Callista Roy and Betty Neuman’s theories view the person (individual, group, or community) as a holistic adaptive system that constantly interacts with the internal and external environments. Both theories view the person as being the center of nursing and present health/wellness and illness as parts of the same continuum, however there are some key assumptions that are different. As such, select one of the theories and identify 1 assumption of the theory and discuss how the care rendered for this patient by an advanced practice nurse would be structured (assessment, diagnosis, planning, intervention, evaluation) according to the theory. Give 2 specific examples of interventions that you anticipate will be included in the patient’s care.   

Mr. Reynolds is a 32 year-old male patient hospitalized on the orthopedic unit of the hospital. He is status-post motorcycle accident and right leg below the knee amputation. He has a history of Depression and Schizophrenia. He is currently separated from his wife and estranged from his family. He is awaiting social work for placement in a rehabilitation facility, where he will continue his recovery.

I need at least 2 references 

 

Throughout this course, you’ve examined the importance of anticipating financial fluctuations that may impact your organization’s ability to provide services. While financial managers have no time machines or crystal balls, they do have expense forecasts. Expense forecasting is one of the preeminent tools that financial managers can use to prepare their organizations for future fiscal turbulence. In this Assignment, you will examine a scenario and generate a corresponding expense forecast in Excel.

Before pursuing an opportunity or making a major purchase, financial decision makers must first ascertain if the expenditures are justified. Determining whether a new process, system, or purchase will yield worthwhile returns is no easy task. However, managers have a variety of tools to help them decide whether the new expenditure is warranted. Analyzing a venture’s benefit/cost ratio, marginal profit and loss statement, and break-even points enable nurse managers to make educated decisions about how they choose to commit their funds.

Note: For those Assignments in this course that require you to perform calculations you must:Use the Excel spreadsheet template for the Week 3 assignment
Show all your calculations and formulas in the spreadsheet.
Answer any questions included with the problems (as text in the Excel spreadsheet).

 

Expense Forecasting

In this Application Assignment you calculate scenarios focusing on benefit/cost ratio analysis, marginal profit and loss statements, and break-even analysis. For these scenarios, you will utilize the provided figures to perform calculations and then make recommendations about the viability of the investment opportunities 

Expense Forecasting Scenario

Your department has performed 20,000 procedures during the first six months (January–June) of 20X1. Spending during that period of time was $210,000 for fixed expense items and $1,200,000 for variable expense items. Of those amounts, $50,000 of fixed expense money was spent on preparing for a Joint Commission survey. Volume is anticipated to be 10% higher in the second half of the year. On November 1st, two new procedure technicians will begin work. The salary and fringe benefit costs for each are $96,000/year. Based on the information provided, prepare an expense forecast for 20X1.

Annualization for Fixed:  (Adjusted Total for Year to Date Expense/6) * 12 =Total Annualized Amounts

Annualization for Variable (Adjusted Total for Year to Date Expense/ 20,000) * 40,000 =Total Annualized Amounts.

Financial Analysis Cycle

Marginal Profit and Loss Statement Scenario

You are examining a proposal for a new business opportunity – a new procedure for which demand is expected to be 1,400 units the first year, growing by 600 units a year thereafter. The price charged per procedure is $1,000. The collection rate is anticipated to be 80%. Each procedure consumes $300 of supplies. Salary cost is estimated to cost $540,000 each year, fringe benefits are 25% of salaries, rent for the facility is $55,000/yr and operating cost are $120,000/yr.

Questions:

1. Develop a marginal profit and loss statement for this business opportunity.Based on that analysis, should this opportunity be pursued?

Break-Even Analysis Scenario

You can charge $1,075 for a new service. Demand is anticipated to be 8,000 units a year. Your business is able to handle up to 16,500 units annually, so capacity should not be a problem. The average collection rate is 80%. The new service has annual fixed costs of $4,700,000. Variable cost per unit of service is $420.

Question: Use break-even analysis to determine if this new service is financially viable. If the business is not financially viable, what steps could you take to make a case to proceed with implementation?  Explain your decision.

Benefit/Cost Ratio Analysis Scenario

You are considering the acquisition of a new piece of equipment with a useful life of five years. This new technology will make your clinical operation more efficient and allow for a reduction of 10 FTEs. The equipment purchase price is $4,500,000 plus 10% installation fee. The purchase price includes service for the first year, an item that has an annual cost of $10,000. There is a potential for additional volume of 150,000 units in the first year, growing by 30,000 each year thereafter. The price charged per unit is $15.00 with a 50% collection rate. The staff being eliminated are paid $12.50 per hour. The fringe benefits rate is 20%. The hurdle rate is 7.5%.

Questions: After reviewing Dr. Ward’s Video and the calculations below, please answer the following questions:

• What is meant by  benefit/cost ratio, average payback period and ROI  and why are the all  important to understand when purchasing new equipment?
• Based on this information, would you pursue this opportunity?
• Explain your decision  in 250-500 words in the text box below.

References:

 

Baker, J. J., Baker, R. W., & Dworkin, N. R.  (2018). Health care finance: Basic  tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and  Bartlett Learning.

Chapter 14, “Trend Analysis, Common Sizing, and Forecasted Data” (pp. 149-160)
The focus of this chapter is the use of trend analysis and forecasting to develop future budgets and make financial decisions about capital purchases, programs, and personnel.
Chapter 15, “Using Comparative Data” (pp. 161-173)
In this chapter, you are introduced to the criteria for identifying other health care organizations that are comparable to your own. Data from these organizations can then be used to evaluate your own organizational performance.
Chapter 19, “Estimates, Benchmarking, and Other Measurement Tools” (pp. 223-231)
In this chapter, you continue exploring the concept of financial benchmarking. The chapter focuses on the importance of benchmarking for identifying performance gaps.

Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.
Retrieved from the Walden Library databases.
Chapter 5, “Working Capital Management” (pp. 187–231)
This chapter examines the concept of working capital. The authors explore the specifics of current assets and the management of the working capital cycle.
Chapter 11, “Responsibility Accounting” (pp. 468–497)
Review: This chapter explores the trend toward the decentralization of health care organizations and the challenges this presents. This chapter also describes responsibility centers, or organizational units intended to achieve specific tasks.

Mulva, S., & Dai, J. (2009) Health care facility benchmarking. HERD, 3(1), 28–37.
Reprinted by permission of Sage Publications via the Copyright Clearance Center.

This article describes a national health care facility’s benchmarking program. It is designed to compare measures of capital project performance.

Agency for Healthcare Research and Quality. (2013). Measuring and benchmarking clinical performance. Retrieved from www.ahrq.gov

Ettorchi-Tardy, A., Levif, M., & Michel, P. (2012). Benchmarking: A Method for Continuous Quality Improvement in Health. Healthcare Policy, e101-e119. Retrieved fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3359088/

 

First Steps on Becoming a Grassroots Lobbyist/Advocate for Health Care Policy

This assignment has two parts, numbered below. Write each question as a new topic area, then follow with a paragraph or two to answer the question. You may find it necessary to search for answers to the questions outside of the assigned reading. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources.

Tasks:

1. Imagine that you are going to make a visit to your representative in Congress. Develop a one-page document that supports your position on the AHCA that you would leave with your representative or his or her aide when you make your visit. This one-pager, also called a “leave behind,” should state your position clearly in bullet points and give your reasons why your position is preferred. This “leave behind” should have 1 inch margins and utilize 14-point font throughout. If you were making this visit in person, you would present your “leave behind” to the person with whom you speak during your visit. Include a second page that describes your rationale for the position in your “leave behind” page supported by at least two journal articles.
2. Write a two-page brief to describe the scenario surrounding your legislative visit. Understanding the political affiliation of your representative, include answers to the following:
   • Was your member in support or in opposition to the AHCA?
   • State three points that you would cover in support or opposition to your representative’s position.
   • How does your nursing experience influence the advocacy position that you take on the AHCA?

Submission Details:

• Submit your response in a 4-page Microsoft Word document.
• Name your document SU_NSG4068_W3_Project_LastName_FirstInitial.doc.
• Submit your document to the Submissions Area by the due date assigned.
• Cite sources in the APA format on a separate page.

  

Question

1. Question :

The drug recommended as primary prevention of osteoporosis in men over seventy years is:

Alendronate (Fosamax)

Ibandronate (Boniva)

Calcium carbonate

Raloxifene (Evista)

Question 2. Question :

Alterations in drug metabolism among Asians may lead to:

Slower metabolism of antidepressants, requiring lower doses

Faster metabolism of neuroleptics, requiring higher doses

Altered metabolism of omeprazole, requiring higher doses

Slower metabolism of alcohol, requiring higher doses

Question 3. Question :

Some research supports that testosterone replacement therapy may be indicated in which of the following diagnoses in men?

Age-related decrease in cognitive functioning

Metabolic syndrome

Decreased muscle mass in aging men

All of the above

Question 4. Question :

The chemicals that promote the spread of pain locally include _________.

serotonin

norepinephrine

enkephalin

neurokinin A

Question 5. Question :

The DEA:

Registers manufacturers and prescribes controlled substances

Regulates NP prescribing at the state level

Sanctions providers who prescribe drugs off-label

Provides prescribers with a number they can use for insurance billing

Question 6. Question :

The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for RA is _____.

forty-eight hours

four to six days

four weeks

two months

Question 7. Question :

The route of excretion of a volatile drug will likely be:

The kidneys

The lungs

The bile and feces

The skin

Question 8. Question :

Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials include:

Pregnancy

Renal parenchymal disease

Stable angina

Dyslipidemia

Question 9. Question :

The American Diabetic Association has recommended which of the following tests for ongoing management of diabetes?

Fasting blood glucose

Hemoglobin A1c

Thyroid function tests

Electrocardiograms

Question 10. Question :

The angiotensin converting enzyme (ACE) inhibitor lisinopril is a known teratogen. Teratogens cause Type ____ ADR.

A

B

C

D

Question 11. Question :

The goals of therapy when prescribing HRT include reducing:

Cardiovascular risk

Risk of stroke or other thromboembolic event

Breast cancer risk

Vasomotor symptoms

Question 12. Question :

Patients who have angina, regardless of class, who are also diabetic should be on:

Nitrates

Beta blockers

ACE inhibitors

Calcium channel blockers

Question 13. Question :

The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is:

Class I

Class II

Class III

Class IV

Question 14. Question :

Patients with allergic rhinitis may benefit from a prescription of:

Fluticasone (Flonase)

Cetirizine (Zyrtec)

OTC cromolyn nasal spray (Nasalcrom)

Any of the above

Question 15. Question :

Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is:

Oral folic acid 1 to 2 mg/day

Oral folic acid 1 gm/day

IM folate weekly for at least six months

Oral folic acid 400 mcg daily

Question 16. Question :

The treatment for vitamin B12 deficiency is:

1,000 mcg daily of oral cobalamin

2 gm/day of oral cobalamin

100 mcg/day vitamin B12 IM

500 mcg/dose nasal cyanocobalamin two sprays once a week

Question 17. Question :

Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that:

Has a short half-life so that missing one dose has limited effect

Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down

Has a tolerability profile with less of the adverse effects that are considered “irritating,” such as nausea and dizziness

Must be taken no more than twice a day

Question 18. Question :

Type II diabetes is a complex disorder involving:

Absence of insulin production by the beta cells

A suboptimal response of insulin-sensitive tissues in the liver

Increased levels of GLP in the postprandial period

Too much fat uptake in the intestine

Question 19. Question :

Metformin is a primary choice of drug to treat hyperglycemia in type II diabetes because it:

Substitutes for insulin usually secreted by the pancreas

Decreases glycogenolysis by the liver

Increases the release of insulin from beta cells

Decreases peripheral glucose utilization

Question 20. Question :

Gender differences between men and women in pharmacokinetics include:

More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites

Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution

Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations

Slower organ blood flow rates so that drugs tend to take longer to be excreted

Question 21. Question :

If not chosen as the first drug in hypertension treatment, which drug class should be added as the second step because it will enhance the effects of most other agents?

ACE inhibitors

Beta blockers

Calcium channel blockers

Diuretics

Question 22. Question :

A nineteen-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:

Bradykinesia, akathisia, and agitation

Excessive weight gain

Hypertension

Potentially fatal agranulocytosis

Question 23. Question :

Levetiracetam has known drug interactions with:

Oral contraceptives

Carbamazepine

Warfarin

Few, if any, drugs

Question 24. Question :

When the total daily insulin dose is split and given twice daily, which of the following rules may be followed?

Give two-thirds of the total dose in the morning and one-third in the evening.

Give 0.3 units/kg of premixed 70/30 insulin, with one-third in the morning and two-thirds in the evening.

Give 50% of an insulin glargine dose in the morning and 50% in the evening.

Give long-acting insulin in the morning and short-acting insulin at bedtime.

Question 25. Question :

Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen?

Complexity of the drug regimen

Patient’s perception of the potential adverse effects of the drugs

Both A and B

Neither A nor B

Question 26. Question :

The time required for the amount of drug in the body to decrease by 50% is called:

Steady state

Half-life

Phase II metabolism

Reduced bioavailability time

Question 27. Question :

Drugs that are absolutely contraindicated in lactating women include:

Selective serotonin reuptake inhibitors

Antiepileptic drugs such as carbamazepine

Antineoplastic drugs such as methotrexate

All of the above

Question 28. Question :

Tobie presents to clinic with moderate acne. He has been using OTC benzoyl peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education of Tobie would include which one of the following instructions?

He should see an improvement in his acne within the first two weeks of treatment.

If there is no response in a week, he should double the daily application of adapalene (Differin).

He may see an initial worsening of his acne that will improve in six to eight weeks.

Adapalene may cause bleaching of clothing.

Question 29. Question :

Martin is a sixty-year-old with hypertension. The first-line decongestant to be prescribed would be:

Oral pseudoephedrine

Oral phenylephrine

Nasal oxymetazoline

Nasal azelastine

Question 30. Question :

A woman who is pregnant and has hyperthyroidism is best managed by a specialty team that will most likely treat her with:

Methimazole.

Propylthiouracil.

Radioactive iodine.

Nothing; treatment is best delayed until after her pregnancy ends.

Question 31. Question :

A twenty-four-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for Type __ ADR when he no longer requires the opioids.

A

C

E

G

Question 32. Question :

Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they:

Are more effective than first-generation antihistamines

Are less sedating than first-generation antihistamines

Are prescription products and, therefore, are covered by insurance

Can be taken with CNS sedatives, such as alcohol

Question 33. Question :

Steady state is:

The point on the drug concentration curve when absorption exceeds excretion

When the amount of drug in the body remains constant

When the amount of drug in the body stays below the minimum toxic concentration (MTC)

All of the above

Question 34. Question :

Jayla is a nine-year-old who has been diagnosed with migraines for almost two years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?

Prescribe amitriptyline (Elavil) daily, start at a low dose and increase the dose slowly every two weeks until effective in eliminating migraines.

Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache.

Prescribe propranolol (Inderal) to be taken daily for at least three months.

Explain that it is rare for a nine-year-old to get migraines and that she needs an MRI to rule out a brain tumor.

Question 35. Question :

Josie is a five-year-old who presents to the clinic with a forty-eight-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down, and her weight is 4 pounds less than her last recorded weight. Besides intravenous (IV) fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie?

Prochlorperazine (Compazine)

Meclizine (Antivert)

Promethazine (Phenergan)

Ondansetron (Zofran)

Question 36. Question :

Long-term use of PPIs may lead to:

Hip fractures in at-risk persons

Vitamin B6 deficiency

Liver cancer

All of the above

Question 37. Question :

Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing with their providers or a pharmacist first?

Patients with kidney stones

Pregnant patients

Patients with heartburn

IN Postmenopausal women

0 of 2.5

Question 38. Question :

Beta blockers treat hypertension because they:

Reduce peripheral resistance.

Vasoconstrict coronary arteries.

Reduce norepinephrine.

Reduce angiotensin II production.

Question 39. Question :

Precautions that should be taken when prescribing controlled substances include:

Faxing the prescription for a Schedule II drug directly to the pharmacy

Using tamper-proof papers for all prescriptions written for controlled drugs

Keeping any presigned prescription pads in a locked drawer in the clinic

Using only numbers to indicate the amount of drug to be prescribed

Question 40. Question :

The tricyclic antidepressants should be prescribed cautiously in patients with:

Eczema

Asthma

Diabetes

Heart disease

Question 41. Question :

An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes better than either drug alone?

Beta blockers

Diuretics

Nondihydropyridine calcium channel blockers

Angiotensin II receptor blockers

Question 42. Question :

Metoclopramide improves GERD symptoms by:

Reducing acid secretion

Increasing gastric pH

Increasing lower esophageal tone

Decreasing lower esophageal tone

Question 43. Question :

Patient education regarding prescribed medication includes:

Instructions written at the high school reading level

Discussion of expected ADRs

How to store leftover medication such as antibiotics

Verbal instructions always in English

Question 44. Question :

If a patient with H. pylori positive PUD fails first-line therapy, the second-line treatment is:

A PPI BID plus metronidazole plus tetracycline plus bismuth subsalicylate for fourteen days

Testing H. pylori for resistance to common treatment regimens

A PPI plus clarithromycin plus amoxicillin for fourteen days

A PPI and levofloxacin for fourteen days

Question 45. Question :

A patient with a COPD exacerbation may require:

Doubling of inhaled corticosteroid dose

Systemic corticosteroid burst

Continuous inhaled beta 2 agonists

Leukotriene therapy

Question 46. Question :

Angela is a black woman who has heard that women of African descent do not need to worry about osteoporosis. What education would you provide Angela about her risk?

She is ; black women do not have much risk of developing osteoporosis due to their dark skin.

Black women are at risk of developing osteoporosis due to their lower calcium intake as a group.

If she doesn’t drink alcohol, her risk of developing osteoporosis is low.

If she has not lost more than 10% of her weight lately, her risk is low.

Question 47. Question :

The role of the nurse practitioner in the use of herbal medication is to:

Maintain competence in the prescribing of common herbal remedies.

Recommend common OTC herbs to patients.

Educate patients and guide them to appropriate sources of care.

Encourage patients to not use herbal therapy due to the documented dangers.

Question 48. Question :

Ray has been diagnosed with hypertension, and an ACE inhibitor is determined to be needed. Prior to prescribing this drug, the nurse practitioner should assess for:

Hypokalemia

Impotence

Decreased renal function

Inability to concentrate

Question 49. Question :

Long-acting beta-agonists received a black box warning from the US Food and Drug Administration due to the:

Risk of life-threatening dermatological reactions

Increased incidence of cardiac events when long-acting beta-agonists are used

Increased risk of asthma-related deaths when long-acting beta-agonists are used

Risk for life-threatening alterations in electrolytes

Question 50. Question :

Off-Label prescribing is:

Regulated by the FDA

Illegal by NPs in all states (provinces)

Legal if there is scientific evidence for the use

Regulated by the DEA

Question 51. Question :

Adam has type I diabetes and plays tennis for his university. He exhibits knowledge deficit about his insulin and his diagnosis. He should be taught that:

He should increase his increase his carbohydrate intake during times of exercise intake during times of exercise.

Each brand of insulin is equal in bioavailability, so buy the least expensive.

Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts.

If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes.

Question 52. Question :

Prior to starting antidepressants, patients should have laboratory testing to rule out:

IN Hypothyroidism

Anemia

Diabetes mellitus

Low estrogen levels

0 of 2.5

Question 53. Question :

What impact does developmental variation in renal function has on prescribing for infants and children?

Lower doses of renally excreted drugs may be prescribed to infants younger than six months

Higher doses of water-soluble drugs may need to be prescribed due to increased renal excretion

Renal excretion rates have no impact on prescribing

Parents need to be instructed on whether drugs are renally excreted or not

Question 54. Question :

All diabetic patients with hyperlipidemia should be treated with:

3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors

Fibric acid derivatives

Nicotinic acid

Colestipol

Question 55. Question :

Treatment failure in patients with PUD associated with H. pylori may be due to:

Antimicrobial resistance

Ineffective antacid

Overuse of PPIs

All of the above

Question 56. Question :

To improve positive outcomes when prescribing for the elderly, the NP should:

Assess cognitive functioning in the elder

Encourage the patient to take a weekly “drug holiday” to keep drug costs down

Encourage the patient to cut drugs in half with a knife to lower costs

All of the above options are

Question 57. Question :

Erik presents with a golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive treatment. Which medication would be the best choice for treatment?

Mupirocin (Bactroban)

Bacitracin and polymixin B (generic double antibiotic ointment)

Retapamulin (Altabax)

Oral cephalexin (Keflex)

Question 58. Question :

Nonselective beta blockers and alcohol create serious drug interactions with insulin because they:

Increase blood glucose levels.

Produce unexplained diaphoresis.

Interfere with the ability of the body to metabolize glucose.

Mask the signs and symptoms of altered glucose levels.

Question 59. Question :

Infants and young children are at higher risk of ADRs due to:

Immature renal function in school-age children

Lack of safety and efficacy studies in the pediatric population

Children’s skin being thicker than adults, requiring higher dosages of topical medication

Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution

Question 60. Question :

Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

Toxic levels of warfarin building up

Decreased response to warfarin

Increased risk for significant drug interactions with warfarin

Less risk of drug interactions with warfarin

Question 61. Question :

Jose is a twelve-year-old overweight child with a total cholesterol level of 180 mg/dL and LDL of 125 mg/dL. Along with diet education and recommending increased physical activity, a treatment plan for Jose would include ____ with a reevaluation in six months.

statins

niacin

sterols

bile acid-binding resins

Question 62. Question :

A potentially life-threatening adverse response to ACE inhibitors is angioedema. Which of the following statements is true about this adverse response?

Swelling of the tongue and hoarseness are the most common symptoms.

It appears to be related to a decrease in aldosterone production.

The presence of a dry, hacky cough indicates a high risk for this adverse response.

Because it takes time to build up a blood level, it occurs after being on the drug for about one week.

Question 63. Question :

Amber is a twenty-four-year-old who has had migraines for ten years. She reports a migraine on average of once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling Amber’s naratriptan education would include which of the following?

Naratriptan will interact with antidepressants, including selective serotonin reuptake inhibitors and St John’s Wort, and she should inform any providers she sees that she has migraines.

Continue to monitor her headaches; if the migraine is consistently happening around her menses, then there is preventive therapy available.

Pregnancy is contraindicated when taking a triptan.

All the given options are correct.

Question 64. Question :

One of the main drug classes used to treat acute pain is NSAIDs. They are used due to which of the following reasons?

They have less risk for liver damage than acetaminophen.

Inflammation is a common cause of acute pain.

They have minimal GI irritation.

Regulation of blood flow to the kidney is not affected by these drugs.

Question 65. Question :

A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his or her leg. Normal adverse effects of silver sulfadiazine cream include:

Transient leukopenia on days two to four that should resolve

Worsening of burn symptoms briefly before resolution

A red, scaly rash that will resolve with continued use

Hypercalcemia

Question 66. Question :

Sulfonylureas may be added to a treatment regimen for type II diabetics when lifestyle modifications and metformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they:

Increase endogenous insulin secretion.

Have a significant risk for hypoglycemia.

Address the insulin resistance found in type II diabetics.

Improve insulin binding to receptors.

Question 67. Question :

Narcotics are exogenous opiates. They act by ______.

inhibiting pain transmission in the spinal cord

attaching to receptors in the afferent neuron to inhibit the release of substance P

blocking neurotransmitters in the midbrain

increasing beta-lipoprotein excretion from the pituitary

Question 68. Question :

Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of __________.

serum glucose

stool culture

folate levels

vitamin B12

Question 69. Question :

Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?

High-dose colchicines

Low-dose colchicines

High-dose aspirin

Acetaminophen with codeine

Question 70. Question :

Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective-serotonin reuptake inhibitors. What is the initial dosage adjustment when starting a taper off antidepressants?

Change the dose to every other day dosing for a week.

Reduce the dose by 50% for three to four days.

Reduce the dose by 50% every other day.

Escitalopram (Lexapro) can be stopped abruptly due to its long half-life.

Question 71. Question :

Christy has exercise and mild persistent asthma and is prescribed two puffs of albuterol fifteen minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (Qvar) is also prescribed. Teaching regarding her inhalers includes which one of the following?

She should use one to two puffs of albuterol per day to prevent an attack, with no more than eight puffs per day.

Beclomethasone needs to be used every day to treat her asthma.

She should report any systemic side effects she is experiencing, such as weight gain.

She should use the albuterol MDI immediately after her corticosteroid MDI to facilitate bronchodilation.

Question 72. Question :

Asthma exacerbations at home are managed by the patient by:

Increasing the frequency of beta 2 agonists and contacting his or her provider

Doubling inhaled corticosteroid dose

Increasing the frequency of beta 2 agonists

Starting montelukast (Singulair)

Question 73. Question :

A woman with an intact uterus should not be prescribed:

Estrogen/progesterone combination

Intramuscular (IM) medroxyprogesterone (Depo Provera)

Estrogen alone

Androgens

Question 74. Question :

The drug recommended as primary prevention of osteoporosis in women over seventy years old is:

Alendronate (Fosamax)

Ibandronate (Boniva)

Calcium carbonate

Raloxifene (Evista)

Question 75. Question :

Patient education when prescribing the vitamin D3 derivative calcipotriene for psoriasis includes:

Applying calcipotriene thickly to affected psoriatic areas two to three times a day

Applying a maximum of 100 grams of calcipotriene per week

Not using calcipotriene in combination with its topical corticosteroids

Augmenting calcipotriene with the use of coal-tar products

Question 76. Question :

Both ACE inhibitors and some angiotensin-II receptor blockers have been approved in treating:

Hypertension in diabetic patients

Diabetic nephropathy

Both A and B

Neither A nor B

Question 77. Question :

Scott is presenting for follow-up on his lipid panel. He had elevated total cholesterol, elevated triglycerides, and an LDL of 122 mg/dL. He has already implemented diet changes and increased physical activity. He has mildly elevated liver studies. An appropriate next step for therapy would be:

Atorvastatin (Lipitor)

Niacin (Niaspan)

Simvastatin and ezetimibe (Vytorin)

Gemfibrozil (Lopid)

Question 78. Question :

Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:

“Fruity” breath odor and rapid respiration

Diarrhea, abdominal pain, weight loss, and hypertension

Dizziness, confusion, diaphoresis, and tachycardia

Easy bruising, palpitations, cardiac dysrhythmias, and coma

Question 79. Question :

Incorporating IT into a patient encounter takes skill and tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by:

Turning the screen around so the patient can see material being recorded

Not placing the computer screen between the provider and the patient

Both A and B

Neither A nor B

Question 80. Question :

Which one of the below-given instructions can be followed for applying a topical antibiotic or antiviral ointment?

Apply thickly to the infected area, spreading the medication well past the borders of the infection

If the rash worsens, apply a thicker layer of medication to settle down the infection

Wash hands before and after application of topical antimicrobials

None of the above

Question 81. Question :

Sadie is a ninety-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

Increased volume of distribution

Decreased lipid solubility

Decreased plasma proteins

Increased muscle-to-fat ratio

Question 82. Question :

First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:

OTC topical azole (clotrimazole, miconazole)

Oral terbinafine

Oral griseofulvin microsize

Nystatin cream or ointment

Question 83. Question :

Which of the following is true about procainamide and its dosing schedule?

It produces bradycardia and should be used cautiously in patients with cardiac conditions that a slower heart rate might worsen.

GI adverse effects are common, so the drug should be taken with food.

Adherence can be improved by using a sustained-release formulation that can be given once daily.

Doses of this drug should be taken evenly spaced around the clock to keep an even blood level.

Question 84. Question :

A nurse practitioner would prescribe the liquid form of ibuprofen for a six-year-old because:

Drugs given in liquid form are less irritating to the stomach.

A six-year-old may have problems swallowing a pill.

Liquid forms of medication eliminate the concern for first-pass effect.

Liquid ibuprofen does not have to be dosed as often as tablet form.

Question 85. Question :

Kristine would like to start HRT to treat the significant vasomotor symptoms she is experiencing during menopause. Education for a woman considering hormone replacement would include:

Explaining that HRT is totally safe if used for a short term

Telling her to ignore media hype regarding HRT

Discussing the advantages and risks of HRT

Encouraging the patient to use phytoestrogens with the HRT

Question 86. Question :

Xi, a fifty-four-year-old female, has a history of migraine that does not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Which of the following actions would you take for appropriate decision making?

Prescribe Maxalt, but to monitor the use, only give her four tablets with no refills.

Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).

Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.

Question 87. Question :

The elderly are at high risk of ADRs due to:

Having greater muscle mass than younger adults, leading to higher volume of distribution

The extensive studies that have been conducted on drug safety in this age group

The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect

Age-related decrease in renal function

Question 88. Question :

Jim presents with fungal infection of two of his toenails (onychomycosis). Treatment for fungal infections of the nail includes:

Miconazole cream

Ketoconazole cream

Oral griseofulvin

Mupirocin cream

Question 89. Question :

GLP-1 agonists:

Directly bind to a receptor in the pancreatic beta cell.

Have been approved for monotherapy.

Speed gastric emptying to decrease appetite.

Can be given orally once daily.

Question 90. Question :

Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?

Selective estrogen-receptor modulators

Aspirin

Glucocorticoids

Calcium supplements

Question 91. Question :

Inadequate vitamin D intake can contribute to the development of osteoporosis by:

Increasing calcitonin production

Increasing calcium absorption from the intestine

Altering calcium metabolism

Stimulating bone formation

Question 92. Question :

Which of the following statements is true about age and pain?

Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.

Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.

Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.

Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

Question 93. Question :

Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively:

Inhibiting magnesium resorption in the kidneys

Increasing calcium absorption from the gastrointestinal (GI) tract

Acting on the bone to inhibit osteoblast activity

Selectively acting on the estrogen receptors in the bone

Question 94. Question :

When a patient is on selective-serotonin reuptake inhibitors:

The complete blood count must be monitored every three to four months

Therapeutic blood levels must be monitored every six months after a steady state is achieved.

Blood glucose must be monitored every three to four months.

There is no laboratory monitoring required.

Question 95. Question :

Patients whose total dose of prednisone exceed 1 gram will most likely need a second prescription for _________.

metformin, a biguanide to prevent diabetes

omeprazole, a proton pump inhibitor to prevent peptic ulcer disease

naproxen, an NSAID to treat joint pain

furosemide, a diuretic to treat fluid retention

Question 96. Question :

The ongoing monitoring of patients over the age sixty-five years taking alendronate (Fosamax) or any other bisphosphonate is:

Annual dual energy X-ray absorptiometry (DEXA) scans

Annual vitamin D level

Annual renal function evaluation

Electrolytes every three months

Question 97. Question :

Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:

Reduce the chance of tardive dyskinesia.

Potentiate the effects of the drug.

Reduce the tolerance that tends to occur.

Increase CNS depression.

Question 98. Question :

Diagnostic criteria for diabetes include:

Fasting blood glucose greater than 140 mg/dl on two occasions

Postprandial blood glucose greater than 140 mg/dl

Fasting blood glucose 100 to 125 mg/dl on two occasions

Symptoms of diabetes plus a casual blood glucose greater than 200 mg/dl

Question 99. Question :

Insulin preparations are divided into categories based on onset, duration, and intensity of action following subcutaneous inject. Which of the following insulin preparations has the shortest onset and duration of action?

Insulin lispro

Insulin glulisine

Insulin glargine

Insulin detemir

Question 100. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?

Valproate is safe during all trimesters of pregnancy.

She can get pregnant while taking valproate, but she should take adequate folic acid.

Valproate is not safe at any time during pregnancy.

Valproate is a known teratogen but may be taken after the first trimester if necessary.