Nokea
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.
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An agonist activates a receptor and stimulates a response. When given frequently over time, the body may:
- A. Upregulate the total number of receptors
- B. Block the receptor with a partial agonist
- C. Alter the drug's metabolism
- D. Downregulate the numbers of that specific receptor
Correct Answer: D
Rationale: Choice D is correct because frequent agonist use can cause the body to downregulate receptors, reducing sensitivity to overstimulation as a compensatory mechanism. Choice A is incorrect as upregulation occurs with antagonists, not agonists. Choice B is wrong because partial agonists compete, not result from frequent use. Choice C is incorrect since metabolism changes aren't the primary receptor response.
The U.S. Drug Enforcement Administration:
- A. Registers manufacturers and prescribers of controlled substances
- B. Regulates NP prescribing at the state level
- C. Sanctions providers who prescribe drugs off-label
- D. Provides prescribers with a number they can use for insurance billing
Correct Answer: A
Rationale: Choice A is correct because the DEA registers those handling controlled substances, issuing numbers for tracking and prescribing, its primary role. Choice B is incorrect as state boards, not the DEA, regulate NP prescribing. Choice C is wrong because off-label prescribing isn't DEA-regulated. Choice D is incorrect since the DEA number is for controlled substances, not insurance billing.
The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:
- A. Minimum adverse effect level
- B. Peak of action
- C. Onset of action
- D. Therapeutic range
Correct Answer: C
Rationale: Choice C is correct because the onset of action is when a drug first shows a therapeutic effect on the concentration curve, marking the start of its clinical impact. Choice A is incorrect as ‘minimum adverse effect level' isn't a standard term; it confuses with toxicity thresholds. Choice B is wrong because peak of action is the maximum effect, not the first sign. Choice D is incorrect since therapeutic range is the concentration window for efficacy, not a specific time point.
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 who has HIV has been receiving a two-drug combination therapy for 6 months. At an annual physical examination, the primary care NP notes that the patient has a viral load of 60 copies/mL and a CD4 cell count of 350 cells/mm. The NP should contact the patient's infectious disease specialist to discuss:
- A. changing one of the medications.
- B. increasing the dose of both medications.
- C. discontinuing the medications for a short period.
- D. adding a third medication.
Correct Answer: B
Rationale: The correct answer is B because a high viral load and low CD4 suggest poor control, often needing dose adjustment. Choice A is incorrect (both should change if switching). Choice C is wrong (discontinuing risky). Choice D is inaccurate (text-based, not an option).