6 months C. Decline in lean body mass over a 12-month period D. Increase in central versus peripheral body adiposity ____ 21. The drugs recommended for older adults with Type 2 diabetes include: A. Second generation sulfonylureas B. Metformin C. Pioglitazone D. Third generation sulfonylureas ____ 22. Ethnic groups differ in their risk for and presentation of diabetes. Hispanics: A. Have a high incidence of obesity, elevated triglycerides, and hypertension B. Do best with drugs that foster weight loss, such as metformin C. Both A and B D. Neither A nor B ____ 23. The American Heart Association states that people with diabetes have a 2- to 4-fold increase in the risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: A. Glycemic targets between 7% and 7.5% B. Use of insulin in Type 2 diabetics C. Control of hypertension and hyperlipidemia D. Stopping smoking ____ 24. All diabetic patients with known cardiovascular disease should be treated with: A. Beta blockers to prevent MIs B. ACE inhibitors and aspirin to reduce risk of cardiovascular events C. Sulfonylureas to decrease cardiovascular mortality D. Pioglitazone to decrease atherosclerotic plaque buildup ____ 25. All diabetic patients with hyperlipidemia should be treated with: A. HMG-CoA reductase inhibitors B. Fibric acid derivatives C. Nicotinic acid D. Colestipol ____ 26. Both ACE inhibitors and some Angiotensin-II receptor blockers have been approved in treating: A. Hypertension in diabetic patients B. Diabetic nephropathy C. Both A and B D. Neither A nor B ____ 27. Protein restriction helps slow the progression of albuminuria, GFR decline, and ESRD is some patients with diabetes. It is useful for patients who: A. Cannot tolerate ACE inhibitors or ARBs B. Have uncontrolled hypertension C. Have HbA1C levels above 7% D. Show progression of diabetic nephropathy despite optimal glucose and blood pressure control ____ 28. Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of diabetes. Symptoms associated with DAN include: A. Resting tachycardia, exercise intolerance, and orthostatic hypotension B. Gastroparesis, cold intolerance, and moist skin C. Hyperglycemia, erectile dysfunction, and deficiency of free fatty acids D. Pain, loss of sensation, and muscle weakness ____ 29. Drugs used to treat diabetic peripheral neuropathy include: A. Metoclopramide B. Cholinergic agonists C. Cardioselective beta blockers D. Gabapentin ____ 30. The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes? A. Fasting blood glucose B. HbA1C C. Thyroid function tests D. Electrocardiograms Chapter 34: Gastroesophageal Reflux and Peptic Ulcer Disease Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that effects lower esophageal sphincter (LES) tone: A. Calcium carbonate B. Estrogen C. Furosemide D. Metoclopramide ____ 2. Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Foods that may aggravate GERD include: A. Eggs B. White bread C. Chocolate D. Chicken ____ 3. Metoclopramide improves GERD symptoms by: A. Reducing acid secretion B. Increasing gastric pH C. Increasing lower esophageal tone D. Decreasing lower esophageal tone ____ 4. Antacids treat GERD by: A. Increasing lower esophageal tone B. Increasing gastric pH C. Inhibiting gastric acid secretion D. Increasing serum calcium level ____ 5. When treating patients using the “Step-Down” approach the patient with GERD is started on ____ first. A. Antacids B. Histamine2 receptor antagonists C. Prokinetics D. Proton pump inhibitors ____ 6. When using the “Step-Up” approach in caring for patients with GERD, the “step up” from OTC antacid use is: A. Prokinetic (metoclopramide) for 4 to 8 weeks B. Proton pump inhibitor (omeprazole) for 12 weeks C. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks D. Cytoprotective drug (misoprostol) for 2 weeks ____ 7. When using the “Step-Up” approach in caring for patients with GERD, the “step up” from once daily proton pump inhibitor use is: A. Prokinetic (metoclopramide) for 8 to 12 weeks B. Proton pump inhibitor (omeprazole) twice a day for 4 to 8 weeks C. Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks D. Cytoprotective drug (misoprostol) for 4 to 8 weeks ____ 8. When using “Step-Up” therapy for GERD, the next “step up” in treatment when a patient has been on proton pump inhibitors for 12 weeks is: A. Add a prokinetic (metoclopramide) B. Referral for endoscopy C. Switch to another proton pump inhibitor D. Add a cytoprotective drug ____ 9. Infants with reflux are initially treated with: A. Histamine2 receptor antagonist (ranitidine) B. Proton pump inhibitor (omeprazole) C. Anti-reflux maneuvers (elevate head of bed) D. Prokinetic (metoclopramide) ____ 10. Long-term use of proton pump inhibitors may lead to: A. Hip fractures in at-risk persons B. Vitamin B6 deficiency C. Liver cancer D. All of the above ____ 11. An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: A. Histamine2 receptor antagonists for 4 to 8 weeks B. Proton pump inhibitor BID for 12 weeks until healing is complete C. Proton pump inhibitor BID plus clarithromycin plus amoxicillin for 14 days D. Proton pump inhibitor BID and levofloxacin for 14 days ____ 12. Treatment failure in patients with peptic ulcer disease associated with H. pylori may be due to: A. Antimicrobial resistance B. Ineffective antacid C. Overuse of proton pump inhibitors D. All of the above ____ 13. If a patient with H. pylori positive peptic ulcer disease fails first-line therapy the second-line treatment is: A. Proton pump inhibitor BID plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days B. Test H. pylori for resistance to common treatment regimens C. Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days D. Proton pump inhibitor and levofloxacin for 14 days ____ 14. After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: A. Testing for H. pylori eradication with a serum ELISA test B. Endoscopy by a specialist C. Proton pump inhibitor for 8 to 12 weeks until healing is complete D. All of the above Chapter 35: Headaches Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Paige has a history of chronic migraines and would benefit from preventative medication. Education regarding migraine preventive medication includes: A. Medication is taken at the beginning of the headache to prevent it from getting worse B. Medication alone is the best preventative against migraines occurring C. Medication should not be used more than four times a month D. The goal of treatment is to reduce migraine occurrence by 50% ____ 2. A first-line drug for abortive therapy in simple migraine is: A. Sumatriptan (Imitrex) B. Naproxen (Aleve) C. Butorphanol nasal spray (Stadol NS) D. Butalbital and acetaminophen (Fioricet) ____ 3. Vicky, age 56 years, comes to clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraine and states one dose usually works to abort her migraine. What is the best care for her? A. Switch her to sumatriptan (Imitrex) to treat her migraines B. Assess how often she is using Fiorinal and refill medication C. Switch her to a beta-blocker such as propranolol to prevent her migraine D. Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines ____ 4. When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient education would include: A. Ergotamine will briefly make the migraine worse before the migraine resolves B. The patient may experience bradycardia and dizziness C. They may need premedication with an antinausea medication D. Ergotamine works best if the patient starts off with a full suppository to get the full effect ____ 5. Migraines in pregnancy may be safely treated with: A. Acetaminophen with codeine (Tylenol #3) B. Sumatriptan (Imitrex) C. Ergotamine tablets (Ergostat) D. Dihydroergotamine (DHE) ____ 6. Xi, a 54-year-old female, has a history of migraine that does not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision making would be: A. Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use B. Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose C. Explain that rizatriptan is not used for post-menopausal migraines and recommend Fiorinal (aspirin and butalbital) D. Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan ____ 7. Kelly is a 14 year old who presents to clinic with a classic migraine. She says she is having a headache two to three times a month. The initial plan would be: A. Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers B. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress C. Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine D. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic ____ 8. Jayla is a 9 year old who has been diagnosed with migraines for almost 2 years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate? A. Prescribe amitriptyline (Elavil) daily, start at a low dose and increase dose slowly every 2 weeks until effective in eliminating migraines B. Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache C. Prescribe propranolol (Inderal) to be taken daily for at least 3 months D. Explain that it is rare for a 9 year old to get migraines and she needs an MRI to rule out a brain tumor ____ 9. Amber is a 24 year old who has had migraines for 10 years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber’s naratriptan education would include: A. Naratriptan will interact with antidepressants, including SSRIs and St John’s Wort, and she should inform any providers she sees that she has migraines B. Continue to monitor her headaches, if the migraine is consistently happening around her menses there is preventive therapy available C. Pregnancy is contraindicated when taking a triptan D. All of the above ____ 10. When prescribing for migraine, patient education includes: A. Triptans are safe to be used as often as needed as long as the patient is healthy B. Use triptan before trying OTC meds such as acetaminophen or naproxen C. Stress reduction and regular sleep are integral to migraine treatment D. If migraines worsen they are to increase their medication ____ 11. Juanita presents to clinic with a complaint of headaches off and on for months. She reports they feel like someone is “squeezing” her head. She occasionally takes Tylenol for the pain, but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary and a prescription for: A. Sumatriptan (Imitrex) B. Naproxen (Aleve) C. Ergotamine (Ergostat) D. Tylenol with codeine (Tylenol #3) ____ 12. Nonpharmacologic therapy for tension headaches includes: A. Biofeedback B. Stress management C. Massage therapy D. All of the above ____ 13. James has been diagnosed with cluster headaches. Appropriate acute therapy would be: A. Butalbital and aspirin (Fiorinal) B. Meperidine IM (Demerol) C. Oxygen 100% for 15 to 30 minutes D. Indomethacin (Indocin) ____ 14. Preventative therapy for cluster headaches includes: A. Massage or relaxation therapy B. Ergotamine nightly before bed C. Intranasal lidocaine four times a day during “clusters” of headaches D. Propranolol (Inderal) daily ____ 15. When prescribing any headache therapy, appropriate use of medications needs to be discussed to prevent medication-overuse headaches. The clinical characteristics of medication-overuse headaches include: A. Headaches are increasing in frequency B. Headaches are increasing in intensity C. Headaches recur when medication wears off D. Headaches begin to “cluster” into a pattern

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