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Test bank pharmaco.docx NURSING NGR 5035 Chapter 36-45

Test bank NURSING NGR 5035 Chapter 36-45 Chapter 36: Heart Failure Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. ACE inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors? A. Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently. B. Reduced formation of cross-bridges so that contractile force decreases. C. Activation of the sympathetic nervous system that increases heart rate and preload. D. Decreased renal blood flow that decreases oxygen supply to the kidneys. ____ 2. One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include: A. Myocardial ischemia and injury secondary to myocardial infarction B. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction C. Increased demands of the heart beyond its ability to adapt secondary to anemia D. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension ____ 3. The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as: A. Stage A B. Stage B C. Stage C D. Stage D ____ 4. Diagnosis of heart failure cannot be made by symptoms alone since many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is: A. Chest x-rays that show cephalization and measure heart size B. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction C. Complete blood count, BUN, and serum electrolytes that facilitate staging for end-organ damage D. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction ____ 5. Treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with: A. Drugs for hypertension and hyperlipidemia, if they exist B. Lifestyle management including diet, exercise, and smoking cessation only C. ACE inhibitors to directly affect the heart failure only D. No drugs are used in this early stage ____ 6. Class I recommendations for Stage A heart failure include: A. Aerobic exercise within tolerance levels to prevent the development of heart failure B. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention C. Beta blockers for all patients regardless of cardiac history D. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias ____ 7. Stage B patients should have beta blockers added to their heart failure treatment regimen when: A. They have an ejection fraction less than 40% B. They have had a recent MI C. Both A and B D. Neither A nor B ____ 8. Increased life expectancy for patients with heart failure has been associated with the use of: A. ACE inhibitors, especially when started early in the disease process B. All beta blockers regardless of selectivity C. Thiazide and Loop diuretics D. Cardiac glycosides ____ 9. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true? A. Diuretics reduce preload associated with fluid retention. B. Diuretics can be used earlier than Stage C when the goal is control of hypertension. C. Diuretics may produce problems with electrolyte imbalances and abnormal glucose and lipid metabolism. D. Diuretics from the potassium-sparing class should be used when using an ARB. ____ 10. Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with: A. Ejection fractions above 40% B. An audible S3 C. Mitral stenosis as a primary cause for heart failure D. Renal insufficiency ____ 11. Which of the following classes of drugs is contraindicated in heart failure? A. Nitrates B. Long-acting dihydropyridines C. Calcium channel blockers D. Alpha-beta blockers ____ 12. Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years old). The drug of choice for this population is: A. Aldosterone antagonists B. Eplerenone C. ACE inhibitors D. ARBs ____ 13. ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes are considered to be safe, at least in the later parts of pregnancy? A. Diuretics B. ARBs C. Beta blockers D. Nitrates ____ 14. Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when: A. Symptoms markedly worsen or the patient becomes hypotensive and has syncope B. There is evidence of progressive renal insufficiency or failure C. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic D. Any of the above Chapter 37: Human Immunodeficiency Virus Disease and Acquired Immunodefiency Syndrome Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The goals of treatment when prescribing antiretroviral medication to patients with HIV include: A. Prevent vertical HIV transmission B. Improve quality of life C. Prolong survival D. All of the above ____ 2. A challenge faced with antiretroviral therapy (ART) is: A. Patients abusing ART B. Drug-resistant mutations of HIV C. Reduction of transmissibility of HIV D. Lack of efficacy data ____ 3. Predictors for successful treatment with antiretroviral therapy (ART) in HIV-positive patients include: A. They respond to low potency treatment regimen B. They have demonstrated resistance in the past and should respond to newer ART drugs C. The patient is strictly adherent to the ART treatment regimen D. Lower baseline CD4 T-cell count at baseline ____ 4. The goal of antiretroviral therapy (ART) in HIV-positive patients is: A. Maximum suppression of HIV replication B. Eradication of HIV virus from the body C. Determining a treatment regimen that is free of adverse effects D. Suppression of CD4 T-cell count ____ 5. Pregnant women who are HIV positive: A. Are treated with AZT alone to prevent birth defects B. Are treated with a combination ART regimen C. Should not be treated with ART due to teratogenicity of the drugs D. Are at high risk of developing resistance to ART drugs ____ 6. Antiretroviral therapy is recommended for HIV-positive patients with: A. A history of AIDS-defining illness B. Pregnant women C. Hepatitis B co-infection D. All of the above ____ 7. If considering starting a patient on the nucleoside reverse transcriptase inhibitor (NRTI) abacavir, the following testing is recommended prior to prescribing: A. Renal function B. HLA B*5701 testing C. Pancreatic enzyme levels D. CYP 450 enzyme activity ____ 8. Suzanne is pregnant and has tested HIV positive. Which antiretroviral drug should be avoided in women who are pregnant? A. Lopinavir/r B. Zidovudine C. Ritonavir D. Lopinavir/ritonavir ____ 9. The cost of HIV treatment can be prohibitive for any patient. Patients can receive assistance from the: A. Best Pharmaceuticals for HIV/AIDS Patient Act B. Ryan White HIV/AIDS Treatment Modernization Act C. National Institute of Health HIV/AIDS Assistance Fund D. Centers for Disease Control HIV/AIDS Treatment Fund ____ 10. Resistance to antiretroviral therapy (ART) is measured by: A. Measuring the DNA viral load in the serum B. Determining plasma viral RNA on two successive measurements C. Phenotype assays of the combination of ART the patient is on D. Elevation of T4 counts ____ 11. Phenotype assays are used to measure ____ of antiretroviral therapy (ART). A. Effectiveness B. Genotype C. Sensitivity D. Hypersensitivity susceptibility ____ 12. Patient factors that contribute to antiretroviral therapy (ART) failure include: A. Being a male who has sex with males B. HIV diagnosis in pregnancy C. Good compliance with ART treatment regimen D. ART adverse effects ____ 13. Patients who are taking antiretroviral therapy (ART) need to have the following monitored: A. Lipid levels B. Sexual functioning C. Platelet count D. All of the above ____ 14. Successful antiretroviral therapy (ART) in an HIV-positive patient is determined by: A. Being able to stop ART therapy due to HIV virus eradication B. Lowering HIV viral load to unmeasurable amounts C. Individual measures of success based on their personal situation D. Normal blood hematologic factors Chapter 38: Hormone Replacement Therapy and Osteoporosis Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: A. Cardiovascular risk B. Risk of stroke or other thromboembolic event C. Breast cancer D. Vasomotor symptoms ____ 2. The optimal maximum time frame for hormone replacement therapy (HRT) or estrogen replacement therapy (ERT) is: A. 2 years B. 5 years C. 10 years D. 15 years ____ 3. Dosage changes of conjugated equine estrogen (Premarin) are made at ____ intervals. A. 1 to 2 week B. 2 to 4 week C. 6 to 8 week D. 12 week ____ 4. The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and dryness is: A. Ability to deliver higher doses of estrogen in a non-oral form B. The vaginal cream formula provides moisture to the vaginal area C. Relief of symptoms without increasing cardiovascular risk D. All of the above ____ 5. Women with an intact uterus should be treated with both estrogen and progestin due to: A. Increased risk for endometrial cancer if estrogen alone is used B. Combination therapy provides the best relief of menopausal vasomotor symptoms C. Reduced risk for colon cancer with combined therapy D. Lower risk of developing blood clots with combined therapy ____ 6. Ongoing monitoring for women on estrogen replacement therapy (ERT) includes: A. Lipid levels, repeated annually if abnormal B. Annual health history and review of risk profile C. Annual mammogram D. All of the above ____ 7. Kristine would like to start hormone replacement therapy (HRT) to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering hormone replacement would include: A. Explaining that HRT is totally safe if used short term B. Telling her to ignore media hype regarding HRT C. Discussing the advantages and risks of HRT D. Encouraging the patient to use phytoestrogens with the HRT ____ 8. Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk? A. She is correct, black women do not have much risk of developing osteoporosis due to their dark skin B. Black women are at risk of developing osteoporosis due to their lower calcium intake as a group C. If she doesn’t drink alcohol, her risk of developing osteoporosis is low D. If she has not lost more than 10% of her weight lately, her risk is low ____ 9. Drugs that increase the risk of osteoporosis developing include: A. Oral combined contraceptives B. Carbamazepine C. Calcium channel blockers D. High doses of Vitamin D ____ 10. Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively: A. Inhibiting magnesium resorption in the kidneys B. Increasing calcium absorption from the GI tract C. Acting on the bone to inhibit osteoblast activity D. Selectively acting on the estrogen receptors in the bone ____ 11. Sallie has been diagnosed with osteoporosis and is asking about the “once a month” pill to treat her condition. How do bisphosphonates treat osteoporosis? A. By selectively activating estrogen pathways in the bone B. By reducing bone resorption by inhibiting PTH C. By reducing bone resorption and inhibiting osteoclastic activity D. By increasing parathyroid hormone production ____ 12. Inadequate Vitamin D intake can contribute to the development of osteoporosis by: A. Increasing calcitonin production B. Increasing calcium absorption from the intestine C. Altering calcium metabolism D. Stimulating bone formation ____ 13. Cassie is a 15-year-old female who presents to clinic for a sports physical. Her diet history indicates she drinks less than one glass of milk per day and avoids dairy products to lose weight. What is the recommended daily calcium intake for Cassie? A. 500 mg B. 1,000 mg C. 1,300 mg D. 1,500 mg ____ 14. Susan is a 52-year-old perimenopausal woman who is lactose intolerant. What is her recommended calcium and vitamin D requirement? A. 1,500 mg calcium and 200 IU Vitamin D B. 1,200 mg calcium and 400 IU Vitamin D C. 1,300 mg calcium and 400 IU Vitamin D D. 1,000 mg calcium and 400 IU Vitamin D ____ 15. The drug recommended as primary prevention of osteoporosis in women over age 70 years is: A. Alendronate (Fosamax) B. Ibandronate (Boniva) C. Calcium carbonate D. Raloxifene (Evista) ____ 16. The drug recommended as primary prevention of osteoporosis in men over age 70 years is: A. Alendronate (Fosamax) B. Ibandronate (Boniva) C. Calcium carbonate D. Raloxifene (Evista) ____ 17. Intranasal calcitonin is used in the treatment of osteoporosis. Calcitonin therapy is appropriate for which patient? A. Thin, Caucasian perimenopausal women B. Men over age 65 with osteoporosis C. Women over age 65 years with osteopenia D. Women over age 65 with severe osteoporosis ____ 18. The ongoing monitoring for patients over age 65 years taking alendronate (Fosamax) or any other bisphosphonate is: A. Annual DEXA scans B. Annual Vitamin D level C. Annual renal function evaluation D. Electrolytes every 3 months Chapter 39: Hyperlipidemia Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The overall goal of treating hyperlipidemia is: A. Maintain an LDL level of less than 160 mg/dL B. To reduce atherogenesis C. Lowering apo B, one of the apoliproteins D. All of the above ____ 2. When considering which cholesterol-lowering drug to prescribe which factor determines the type and intensity of treatment? A. Total LDL B. Fasting HDL C. Coronary artery disease risk level D. Fasting total cholesterol ____ 3. First-line therapy for hyperlipidemia is: A. Statins B. Niacin C. Lifestyle changes D. Bile acid-binding resins ____ 4. James is a 45 year old with an LDL level of 120 and normal triglycerides. Appropriate first- line therapy for James may include diet counseling, increased physical activity, and: A. A statin B. Niacin C. Sterols D. A fibric acid derivative ____ 5. Joanne is a 60 year old with an LDL of 132 and a family history of coronary artery disease. She has already tried diet changes (increased fiber and plant sterols) to lower her LDL and after 6 months her LDL is slightly higher. The next step in her treatment would be: A. A statin B. Niacin C. Sterols D. A fibric acid derivative ____ 6. Sharlene is a 65 year old who has been on a lipid-lowering diet and using plant sterol margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be: A. A statin B. Niacin C. A fibric acid derivative D. Determined by her risk factors ____ 7. Mike is a 47 year old who has been on standard dose atorvastatin for 3 months and his repeat LDL is 124 mg/dL. He is a smoker and has a strong family history of cardiovascular disease. His treatment plan would include reinforcing diet, exercise, plant sterol intake, and: A. Increasing his dose of atorvastatin B. Changing to another statin C. Adding niacin to the treatment regimen D. Adding a bile acid-binding resin ____ 8. Phil is a 54-year-old male with multiple risk factors who has been on a high dose statin for 3 months to treat his high LDL level. His LDL is 135 mg/dL and his triglycerides are elevated. A reasonable change in therapy would be to: A. Discontinue the statin and change to a fibric acid derivative B. Discontinue the statin and change to ezetimibe C. Continue the statin and add in ezetimibe D. Refer him to a specialist in managing patients with recalcitrant hyperlipidemia ____ 9. Scott is presenting for follow up on his lipid panel. He had elevated total cholesterol, triglycerides, and an LDL of 122 mg/dL. He has already implemented diet changes and increased physical activity. He has mildly elevated liver studies. An appropriate next step for therapy would be: A. Atorvastatin (Lipitor) B. Niacin (Niaspan) C. Simvastatin and ezetimibe (Vytorin) D. Gemfibrozil (Lopid) ____ 10. Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman? A. A statin B. Niacin C. Fibric acid derivative D. Bile acid-binding resins ____ 11. 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: A. Sterol B. Niacin C. Fibric acid derivative D. Bile acid-binding resin ____ 12. 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 reevaluation in 6 months. A. Statins B. Niacin C. Sterols D. Bile acid-binding resins ____ 13. Monitoring of a patient who is on a lipid-lowering drug includes: A. Fasting total cholesterol every 6 months B. Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy then again in 6 weeks C. Complete blood count, CRP, and ESR after 6 weeks of therapy D. All of the above ____ 14. Before starting therapy with a statin, the following baseline laboratory values should be evaluated: A. Complete blood count B. Liver function (ALT/AST) and CK C. C-reactive protein D. All of the above ____ 15. When starting a patient on a statin, education would include: A. If they stop the medication their lipid levels will return to pre-treatment levels B. Medication is a supplement to diet therapy and exercise C. If they have any muscle aches or pain, they should contact their provider D. All of the above Chapter 40: Hypertension Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. At which stage/classification of hypertension should drug therapy be instituted according to the JNC-7 Report? A. Prehypertension B. Stage 1 C. Stage 2 D. Any stage where the blood pressure is greater than 120/80 mm Hg ____ 2. Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they: A. Increase renin secretion B. Decrease the production of aldosterone C. Deplete body sodium and reduce fluid volume D. Decrease blood viscosity ____ 3. Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to receive: A. Potassium supplements B. Calcium supplements C. Magnesium supplements D. Phosphates supplements ____ 4. All patients with hypertension benefit from diuretic therapy, but those who benefit the most are: A. Those with orthostatic hypertension B. African Americans C. Those with stable angina D. Diabetics ____ 5. Beta blockers treat hypertension because they: A. Reduce peripheral resistance B. Vasoconstrict coronary arteries C. Reduce norepinephrine D. Reduce angiotensin II production ____ 6. Which of the following disease processes could be made worse by taking a nonselective beta blocker? A. Asthma B. Diabetes C. Both might worsen D. Beta blockade does not affect these disorders ____ 7. Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: A. Heart failure B. Angina C. Myocardial infarction D. Dyslipidemia ____ 8. ACE inhibitors treat hypertension because they: A. Reduce sodium and water retention B. Decrease vasoconstriction C. Increase vasodilation D. All of the above ____ 9. Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials includes: A. Pregnancy B. Renal parenchymal disease C. Stable angina D. Dyslipidemia ____ 10. An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone? A. Beta blockers B. Diuretics C. Nondihydropyridine calcium channel blockers D. Angiotensin II receptor blockers ____ 11. If not chosen as the first drug in hypertension treatment, which drug class should be added as second step because it will enhance the effects of most other agents? A. ACE inhibitors B. Beta blockers C. Calcium channel blockers D. Diuretics ____ 12. Treatment costs are important for patients with hypertension. Which of the following statements about cost is NOT true? A. Hypertension is a chronic disease where patients may be taking drugs for a long time. B. Most patients will require more than one drug to treat the hypertension. C. The cost includes the price of any routine or special lab tests that a specific drug may require. D. Few antihypertensive drugs come in generic formulations. ____ 13. Caffeine, exercise, and smoking should be avoided for at least how long before blood pressure measurement? A. 15 minutes B. 30 minutes C. 60 minutes D. 90 minutes ____ 14. Blood pressure checks in children: A. Should occur with their annual physical examinations after age 6 B. Require a blood pressure cuff that is one-third the diameter of the child’s arm C. Should be done during every health-care visit after age 3 D. Require additional lab tests such as serum creatinine ____ 15. Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include: A. Lifestyle changes are difficult to achieve and maintain B. Adverse drug reactions are common and often fall into the categories more associated with nonadherence C. Costs of drugs and monitoring with labs can be expensive D. All of the above ____ 16. Lifestyle modifications for patients with prehypertension or hypertension include: A. Diet and increase exercise to achieve a BMI greater than 25 B. Drink 4 ounces of red wine at least once per week C. Adopt the DASH diet D. Increase potassium intake Chapter 41: Hyperthyroidism and Hypothyroidism Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. When methimazole is started for hyperthyroidism it may take ____ to see total reversal of hyperthyroid symptoms. A. 2 to 4 weeks B. 1 to 2 months C. 3 to 4 months D. 6 to 12 months ____ 2. In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for: A. A calcium channel blocker B. A beta blocker C. Liothyronine D. An alpha blocker ____ 3. After starting a patient with Grave’s disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every: A. 1 to 2 weeks B. 3 to 4 weeks C. 2 to 3 months D. 6 to 9 months ____ 4. A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with: A. Methimazole B. Propylthiouracil (PTU) C. Radioactive iodine D. Nothing, treatment is best delayed until after her pregnancy ends ____ 5. Goals of treatment when treating hypothyroidism with thyroid replacement include: A. Normal TSH and free T4 levels B. Resolution of fatigue C. Weight loss to baseline D. All of the above ____ 6. When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in: A. 2 weeks B. 4 weeks C. 2 months D. 6 months ____ 7. Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every: A. 2 weeks B. 4 weeks C. 2 months D. 6 months ____ 8. Treatment of a patient with hypothyroidism and cardiovascular disease consists of: A. Levothyroxine B. Liothyronine C. Liotrix D. Methimazole ____ 9. Infants with congenital hypothyroidism are treated with: A. Levothyroxine B. Liothyronine C. Liotrix D. Methimazole ____ 10. When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include: A. They should feel symptomatic improvement in 1 to 2 weeks B. Drug adverse effects such as lethargy and dry skin may occur C. It may take 4 to 8 weeks to get to euthyroid symptomatically and by lab testing D. Due to its short half-life, levothyroxine doses should not be missed 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: A. Haemophilus influenzae B. Staphylococcus aureus C. Mycoplasma pneumoniae D. Streptococcus pneumoniae ____ 2. The first-line drug choice for a previously healthy adult patient diagnosed with community acquired pneumonia would be: A. Ciprofloxacin B. Azithromycin C. Amoxicillin D. 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: A. Levofloxacin B. Amoxicillin C. Ciprofloxacin D. Cephalexin ____ 4. If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be: A. IV or IM gentamicin B. IV or IM ceftriaxone C. IV amoxicillin D. 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? A. Levofloxacin B. Azithromycin C. Amoxicillin D. Doxycycline ____ 6. Adults with pneumonia who are responding to antimicrobial therapy should show improvement in their clinical status in: A. 12 to 24 hours B. 24 to 36 hours C. 48 to 72 hours D. 4 or 5 days ____ 7. Along with prescribing antibiotics, adults with pneumonia should be instructed on lifestyle modifications to improve outcomes, including: A. Adequate fluid intake B. Increased fiber intake C. Bedrest for the first 24 hours D. All of the above ____ 8. John is a 4-week-old infant who has been diagnosed with chlamydial pneumonia. The appropriate treatment for his pneumonia would be: A. Levofloxacin B. Amoxicillin C. Erythromycin D. Cephalexin ____ 9. Wing-Sing is a 4 year old who has a 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? A. Ceftriaxone B. Azithromycin C. Cephalexin D. Levofloxacin ____ 10. Giselle is a 14 year old who presents to clinic with symptoms consistent with mycoplasma pneumonia. What is the treatment for suspected mycoplasma pneumonia in an adolescent? A. Ceftriaxone B. Azithromycin C. Ciprofloxacin D. Levofloxacin Chapter 43: Smoking Cessation Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Nicotine withdrawal symptoms include: A. Nervousness B. Increased appetite C. Difficulty concentrating D. All of the above ____ 2. If a patient wants to quit smoking, nicotine replacement therapy is recommended if the patient: A. Smokes more than 10 cigarettes a day B. Smokes within 30 minutes of awakening in the morning C. Smokes when drinking alcohol D. All of the above ____ 3. Instructions for a patient who is starting nicotine replacement therapy include: A. Smoke less than 10 cigarettes a day when starting nicotine replacement B. Nicotine replacement will help with the withdrawal cravings associated with quitting tobacco C. Nicotine replacement can be used indefinitely D. Nicotine replacement therapy is generally safe for all patients ____ 4. Nicotine replacement therapy should not be used in which patients? A. Pregnant women B. Patients with worsening angina pectoris C. Immediately after an acute myocardial infarction D. All of the above ____ 5. Instructions for the use of nicotine gum include: A. Chew the gum quickly to get a peak effect B. The gum should be “parked” in the buccal space between chewing C. Acidic drinks such as coffee help with the absorption of the nicotine D. The highest abstinence rates occur if the patient chews the gum when he or she is having cravings ____ 6. Patients who choose the nicotine lozenge to assist in quitting tobacco should be instructed: A. Chew the lozenge well B. Drink at least 8 ounces of water after the lozenge dissolves C. Use one lozenge every 1 to 2 hours (at least nine per day with a maximum of twenty per day) D. A tingling sensation in the mouth should be reported to the provider ____ 7. Transdermal nicotine replacement (patch) is an effective choice in tobacco cessation because: A. The patch provides a steady level of nicotine without reinforcing oral aspects of smoking B. There is the ability to “fine tune” the amount of nicotine that is delivered to the patient at any one time C. There is less of a problem with nicotine toxicity than other forms of nicotine replacement D. Transdermal nicotine is safer in pregnancy ____ 8. The most common adverse effect of the transdermal nicotine replacement patch is: A. Nicotine toxicity B. Tingling at the site of patch application C. Skin irritation under the patch site D. Life-threatening dysrhythmias ____ 9. If a patient is exhibiting signs of nicotine toxicity when using transdermal nicotine, they should remove the patch and: A. Wash the area thoroughly with soap and water B. Flush the area with clear water C. Reapply a new patch in 8 hours D. Take acetaminophen for the headache associated with toxicity ____ 10. When a patient is prescribed nicotine nasal spray for tobacco cessation, instructions include: A. Inhale deeply with each dose to ensure deposition in the lungs B. The dose is one to two sprays in each nostril per hour, not to exceed 40 sprays per day C. If they have a sensation of “head rush” this indicates the medication is working well D. Nicotine spray may be used for up to 12 continuous months ____ 11. If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include: A. Bupropion (Zyban) is started 1 to 2 weeks before the quit date B. Nicotine replacement products should not be used with bupropion C. If they smoke when taking bupropion they may have increased anxiety and insomnia D. Since they are not using bupropion as an antidepressant, they do not need to worry about increased suicide ideation when starting therapy ____ 12. Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include: A. The maximum time varenicline can be used is 12 weeks B. Nausea is a sign of varenicline toxicity and should be reported to the provider C. The starting regimen for varenicline is start taking 1 mg twice a day a week before the quit date D. Neuropsychiatric symptoms may occur ____ 13. The most appropriate smoking cessation prescription for pregnant women is: A. Nicotine replacement patch at lowest dose available B. Bupropion (Zyban) C. Varenicline (Chantix) D. Nonpharmacologic measures Chapter 44: Sexually Transmitted Infections and Vaginitis Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The goals of treatment when prescribing for sexually transmitted infections include: A. Treatment of infection B. Prevention of disease spread C. Prevention of long-term sequelae from the infection D. All of the above ____ 2. The drug of choice for treatment of primary or secondary syphilis is: A. Ceftriaxone IM B. Benzathine penicillin G IM C. Oral azithromycin D. Oral ciprofloxacin ____ 3. The drug of choice for treatment of early latent or tertiary syphilis is: A. Ceftriaxone IM B. Benzathine penicillin G IM C. Oral azithromycin D. Oral ciprofloxacin ____ 4. Demione is a 24 year old who is 32 weeks pregnant and has tested positive for syphilis. The best treatment for her would be: A. IM ceftriaxone B. IM benzathine penicillin G C. Oral azithromycin D. Any of the above ____ 5. Treatment for suspected gonorrhea is: A. Ceftriaxone 250 mg IM x 1 B. Ceftriaxone 2 grams IM x 1 C. Ciprofloxacin 500 mg PO x 1 D. Doxycycline 100 mg BID x 7 days ____ 6. When treating suspected gonorrhea in a non-pregnant patient, the patient should be concurrently treated for Chlamydia with: A. Azithromycin 1 gram PO x 1 B. Amoxicillin 500 mg PO x 1 C. Ciprofloxacin 500 mg PO x 1 D. Penicillin G 2.4 million units IM x 1 ____ 7. Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened for gonorrhea and Chlamydia in: A. 4 weeks B. 3 to 6 weeks C. 3 to 6 months D. 1 year ____ 8. A test of cure is recommended after treating Chlamydia in which patient population? A. Men who have sex with men B. Adolescent females C. Pregnant patients D. All of the above ____ 9. Treatment for chancroid in a non-pregnant patient would be: A. Oral azithromycin B. IM ceftriaxone C. Oral ciprofloxacin D. Any of the above ____ 10. Jamie was treated for chancroid. Follow-up testing after treatment of chancroid would be: A. Syphilis and HIV testing at 3-month intervals B. Chancroid-specific antigen test every 3 months C. Urine testing for Haemophilus ducreyi in 3 to 6 months for test of cure D. Annual HIV testing if engaging in high-risk sexual behavior ____ 11. Helima presents with a complaint of vaginal discharge that when tested meets the criteria for bacterial vaginosis. Treatment of bacterial vaginosis in a non-pregnant symptomatic women would be: A. Metronidazole 500 mg PO BID x 7 days B. Doxycycline 100 mg PO BID x 7 days C. Intravaginal tinidazole daily x 5 days D. Metronidazole 2 grams PO x 1 dose ____ 12. Besides prescribing antimicrobial therapy, patients with bacterial vaginosis require education regarding: A. The most recent partners in the past 60 days should also be treated B. Alcohol should not be consumed during and for 1 day after metronidazole is taken C. Condoms should be used during intercourse if intravaginal clindamycin cream is used D. Necessity of co-treatment for Chlamydia ____ 13. Sydney presents to clinic with vulvovaginal candidiasis. Appropriate treatment for her would be: A. OTC intravaginal clotrimazole B. OTC intravaginal miconazole C. Oral fluconazole one-time dose D. Any of the above ____ 14. If a woman presents with recurrent vulvovaginal candidiasis she may be treated with: A. Weekly intravaginal butoconazole for 3 months B. Fluconazole 150 mg PO daily x 7 doses then monthly for 6 months C. Weekly fluconazole 150 mg PO x 6 months D. Intravaginal tioconazole x 14 days ____ 15. Zoe presents with genital warts present on her labia. Patient-applied topical therapy for warts includes: A. Podofilox 0.5% gel B. Podophyllin 10% resin C. Trichloracetic acid D. Any of the above ____ 16. Sophie presents to clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include: A. Metronidazole 2 grams PO x 1 dose B. Topical intravaginal metronidazole daily x 7 days C. Intravaginal clindamycin daily x 7 days D. Azithromycin 2 grams PO x 1 dose ____ 17. In addition to antimicrobial therapy, patients treated for Trichomonas infection should be educated regarding: A. Necessity of treating sexual partner simultaneously B. Abstaining from intercourse until both partners are treated C. Need for retesting in 3 months due to high reinfection rate D. All of the above Chapter 45: Tuberculosis Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Drug resistant tuberculosis (TB) is defined as TB that is resistant to: A. Fluoroquinolones B. Rifampin and isoniazid C. Amoxicillin D. Ceftriaxone ____ 2. Goals of treatment when treating tuberculosis include: A. Completion of recommended therapy B. Negative PPD at the end of therapy C. Completely normal chest x-ray D. All of the above ____ 3. The principles of drug therapy for the treatment of tuberculosis include: A. Patients are treated with a drug M. tuberculosis is sensitive to B. Drugs need to be taken on a regular basis for a sufficient amount of time C. Treatment continues until the patient’s PPD is negative D. All of the above ____ 4. Isabella has confirmed tuberculosis and is placed on a 6-month treatment regimen. The 6-month regimen consists of: A. 2 months of four drug therapy (INH, rifampin, pyrazinamide, and ethambutol) followed by 4 months of INH and rifampin B. 6 months of INH with daily pyridoxine throughout therapy C. 6 months of INH, rifampin, pyrazinamide, and ethambutol D. Any of the above ____ 5. Kaleb has extensively resistant tuberculosis (TB). Treatment for extensively resistant TB would include: A. INH, rifampin, pyrazinamide, and ethambutol for at least 12 months B. INH, ethambutol, kanamycin, and rifampin C. Treatment with at least two drugs the TB is susceptible to D. Levofloxacin ____ 6. Lila is 24 weeks pregnant and has been diagnosed with tuberculosis. Treatment regimens for a pregnant patient with TB would include: A. Streptomycin B. Levofloxacin C. Kanamycin D. Pyridoxine ____ 7. Bilal is a 5 year old who has been diagnosed with tuberculosis. His treatment would include: A. Pyridoxine B. Ethambutol C. Levofloxacin D. Rifabutin ____ 8. Ezekiel is a 9 year old who lives in a household with a family member newly diagnosed with tuberculosis. To prevent Ezekiel from developing TB he should be treated with: A. 6 months of INH and rifampin B. 2 months of INH, rifampin, pyrazinamide, and ethambutol, followed by 4 months of INH C. 9 months of INH D. 12 months of INH ____ 9. Leonard is completing a 6-month regimen to treat tuberculosis. Monitoring of a patient on TB therapy includes: A. Monthly sputum cultures B. Monthly chest x-ray C. Bronchoscopy every 3 months D. All of the above ____ 10. Compliance with directly observed therapy (DOT) can be increased by: A. Convenient clinic times B. Incentives such as food, clothing, and transportation costs C. Offering gifts for compliance D. All of the above

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