Nokea
An NP is caring for a 70-year-old patient who reports having seasonal allergies with severe rhinorrhea. Using the Beers criteria, which of the following medications should the NP recommend for this patient?
- A. Loratadine (Claritin)
- B. Hydroxyzine (Vistaril)
- C. Diphenhydramine (Benadryl)
- D. Chlorpheniramine maleate (Chlorphen 12)
Correct Answer: A
Rationale: The correct answer is A because loratadine is a nonsedating antihistamine, safer for elderly per Beers criteria, unlike the sedating options B, C, and D, which increase fall risk and cognitive impairment in older adults.
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Risks associated with polypharmacy include:
- A. Increased adverse drug reactions
- B. Drug-drug interactions
- C. Nonadherence
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because polypharmacy raises ADR risk (more drugs, more side effects), interactions (competing metabolism), and nonadherence (complex regimens), per geriatric studies. Choice A is incorrect alone as it's one risk. Choice B is wrong by itself because interactions are just part. Choice C is incorrect solo since nonadherence is only one issue.
Upregulation or hypersensitization may lead to:
- A. Increased response to a drug
- B. Decreased response to a drug
- C. An exaggerated response if the drug is withdrawn
- D. Refractoriness or complete lack of response
Correct Answer: C
Rationale: Choice C is correct because upregulation (more receptors) or hypersensitization from chronic antagonist use can cause an exaggerated rebound response if withdrawn, as seen with beta blockers. Choice A is incorrect as increased response occurs during use, not withdrawal. Choice B is wrong because decreased response isn't typical of upregulation. Choice D is incorrect since refractoriness relates to agonists, not this scenario.
Drugs that are Pregnancy Category C:
- A. Have known fetal risks that outweigh the benefits
- B. Have no adequate studies in pregnant women
- C. Are proven safe in pregnancy
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because Category C drugs lack sufficient human studies, with animal studies showing risk or no data, used only if benefits justify, per FDA. Choice A is incorrect as that defines Category X, not C. Choice C is wrong because Category B, not C, indicates safety. Choice D is incorrect since only B fits Category C.
Drugs that may cause sedation in the elderly include:
- A. Benzodiazepines
- B. Antihistamines
- C. Opioids
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because benzodiazepines (e.g., lorazepam), antihistamines (e.g., diphenhydramine), and opioids (e.g., oxycodone) all cause sedation, increasing fall risk in the elderly, per Beers Criteria. Choice A is incorrect alone as it's one class. Choice B is wrong by itself because antihistamines are just part. Choice C is incorrect solo since opioids are only one group.
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).