Nokea
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).
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The primary care NP sees a 4-year-old child who has received four doses of PCV 7 in the first 15 months of life. The NP should administer:
- A. PCV 7.
- B. PCV 13.
- C. PPV 23.
- D. no PCV.
Correct Answer: B
Rationale: The correct answer is B because children under 5 with PCV 7 series should get one PCV 13 dose. Choice A is incorrect (PCV 7 outdated). Choice C is wrong (PPV 23 not for this age). Choice D is inaccurate (vaccine needed).
The primary care NP sees a 5-year-old child for a prekindergarten physical examination. The child's parents do not have immunization records, and a local record search does not provide proof of vaccinations, although the parent thinks the child may have had some vaccines several years ago. The NP's initial action will be to:
- A. assume the child is unvaccinated and start the full series.
- B. check titers for all vaccine-preventable diseases.
- C. administer a single dose of each vaccine today.
- D. consult state immunization registry again.
Correct Answer: A
Rationale: The correct answer is A because without records, assuming unvaccinated and starting the series ensures protection. Choice B is incorrect (titers not practical initially). Choice C is wrong (single doses insufficient). Choice D is inaccurate (registry already checked).
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.
Off-label use of drugs is:
- A. Illegal
- B. Regulated by the FDA
- C. Permitted with scientific evidence
- D. All of the above
Correct Answer: C
Rationale: Choice C is correct because off-label use is legal and common, permitted with scientific backing or clinical judgment, not FDA-regulated post-approval. Choice A is incorrect as it's not illegal. Choice B is wrong because FDA doesn't regulate off-label practice. Choice D is incorrect since only C applies.
Drugs that require refrigeration include:
- A. Insulin
- B. Amoxicillin suspension
- C. Vaccines
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because insulin (protein stability), amoxicillin suspension (post-reconstitution), and vaccines (biological potency) require refrigeration to maintain efficacy, per storage guidelines. Choice A is incorrect alone as it's one drug. Choice B is wrong by itself because amoxicillin is just part. Choice C is incorrect solo since vaccines are only one group.