Test Bank for Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew

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Test Bank for Pharmacology For the Primary Care Provider 4th Edition by Edmunds Mayhew

 

 

Sample:

 

Chapter 06: Special Populations: Pregnant and Nursing Women

Test Bank

 

MULTIPLE CHOICE

 

  1. A woman is in the 36th week of pregnancy. The nurse practitioner (NP) providing prenatal care learns that the woman has a history of two previous urinary tract infections during this pregnancy. A dipstick urinalysis in the office today is negative for leukocyte esterase and nitrites. The NP should:
a. prescribe a low-dose sulfonamide antibiotic for urinary tract infection prophylaxis.
b. order nitrofurantoin daily to minimize the patient’s risk of urinary tract infection late in her pregnancy.
c. encourage the patient to increase daily water intake and to wear only cotton underwear.
d. order a voiding cystourethrogram to rule out structural anomalies that may cause urinary tract infection.

 

 

ANS:  C

For women at risk for recurrent urinary tract infection while pregnant, prevention and treatment begin with nonpharmacologic therapy: forcing fluids and wearing cotton underpants. Sulfonamide antibiotics and nitrofurantoin are used for documented urinary tract infection during pregnancy, but not after the 36th week of gestation. A voiding cystourethrogram is not indicated and would expose the fetus to radiation.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   77 – 78

 

  1. A woman tells a primary care NP that she is considering getting pregnant. During a health history, the NP learns that the patient has seasonal allergies, asthma, and epilepsy, all of which are well controlled with a second-generation antihistamine daily, an inhaled steroid daily with albuterol as needed, and an antiepileptic medication daily. The NP should counsel this patient to:
a. take her asthma medications only when she is having an acute exacerbation.
b. avoid using antihistamine medications during her first trimester of pregnancy.
c. discontinue her seizure medications at least 6 months before becoming pregnant.
d. use only oral corticosteroids and not inhaled steroids while pregnant for improved asthma control.

 

 

ANS:  B

Optimal treatment of asthma during pregnancy includes treatment of comorbid allergic rhinitis, which can trigger symptoms. Antihistamines are recommended after the first trimester, if possible. Asthma medications should be continued during pregnancy because poorly controlled asthma can be detrimental to the fetus; she should continue using her daily inhaled corticosteroid. Although discontinuing seizure medications is optimal, this must be done in conjunction with this woman’s neurologist because management of epilepsy during pregnancy is beyond the scope of the primary care provider. Oral corticosteroids have greater systemic side effects and greater effects on the fetus and should be used only as necessary.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   78 – 79

 

  1. A woman has just learned she is pregnant and is in her 10th gestational week. The woman reports that she takes valproic sodium (Depakote) for a seizure disorder and has been seizure-free for several years. The NP should:
a. prescribe folic acid supplements.
b. change her antiepileptic drug to lamotrigine (Lamictal).
c. order prophylactic vitamin K to be given in the second trimester.
d. recommend that she discontinue taking the valproic sodium by 12 weeks.

 

 

ANS:  A

Maternal folic acid deficiency is induced by anticonvulsants, especially valproic acid, so folic acid supplements must be given. Although antiepileptic drugs can have consequences for the developing fetus, once a woman is pregnant, the benefit-risk ratio favors continued use of the woman’s current antiepileptic medication, so she should not discontinue the medication or change to lamotrigine. Vitamin K is recommended beginning at 36 weeks of gestation and for the newborn at birth to counter the possibility of hemorrhagic disease of the newborn.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   79

 

  1. A woman who is pregnant develops gestational diabetes. The NP’s initial action is to:
a. prescribe an oral antidiabetic agent.
b. give her information about diet and exercise.
c. begin treating her with daily insulin injections.
d. reassure her that her glucose levels will return to normal after pregnancy.

 

 

ANS:  B

Patients with gestational diabetes should be treated with diet and exercise, with insulin added as needed for poor control. There is insufficient evidence to support the use of oral antidiabetic agents during pregnancy, and some of these are pregnancy category D. Insulin injections may be used but are not the initial intervention. Although glucose levels will return to prepregnancy values in the postpartum period, the NP must initiate therapy.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   79 – 80

 

  1. A woman who takes an angiotensin converting enzyme inhibitor for hypertension tells her primary care NP that she is trying to get pregnant. The NP should:
a. consider replacing her angiotensin converting enzyme inhibitor with methyldopa.
b. lower her angiotensin converting enzyme inhibitor dose during the first trimester.
c. counsel her to increase her antihypertensive medications during pregnancy.
d. add an angiotensin receptor blocker (ARB) during the first trimester of her pregnancy.

 

 

ANS:  A

Angiotensin converting enzyme inhibitors, ARBs, and statins are contraindicated during the first trimester of pregnancy and should be discontinued before conception and replaced by safer alternatives, such as methyldopa. The use of antihypertensives during pregnancy remains controversial; increasing the dose is not indicated.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   80

 

  1. A woman who is pregnant tells an NP that she has been taking sertraline for depression for several years but is worried about the effects of this drug on her fetus. The NP will consult with this patient’s psychiatrist and will recommend that she:
a. stop taking the sertraline now.
b. continue taking the antidepressant.
c. change to a monoamine oxidase inhibitor (MAOI).
d. discontinue the sertraline a week before delivery.

 

 

ANS:  B

Many women are taking medication for depression before becoming pregnant. Abrupt discontinuation is not recommended, and many clinicians suggest that women at high risk for serious depression during pregnancy might best be served by continuing medication throughout pregnancy. MAOIs may limit fetal growth and are generally discouraged during pregnancy. It is not necessary to discontinue the sertraline just before delivery.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   80

 

  1. A woman is 4 weeks pregnant. The primary care NP sees her for her first prenatal visit and obtains a rubella titer, which is negative. The woman tells the NP that she drinks 2 cups of coffee and smokes 3 to 5 cigarettes each day. She denies alcohol use. The NP should:
a. administer rubella vaccine.
b. provide smoking cessation information.
c. counsel her to avoid caffeine while pregnant.
d. reassure her that her habits are not likely to cause harm.

 

 

ANS:  B

Each cigarette smoked decreases maternal blood pressure for up to 15 minutes and decreases uteroplacental perfusion. The NP should encourage the woman to quit smoking. Rubella vaccine should be given after the baby is delivered because rubella vaccine is a live virus, with severe teratogenic effects. There is no conclusive evidence that women who are pregnant should avoid caffeine completely. Her habits, although not severe, are not harmless.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   82 – 83

 

  1. A woman who is breastfeeding her infant asks the primary care NP what she can use for headaches while she is nursing. The NP tells her:
a. most medications enter breast milk and are not safe.
b. most over-the-counter medications are safe for the breastfed infant.
c. she may need to interrupt breastfeeding when taking headache medications.
d. she should consider weaning her infant to formula if her headaches are frequent.

 

 

ANS:  B

Most over-the-counter medications are considered safe for the breastfed infant and do not necessitate a disruption of breastfeeding, even though most medications cross easily into breast milk. Any interruption of breastfeeding carries a risk of premature weaning and so is indicated only when the mother must take medications known to cause serious harm to the baby. It is not recommended that she wean her infant to formula when she needs medications for her headaches.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   85

 

Chapter 07: Over-the-Counter Medications

Test Bank

 

MULTIPLE CHOICE

 

  1. A patient asks a primary care nurse practitioner (NP) about using over-the-counter medications to treat an upper respiratory infection with symptoms of cough, fever, and nasal congestion. The NP should:
a. recommend a cough preparation that also contains acetaminophen.
b. suggest using single-ingredient products to treat each symptom separately.
c. recommend a product containing antitussive, antipyretic, and decongestant ingredients.
d. tell the patient that over-the-counter medications are usually not effective in manufacturer-recommended doses.

 

 

ANS:  B

A basic principle guiding over-the-counter use is to look at specific symptoms and treat each separately because some products contain therapeutic doses of one ingredient and subtherapeutic doses of others. Cough preparations containing acetaminophen often do not contain therapeutic doses, and patients often overdose when they supplement with acetaminophen. Over-the-counter medications are effective at recommended doses. Patients should follow dosing recommendations on the package.

 

DIF:    Cognitive Level: Understanding (Comprehension)          REF:   89| 90

 

  1. A patient asks a primary care NP whether over-the-counter drugs are safer than prescription drugs. The NP should explain that over-the-counter drugs are:
a. generally safe when label information is understood and followed.
b. safer because over-the-counter doses are lower than prescription doses of the same drug.
c. less safe because they are not well regulated by the Food and Drug Administration (FDA).
d. not extensively tested, so claims made by manufacturers cannot be substantiated.

 

 

ANS:  A

Over-the-counter products have a wider margin of safety because most of these drugs have undergone rigorous testing before marketing and further refinement through years of over-the-counter use by consumers. When labels are understood and followed, over-the-counter medications are safe. Over-the-counter medications are regulated by the FDA.

 

DIF:    Cognitive Level: Understanding (Comprehension)          REF:   88

 

  1. A parent calls a clinic for advice about giving an over-the-counter cough medicine to a 6-year-old child. The parent tells the NP that the medication label does not give instructions about how much to give a child. The NP should:
a. order a prescription antitussive medication for the child.
b. ask the parent to identify all of the ingredients listed on the medication label.
c. calculate the dose for the active ingredient in the over-the-counter preparation.
d. tell the parent to approximate the dose at about one third to one half the adult dose.

 

 

ANS:  B

Over-the-counter cough medications often contain dextromethorphan, which can be toxic to young children. It is important to identify ingredients of an over-the-counter medication before deciding if it is safe for children. A prescription antitussive is probably not warranted until the cough is evaluated to determine the cause. Until the ingredients are known, it is not safe to approximate the child’s dose based on only the active ingredient.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   89

 

  1. A primary care NP recommends an over-the-counter medication for a patient who has acid reflux. When teaching the patient about this drug, the NP should tell the patient:
a. to take the dose recommended by the manufacturer.
b. not to worry about taking this drug with any other medications.
c. to avoid taking other drugs that cause sedation while taking this drug.
d. that over-the-counter acid reflux medications are generally safe to take with other medications.

 

 

ANS:  A

Because patients often increase over-the-counter drug doses themselves, it is important to reinforce the need to follow the manufacturer’s recommendations for dosing. As with any drug, interactions may occur with other medications. Antacids do not cause sedation, so patients need not be cautioned to avoid other sedating medications.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   89

 

  1. A primary care NP is performing a previsit health history on a new patient. The patient reports taking vitamins every day. The NP should:
a. ask the patient to bring all vitamin bottles to the clinic appointment.
b. recommend natural vitamin products over synthetic vitamin products.
c. reassure the patient that vitamins that are high in folic acid are safe to take.
d. tell the patient that some vitamins, such as vitamin C, are safe in large doses.

 

 

ANS:  A

It is important to determine exactly what the patient is taking, so asking patients to bring vitamin bottles to the clinic is appropriate. There is no evidence that natural products are better than synthetic products. High doses of folic acid may mask signs of vitamin B12 deficiency. Vitamin C in high doses can cause dependency.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   89

 

  1. A patient reports taking antioxidant supplements to help prevent cancer. The primary care NP should:
a. review healthy dietary practices with this patient.
b. make sure that the supplements contain large doses of vitamin A.
c. tell the patient that antioxidants are especially important for patients who smoke.
d. tell the patient that evidence shows antioxidants to be effective in preventing cancer.

 

 

ANS:  A

Epidemiologic evidence indicates that people who eat fruits and vegetables regularly have a decreased risk of cancer. Although retrospective studies have suggested major benefits from antioxidants, no intervention studies have determined conclusively that antioxidants prevent cancer. Large doses of vitamin A can produce a yellow hue to the skin. Antioxidants can be beneficial, but in certain populations, such as smokers, they may be harmful.

 

DIF:    Cognitive Level: Understanding (Comprehension)          REF:   89

 

  1. A patient who has an upper respiratory infection reports using over-the-counter cold preparations. The primary care NP should counsel this patient to use caution when taking additional over-the-counter medications such as:
a. antipyretics.
b. calcium supplements.
c. acid reflux medications.
d. antioxidant supplements.

 

 

ANS:  A

Cold preparations often contain antipyretics such as acetaminophen or aspirin. Patients should be cautioned about taking additional antipyretics to avoid overdose.

 

DIF:    Cognitive Level: Applying (Application)                         REF:   89