MN553 Unit 8 Practice Quiz Latest 2017

Question
Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic hyperplasia
Doxazosin has been chosen to treat his hypertension because it:
Increases peripheral vasoconstriction
Decreases detrusor muscle contractility
Lowers supine blood pressure more than standing pressure
Relaxes smooth muscle in the bladder neck
Which of the following adverse effects are less likely in a beta1-selective blocker?
Dysrhythmias
Impaired insulin release
Reflex orthostatic changes
Decreased triglycerides and cholesterol
Beta blockers have favorable effects on survival and disease progression in heart failure
Treatment should be initiated when the:
Symptoms are severe
Patient has not responded to other therapies
Patient has concurrent hypertension
Left ventricular dysfunction is diagnosed
You are treating a patient with a diagnosis of Alzheimer’s disease
The patient’s wife mentions difficulty with transportation to the clinic
Which medication is the best choice?
Donepezil
Tacrine
Doxazosin
Verapamil
Antonia is a 3-year-old child who has a history of status epilepticus
Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus
IV phenobarbital
Rectal diazepam (Diastat)
IV phenytoin (Dilantin)
Oral carbamazepine (Tegretol)
Dwayne has recently started on carbamazepine to treat seizures
He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low
The possible cause for the low carbamazepine levels include:
Dwayne hasn’t been taking his carbamazepine because it causes insomnia
Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance
Dwayne was not originally prescribed the correct amount of carbamazepine
Carbamazepine is probably not the right antiseizure medication for Dwayne
Kasey fractured his ankle in two places and is asking for medication for his pain
The appropriate first-line medication would be:
Ibuprofen (Advil)
Acetaminophen with hydrocodone (Vicodin)
Oxycodone (Oxycontin)
Oral morphine (Roxanol)
Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin)
He and his parents should be educated about the side effects of methylphenidate, which are:
Slurred speech and insomnia
Bradycardia and confusion
Dizziness and orthostatic hypotension
Insomnia and decreased appetite
An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:
Alprazolam (Xanax)
Diazepam (Valium)
Buspirone (Buspar)
Amitriptyline (Elavil)
David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression
David’s education regarding his medication would include:
Paroxetine may cause intermittent diarrhea
He may experience sexual dysfunction beginning a month after he starts therapy
He may have constipation and he should increase fluids and fiber
Paroxetine has a long half-life so he may occasionally skip a dose
An appropriate drug for the treatment of depression with anxiety would be:
Escitalopram (Lexapro)
The longer-term Xanax patient comes in and states they need a higher dose of the medication
They deny any additional, new, or accelerating triggers of their anxiety
What is the probable reason?
They have become tolerant of the medication, which is characterized by the need for higher and higher doses
They are a drug seeker
They are suicidal
They only need additional counseling on lifestyle modification
A first-line drug for abortive therapy in simple migraine is:
Sumatriptan (Imitrex)
Naproxen (Aleve)
Butorphanol nasal spray (Stadol NS)
Butalbital and acetaminophen (Fioricet)
Xi, a 54-year-old female, has a history of migraines that do not respond well to OTC migraine medication
She is asking to try Maxalt (rizatriptan) because it works well for her friend
Appropriate decision making would be:
Prescribe the Maxalt, but only give her four tablets with no refills to monitor the use
Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose
Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital)
Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan
Kelly is a 14-year-old patient who presents to the clinic with a classic migraine
She says she is having a headache two to three times a month
The initial plan would be:
Prescribe NSAIDs as abortive therapy and have her keep a headache diary to identify her triggers
Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress
Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine
Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic
James has been diagnosed with cluster headaches
Appropriate acute therapy would be:
Butalbital and aspirin (Fiorinal)
Meperidine IM (Demerol)
Oxygen 100% for 15 to 30 minutes
Indomethacin (Indocin)
If interventions to resolve the cause of pain (e
g
, rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain
Drugs are given in which order of use?
NSAIDs, opiates, corticosteroids
Low-dose opiates, salicylates, increased dose of opiates
Opiates, non-opiates, increased dose of non-opiate
Non-opiate, increased dose of non-opiate, opiate
Chemical dependency assessment is integral to the initial assessment of chronic pain
Which of the following raises a “red flag” about potential chemical dependency?
Use of more than one drug to treat the pain
Multiple times when prescriptions are lost with requests to refill
Preferences for treatments that include alternative medicines
Presence of a family member who has abused drugs
The Pain Management Contract is appropriate for:
Patients with cancer who are taking morphine
Patients with chronic pain who will require long-term use of opiates
Patients who have a complex drug regimen
Patients who see multiple providers for pain control
Which of the following statements is true about age and pain?
Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children
Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs
Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain
Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs
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