BCPS Exam 1 Questions and Answers 100% CorrectBCPS Exam 1 Questions and Answers 100% CorrectBCPS Exam 1 Questions and Answers 100% CorrectBCPS Exam 1 Questions and Answers 100% CorrectA newly added medication to the formulary has been causing a significant number of drug interactions and adverse ef...
a newly added medication to the formulary has been
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BCPS Exam 1 Questions and
Answers 100% Correct
A newly added medication to the formulary has been causing a significant number
of drug interactions and adverse effects. You are part of the P&T committee and are
of the opinion that this medication should be removed from formulary as other
reasonable alternatives exist. Which of the following actions would NOT be
appropriate?
A. Remove the medication from the formulary as perceived harm outweighs
potential risks, this can be done unilaterally by the P&T committee if necessary to
minimize patient risk and maximize patient safety
B. Continue to monitor the safety and reactions until removal of the drug from the
formulary is approved
C. Discuss the issue with colleagues to obtain as much information as possible
D. Establish special monitoring procedures in the pharmacy department to help
track the safety profile of this particular medication - ANSWER - Answer: A. Remove
the medication from the formulary as perceived harm outweighs potential risks, this
can be done unilaterally by the P&T committee if necessary to minimize patient risk
and maximize patient safety - Actions of the P&T committee are subject to the
medical board's approval and the P&T committee cannot act unilaterally. The other
answers all represent reasonable approaches to address and monitor the safety risk
of the medication.
38 year old male with a history of Multiple Sclerosis. Past medical history is minimal
other than MS. With treatment of Interferon Beta 1a for MS, what is the best choice
for prevention of side effects?
A. Low dose corticosteroid
B. Acetaminophen scheduled three times daily
C. Ibuprofen 600 mg with injection
D. Benadryl 50 mg with injection - ANSWER - Answer: C. Ibuprofen 600 mg with
injection - Flu like symptoms are common with Interferon Beta 1a. Acetaminophen
or Ibuprofen would be appropriate. Three times daily acetaminophen would be
excessive for prevention of injection site reaction. Steroids would not be indicated
due to long term adverse effects risk like hyperglycemia, osteoporosis, adrenal
suppression, etc. Benadryl doesn't have any analgesic properties.
,A 78 year old male has an extensive seizure history, but no recent seizures within
the last year. Currently receives Dilantin 300 mg daily. Dilantin level drawn today
was low at 8.3 (Normal range 10-20). Previous total levels have ranged in the 10-15
range. Other labs LFT - normal limit, hemoglobin 13.3, WBC - 8.7, Platelets 164,
Albumin 3.2, Alkaline Phosphatase 174. What is your recommendation?
A. Leave current dosing as is
B. Increase phenytoin to 330 mg daily
C. Increase phenytoin to 400 mg daily
D. Increase phenytoin to 600 mg daily - ANSWER - Answer: A. Leave current dosing
as is - No recent seizures, so why risk toxicity? Corrected level will actually give you
a value higher than 8.3. Also remember that phenytoin can cause transient
increases in alkaline phosphatase which is generally not an issue. If you get a case
where you are recommending an increase, remember the dose dependent kinetics.
Small increases in dose can lead to huge increases in serum concentration. Never
double a maintenance dose, and if you see it done, watch for toxicity because it will
likely happen. Albumin and BUN also have the potential to affect phenytoin levels.
Newly diagnosed 85 year old patient with atrial fibrillation at a routine visit to the
clinic. Past medical history includes hypertension, rheumatoid arthritis, constipation,
heart failure, diabetes and GERD. What is appropriate recommendation regarding
the possible use of anticoagulation?
A. Aspirin use is acceptable
B. Initiate warfarin with goal of 2-3 INR
C. Initiate dabigatran
D. Anticoagulation is not necessary - ANSWER - Answer: B. Initiate warfarin with
goal of 2-3 INR - CHADS-2Vasc score is three, so anticoagulation is definitely
indicated. Dabigatran bleed risk caution in an 85 year old would probably not be the
ideal choice. Initiating warfarin would be the best choice barring any other
contraindications.
EC is receiving cycle 1 dose-dense AC, which is true about growth factor support in
this patient.
A. This regimen is considered high risk for febrile neutropenia> 20% and patient
should receive pegfilgrastim
B. This regimen is considered intermediate risk for febrile neutropenia 10-20% but
patient does not have any additional risk factors to recommend pegfilgrastim
C. This regimen is considered low risk for febrile neutropenia < 10% therefore, this
patient should not receive pegfilgrastim
, D. This regimen is considered intermediate risk for febrile neutropenia 10 -20% and
since patient has other risk factors he should receive pegfilgrastim. - ANSWER -
Answer: A. This regimen is considered high risk for febrile neutropenia >20% and
patient should receive pegfilgrastim - In this case, the regimen is high risk for
neutropenia and CSF should be given.
What is the most likely agent that would cause the worsening confusion?
A. Propranolol
B. Insulin glargine
C. Naproxen
D. Ranitidine - ANSWER - Answer: D. Ranitidine - While propranolol can certainly
cause some cognition/sedation issues, the likely cause here with the change in
kidney function is the accumulation of ranitidine. H2 blockers are primarily
eliminated via the kidney. Propranolol is primarily eliminated via the liver.
Which medications are most likely to cause an elevation in lithium levels?
A. Hydrochlorothiazide and Clozapine
B. Ibuprofen and Hydrochlorothiazide
C. Venlafaxine and Clozapine
D. Ibuprofen and Clozapine - ANSWER - Answer: B. Ibuprofen and
Hydrochlorothiazide - NSAIDs and thiazide diuretics are two classic examples of very
common medications that can potentially increase lithium concentrations.
Whenever these medications are added or increased, at a minimum ramped up
monitoring is recommended.
An infant female is now 4 months old and was born premature at 27 weeks. Due to
premature nature of birth the infant had received 2 doses of palivizumab each
separated by a month for RSV prophylaxis. She is now presenting with respiratory
symptoms and is RSV positive. What should be your recommendation in regards to
palivizumab therapy?
A. Continue palivizumab at monthly intervals up to 5 total doses
B. Discontinue palivizumab treatments
C. Increase frequency to weekly for a max of 5 doses or until symptoms resolve
D. Continue palivizumab monthly until the infant reaches 1 year of age - ANSWER -
Answer: B. Discontinue palivizumab treatments - The infant has contracted the virus
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