Leik - FNP Review Question and answer 2023 verified

Leik - FNP Review Question and answer 2023 verifiedWhich of the following drugs interact with warfarin/coumadin? a. Imodium (loperamide) b. Diltiazem Hydrochloride SR (diltiazem) c. trimethoporim-sulfamethoxazole (Bactrim) d. sumatriptan (Imitrex) c Sulfa drugs will interact with warfarin (increases the blood level), which results in an elevation of the INR and the risk of bleeding. The following drugs are potent inhibitors of the CYP450 system except: a. Erythromycin (Erythrocin) b. Cimetidine (Tagamet) c. Ceftazidime (Tazicef) d. Diltiazem (Cardizem) a Erythromycin acts as inhibitors slow down drug clearance, increasing drug concentration. This may lead to drug overdose. A 57 year old patient comes to the clinic for her routine physical. She has no new complaints. The only medication that she takes is digoxin (Lanoxin) for her atrial fibrillation. Which of the following electrolyte levels should be monitored in this patient? a. potassium, calcium, chloride b. magnesium, calcium, chloride c. potassium, calcium, magnesium d. magnesium, calcium, phosphate c Monitor digoxin level, EKG, electrolytes (potassium, magnesium, and calcium) A 48 year old female patient comes to the clinic today to discuss her ongoing use off Lithium. She states that she has begun feeling very tired and feels cold during the day. She thinks that her increase in Lithium dose is causing her symptoms. What should the nurse practitioner order? a. TSH b. CBC c. LFT d. BUN a Patients taking lithium have an increased risk of developing hypothyroidism by decreasing the production of T4. Levothyroxine replacement therapy concurrently with lithium administration especially in the presence of clinically overt hypothyroidism. A patient has recently been prescribed omeprazole (Prilosec) for GERD. He also takes lisinopril (Zestril). His PMH includes migraines, hypertension, and chronic kidney disease. The nurse practitioner notes: a. The patient should stop taking the omeprazole (Prilosec) due his diagnosis of chronic kidney disease. b. The patient should stop taking omeprazole (Prilosec) due to drug interaction with lisinopril (Zestril). c. The patient may continue taking the omeprazole (Prilosec) but should monitor blood pressure. d. The patient may continue taking omeprazole (Prilosec) as prescribed. a Studies suggest that PPIs may increase the risk of kidney disease. Using PPIs may also cause acute interstitial nephritis. A patient that has already been diagnosed with CKD should not take PPIs. A patient taking Warfarin (Coumadin) is having abdominal surgery in one month. She wants to know when she should stop taking her Warfarin (Coumadin). The nurse practitioner advises: a. The day before scheduled surgery. b. Do not stop taking Warfarin (Coumadin) c. 3 days before surgery. d. 7 days before surgery. d Patients should discontinue warfarin 7 days before surgery. A 71 year old patient has been diagnosed with stage III congestive heart failure. Which of the following class of medications may cause an exacerbation of congestive heart failure a. Thiazolidinediones b. Narcotics c. NSAIDs d. ACE Inhibitors a Improved glycemic control decreases the risk of end organ damage and heart failure in patients with diabetes. Thiazolidinediones are very useful drugs, particularly for patients with marked insulin resistance and hyperlipidemia. However, they do precipitate edema and heart failure. The edema can be severe enough to lead to discontinuation of the drug, and the risk of heart failure limits the population in which they can be used. They can be used safely in some cardiac patients but, as noted in the article, they should be avoided or used with caution in patients with CHF. Patients taking a TZD who subsequently develop edema should be carefully evaluated for CHF. NY Health Association Class III or IV heart failure should not use TZDs. Which of the following medications may have a high risk of weight gain? a. Bupropion (Wellbutrin) b. Metformin (Glucophage) c. Quetiapine (Seroquel) d. Topiramate (Topamax) c High risk of weight gain, higher mortality in elderly patients. Weight should be monitored every 3 months, monitor TSH and lipids. A patient is newly prescribed risedronate (actonel). What should the nurse practitioner include in patient education regarding this medication? a. Take the medication in the evening with a large glass of water. b. Take the medication upon wakening with a large glass of water. c. Take the medication with a meal. d. Take the medication 30 minutes after eating. b Risedronate (actonel) is a bisphosphonate that is use to treat osteoporisis/penia. Patients should be advised to take risedronate (actonel) upon awakening with a glass of water, before breakfast. They should not lie down for 30 minutes afterward. Should not mix with other drugs. Bisphosphonates are contraindicated in which of the following conditions except: a. CKD b. GERD c. Celiac Disease d. Espohageal Stricture c Osteoporosis is a complication of untreated celiac disease. Bisphosphonates, such as fosamax and actonel, are used to prevent or treat osteoporisis/penia. A patient has been taking simvastatin (Zocor), 40 mg, two times per day for the past 2 weeks. He returns to the clinic with complaints of muscle pain and tenderness. Which of the following should the nurse practitioner do? a. Tell the patient that it is normal to have these side effects when taking a new medication and they should resolve within 4 weeks. b. Prescribe 600 mg/day of ibuprofen to improve pain. c. Prescribe physical therapy for 4 weeks. d. Send the patient to the emergency room for immediate evaluation. d The patient is presenting with signs of potential rhabdomyolysis. The risk of rhabdomyolysis increases with high dose Zocor (80 mg). Rhabdomyolysis can be life-threatening and the patient needs prompt emergent evaluation.