Nokea
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.
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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.
Over-the-counter drugs that should be avoided in patients with hypertension include:
- A. Acetaminophen
- B. Pseudoephedrine
- C. Ibuprofen
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because pseudoephedrine, a decongestant, raises blood pressure via vasoconstriction, risky in hypertension, per guidelines. Choice A is incorrect as acetaminophen doesn't affect BP. Choice C is wrong because ibuprofen's BP effect is milder and not absolute avoidance. Choice D is incorrect since only pseudoephedrine is key.
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).
Pharmacokinetic changes in the elderly that affect drug dosing include:
- A. Decreased renal function
- B. Increased liver metabolism
- C. Decreased body fat
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because decreased renal function in the elderly slows drug excretion, requiring dose adjustments to prevent accumulation, per geriatric pharmacology. Choice B is incorrect as liver metabolism decreases, not increases. Choice C is wrong because body fat increases, not decreases. Choice D is incorrect since only A is accurate.
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).