Download NR 566 MIDTERM EXAM QUESTIONS WITH COMPLETE SOLUTIONS and more Exams Nursing in PDF only on Docsity!
NR 566 MIDTERM EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
1st line treatment for Mild acne Correct Answers Benzoyl peroxide or topical combination therapy w/ BP and antibiotic or retinoid + BP or retinoid +BP+antibitoic 1st line treatment for Moderate acne Correct Answers Antibiotics: doycycliene, minocycline combination: clindamycin/benzoyl peroxide and tretinoin 1st line treatment for severe acne Correct Answers isotetinoin or combination doxycyline and topical retinoid Abacavir (Ziagen) - Adverse Effects Correct Answers -Lactic acidosis and hepatomegaly w/ steatosis -hypersensitivity reaction (Setevens Johnson syndrome) -MI -Lipodystrophy w/ redistribution of adipose tissue may occur (Cushingoid appearance) Allergic Rhinitis - Monoclonal antibody drug treatment option Correct Answers Omalizumab (Xolair) Aminoglycosides - patient education Correct Answers -caution when combining w/ nephrotoxic or ototoxic drugs -pt should report s/s of ototoxicity (hearing impairment, disruption of balance.. 1st signs tinnitus and persistent HA -can cause irreversible ototoxicity -Neurotoxic symptoms: numbness, tingling, muscle twitching, and seizures
-Caution in patients w/ renal impairment Amoxicillin common doses Correct Answers Adults: 750- 1,750 mg PO q8h Children: 20-90 mg/kg PO q8H Amoxicillin indications for use Correct Answers Acute Otitis Media Dosing for AOM: Amoxicillin 40-45 mg/kg BID Anthelmintic drugs - which are safe during pregnancy? Correct Answers In 2nd and 3rd trimester: -mebendazole -albendazole -pyrantel pamoate Anthelmintic drugs - which is generally safe to give w/o obtaining baseline data? Correct Answers Pyrantel Pamoate Anthelmintic drugs - which ones can cause bone marrow suppression and liver impairment? Correct Answers - Albendazole -Mebendazole Anthelmintic drugs - which ones carry a risk for hypotension w/ patients on antihypertensives? Correct Answers -Ivermectin -Moxidectin Antifungals to use in immunocompramised patients Correct Answers Oral Fluconazole or Ketoconazole AVOID Amphotericin B
Budesonide - risks of use in children Correct Answers Long- term use of steroid medication can inhibit bone growth and cause decreased stature Use during this period can increase the risk for lifetime osteoporosis C. Diff associated diarrhea - how to treat? Correct Answers Stop prior antibiotic and start Vancomycin or Fidaxomicin or Metronidazole Chart in Book Cephalosporins - Patient Education Correct Answers -Do not take if allergic to penicillin -Interacts w/ alcohol (disulfiram-like reaction) -Interacts with Vitamin K clotting factors (Can promote bleeding esp. w/ NSAIDs, thrombolytics, and anticoagulants) -Increases risk for C. Diff, notify provider of increased stool frequency Cephalosporins - Pregnant patients Correct Answers Safe to prescribe Community Acquired Pneumonia - 1st line treatment for previously healthy adults and what to give if 1st drug didn't work? Correct Answers 1st line: Amoxicillin, doxycycline and macrolide (Azithromycin) Second choice: Levaquin (Fluroquinolones) Community Acquired Pneumonia - Common Pathogens Correct Answers -S. pneumoniae -Mycoplasma spp.
-H. influenzae -Staphylococcus aureus Cromolyn - MOA Correct Answers Prevents release of inflammatory mediators from mast cells and thus can decrease all symptoms. However, benefits are modest. Drug class known for ALL drugs in class to promote development of C. Diff Correct Answers -Cephalosporins Specifically: 2nd generation (Cefoxitin) and 3rd generation (Cefotaxime) -Fluoroquinolones (Ciprofloxacin and Levofloxacin) -Clindamycin Empiric antibiotics - What are they? Correct Answers Broad spectrum antibiotics -Ciprofloxacin, timethoprim/sulfamethoxazole, Amoxicillin Enterobius Vermicularis - what is it and who would you expect to have it? Correct Answers "Pinworm Infestation" -children, most prevalent where sanitation is poor -Most common in Southern U.S. -usually asymptomatic, some have intense perianal itching -all family members of infected person should be treated simultaneously Excessive cerumen in ear - Causes & Treatment Correct Answers Cause: pt pushing excessive cerumen further into the ear canal while cleaning
-retinal disorders and/or optic neuritis -HA, n/v, rash How to D/C phentermine and/or topiramate Correct Answers if a pt who is taking phentermine and topiramate has not lost 5% of weight by 6 months, the drugs should be discontinued and taper off medication How to measure success with antiretroviral therapy for HIV? Correct Answers -reduction in plasma HIV RNA. With ART, plasma HIV RNA should decline to 10% of baseline w/n 2- weeks. After 16-20 weeks of treatment, plasma HIV RNA should reach its minimum -CD4 T-cell counts increase How to treat acute otitis media Correct Answers -Pain medication and some should get antibiotics -All children younger than 6 months should receive antibiotics, regardless -Amoxicillin alone or in combo w/ clavulanate How to treat fungal infections Correct Answers Polyene Antibiotics - Amphotericin B Azoles - Fluconazole or Ketoconazole Echinocandins Anidulafungin Pyrimidine analogs - Flucytosine How to treat glaucoma in someone with COPD or asthma Correct Answers Betaxolol -beta selective meaning that it has less chance of causing bronchial constriction
How to treat otomycosis Correct Answers Thorough cleansing and application of acidifying drops -2% acetic acid solution applied 3-4 times a day for 7 days An antifungal drug solution may be used when acidifying drops are not effective. Neither antibiotic ear drops or oral antibiotics are indicated as the first course of treatment If someone has been treated w/ an antibiotic in the previous 90 days of contracting CAP, a quinolone would be prudent choice to prescribe. Be familiar with drug examples w/n the antibiotic class Correct Answers "floxacin" Genifloxacin Ciprofloxacin Isotretinoin Patient Education Correct Answers -may affect vision in the dark -sunburn easily -periodic blood test -need two forms of reliable birth control -notify Dr. w/ missed period -cannot donate blood and 1 month after treatment -avoid supplements w/ vitamin A -avoid alcohol -scarring may occur w/ cosmetic skin procedures, avoid waxing, laser therapy, dermabrasion -notify provider of: severe HA, vision changes (other than night), vomiting, weakness, or seizure (may have increased pressure in the brain
Macrolides - Patient education Correct Answers -can cause QT prolongation and risk for torsades de pointes -GI effects: n/v, diarrhea ( take with meals to avoid this) Metronidazole - patient teaching Correct Answers -avoid breastfeeding for 12-24 hours after treatment -avoid alcohol (disulfiram like reaction) -recommend concurrent treatment of partner if treating STD -Avoid in 1st trimester of pregnancy Monitoring needs for long-term antifungal use Correct Answers liver function -AST, ALT, alkaline phosphatase, and bilirubin Naltrexon/bupropion (Contrave) - patient education Correct Answers decreases the effectiveness of opioid analgesics, increased risk of suicide in children, adolescents, and young adults. Caution in those taking or discontinuing Wellbutrin. Can cause severe neuropsychiatric reactions, including depression, mania, psychosis, and homicidal ideation Naltrexon/bupropion (Contrave) Baseline data needed and ongoing monitoring/assessment needs. Correct Answers Baseline: Blood glucose, liver function, renal function, and mental status Ongoing: Periodic assessment for blood glucose, liver and renal function, s/s of depression, anxiety or panic attacks, suicidal ideation, and mania
Narrow-spectrum antibiotics Correct Answers -active against only a few species of microogranisms -used when pathogen is known -reduces risk of disruption of normal flora and development of antibiotic resistance -preferred when possible -Gram + cocci, Gram - bacilli, gram - aerobes, mycobacterium TB Organic sunscreen needs what ingredient to be effective? Correct Answers Avobenzone - must be in sunscreen to provide protection against the full range of UV radiation Orlistat - patient education Correct Answers -take daily multivitamin supplement to acoid vitamin A,D,E, and K deficiency -administration of vitamin should be done 2 hours before or 2 hours after taking orlistat -Reduces fat absorption; stools are fatty or oily and fecal incontinence can occur. (Bulk-forming laxatives can help w/ this side effect -Pt's must have a calorie diet w/ 30% fat content -taking the drug more often does not increase weight loss -may cause hypothyroidism in pt;s taking levothyroxine - administer 2 hours apart -monitor coagulation and may need to reduce warfarin dose -take Orlistat w/ food Orlistat side effects Correct Answers associated w/ rare cases of severe liver damage
Saquinavir Risk Correct Answers -PR interval prolongation -QT interval prolongation -redistribution of adipose tissue -renewed bleeding in pt's w/ hemophilia -abd pain, diarrhea, fatigue -To reduce risk of bone loss, pt's should have adequate intake of calcium and vitamin D Sulfonamides - patient education Correct Answers -complete full prescribed course -drink at least 8-10 glasses of water or non caffeinated fluids per day to decrease risk of crystalluria -avoid prolonged sun exposure (photsensitivity) -hypersensitivity (rash) should be reported Sulfonamides - prescribing in pregnant patients Correct Answers May cause birth defects especially in 1st trimester Kernicterus if taken near term AVOID Sympathomimetics - MOA Correct Answers Activate vascular beta 1 receptors and cause vasoconstriction, which reduces nasal congestion; does not decrease sneezing, itching, or rhinorrhea Tetracycline common dose Correct Answers Adults: 1,000- 2,000 mg PO q6h Children older than 8 years: 25-50 mg/kg PO q6h Tetracycline indications Correct Answers -Rickettsial diseases (Rocky Mountain spotted fever, typhus fever, Q fever
-infections caused by chlamydia trachomatis (trachoma, lymphogranuloma venereum, urethritis, cervicitis -brucellosis -cholera -pneumonia caused by mycoplasma pneumoniae -lyme disease -anthrax -H. pylori -Acne -Periodontal disease Tetracyclines - patient education Correct Answers -Do NOT administer w/ calcium supplements, milk products, Iron supplements, magnesium (contain laxatives), most antacids) -Avoid prolonged sun exposure -most common side effect: n/v, diarrhea (take with meals to avoid) Tetracyclines - Prescribing in pregnant patients Correct Answers can cause fetal harm and permanent staining of infants teeth AVOID Timolol Ophthalmic - indication Correct Answers manage Glaucoma Timolol Ophthalmic common doses Correct Answers 0.25%, 0.5% solution, 0.25% or 0.5% gel. 1 drop every day or BID. Tinea capitis -treatment Correct Answers Oral Griseofulvin 8- 10 weeks or Terbinafine 2-4 weeks
(drugs metabolized by CYP2D6 isoenzymes) the serum levels of the substrates can be increased. To decrease the risk for toxicity when both drugs are prescribed, the substrate may have to be prescribed at a lower dose CYP2D6 substrate examples: Fluoxetine, Timolol, Oxycodone, Paroxetine, Codeine, Ritonavir, Clozopine, Diltiazem When do you use foscarnet in HIV+ patients? Correct Answers Acyclovir-resistant mucocutaneous HSV and VZV infection in the immunocompromised host. When to prescribe an intranasal glucocorticoid? Correct Answers -Prevent or suppress the major symptoms of allergic rhinitis: congestion, rhinorrhea, sneezing, nasal itching, and erythema -Budesonide (Rhinocort Aqua), Fluticasone propionate (Flonase), and Trimcinolone (Nasacort Allergy 24 hours) -most effect for prevention and treatment of seasonal and perennial rhinitis When to prescribed empiric antibiotics Correct Answers - patient has severe infection -before test results are available -based on clinical evaluation and knowledge of microbes that are most likely causing the infection When to use a broad-spectrum anitbiotic? Correct Answers - before cultures result -critically ill patient -empiric therapy -pathogen is unknown or multiple types of bacteria suspected
-Gram + cocci and Gram - Bacilli Which weight loss drugs are associated w/ a suicide risk in children, adolescents, and young adults? Correct Answers Naltrexone Bupropion (Contrave) Which weight loss drugs are DEA scheduled drugs? All are schedule IV Correct Answers -Lorcaserin -Diethylpropion -Phentermine -Phentermine/topiramate
