Nokea
A woman who is pregnant tells an NP that she has been taking sertraline for depression for several years but is worried about the effects of this drug on her fetus. The NP will consult with this patient's psychiatrist and will recommend that she:
- A. stop taking the sertraline now.
- B. continue taking the antidepressant.
- C. change to a different antidepressant.
- D. taper off the sertraline gradually.
Correct Answer: B
Rationale: The correct answer is B because continuing sertraline is often safer than untreated depression, with psychiatric consultation. Choice A is incorrect (abrupt stopping risky). Choice C is wrong (changing not first step). Choice D is inaccurate (tapering not indicated without specialist input).
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Drugs that may interact with vaccines include:
- A. Immunosuppressants
- B. Antibiotics
- C. Antihistamines
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because immunosuppressants (e.g., prednisone) reduce vaccine efficacy by weakening immune response, per CDC guidelines. Choice B is incorrect as antibiotics don't typically affect vaccines. Choice C is wrong because antihistamines lack vaccine interactions. Choice D is incorrect since only immunosuppressants apply.
An 80-year-old patient who has COPD takes TMP/SMX for acute exacerbations, which occur three or four times each year. To monitor this patient for adverse drug reactions, the primary care NP should order:
- A. liver function tests.
- B. blood urea nitrogen and creatinine.
- C. serum bilirubin levels.
- D. a complete blood count (CBC) with differential.
Correct Answer: D
Rationale: The correct answer is D because elderly patients on TMP/SMX risk bone marrow suppression, monitored via CBC. Choice A is incorrect (liver tests pre-treatment). Choice B is wrong (renal pre-treatment). Choice C is inaccurate (bilirubin not primary).
Herbal products that may increase INR include:
- A. Ginkgo biloba
- B. St John's wort
- C. Valerian root
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because ginkgo biloba can increase INR by enhancing warfarin's effect through antiplatelet activity, risking bleeding. Choice B is incorrect as St John's wort induces CYP2C9, decreasing INR and warfarin efficacy. Choice C is wrong because valerian root doesn't significantly alter INR. Choice D is incorrect since only ginkgo biloba increases INR.
Resources for patients with drug abuse issues include:
- A. Substance Abuse and Mental Health Services Administration (SAMHSA)
- B. National Institute on Drug Abuse (NIDA)
- C. Local support groups
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because SAMHSA (helpline), NIDA (research/support), and local groups (e.g., AA) provide comprehensive resources for drug abuse, per national frameworks. Choice A is incorrect alone as it's one resource. Choice B is wrong by itself because NIDA is just part. Choice C is incorrect solo since groups are only one option.
A patient is taking drug A and drug B. The primary care NP notes increased effects of drug B. The NP should suspect that in this case drug A is a cytochrome P450 (CYP450) enzyme:
- A. inhibitor.
- B. substrate.
- C. inducer.
- D. metabolizer.
Correct Answer: A
Rationale: The correct answer is A because a CYP450 inhibitor (drug A) reduces metabolism of drug B, increasing its effects. Choice B is incorrect as a substrate is acted upon, not inhibiting. Choice C is wrong since an inducer increases metabolism, reducing effects. Choice D is inaccurate as 'metabolizer' isn’t a CYP450 role.