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Test bank pharmaco.docx NURSING NGR 5035 Chapter 16-20

Test bank NURSING NGR 5035 Chapter 11-15 Chapter 16: Drugs Affecting the Cardiovascular and Renal Systems Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Ray has been diagnosed with hypertension and an ACE inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for: A. Hypokalemia B. Impotence C. Decreased renal function D. Inability to concentrate ____ 2. ACE inhibitors are the drug of choice in treating hypertension in diabetic patients because they: A. Improve insulin sensitivity B. Improve renal hemodynamics C. Reduce the production of angiotensin II D. All of the above ____ 3. A potentially life-threatening adverse response to ACE inhibitors is angioedema. Which of the following statements is true about this adverse response? A. Swelling of the tongue or hoarseness are the most common symptoms. B. It appears to be related to the decrease in aldosterone production. C. Presence of a dry, hacky cough indicates a high risk for this adverse response. D. Because it takes time to build up a blood level, it occurs after being on the drug for about 1 week. ____ 4. ACE inhibitors are useful in a variety of disorders. Which of the following statements are true about both its usefulness in the disorder and the reason for its use? A. Stable angina because it decreases the thickening of vascular walls to decreased MOD. B. Heart failure because it reduces remodeling of injured myocardial tissues. C. Both A and B are true and the reasons are correct D. Both A and B are true but the reasons are wrong E. Neither A nor B are true ____ 5. Despite good blood pressure control, a NP might change a patient’s drug from an ACEI to an angiotensin II receptor blocker (ARB) because the ARB: A. Is stronger than the ACEI B. Does not produce a dry, hacky cough C. Has no effect on the renal system D. Reduces sodium and water retention ____ 6. While taken an ARB, patients need to avoid certain over-the-counter drugs without first consulting the provider because: A. Cimetidine is metabolized by the CYP 3A4 isoenzymes B. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels C. Both A and B D. Neither A nor B ____ 7. Laboratory monitoring for patients on ACEIs or ARBs should include: A. White blood cells counts with the drug dose increased for elevations above 10,000 B. Liver function tests with the drug dose stopped for ALT values 2 normal C. Serum creatinine levels with the drug dose reduced for values above 2.5 mg/dL D. Serum glucose levels with the drug dose increased for levels above 120 mg/dL ____ 8. Jacob has hypertension for which a calcium channel blocker has been prescribed. This drug helps control blood pressure because it: A. Decreases the amount of calcium inside the cell B. Reduces stroke volume C. Increases the activity of the Na /K /ATPase pump indirectly D. Decreases heart rate ____ 9. Which of the following adverse effects may occur due to a dihydropyridine-type calcium channel blocker? A. Bradycardia B. Hepatic impairment C. Increased contractility D. Edema of the hands and feet ____ 10. Patient teaching related to amlodipine includes: A. Increase calcium intake to prevent osteoporosis from calcium blockade. B. Do not crush the tablet; it must be given in liquid form if the patient has trouble swallowing it. C. Avoid grapefruit juice as it affects the metabolism of this drug. D. Rise slowly from a supine position to reduce orthostatic hypotension. ____ 11. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker doses for her should be: A. Started at about half the usual dose B. Not raised above the usual dose for an adult C. Given once daily due to memory issues in the older adult D. Withheld if she experiences gastroesophageal reflux ____ 12. Larry has heart failure which is being treated with digoxin because it exhibits: A. Negative inotropism B. Positive chronotropism C. Both A and B D. Neither A nor B ____ 13. Furosemide is added to a treatment regimen for heart failure which includes digoxin. Monitoring for this combination includes: A. Hemoglobin B. Serum potassium C. Blood urea nitrogen D. Serum glucose ____ 14. Which of the following create higher risk for digoxin toxicity? Both the cause and the reason for it must be correct. A. Older adults due to reduced renal function B. Administration of aldosterone antagonist diuretics due to decreased potassium levels C. Taking an antacid for GERD because it increases the absorption of digoxin D. Doses between 0.25 and 0.5 mg/day ____ 15. Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: A. Within 6 hours of the last dose B. Because a reference point is needed in adjusting a dose C. After three half-lives from the starting of the drug D. When a patient has stable renal function ____ 16. Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate: A. Widening of the area of infarction B. Onset of congestive heart failure C. An electrolyte imbalance involving potassium D. Renal dysfunction ____ 17. Which of the following is true about procainamide and its dosing schedule? A. It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen. B. Gastrointestinal adverse effects are common so the drug should be taken with food. C. Adherence can be improved by using a sustained release formulation that can be given once daily. D. Doses of this drug should be taken evenly spaced around the clock to keep an even blood level. ____ 18. Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient teaching should include all of the following EXCEPT: A. Notify your health-care provider immediately if you have visual change B. Monitor your own blood pressure and pulse daily C. Take a hot shower or bath if you feel dizzy D. Use a sunscreen on exposed body surfaces ____ 19. The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he does not have thyroid disease and wants to know why the test is ordered. Which is a correct response? A. “Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.” B. “Amiodarone damages the thyroid gland and can result in inflammation of that gland causing hyperthyroidism.” C. “Amiodarone is a broad spectrum drug with many adverse effects. Many different tests need to be done before it is given.” D. “Amiodarone can cause corneal deposits in up to 25% of patients.” ____ 20. Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 AM and 2 PM because: A. It is a long-acting drug with potential for toxicity B. Nitrate tolerance can develop C. Orthostatic hypotension is a common adverse effect D. It must be taken with milk or food ____ 21. Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be: A. “This is a parasympathetic response to the vasodilating effects of the drug.” B. “Headaches are common side effects with these drugs. How severe are they?” C. “This is associated with your smoking. Let’s work on having you stop smoking.” D. “This is not related to your medication. Are you under a lot of stress?” ____ 22. In teaching about the use of sublingual nitroglycerine, the patient should be instructed: A. To swallow the tablet with a full glass of water B. To place one tablet under the tongue if chest pain occurs and allow it to dissolve C. To take one tablet every 5 minutes until the chest pain goes away D. That it should “burn” when placed under the tongue or it is no longer effective ____ 23. Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: A. Become a vegetarian since this disorder is associated with eating red meat B. Stop taking the drug if abdominal cramps and diarrhea develop C. Report muscle weakness or tenderness and dark urine to his provider immediately D. Expect “hot flash” sensations during the first 2 weeks of therapy ____ 24. Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor? A. Elevated serum transaminase B. Increased serum creatinine C. Elevated creatinine kinase D. Increased white blood cells counts ____ 25. Because of the pattern of cholesterol synthesis, reductase inhibitors are given: A. In the evening in a single daily dose B. Twice daily in the morning and the evening C. With each meal and at bedtime D. In the morning before eating ____ 26. Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the following labs should be monitored? A. Serum alanine aminotransferase B. Serum amylase C. Serum creatinine D. Phenylketonuria ____ 27. Niaspan is less likely to cause which side effect that is common to niacin? A. Gastrointestinal irritation B. Cutaneous flushing C. Dehydration D. Headaches ____ 28. Which of the following statements is true? A. Niacin is a B-complex vitamin and taking double the dose of the over-the-counter vitamin will lower LDL and save money. B. Niacin has been shown to reduce all-cause mortality for patients with CAD if taken in prescription strength. C. Niacin should be given on an empty stomach to avoid GI irritation. D. All of the above ____ 29. Dulcea has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? A. Reactive airway disease/asthma B. Inflammatory bowel disease C. Allergy to aspirin D. Gallbladder disease ____ 30. Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. A. Reductase inhibitors, due to an increased risk for rhabdomyolysis B. Bile-acid sequestering resins, due to interference with folic acid absorption C. Grapefruit juice, due to interference with metabolism D. Niacin, due to decreased gemfibrozil activity ____ 31. Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other anti-lipidemics, this drug: A. Blocks synthesis of cholesterol in the liver B. Exchanges chloride ions for negatively charged acids in the bowel C. Increases HDL levels the most among the classes D. Blocks the lipoprotein lipase pathway ____ 32. Because of their site of action, bile acid sequestering resins: A. Should be administered separated from other drugs by at least 4 hours B. May increase the risk for bleeding C. Both A and B D. Neither A nor B ____ 33. Colestipol comes in a powdered form. The patient is taught to: A. Take the powder dry and follow it with at least 8 ounces of water B. Take it with a meal to enhance its action on fatty food C. Mix the powder with 4 to 6 ounces of milk or fruit juice D. Take after the evening meal to coincide with cholesterol synthesis ____ 34. The choice of diuretic to use in treating hypertension is based on: A. Presence of diabetes with loop diuretics being used for these patients B. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher than the mid-40 mL/min range C. Ethnicity with aldosterone antagonists best for African Americans and older adults D. Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL Chapter 17: Drugs Affecting the Respiratory System Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Digoxin levels need to be monitored closely when the following medication is started: A. Loratadine B. Diphenhydramine C. Ipratropium D. Albuterol ____ 2. Patients with pheochromocytoma should avoid which of the following classes of drugs due to the possibility of developing hypertensive crisis? A. Expectorants B. Beta-2-agonists C. Antitussives D. Antihistamines ____ 3. Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? A. Betamethasone, an inhaled corticosteroid B. Salmeterol, an inhaled long-acting beta-agonist C. Albuterol, a short-acting beta-agonist D. Montelukast, a leukotriene modifier ____ 4. Long-acting beta-agonists (LTBAs) received a Black Box warning from the U.S. Food and Drug Administration due to the: A. Risk of life-threatening dermatological reactions B. Increased incidence of cardiac events when LTBAs are used C. Increased risk of asthma-related deaths when LTBAs are used D. Risk for life-threatening alterations in electrolytes ____ 5. The bronchodilator of choice for patients taking propranolol is: A. Albuterol B. Pirbuterol C. Formoterol D. Ipratropium ____ 6. James is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin’s diet for weight loss. The appropriate response would be: A. Congratulate him on making a positive change in his life B. Recommend he try stopping smoking instead of the Atkin’s diet C. Schedule him for regular serum theophylline levels during his diet due to increased excretion of theophylline D. Decrease his theophylline dose because a high-protein diet may lead to elevated theophylline levels ____ 7. Li takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to: A. Reassure him this is probably a viral infection and should be better soon B. Have him seen the same day for an assessment and theophylline level C. Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better D. Order a theophylline level at the lab for him ____ 8. Tiotropium bromide (Spiriva) is an inhaled anticholinergic: A. Used for the treatment of COPD B. Used in the treatment of asthma C. Combined with albuterol for treatment of asthma exacerbations D. Combined with fluticasone for the treatment of persistent asthma ____ 9. Christy has exercise and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes: A. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day B. Beclomethasone needs to be used every day to treat her asthma C. Report any systemic side effects she is experiencing, such as weight gain D. Use the albuterol MDI immediately after her corticosteroid MDI to facilitate bronchodilation ____ 10. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed: A. Montelukast twice a day is started when there is an asthma exacerbation B. Patients may experience weight gain on montelukast C. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast D. Lethargy and hypersomnia may occur when taking montelukast ____ 11. Montelukast (Singulair) may be prescribed for: A. A 6 year old with exercise-induced asthma B. A 2 year old with moderate persistent asthma C. An 18 month old with seasonal allergic rhinitis D. None of the above; montelukast is not approved for use in children ____ 12. The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include: A. Albuterol B. MMR vaccine C. Insulin D. None of the above ____ 13. When educating patients who are starting on inhaled corticosteroids, the provider should include: A. They need to get any live vaccines before starting the medication. B. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective. C. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. D. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids. ____ 14. Patients with allergic rhinitis may benefit from a prescription of: A. Fluticasone (Flonase) B. Cetirizine (Zyrtec) C. OTC cromolyn nasal spray (Nasalcrom) D. Any of the above ____ 15. Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: A. Urinary retention B. Cardiac output C. Peripheral edema D. Skin for rash ____ 16. First generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are: A. More effective than first generation antihistamines B. Less sedating than the first generation antihistamines C. Prescription products, therefore are covered by insurance D. Able to be taken with CNS sedatives, such as alcohol ____ 17. When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to: A. Take the dimenhydrinate after they get nauseated B. Drink lots of water while taking the dimenhydrinate C. Take the dimenhydrinate 15 minutes before it is needed D. Double the dose if one tablet is not effective ____ 18. Decongestants such as pseudoephedrine (Sudafed): A. Are Schedule III drugs in all states B. Should not be prescribed or recommended for children under 4 years of age C. Are effective in treating the congestion children experience with the common cold D. May cause drowsiness in patients of all ages ____ 19. Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population: A. Older adults B. Hypertensive patients C. Infants D. All of the above ____ 20. Martin is a 60 year old with hypertension. The first-line decongestant to prescribe would be: A. Oral pseudoephedrine B. Oral phenylephrine C. Nasal oxymetazoline D. Nasal azelastine ____ 21. The first-line treatment for cough related to a URI in a 5 year old is: A. Fluids and symptomatic care B. Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids) C. Guaifenesin and codeine syrup (Tussin AC) D. Chlorpheniramine and dextromethorphan syrup (Nyquil for Kids) Chapter 18: Drugs Affecting the Hematopoietic System Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is: A. Ibuprofen 400 mg three times a day B. Acetaminophen, not to exceed 4 grams per day C. Prescribe acetaminophen with codeine D. Aspirin 640 mg three times a day ____ 2. Juanita had a DVT and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to: A. Contact the hospitalist as this is not the normal guideline for proscribing these two medications and she may have had a more complicated case B. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness C. Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission D. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times ____ 3. The safest drug to use to treat pregnant women who require anticoagulant therapy is: A. Low molecular weight heparin B. Warfarin C. Aspirin D. Heparin ____ 4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients? A. Pregnant women B. Elderly men C. Overweight or obese patients D. Patients with multiple comorbidities ____ 5. Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting “a shot” to prevent blood clots like his friend Ralph did before international travel. The correct respond would be: A. Administer one dose of low-molecular weight heparin 24 hours before travel B. Prescribe one dose of warfarin to be taken the day of travel C. Consult with a hematologist regarding a treatment plan for Cecil D. Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling ____ 6. Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended? A. He has arthritis and this will help with the inflammation and pain. B. Aspirin has anti-platelet activity and prevents clots that cause heart attacks. C. Aspirin acidifies the urine and he needs this for prostrate health. D. He has a history of GI bleed, and one aspirin a day is a safe dose. ____ 7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity she would need to be evaluated for: A. Tinnitus B. Diarrhea C. Hearing loss D. Photosensitivity ____ 8. Patient education when prescribing clopidogrel includes: A. Do not take any herbal products without discussing with the provider B. Monitor urine output closely and contact the provider if it decreases C. Clopidogrel can be constipating, use a stool softener if needed D. The patient will need regular anticoagulant studies while on clopidogrel ____ 9. For patients taking warfarin INRs are best drawn: A. Monthly throughout therapy B. Three times a week throughout therapy C. Two hours after the last dose of warfarin to get an accurate peak level D. In the morning if the patient takes their warfarin at night ____ 10. Patients receiving heparin therapy require monitoring of: A. Platelets every 2 to 3 days for thrombocytopenia that may occur on Day 4 of therapy B. Electrolytes for elevated potassium levels in the first 24 hours of therapy C. INR throughout therapy to keep in the range around 2.0 D. Blood pressure for hypertension that may occur in the first 2 days of treatment ____ 11. The routine monitoring recommended for low molecular weight heparin is: A. INR every 2 days until stable then weekly B. aPTT every week while on therapy C. Factor Xa levels if patient is pregnant D. White blood cell count every 2 weeks ____ 12. When writing a prescription for warfarin it is common to write ____ on the prescription. A. OK to substitute for generic B. The brand name of warfarin and Do Not Substitute C. PRN refills D. Refills for 1 year ____ 13. Education of patients who are taking warfarin includes discussing their diet. Instructions include: A. Avoiding all vitamin K-containing foods B. Avoiding high vitamin K-containing foods C. Increasing intake of iron-containing foods D. Making sure they eat 35 grams of fiber daily ____ 14. Patients who are being treated with epoetin alfa need to be monitored for the development of: A. Thrombocytopenia B. Neutropenia C. Hypertension D. Gout ____ 15. The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that: A. ESAs no longer be prescribed to patients with chronic renal failure B. The risk of tumor development be explained to cancer patients on ESA therapy C. Patients should no longer receive ESA therapy to prepare for allogenic transfusions D. ESAs be prescribed only to patients younger than age 60 years ____ 16. When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in: A. 6 weeks if they are a cancer patient B. 1 week if they have chronic renal failure C. 2 weeks if taking for allogenic transfusion D. Weekly throughout therapy ____ 17. Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed: A. Folic acid to prevent megaloblastic anemia B. Iron, to start when the epogen starts C. An antihypertensive to counter the adverse effects of epogen D. Vitamin B12 to prevent pernicious anemia ____ 18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes: A. Reticulocyte count 1 week after therapy is started B. Complete blood count every 2 weeks throughout therapy C. Hemoglobin level at 1 week of therapy D. INR weekly throughout therapy ____ 19. Patient education regarding taking iron replacements includes: A. Doubling the dose if they miss a dose to maintain therapeutic levels B. Taking the iron with milk or crackers if it upsets their stomach C. Iron is best taken on an empty stomach with juice D. Antacids such as Tums may help the upset stomach caused by iron therapy ____ 20. Patients with pernicious anemia require treatment with: A. Iron B. Folic acid C. Epogen alpha D. Vitamin B12 ____ 21. The first lab value indication that Vitamin B12 therapy is adequately treating pernicious anemia is: A. Hematocrit levels start to rise B. Hemoglobin levels return to normal C. Reticulocyte count begins to rise D. Vitamin B12 levels return to normal ____ 22. Patients who are beginning therapy with Vitamin B12 need to be monitored for: A. Hypertensive crisis that may occur in the first 36 hours B. Hypokalemia that occurs in the first 48 hours C. Leukopenia that occurs at 1 to 3 weeks of therapy D. Thrombocytopenia that may occur at any time in therapy Chapter 19: Drugs Affecting the Immune System Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Attenuated vaccines are also known as: A. Killed vaccines B. Booster vaccines C. Inactivated vaccines D. Live vaccines ____ 2. Live attenuated influenza vaccine (FluMist) may be administered to: A. All patients over 6 months of age B. Patients between age 2 years and 49 years with no risk factors C. Patients with a URI or asthma D. Pregnant women ____ 3. The reason that two MMR vaccines at least a month apart are recommended is: A. The second dose of MMR “boosts” the immunity built from the first dose B. Two vaccines 1 month apart is the standard dosing for all live virus vaccines C. If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine D. Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR ____ 4. MMR vaccine is not recommended for pregnant women because: A. Pregnant women do not build adequate immunity to the vaccine B. There is a risk of the pregnant women developing measles encephalopathy C. There is a risk of the fetus developing congenital rubella syndrome D. Pregnant women can receive the MMR vaccine ____ 5. If the MMRV (measles, mumps, rubella, and varicella) combined vaccine is ordered to be given as the first MMR and varicella dose to a child the CDC recommends: A. Parents be informed of the increased risk of fever and febrile seizures over the MMR plus varicella 2 shot regimen B. Patients must also receive MMRV as the second dose of MMR and varicella in order to build adequate immunity C. Patients be premedicated with acetaminophen 15 minutes before the vaccine is given D. Patients should not be around pregnant women for the first 48 hours after the vaccine is given ____ 6. The rotavirus vaccine (RotaTeq, Rotarix): A. Is a live vaccine that replicates in the small intestine, providing active immunity against rotavirus B. Should not be administered to infants who are or may be potentially immunocompromised C. Is not given to an infant who has a febrile illness (temperature greater than 100.5°F) D. All of the above ____ 7. Varicella vaccine is recommended to be given to patients who are: A. HIV positive with a CD4 T-lymphocyte percentage less than 15 percent B. Taking corticosteroids (up to 2 mg/kg/day or less than 20 mg/day) C. Pregnant D. Immunocompromised ____ 8. Zoster vaccine (Zostavax) is: A. A live varicella zoster vaccine from the same strain used to develop the varicella vaccine B. Effective in preventing varicella zoster in patients of all ages C. Recommended for patients age 40 to 80 who have had chickenpox D. Administered at the same time as other live vaccines, as long as they are given the same day ____ 9. True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include: A. Fever up to 104°F (40.5°C) after previous DTaP vaccine B. Family history of seizures after DTaP vaccine C. Adolescent pregnancy D. Anaphylactic reaction with a previous dose ____ 10. Hepatitis B vaccine (HBV) is contraindicated in patients who: A. Were born less than 32 weeks gestation (give first dose at age 6 months) B. Are pregnant C. Are on hemodialysis D. Are allergic to yeast ____ 11. Human papillomavirus (HPV) vaccine (Gardasil, Cervarix): A. Is a live virus vaccine that provides immunity to six strains of HPV virus B. Has a common adverse effect of syncope within 15 minutes of giving the vaccine C. Should not be given to males younger than age 12 years D. May be given to pregnant women ____ 12. Influenza vaccine may be administered annually to: A. Patients with egg allergy B. Pregnant patients C. Patients age 6 weeks or older D. Patients with acute febrile illness ____ 13. Immune globulin serums (IGs): A. Provide active immunity against infectious diseases B. Are contraindicated during pregnancy C. Are heated to above body temperature to kill most hepatitis, HIV, and other viruses such as parvovirus D. Are derived from pooled plasma of adults and contain specific antibodies in proportion to the donor population ____ 14. Hepatitis B immune globulin (HBIG) is administered to provide passive immunity to: A. Infants born to HBsAg-positive mothers B. Household contacts of hepatitis-B virus infected people C. Persons exposed to blood containing hepatitis B virus D. All of the above ____ 15. Rho(D) immune globulin (RhoGAM) is given to: A. Infants born to women who are Rh positive B. Sexual partners of Rh positive women C. Rh negative women after a birth, miscarriage, or abortion D. Rh negative women at 36 weeks gestation ____ 16. Tuberculin purified protein derivative (PPD): A. Is administered to patients who are known tuberculin-positive reactors B. May be administered to patients who are on immunosuppressives C. May be administered 2 to 3 weeks after an MMR or varicella vaccine D. May be administered the same day as the MMR and/or varicella vaccine ____ 17. Diane may benefit from cyclosporine (Sandimmune). Cyclosporin may be prescribed to: A. Treat rheumatoid arthritis B. Treat patients with corn allergy C. Pregnant patients D. Treat patients with liver dysfunction ____ 18. Azathioprine has significant adverse drug effects, including: A. Hypertension B. Hirsutism C. Risk of cancer D. Gingival hyperplasia Chapter 20: Drugs Affecting the Gastrointestinal System Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing with their provider or a pharmacist first? A. Patients with kidney stones B. Pregnant patients C. Patients with heartburn D. Post-menopausal women ____ 2. Patients taking antacids should be educated regarding these drugs, including: A. They may cause constipation or diarrhea B. Many are high in sodium C. Separate antacids from other medications by 1 hour D. All of the above ____ 3. Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: A. Can be given to all age patients, including infants and children, for viral gastroenteritis B. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea C. Is the treatment of choice for the diarrhea associated with E. coli 0157 D. May be used in pregnancy and by lactating women ____ 4. Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate: A. May lead to toxicity if taken with aspirin B. Is contraindicated in children with flu-like illness C. Has antimicrobial effects against bacterial and viral enteropathogens D. All of the above ____ 5. Hannah will be traveling to Mexico with her church group over Spring Break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes normal food and water precautions as well as: A. Loperamide four times a day throughout the trip B. Bismuth subsalicylate with each meal and bedtime C. A prescription for diphenoxylate with atropine to use if she gets diarrhea D. None of the above ____ 6. Josie is a 5 year old who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? A. Prochlorperazine (Compazine) B. Meclizine (Antivert) C. Promethazine (Phenergan) D. Ondansetron (Zofran) ____ 7. Jim presents with complaints of “heart burn” that is minimally relieved with Tums (calcium carbonate) and is diagnosed with GERD. An appropriate first step therapy would be: A. Omeprazole (Prilosec) twice a day B. Ranitidine (Zantac) twice a day C. Famotidine (Pepcid) once a day D. Metoclopramide (Reglan) four times a day ____ 8. Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: A. Iron deficiency anemia, vitamin B12 and calcium deficiency B. Folate and magnesium deficiency C. Elevated uric acid levels leading to gout D. Hypokalemia and hypocalcemia ____ 9. Sadie is a 72 year old who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: A. Megaloblastic anemia B. Osteoporosis C. Hypertension D. Strokes ____ 10. Patrick is a 10 year old who presents with constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10 year old would be: A. PEG 3350 (Miralax) B. Bisacodyl (Dulcolax) suppository C. Docusate (Colace) suppository D. Polyethylene glycol electrolyte solution

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