Pharmacology One_Unified Final Exam_Summer - Adelphi University
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Free Pharmacology One_Unified Final Exam_Summer - Adelphi University Questions
A patient is given a prescription for azithromycin (Zithromax) and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct?
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"The four smaller doses help the body taper the amount of drug more gradually."
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"The first dose is larger to minimize the first pass effect of the liver."
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"A large initial dose helps to get the drug to optimal levels in the body faster."
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"Tubular reabsorption is faster with initial doses, so more is needed at first."
Explanation
Correct Answer: (C) "A large initial dose helps to get the drug to optimal levels in the body faster." This describes a loading dose, which is given to rapidly achieve a therapeutic drug concentration in the body before transitioning to smaller maintenance doses that sustain that level.
Why Other Options are Incorrect:
A. "The four smaller doses help the body taper the amount of drug more gradually." — This describes the maintenance doses but does not explain the rationale for the larger first dose.
B. "The first dose is larger to minimize the first pass effect of the liver." — The first-pass effect refers to hepatic metabolism reducing drug bioavailability, which is unrelated to the loading dose strategy.
D. "Tubular reabsorption is faster with initial doses, so more is needed at first." — This is not an accurate pharmacokinetic explanation for why a loading dose is used.
A patient had a "terrible cold" and had difficulty breathing through her nose. The patient has been using over the counter oxymetazoline (Afrin) nasal spray 5 times daily for more than one week (the package insert recommends twice daily for no longer than 3-5 days). After one week, most of the patient's cold symptoms have resolved but the patient reports that she has increased pressure in her nose and sinuses and is unable to breathe through her nose at all. The patient is examined by the nurse practitioner and is diagnosed with rhinitis medicamentosa (caused by medication). You know that this diagnosis refers to which of the following statements?
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A covid 19 diagnosis.
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The large expense of over the counter cold medications.
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An allergic reaction to oxymetazoline (Afrin).
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A syndrome of rebound swelling occurring in the nasal tissues in response to prolonged use of adrenergic nasal sprays.
Explanation
Correct Answer: (D) A syndrome of rebound swelling occurring in the nasal tissues in response to prolonged use of adrenergic nasal sprays. Rhinitis medicamentosa occurs when a topical decongestant like oxymetazoline is used beyond the recommended duration, causing rebound nasal congestion as the nasal tissues become dependent on the medication for vasoconstriction.
Why the other options are incorrect:
A. A covid 19 diagnosis — The scenario describes a medication-induced condition, not an infectious diagnosis like COVID-19.
B. The large expense of over the counter cold medications — This is unrelated to the pathophysiology of rhinitis medicamentosa, which is a physical condition, not a financial concern.
C. An allergic reaction to oxymetazoline (Afrin) — This condition is caused by rebound vasodilation from overuse, not an allergic hypersensitivity reaction to the medication.
The nurse knows that lipid soluble drugs have unique characteristics. Which of the following best describes these characteristics? Select two (2) that apply:
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Cause Weakness.
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Cause Weight Gain.
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Cause Liver Damage.
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Cause Birth Defects.
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Cause Hearing Loss.
Explanation
Megadoses of Vitamin A (Retinol) can cause toxicity manifesting as generalized weakness and significant liver damage due to accumulation of the fat-soluble vitamin. Additionally, Vitamin A is a known teratogen, and given the patient's possible pregnancy, this poses a serious risk of causing birth defects to a developing fetus.
Why the other options are incorrect:
B. Cause Weight Gain — Weight gain is not a recognized or primary adverse effect associated with Vitamin A toxicity.
E. Cause Hearing Loss — Hearing loss is not a characteristic toxicity symptom of excessive Vitamin A intake.
Amphotericin B is used to treat a systemic fungal infection. The nurse knows that which one of the following has the highest priority in monitoring for toxicity?
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Complete Blood Cell Count (CBC).
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Hearing Test.
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Temperature.
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BUN, Creatinine.
Explanation
Correct Answer: (D) BUN, Creatinine. Amphotericin B is well known for its significant nephrotoxic potential. Monitoring BUN and creatinine levels is the highest priority to detect early signs of renal impairment during therapy.
Why Other Options are Incorrect:
A. Complete Blood Cell Count (CBC) — While Amphotericin B can affect blood counts, renal toxicity is the more significant and priority concern associated with this medication.
B. Hearing Test — Ototoxicity is a concern associated with aminoglycosides, not primarily with Amphotericin B.
C. Temperature — While infusion-related fever can occur with Amphotericin B, this is not the highest priority toxicity concern compared to nephrotoxicity.
Teaching Point: Avoid sun exposure and wear protective clothing outdoors in sunlight.
Options for each: Indicated / Nonessential / Contraindicated
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(1) Indicated
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(2) Indicated
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(3) Nonessential
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(4) Indicated
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(5) Contraindicated
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(6) Indicated
Explanation
Fluoroquinolones like levofloxacin carry a risk of tendinitis and tendon rupture, especially of the Achilles tendon, so this must be monitored (1). Because fluoroquinolones can disrupt normal flora, patients are at risk for superinfections such as vaginal yeast infections (2) and oral thrush, which presents as cottage cheese-like lesions in the mouth (4). Dairy products contain calcium, which chelates with fluoroquinolones and significantly reduces their absorption, so taking the medication with dairy is contraindicated (5). Levofloxacin is associated with photosensitivity, so patients should avoid sun exposure and wear protective clothing (6).
Why the other options are incorrect:
(3) Excessive nighttime perspiration is not a recognized or clinically significant adverse effect associated with levofloxacin, making it nonessential teaching rather than an indicated warning.
Labeling (1), (2), (4), or (6) as nonessential or contraindicated would be incorrect, as each represents a real, clinically important adverse effect or superinfection risk associated with fluoroquinolone therapy that patients must be taught to recognize.
Labeling (5) as indicated would be incorrect, as taking the medication with dairy actively impairs drug absorption and reduces its effectiveness, making this teaching point contraindicated rather than something to encourage.
Teaching Point: Observe for pain and swelling of the Achilles Tendon.
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Indicated
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Nonessential
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Contraindicated
Explanation
A nurse is teaching a class to a group of pregnant women. The nurse correctly teaches that the period during which the highest risk of teratogen-induced gross malformations exists is:
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During the third trimester.
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During the second trimester.
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During the first trimester.
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Immediately following preconception.
Explanation
Correct Answer: (C) During the first trimester. The first trimester is the period of organogenesis, when the major organs and body structures are forming. Exposure to teratogens during this critical time carries the highest risk of causing significant structural malformations.
Why the other options are incorrect:
A. During the third trimester — By this stage, organ formation is largely complete, so teratogen exposure is more likely to affect growth and function rather than cause gross structural malformations.
B. During the second trimester — Major organogenesis has already occurred by this point, reducing the risk of gross malformations compared to the first trimester.
D. Immediately following preconception — Organ development has not yet begun at this stage, as this is prior to implantation and early embryonic development.
An analgesic that has antitussive (cough suppression) effects is:
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Ibuprofen.
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Acetaminophen.
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ASA.
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Codeine.
Explanation
Correct Answer: (D) Codeine. Codeine is an opioid analgesic that also possesses antitussive properties, acting on the cough center in the brain to suppress the cough reflex, in addition to its pain-relieving effects.
Why the other options are incorrect:
A. Ibuprofen — This is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic and anti-inflammatory effects, but it does not have cough-suppressing properties.
B. Acetaminophen — This provides analgesic and antipyretic effects but has no antitussive action.
C. ASA (Aspirin) — This is an NSAID with analgesic, antipyretic, and anti-inflammatory effects, but it does not suppress cough.
Mr. K. is a 59-year-old male client who has been diagnosed with osteoarthritis of the left knee. He also has a history of hypertension and is taking a diuretic and ACE inhibitor to manage his blood pressure. He is being seen at the medical clinic with complaints of increasing pain in his knee. He states that he has been researching herbal and dietary supplements and has recently started taking glucosamine and chondroitin for his arthritis. During this visit, he is given a prescription for naproxen (Aleve).
Vital signs: BP 132/82, HR 84, RR 18, BMI 33kg/m2, Temp 97F. PE: unremarkable except for moderate swelling and crepitus of bilateral knees. Labs: unremarkable. Current Medications: Lisinopril 20mg, Hydrochlorothiazide 500mg, Naproxen 250mg twice daily.
In teaching the patient how to take the drug naproxen, the nurse should tell the patient that he should (1)___ to prevent kidney damage.
Options: Stay hydrated
Eat more salt
Take more potassium
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Stay hydrated
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Eat more salt
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Take more potassium
Explanation
NSAIDs such as naproxen can reduce renal blood flow by inhibiting prostaglandins that help maintain kidney perfusion. This risk is heightened in this patient, who is also taking a diuretic and ACE inhibitor. Staying well hydrated helps maintain adequate renal perfusion and reduces the risk of NSAID-induced kidney damage, especially important given his combination of medications affecting renal blood flow and fluid balance.
Why the other options are incorrect:
Eat more salt — Increasing salt intake is not an appropriate recommendation, especially in a hypertensive patient on antihypertensive therapy, and does not address the mechanism of NSAID-related renal risk.
Take more potassium — This is not the relevant teaching point for preventing NSAID-related kidney damage and could be potentially unsafe given his use of an ACE inhibitor, which can already increase potassium levels.
In a discussion of drug-drug interactions, which would be the good example of rectifying an adverse reaction?
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(Questran) cholestyramine blocking the actions of antihypertensive drugs.
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Alcohol blocking the actions of opioids.
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Antacids blocking the action of tetracycline (Sumycin).
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Acetylcysteine (Mucomyst) blocking acetaminophen's (Tylenol's) toxic actions.
Explanation
Acetylcysteine is used as an antidote for acetaminophen overdose, as it works to prevent or reduce the hepatotoxic effects caused by toxic levels of acetaminophen, representing a beneficial and intentional drug interaction used to treat an adverse reaction.
Why the other options are incorrect:
A. (Questran) cholestyramine blocking the actions of antihypertensive drugs — This represents an undesirable interaction that reduces the therapeutic effect of needed antihypertensive medication, not a beneficial correction of an adverse reaction.
B. Alcohol blocking the actions of opioids — This is not an established or clinically beneficial interaction; alcohol combined with opioids is dangerous and increases risk of central nervous system and respiratory depression.
C. Antacids blocking the action of tetracycline (Sumycin) — This is a harmful interaction that reduces the effectiveness of the antibiotic by impairing its absorption, not a beneficial correction of toxicity.
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