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NR565 Week 8 Final Exam

Question 1

Which of the following BEST represents a goal of reducing impairment in asthma management?

Answers: A – D

1. Maintaining normal activity levels, including exercise ✅
   B. Increasing activity levels to a higher level of physical fitness
   C. Minimizing the need for emergency department visits for exacerbations
   D. Preventing recurrent exacerbations

Question 2

The NP is planning triple-therapy for a patient with Helicobacter pylori. The NP selects which of the following drug combinations?

Answers: A – D

1. Clarithromycin (Biaxin XL), tetracycline (Sumycin), and a proton-pump inhibitor
   B. Bismuth subsalicylate (Pepto-Bismol), tetracycline (Sumycin), and clarithromycin (Biaxin XL)
   C. Clarithromycin (Biaxin XL), amoxicillin (Amoxil), and a proton-pump inhibitor ✅
   D. Tetracycline (Sumycin), metronidazole (Flagyl), and bismuth subsalicylate (Pepto-Bismol)

Question 3

Which of the following monitoring strategies is MOST appropriate for a child on long-term (>6 months) high-dose inhaled glucocorticoid therapy?

Answers: A – D

1. Check fasting lipid profile every 3 months
   B. Monitor growth patterns and assess for adrenal suppression ✅
   C. Schedule routine serum potassium checks
   D. Perform liver function testing weekly

Question 4

A 55-year-old patient is diagnosed with a duodenal ulcer and tests positive for Helicobacter pylori. Which of the following BEST explains why eradication of the organism is critical for long-term management?

Answers: A – D

1. It decreases prostaglandin breakdown
   B. It prevents gastric acid hypersecretion
   C. It reduces ulcer recurrence from approximately 80% to 10% ✅
   D. It increases bicarbonate secretion in the stomach

Question 5

When initiating levothyroxine (Synthroid) therapy in older adults, what is the recommended approach?

Answers: A – D

1. Initiate full replacement dose due to delayed metabolic response in the elderly
   B. Use liothyronine instead due to renal clearance concerns
   C. Start with a lower dose (e.g., 25–50 mcg/day) and titrate slowly ✅
   D. Avoid levothyroxine and prioritize desiccated preparations

Question 6

The NP is prescribing a long-acting bronchodilator for a patient with asthma. Which drug must be co-prescribed?

Answers: A – D

1. A proton-pump inhibitor
   B. A mast-cell inactivator
   C. A leukotriene modifier
   D. An inhaled corticosteroid ✅

Question 7

A 35-year-old woman with irritable bowel syndrome with diarrhea (IBS-D) reports frequent cramping and loose stools despite dietary modifications. The NP considers prescribing a drug specifically approved for IBS-D in women. Which agent fits this description?

Answers: A – D

1. Alosetron (Lotronex) ✅
   B. Loperamide (Imodium)
   C. Lubiprostone (Amitiza)
   D. Psyllium (Metamucil)

Question 8

Which patient scenario represents an absolute contraindication to methimazole (Tapazole) use?

Answers: A – D

1. A patient with mild leukopenia from a viral illness
   B. A patient in the first trimester of pregnancy ✅
   C. A patient in the third trimester of pregnancy
   D. A patient with hyperthyroidism awaiting radioactive iodine therapy

Question 9

Which statement BEST describes the mechanism of action of phenothiazine antiemetics such as prochlorperazine (Compazine)?

Answers: A – D

1. They block dopamine-2 receptors in the CTZ ✅
   B. They block serotonin (5-HT₃) receptors in the CTZ
   C. They stimulate acetylcholine release in the vestibular system
   D. They block histamine-1 receptors in the vomiting center

Question 10

A 35-year-old woman with newly diagnosed type 2 diabetes (T2D) is started on metformin (Glucophage). She asks if she should skip her medication on days when she is too busy to eat lunch. Which is the NP’s BEST response?

Answers: A – D

1. “You should hold the dose to prevent hypoglycemia”
   B. “You should only take metformin with a high-carbohydrate meal”
   C. “You should increase your dose if you eat fewer carbohydrates”
   D. “You can take metformin even if you skip a meal” ✅

Question 11
The NP is prescribing a stimulant laxative for a patient who complains of opioid-induced constipation. Which of the following is the MOST correct mechanism of action for stimulant laxatives?

1. Stimulates osmotic retention of fluid in the colon
   B. Facilitates opening of chloride channels in the intestinal epithelium
   C. Stimulates peristalsis ✅
   D. Decreases fluid motility in the small intestine

Question 12
Which of the following medications is used as a first-line drug to manage symptoms such as tachycardia in hyperthyroidism, but does not directly reduce thyroid hormone levels?

1. Propylthiouracil (Propyl)
   B. Propranolol (Inderal) ✅
   C. Levothyroxine (Synthroid)
   D. Methimazole (Tapazole)

Question 13
The NP is managing a patient with Graves’ disease in anticipation of a subtotal thyroidectomy. Which antithyroid drug is appropriate for short-term preoperative therapy?

1. Levothyroxine (Synthroid)
   B. Methimazole (Tapazole) ✅
   C. Radioactive iodine
   D. Liothyronine (Cytomel)

Question 14
A 35-year-old woman presents with Graves’ disease and severe exophthalmos. She is started on methimazole (Tapazole), but her eye findings do not improve. What is the best next step?

1. Increase the dose of methimazole (Tapazole)
   B. Add propranolol (Inderal)
   C. Switch to radioactive iodine
   D. Treat with oral glucocorticoids ✅

Question 15
Which of the following patient education points is MOST appropriate for a patient starting salmeterol (Serevent Diskus) therapy for asthma?

1. Take salmeterol (Serevent Diskus) only if symptoms are severe
   B. Use salmeterol (Serevent Diskus) PRN for acute symptom relief
   C. Use salmeterol (Serevent Diskus) in combination with an inhaled glucocorticoid ✅
   D. Always take salmeterol (Serevent Diskus) with a spacer device

Question 16
Under the FDA’s 2007 Current Good Manufacturing Practices (CGMP) ruling for dietary supplements, which requirement is mandatory for manufacturers?

1. Ensuring products are free from contaminants and accurately labeled for identity, purity, quality, and strength ✅
   B. Reporting all mild adverse events of oral supplements to the FDA within 72 hours
   C. Proof of clinical efficacy before marketing the product as a health supplement
   D. Standardizing all herbal products to contain the same amount of every naturally occurring compound

Question 17
An older adult is prescribed dimenhydrinate (Dramamine) for motion sickness. Which adverse effect is the primary concern for this population?

1. Delirium ✅
   B. Bradycardia
   C. Hypoglycemia
   D. Photosensitivity

Question 18
A 45-year-old patient is vacationing on a cruise ship and wants the MOST effective drug for preventing motion sickness. Which option is BEST?

1. Meclizine (Antivert)
   B. Dimenhydrinate (Dramamine)
   C. Scopolamine (Transderm Scop) ✅
   D. Ondansetron (Zofran)

Question 19
Which of the following types of medications should be prescribed as part of the treatment protocol for patients experiencing nonsteroidal anti-inflammatory drug (NSAID) induced ulcers as well as Helicobacter pylori infection?

1. Antiviral agents
   B. Anti-parasitic agents
   C. Anti-secretory agents ✅
   D. Antifungal agents

Question 20
The NP is counseling a patient newly diagnosed with hypothyroidism who is starting levothyroxine (Synthroid) therapy. Which statement by the patient indicates a correct understanding of the treatment plan?

1. “I will likely need to take this medication for the rest of my life.” ✅
   B. “Once my symptoms improve, I can stop taking the medication.”
   C. “I should only take levothyroxine (Synthroid) when I feel fatigued.”
   D. “If I skip doses for a few days, it won’t affect my thyroid levels.”

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