Final Exam: NUR635/ NUR 635 (Latest 2023/ 2024 Update) Advanced Pharmacology Exam| Questions and Verified Answers| 100% Correct| Grade A- Grand Canyon
Final Exam: NUR635/ NUR 635 (Latest 2023/
2024 Update) Advanced Pharmacology
Exam| Questions and Verified Answers|
100% Correct| Grade A- Grand Canyon
Q: The NP opts NOT to give a beta agonist to which patient?
Answer:
History of pheochromocytoma.
Q: The NP educates which patient population regarding salmeterol’s Black
Box Warning?
Answer:
African Americans
Q: The NP believes the patient needs additional education regarding long-act- ing beta agonist’s
Black Box warning when the patient verbalizes?
Answer:
“I take this medication in case of an asthma attack.”
Q: A 72-year-old presents to the clinic with the cc of “I can’t pee”. Which history does the NP
suspect may be causing this symptoms?
Answer:
Taking Benadryl for seasonal allergies. Benadryl can cause urinary retention.
Q: A patient recently diagnosed with pneumonia, is also found to have os- teoporosis, anemia,
and vitamin B12 deficiency. The NP suspects which TX is causing the patient’s issues?
Answer:
Long Term PPI therapy
Q: When determining appropriate antimicrobial tx, the NP utilizes which tool to assess local
resistance patterns?
Answer:
Antibiogram
Q: After receiving Flagyl for a diverticulitis flare up, the patient calls the clinic complaining of
nausea, vomiting, and ABD pain. The NP focuses on which part of the SOAP note to rule out a
disulfiram reaction?
Answer:
Social history
Q: Which pt should receive fluoroquinolone therapy for CAP (community-ac- quired
pneumonia) diagnosis?
Answer:
A 44-year-old female with DM.
Q: Sulfonamides should be avoided in patients with a G6PD deficiency
(x-linked in African American) due to risk of
Answer:
hemolytic anemia
Q: A 16YO presents to the clinic for tx of her acne. The NP prescribes which medication?
Answer:
Combination antibiotic and topical.
Q: A teenager comes to the clinic with complaint of headache. The NP sus- pects minocycline
may be causing the symptoms due to its risk of
Answer:
Pseudo- tumor cerbri (increased intracranial pressure)
Q: Which tx is appropriate for a patient with new onset of cluster headaches?-
Answer:
100% oxygen for 15-30 minutes
Q: When should the NP expect to see clinical improvement after starting antibiotic therapy for a
pneumonia patient?
Answer:
2-3 days
Q: A 4YO comes in with ear pain and on exam, the TM is erythematous, bulging, and nonmobile. Vital signs are: BP 112/62, P122, RR16, T is 102.5. The NP decides to proceed with
Answer:
Start the patient on amoxicillin or Augmentin.
Q: A 6YO is seen next, with the same symptoms as your previous 4 YO pt but with no fever,
the NP recommends which tx for this patient?
Answer:
Start the pt on lidocaine drops to help with ear pain.
Q: A pt with new diagnosed open-angle glaucoma was recently prescribed timolol. The NP
expresses concern about this medication based on which hx reported by the patient?
Answer:
Asthma.
Q: First line tx for mild acne include
Answer:
Any of the above (Benzoyl peroxide, topical retinoid, topical combination therapy)
Q: Tx for moderate acne include
Answer:
Any of the above (Benzoyl peroxide and
ABX/retinoid, oral ABX, topical combination therapy)
Q: Which oral abx does the NP choose to prescribe for the pt with moderate acne?
Answer:
Doxycycline, Minocycline, Tetracycline or Erythromycin
Q: A 34 YO female comes to the clinic complaining of dysuria, frequency, and urgency. Which
additional information does the NP need prior to deciding on a tx plan?
Answer:
Is the infection in the upper or lower urinary tract? Does the pt have
any history of predisposing factors? Does the pt have a hx of recent UTIs? Is the pt pregnant?
How long have symptoms been going on?
Q: 34 YO female comes to the clinic complaining of dysuria, frequency, and urgency. She has a
lower UTI, no predisposing factors and a history of UTA approximately 6 mo. ago. The NP
chooses which tx plan for the patient?
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First line drug of choice for CAP in a previously healthy adult would include:
Phenytoin hypersensitivity reaction
Skin Reaction (Steven Johnson Syndrome and TEN (Toxic Epidermal necrolysis))
Carbamazepine monitoring should include all of the following except:
Lamictal hypersensitivity reaction.
Lamictal doses will need to be increased while taking oral contraceptives.
Tricyclic antidepressants should be avoided in?
When educating patients regarding antidepressants, the NP should include:
It may take 2-3 weeks for medications to take effect.
After ordering IM Haldol for the patient, the NP knows to assess for EPS using which tool?
AIMS (abnormal involuntary movement scale) test
Digoxin dose will need to be increased.
The NP opts NOT to give a beta agonist to which patient?
The NP educates which patient population regarding salmeterol’s Black Box Warning?
“I take this medication in case of an asthma attack.”
Taking Benadryl for seasonal allergies. Benadryl can cause urinary retention.
Which pt should receive fluoroquinolone therapy for CAP (community-acquired pneumonia) diagnosis?
A 16YO presents to the clinic for tx of her acne. The NP prescribes which medication?
Combination antibiotic and topical.
Pseudotumor cerbri (increased intracranial pressure)
Which tx is appropriate for a patient with new onset of cluster headaches?
Start the patient on amoxicillin or Augmentin.
Start the pt on lidocaine drops to help with ear pain.
First line tx for mild acne include
Any of the above (Benzoyl peroxide, topical retinoid, topical combination therapy)
Any of the above (Benzoyl peroxide and ABX/retinoid, oral ABX, topical combination therapy)
Which oral abx does the NP choose to prescribe for the pt with moderate acne?
Doxycycline, Minocycline, Tetracycline or Erythromycin
Short-course therapy or single dose therapy.
What short course therapy would you prescribe for a 34YO female who isn’t pregnant with a UTI?
Trimethoprim/sulfamethoxazole (Bactrim) for 3 days
Which aminoglycoside would the NP prescribe for a patient diagnosed with conjunctivitis?
This time tomorrow and continue once a day for 5 -7 days.
Advises the pt to discontinue the medication.
NP’s next step would be to decrease the medication dosage.
The NP decides to change the medication to Augmentin.
A 65YO male with hx of COPD is now diagnosed with bronchitis. The NP begins tx with?
Inform the other providers about their use of the medication.
Produces feelings of satiety (makes things taste bad)
Niacin is no longer recommended to help patients lower cholesterol due to:
Which medication can the NP add with ondansetron to assist a pt experiencing chemo-induced nausea?
Which pt would the NP question the lactulose order for?
A patient with an ammonia level of 45.
What causes antimicrobial resistance?
Inappropriate use of antimicrobials.
Your pattern of local resistance.
What is the thing that causes cross sensitivity of cephalosporins and penicillin’s?
Someone on long-term antifungal therapy, like an -azole, you will need to draw what labs?
Patient being treated with Clindamycin and having frequent diarrhea, what would you assess her for?
CDIFF (pseudomembranous colitis)
What should you stay away from if you have G6P dehydrogenase deficiency?
Cannot have fava beans, can trigger anemia.
Are tetracyclines used in pregnant and renal dysfunction or hepatic patients?
NO! We can use them in adolescents who has all their teeth has come in.
Pt with chlamydia infection and given doxycycline, what would you tell her to do?
Use a backup birth control until next menses.
Isoniazid for TB, it can cause decrease in vitamin B6, what do we do?
prescribe them supplemental B6 (pyridoxine)
Valacyclovir for shingles, what do you need to worry about?
Their renal function and tell them to drink fluids.
Patient has conjunctivitis and acute otitis media, what would you treat with?
Amoxicillin first, and then switch to Augmentin if it still hasn’t gone away after a month.
Allergic conjunctivitis, you won’t give ABX but what can you give?
Cromolyn and the patient cannot wear their soft contact lenses while taking it.
If you have a pt with a perforated tympanic membrane, what drops should you not use?
What should you use for moderate-mild anxiety?
Someone has depression, and you want to look at what else?
Thyroid. (low thyroid can cause depression symptoms)
Pts with COPD, when they come to see an NP, what do you do ask about their inhaler?
How many times are they using their rescuer inhaler (albuterol- beta 2 agonist)
If you have someone with COPD exacerbation, what will you prescribe for them?
The sphincter can be more relaxed and can cause food to come up the esophagus.
How does metoclopramide (Reglan) work?
It increases lower esophageal tone; gastric motility.
If a pt has H Pylori, what medications are you looking at using to treat with?
Amoxicillin, Clarithromycin and a PPI.
What is a prophylactic treatment for migraines?
CAP (Community Acquired Pneumonia) treatment?
CAP with comorbidities/immunosuppressed, what do you treat with as an outpatient?
Fluroquinolones “floxacins” i.e. levofloxacin
What is one of the big things we need to educate our patients when they are taking Chantix?
A pt has swimmers ear with an intact tympanic membrane, how would we treat it?
Ciprodex (Cipro with hydrocortisone drops)
What do we give for a genital herpes outbreak?
Which one is NOT true when evaluating someone with osteoporosis?
Calcium and vitamin D is not necessary.
The risk of renal/hepatic injury because you are on treatment for so long.
A pt with shingles and the pt is miserable, what do you treat with?
What do you prescribe for neuropathic pain?
CAP in an adult with comorbid conditions and Levaquin is not an option, what do you treat them with?
What do you treat a community acquired soft tissue MRSA infection with?
What drug causes long term osteopenia?
Which of the following about pancreatic enzymes is true?
You titrate the enzymes according to the decrease in steatorrhea (fatty/oily stool)
In what medical states can pancreatic enzymes be needed?
When giving pancreatic enzymes, you are replacing what?
What units do you prescribe pancreatic enzymes in?
Why do we need full prescriptive authority as a NP?
If you’re providing something with a narrow therapeutic index, what do you need to do?
The inactive ingredients are different and so the rate of solution can be different.
Giving IV gentamycin and your drug level is at a toxic level, so what do you need to look at?
When you write a prescription, what does it need?
Route, dose, frequency (ie, Lasix 20mg PO daily)
They have built up a tolerance.
When is the highest risk of teratogenic risk in pregnancy?
A 5-year-old has grey teeth, why?
No, we give him education and morphine.
To lower intra ocular pressure in patients with glaucoma.
In a patient with asthma because it can cause bronchoconstriction
What do we give for motion sickness on a cruise?
What are some of the side effects of cyclobenzaprine?
Drowsiness, blurred vision, dry mouth and constipation
You have a pt who has seizures and you place them on an antiepileptic drug, what do you do?
It won’t work, so they need to consider a different form of birth control.
Is it ok for pts in 3rd trimester to take aspirin?
No, it closes the ductus arteriosus.
No, because it will make them more immunocompromised.
TDAP, MCV4 (meningococcal), and HPV
What is one of the reasons we start methotrexate early in rheumatoid arthritis?
It reduces the damage; delays how bad the joints deteriorate.
probenecid (not for acute gout, used for chronic)
You’ll need to reduce warfarin dosage.
A pt has had 3 gout flare ups in the last year, what medication do you give them?
Allopurinol (urate lowering drug)
Have a patient with Padgett’s disease (bad bone pain), what drug can we use to treat that?
What do you tell your pt about taking alendronate (for post-menopausal osteoporosis)?
Sit up right for 30 minutes after and with a full glass of water.
Pt has a cough and is advised to use guaifenesin (expectorant) and they ask why?
It stimulates the flow of secretions so they are easier to cough up.
What is step one management for asthma?
Do we give magnesium hydroxide in renal failure?
Chronic alcohol with cirrhosis, what drug will they get and what will you monitor?
Lactulose (ammonia levels will be high) Check potassium and chloride.
Which of the cholesterol therapies cause flushing?
Because it can accelerate the metabolism of some drugs.
A COPD pt who has bronchitis and has a fever, what do you do?
Give and ABX and get a sputum culture.
What cephalosporin treats MRSA?
A pt is receiving aminoglycoside and culture comes back with an anaerobic organism, what do you do?
Prescribe a different class of ABX.
How do we treat simple scattered condones (acne) in adolescents?
A pt with open angle glaucoma and prescribing timolol, what condition could be made worse?
Paxil for depression, what is one big s/e that will resolve that we need to warn pt about?
Sexual dysfunction (might take a month to begin)
What do I give to a pregnant UTI pt?
If I have a pt on a ICS and Beta agonist, which one do they administer first?
Beta first to open airways then steroid.
For an SSRI like Paxil, how long before it takes effect?
Education for a pt that is high risk for osteoporosis?
Take Vit D & calcium with exercise (combined)
A pt has Otitis externa (swimmer’s ear), what is the first thing you are assessing?
First step therapy for a new dx of GERD?
What type of med is Minocycline?
If a pt is on abx and has bloody diarrhea, what is on my differential list?
For pts using phentermine, why do I have to rotate them off for a while?
Their body becomes tolerant, and it is not effective
What education do we give for an asthma pt if their symptoms get worse?
To use their SABA (rescue inhaler) and call provider (may need to step up therapy)
Check to make sure they are using appropriately
What med do we prescribe for a pt with panic disorder?
What are some ADRs to warn pt about with Singular?
Suicidal ideation, aggression, anxiety (psych)
What med can be prescribed for a pt with depression with anxiety?
What do we need to check prior to starting pt on Acyclovir?
How long do you recommend a pt to take the SSRI Celexa to see improvement?
Improvement within the first 1-2 weeks (concentration, mood) (Quick-acting SSRI)
If a pt that has a known G6PD deficiency, what abx do u not give?
For elderly, why am I going away from 1st gen antihistamine and going to second?
Who cannot take Calcium carbonate antiacids?
Decrease med dose by up to 50% every 3-4 days
Treats opiate associated constipation
Because it can cause serotonin syndrome (or any meds that can alter Serotonin)
If a pt comes in with a sprained ankle & swelling, what do we prescribe?
What do we use dimenhydrinate for?
Motion sickness (take 15 mins prior to trip)
If I have to give a pt eyedrops, what education do I give them?
Throw away makeup, don’t touch tip to eye, don’t wear contacts, wash hands.
Lithium education for patients?
Sodium alters lithium levels drastically—have a consistent sodium diet.
Abx treatment for any patient education?
Finish course, monitor for a/e like diarrhea, increase fluid intake for hydration
If you start a pt on ICS for their asthma, what education will you give?
Rinse mouth every time they use it to avoid thrush
A patient is just dx with PUD, what bacteria do we check for?
H Pylori (present in 95-100% of all cases)
Tell her to use back up method until next menstrual cycle.
Who am I most scared of having a fatal asthma attack?
Those that have previously been intubated or admitted to the hospital from an asthma attack.
With medications like Paxil, why is pt education of making sure they have refills so important?
Within 48 hours of symptoms (If they had symptoms Mon & come in Thursday—NO)
Treating a patient for depression and they came back saying they are feeling a little better?
Increase dose or change drug— Treat the patient to remission (partial effectiveness is not ok)
Depression should be fully resolved!!
What if a patient is treated for asthma and still uses their inhaler every day?
If I need to give a decongestant to an older patient, what route am I wanting them to take?
Nasal (localized, no systemic s/e)
sources; https://www.gcu.edu/