MSN 611 : Clinical Pharm & Intervention for APRNs - NKU

Correct Answer: A - Lives with a person who has positive sputum smear results.

Explanation of the Correct Answer: The patient who lives with a person who has positive sputum smear results is at the highest risk of contracting tuberculosis (TB). Sputum smear-positive individuals have a high bacterial load, and the infectious organisms are readily transmitted through airborne particles when they cough or sneeze. Close contact with someone who is actively infectious significantly increases the likelihood of transmission, especially in confined or poorly ventilated spaces. This makes it the most critical risk factor among the choices provided.

Why the Other Options Are Incorrect:

B - Is underweight: Being underweight is a risk factor for developing TB if infected, as malnutrition can impair the immune system and make the body more susceptible to infections. However, being underweight alone does not directly increase the risk of contracting TB. It is more of a contributing factor to the severity or progression of the disease once exposure has occurred, rather than a primary risk factor for initial infection.

C - Lives in a nursing home: While living in a nursing home can increase the risk of TB transmission due to close quarters and potential exposure to individuals who might be infected, the presence of someone with a positive sputum smear result is a more direct and immediate risk. In a nursing home, while the risk of exposure is higher than in the general population, it is not as high as direct exposure to a person with active TB who is coughing and spreading the bacteria.

D - Smokes 2 packs of cigarettes per day: Smoking is a risk factor for many respiratory diseases, including TB, as it weakens lung defenses and increases the risk of respiratory infections. However, smoking itself does not directly increase the likelihood of contracting TB. The primary concern is how smoking can exacerbate the damage caused by the infection if the person is exposed to TB, rather than the risk of contracting TB in the first place.

Correct Answer: C - Hydrocele

Explanation of the Correct Answer: A hydrocele is the most likely condition for a 50-year-old male with a non-tender, enlarged scrotum. A hydrocele refers to the accumulation of fluid in the scrotal sac around the testicle, leading to painless swelling or enlargement. It is typically soft and nontender, which aligns with the description provided in the question. Hydroceles can develop for various reasons, including congenital defects or trauma, but in adults, they are often idiopathic. Hydroceles may not cause pain, but they can cause discomfort due to the size of the swelling.

Why the Other Options Are Incorrect:

A - Orchitis: Orchitis refers to inflammation or infection of the testicle, usually caused by bacterial or viral infections like mumps. Orchitis is typically painful, not non-tender. It may be accompanied by redness, swelling, fever, and tenderness in the scrotum. Therefore, a non-tender scrotal enlargement makes orchitis unlikely in this scenario.

B - Epididymitis: Epididymitis is the inflammation of the epididymis, the tube that carries sperm from the testicle. This condition is commonly caused by infections, especially sexually transmitted infections like chlamydia or gonorrhea. Epididymitis is typically associated with pain, swelling, and sometimes fever. The enlargement is often tender, making it unlikely to be the cause of a non-tender, enlarged scrotum.

D - Prostatitis: Prostatitis is the inflammation of the prostate gland, usually due to infection. While it can cause pelvic pain, urinary symptoms, or fever, it does not typically cause scrotal enlargement. A non-tender, enlarged scrotum would not be expected with prostatitis, as the condition primarily affects the prostate rather than the scrotum.

Correct Answer:

D - bupropion (Wellbutrin)

Explanation of the Correct Answer:

Bupropion (Wellbutrin) is known to cause false positives on urine drug screens, particularly for amphetamines. This is due to the chemical structure of bupropion, which shares similarities with amphetamines and can be mistaken for them on certain types of drug tests. It is a common issue for patients taking bupropion, as the urine drug screen may show a positive result for amphetamine use even if the patient is not using amphetamines. This can occur because bupropion is metabolized into compounds that may cross-react with amphetamine assays.

Why the Other Options Are Incorrect:

A - Metformin (Glucophage):

Metformin is used to treat type 2 diabetes and is not typically associated with causing false positives on urine drug screens. It does not have a chemical structure that would cross-react with common drug screen assays, making it unlikely to produce a false positive result.

B - Alprazolam (Xanax):

Alprazolam (Xanax) is a benzodiazepine, and while it can cause a positive result on a drug screen for benzodiazepines, it does not generally cause false positives for other substances like amphetamines or opiates. Drug tests designed to detect benzodiazepines will accurately identify alprazolam use, without cross-reacting to other drug classes.

C - Loratadine (Claritin):

Loratadine (Claritin) is an antihistamine used for allergies and is not known to cause false positives on urine drug screens. Loratadine does not have the chemical properties to interfere with common drug screen assays, so it is unlikely to cause false positive results for other drugs.

Correct Answer:

C. Topiramate

Explanation of the Correct Answer:

Topiramate is an anticonvulsant and a migraine prophylactic that is associated with an increased risk of kidney stones. The mechanism behind this is that topiramate increases urinary calcium and decreases urinary citrate, both of which are factors that promote the formation of calcium-based stones, particularly calcium oxalate stones. Additionally, topiramate can lead to metabolic acidosis, which further promotes the precipitation of calcium salts in the kidneys, increasing the risk of stone formation.

Why the Other Options Are Incorrect:

A. Omeprazole

Omeprazole is a proton pump inhibitor used to treat gastroesophageal reflux disease (GERD) and peptic ulcers. While it has some potential side effects (such as nutrient malabsorption), it is not typically associated with kidney stone formation.

B. Atenolol

Atenolol is a beta-blocker used for hypertension and other cardiovascular conditions. It is not known to increase the risk of kidney stones. Atenolol’s side effects are more related to cardiovascular and metabolic effects, but kidney stones are not commonly associated with its use.

D. Bupropion

Bupropion is an atypical antidepressant used for depression and smoking cessation. It does not increase the risk of kidney stones. Its side effects are generally related to CNS stimulation, such as seizures, but not nephrolithiasis.

Correct Answer:

D - Beta-2 adrenergic receptors in the bronchial smooth muscle

Explanation of the Correct Answer:

Albuterol is a short-acting beta-agonist (SABA) and works by targeting the beta-2 adrenergic receptors on the bronchial smooth muscle. When albuterol binds to these receptors, it stimulates a cascade of events leading to bronchodilation—the relaxation of the smooth muscle in the bronchi. This helps to open the airways, improving airflow and reducing symptoms such as shortness of breath. This action is particularly beneficial during an acute asthma attack or when asthma symptoms are triggered, such as during exercise (e.g., playing soccer in this case).

Why the Other Options Are Incorrect:

A - Multi-unit smooth muscle:

While smooth muscle contraction is involved in asthma, albuterol specifically targets bronchial smooth muscle, not smooth muscle across multiple units in the body. The drug's action is localized to the respiratory system, where it works to relax the bronchial smooth muscle.

B - Inflammatory cells in the lungs:

Albuterol does not target the inflammatory cells in the lungs. It is a bronchodilator and provides relief by opening the airways. While chronic asthma management may involve anti-inflammatory medications (like corticosteroids), albuterol's role is primarily in acute relief through bronchodilation, not by reducing inflammation.

C - Alpha-adrenergic receptors in the airway:

Albuterol primarily targets beta-2 adrenergic receptors in the bronchial smooth muscle. While alpha-adrenergic receptors play a role in other functions like vasoconstriction, they are not the main target for bronchodilation in asthma treatment.

Correct Answer:

A - Hemorrhagic cystitis.

Explanation of the Correct Answer:

Acrolein is a toxic metabolite produced during the metabolism of cyclophosphamide and ifosfamide. One of the most significant side effects of acrolein is hemorrhagic cystitis, a condition characterized by inflammation and bleeding of the bladder. This occurs because acrolein is excreted in the urine and can directly damage the bladder lining, leading to irritation, bleeding, and even bladder dysfunction. To prevent this, patients receiving cyclophosphamide or ifosfamide may be given mesna, a protective agent that binds to acrolein and reduces its toxic effects on the bladder.

Why the Other Options Are Incorrect:

B - Pulmonary toxicity:

While both cyclophosphamide and ifosfamide can cause pulmonary toxicity, it is not primarily due to acrolein. Pulmonary toxicity in these drugs is more related to other metabolites and drug effects, rather than the toxic effects of acrolein.

C - Myelosuppression:

Myelosuppression (decreased bone marrow function leading to lower blood cell counts) is a common side effect of cyclophosphamide and ifosfamide, but it is not caused by acrolein. Myelosuppression results from the chemotherapy drugs' effects on rapidly dividing cells, including those in the bone marrow.

D - Dermatologic toxicity:

Dermatologic toxicity is not primarily caused by acrolein. While cyclophosphamide and ifosfamide can lead to skin reactions, such as rash or photosensitivity, these effects are not related to acrolein. The main dermatologic concerns are generally due to other mechanisms.

Correct Answer:

A - Simultaneously activate release of norepi and epi.

Explanation of the Correct Answer:

Mixed-acting sympathomimetic drugs work by both directly stimulating adrenergic receptors and indirectly increasing the release of endogenous catecholamines, such as norepinephrine (norepi) and epinephrine (epi). These drugs have two mechanisms of action: they can bind directly to adrenergic receptors, such as alpha and beta receptors, and also promote the release of norepinephrine and epinephrine from storage vesicles. This dual mechanism enhances sympathetic activity, leading to effects such as increased heart rate, vasoconstriction, and bronchodilation.

Why the Other Options Are Incorrect:

B - Directly activate release of norepi while also indirectly inhibiting release of epi:

This option is incorrect because mixed-acting sympathomimetics do not inhibit the release of epinephrine (epi). Instead, they increase the release of both norepinephrine and epinephrine.

C - Directly activate release of norepi while also activating release of dopamine:

While dopamine release can be influenced by some sympathomimetic drugs, mixed-acting sympathomimetics primarily focus on norepinephrine and epinephrine. They do not have a significant role in directly stimulating the release of dopamine.

D - Directly activate release of norepi while also indirectly causing release of norepi:

This option is partially correct but redundant. Mixed-acting sympathomimetics increase the release of both norepinephrine and epinephrine, not just norepinephrine alone. Therefore, the statement does not fully capture the mechanism of action.

Correct Answer:

B - amoxicillin-clavulanate (Augmentin)

Explanation of the Correct Answer:

Amoxicillin-clavulanate (Augmentin) is considered a safe and effective empiric treatment option for asymptomatic bacteriuria during pregnancy, especially in the first trimester. It covers common urinary pathogens like Escherichia coli and other Gram-negative organisms. Treating asymptomatic bacteriuria during pregnancy is crucial because it can lead to pyelonephritis, preterm labor, and low birth weight if left untreated. Amoxicillin-clavulanate has a strong safety profile during pregnancy and is classified as Category B by the FDA, meaning no evidence of harm to the fetus.

Why the Other Options Are Incorrect:

A - trimethoprim/sulfamethoxazole (Bactrim):

While Bactrim can be used in some parts of pregnancy, it is generally avoided during the first trimester because trimethoprim is a folate antagonist and can increase the risk of neural tube defects during early fetal development. It is also avoided near term because sulfamethoxazole can cause kernicterus in the newborn.

C - ciprofloxacin (Cipro):

Ciprofloxacin is a fluoroquinolone, which should be avoided in pregnancy because it has been associated with fetal cartilage and bone development abnormalities based on animal studies, even though definitive human data is lacking. It is not recommended, particularly in the first trimester.

D - doxycycline (Vibramycin):

Doxycycline is a tetracycline antibiotic that should be avoided in pregnancy because it can cause permanent tooth discoloration in the fetus and inhibit bone growth. It is contraindicated throughout pregnancy, particularly in the second and third trimesters.

Correct Answer:

C - a bloated and tense tympanic abdomen.

Explanation of the Correct Answer:

Pyloric stenosis in a 6-week-old infant is characterized by nonbilious, projectile vomiting, which typically occurs shortly after feeding (postprandial). The infant often appears hungry after vomiting and may be at risk for dehydration due to the loss of fluids. One of the classic physical findings in pyloric stenosis is the presence of an olive-shaped mass in the right upper quadrant of the abdomen, which is a hypertrophied pylorus. Sunken orbits and a depressed anterior fontanelle indicate dehydration, which is a common complication of pyloric stenosis due to vomiting.

However, a bloated and tense tympanic abdomen would be unexpected in pyloric stenosis. This type of abdominal distention suggests a different pathology, such as intestinal obstruction or another cause of gas accumulation in the intestines, not pyloric stenosis. In pyloric stenosis, the abdomen may be slightly distended but is not typically bloated or tense.

Why the Other Options Are Incorrect:

A - Postprandial projectile vomiting that is nonbilious:

This is one of the hallmark symptoms of pyloric stenosis. The hypertrophied pylorus causes an obstruction that leads to forceful vomiting after feeding, and the vomit is nonbilious because the obstruction is above the bile duct entry into the small intestine.

B - Sunken orbits and depressed anterior fontanelle, indicating dehydration:

Dehydration is a common complication of pyloric stenosis due to frequent vomiting. Infants with pyloric stenosis may develop signs of dehydration, such as sunken orbits (eyes) and a depressed fontanelle (the soft spot on the skull). These signs indicate fluid loss that needs to be addressed.

D - An olive-shaped mass in the right upper quadrant of the abdomen:

This is a classic finding in pyloric stenosis. The mass represents the hypertrophied pyloric muscle and can often be palpated in the right upper quadrant, just to the right of the midline. It is considered a key diagnostic sign for this condition.