Nokea
Drugs that may cause increased adverse effects in women include:
- A. Lipid-soluble drugs
- B. Water-soluble drugs
- C. Drugs that are highly protein bound
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because women's lower lean mass reduces the volume of distribution for water-soluble drugs, increasing concentrations and ADR risk. Choice A is incorrect as lipid-soluble drugs distribute more in fat, not necessarily causing more ADRs. Choice C is wrong because protein binding isn't sex-specific enough here. Choice D is incorrect since only water-soluble drugs align.
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Clinical judgment in prescribing includes:
- A. Factoring in the cost to the patient of the medication prescribed
- B. Always prescribing the newest medication available for the disease process
- C. Handing out drug samples to poor patients
- D. Prescribing all generic medications to cut costs
Correct Answer: S
Rationale: Choice A is correct because clinical judgment involves balancing efficacy, safety, and cost to ensure patients can afford and adhere to treatment, which is critical for successful outcomes. Choice B is incorrect as always choosing the newest medication ignores evidence-based practice; newer drugs may lack long-term data or be unnecessarily expensive. Choice C is wrong because distributing samples isn't a sustainable prescribing strategy and may not meet ongoing needs. Choice D is also incorrect since mandating generics could compromise efficacy if a brand-name drug is clinically necessary.
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).
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.
A 4-month-old infant has a viral illness with high fever and cough. The infant's parent asks the NP about what to give the infant to help with symptoms. The NP should prescribe which of the following?
- A. Aspirin to treat the fever
- B. Acetaminophen as needed
- C. Dextromethorphan for coughing
- D. An antibiotic to prevent increased infection
Correct Answer: B
Rationale: The correct answer is B because acetaminophen is safe for infants to reduce fever. Choice A is incorrect (aspirin risks Reye’s syndrome). Choice C is wrong (dextromethorphan risks respiratory depression). Choice D is inaccurate (antibiotics don’t treat viral illness).
Passive monitoring of drug effectiveness includes:
- A. Therapeutic drug levels
- B. Adding or subtracting medications from the treatment regimen
- C. Ongoing provider visits
- D. Instructing the patient to report if the drug is not effective
Correct Answer: D
Rationale: Choice D is correct because passive monitoring relies on patient feedback, like reporting ineffectiveness, rather than active measures like lab tests. Choice A is incorrect as therapeutic levels are active monitoring. Choice B is wrong because adjusting medications is an intervention, not monitoring. Choice C is incorrect since provider visits are active engagement, not passive.