WGU D116 OA FULLY COMPREHENSIVE QUESTIONS BANK WITH COMPLETE VERIFIED SOLUTIONS 2025-2026 ( 100% ACCURACY )

An adult who has been self-medicating using nutritional therapy for an elevated cholesterol level complains of repeated episodes of flushing.

What should the provider suspect that the patient has been taking?

1. Pyridoxine

2. Thiamine

3. Niacin

4. Riboflavin

3. Niacin

Correct! Niacin is used to reduce cholesterol levels. When taken in large doses, nicotinic acid can cause vasodilation with resultant flushing, dizziness, and nausea. Flushing is not a side effect of thiamine, riboflavin, or pyridoxine because they do not cause vasodilation.

A patient will begin taking iron supplements to treat anemia. Which food should the provider recommend that the patient take the iron with to facilitate absorption?

1. Orange juice

2. Red meats

3. Cereal

4. Dairy products

1. Orange juice

Correct! Orange juice is a good source of vitamin C, and vitamin C facilitates the absorption of iron. Cereals are often fortified with iron but do not facilitate its absorption. Calcium interferes with the absorption of iron. Red meats are a natural source of iron.

Which vitamin has the highest risk for toxicity?

1. Vitamin A

2. Vitamin C

3. Vitamin B1

4. Vitamin B2

Vitamin A

Correct! Vitamins A, D, E, and K are fat soluble and are stored in the body. Excess intake may lead to toxicity.

True or False

Taking a multivitamin-mineral (MVM) supplement increases overall nutrient intake and helps some people get the recommended amounts of vitamins and minerals when they cannot or do not get them from food alone.

True

False

True

Correct! Taking an MVM increases their overall nutrient intake.

A patient with a vitamin B12 deficiency is admitted with symptoms of hypoxia, anemia, numbness of hands and feet, and oral stomatitis.

Which of the following therapies should the provider order?

1. IM cyanocobalamin and folic acid

2. PO cyanocobalamin and blood transfusions

3. PO cyanocobalamin and folic acid

4. IM cyanocobalamin and antibiotics

1. IM cyanocobalamin and folic acid

Correct! This patient is showing signs of more severe vitamin B12 deficiency with neurologic symptoms; therefore, cyanocobalamin should be given parenterally along with folic acid. Antibiotics are indicated only when signs of infection are present. Oral cyanocobalamin is not recommended.

A patient tells her provider that she is thinking about getting pregnant and asks about nutritional supplements.

What should the provider recommend?

1. A balanced diet high in green vegetables and grains

2. Vitamin B12 supplements

3. A multivitamin with iron

4. 400 to 800 mcg of folic acid per day

4. 400-800 mg of folic acid per day

Correct! The current recommendation is that all women of childbearing age take folic acid supplementation to prevent the development of neural tube defects that can occur early in pregnancy. Dietary folic acid is not sufficient to provide this amount. Iron supplements are given when pregnancy occurs and are not necessary before becoming pregnant. Vitamin B12 supplements are not recommended.

A patient is diagnosed with a moderate vitamin B12 deficiency. The nurse reviews the laboratory work and notes that the plasma B12 is low; also, a Schilling test reveals B12 malabsorption. The provider orders oral cyanocobalamin, 500 mcg per day.

What should the nurse contact the provider to do?

1. Discuss intramuscular dosing

2. Request an order for folic acid

3. Suggest platelet transfusion therapy

4. Suggest an increased dose

4. Suggest an increased dose

Correct! Patients with a vitamin B12 deficiency associated with B12 malabsorption need increased doses of oral cyanocobalamin of 1,000 to 10,000 mcg per day. It is not necessary to give this drug intramuscularly. Folic acid is indicated when B12 deficiency is severe. Platelets are given when B12 deficiency is severe.

A patient in her twenties has frequent urinary tract infections (UTIs), and her prescriber suggests drinking cranberry juice. She asks how drinking this can help.

Which response from the provider is correct?

1. Cranberry juice reduces the odor of the urine.

2. Cranberry juice helps treat established infections.

3. Cranberry juice acidifies the urine to slow the growth of the bacteria.

4. Cranberry juice prevents bacteria from adhering to the urinary tract wall.

4. Cranberry juice prevents bacteria from adhering to the urinary tract wall

Correct! Cranberry juice helps prevent UTIs by preventing bacteria from adhering to the urinary tract wall. It does not acidify the urine or treat established infections. It can reduce odor, but this action does not contribute to decreased infections.

A provider is performing a preoperative drug history on a patient who is admitted to the hospital for surgery. To evaluate the risk of hemorrhage, the provider will ask the patient about antiplatelet and anticoagulant medications as well as which dietary supplement?

1. Ginkgo biloba

2. St. John's wort

3. Ma huang (ephedra)

4. Coenzyme Q-10

1. Ginkgo biloba

Correct! Ginkgo biloba can suppress platelet aggregation and will increase the risk of bleeding in patients taking antiplatelet medications and anticoagulants. Coenzyme Q-10, ma huang, and St. John's wort do not have antiplatelet actions.

Kava's mechanism of action most similarly resembles that of which drug?

1. Amitriptyline

2. Fluoxetine

3. Diazepam

4. Hydroxyzine pamoate

3. Diazepam (valium)

Correct! Kava has targeted actions on the GABA pathway. Diazepam is the prototype drug that directly affects GABA receptors.

True or False

Some supplements can decrease the effects of drugs

True

St. Johns wart can decrease the effectiveness of birth control pills, leading to breakthrough bleeding and an increased risk of unintended pregnancy

True or false

Some supplements can increase the effects - including unwanted side effects - of drugs

True

Herbs that decrease BS may interact with anti-diabetes drugs to cause blood sugar to drop too far

T or F

Some interactions between supplements and drugs are very dangerous

True

Interactions can decrease the effectiveness of critically important drugs - such as drugs that prevent transplanted organs from being rejected

What can the herb schisandra do if taking with other drugs?

May slow down the processes in your body that change drugs into inactive substances (metabolism) which increases the amount of drug in your body which causes the effects of the drug to become too strong

Which herb is one that decreases the effects of drugs?

Black cohosh

Echinacea

Saw palmetto

St. John's wort

St. Johns Wart

Speeds up metabolism which makes less of the drug able to be used and decreases the effects of the drug

What are some of the OTC drugs that can interact with herbal supplements?

Aspirin

Pseudoephedrine

Faxofenadine (allegra)

Name some drugs that have a narrow therapeutic range

Carbamazepine (used to prevent seizures)

Cyclosporine (used to prevent organ transplant rejection)

Digoxin (used to treat heart problems)

Levothyroxine (used to treat thyroid problems)

Phenytoin (used to treat seizures)

Warfarin (an anticoag)

The provider is obtaining a history from a patient who discloses daily use of St. John's wort in addition to prescription drugs.

Which effect of this dietary supplement should most concern the provider?

1. It counteracts the effects of CNS depressants.

2. It enhances the effects of digoxin.

3. It accelerates the metabolism of some drugs.

4. It increases the risk of bleeding.

3. It accelerates the metabolism of some drugs

Induction of P450 accelerates the metabolism of many drugs, causing a loss of therapeutic effects because it is metabolized too quickly

St. Johns wart reduces the effects of digoxin

Can also intensify the effects of serotonin

A client states he has been using the herbal product saw palmetto. The nurse determines the product is helpful when the client reports?

Less difficulty initiating urination

Used to relieve BPH s/s: urinary hesitancy, urgency, and a decrease in urinary stream

A client receiving a theophylline (tx COPD and asthma) drug states he is taking st. john's wart. Nursing assessment should include?

The respiratory status for increased respiratory distress

St. John's Wart DECREASES the effect of theyophylline which may cause the client to experience exacerbation of respiratory distress

A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene.

Which statement should the provider include when teaching this patient about the medication?

1. "Vasomotor symptoms are a common side effect of this drug."

2. "Raloxifene reduces the risk of thromboembolism."

3. "Use of this drug increases the risk of endometrial carcinoma."

4. "This drug is associated with an increased risk of breast cancer."

1. Vasomotor symptoms are a common side effect of this drug

Correct! Raloxifene can induce hot flashes in patients taking this drug. It increases the risk for thromboembolism. It protects against breast cancer and does not pose a risk of uterine cancer.

A provider provides teaching to a patient who has had a hysterectomy and who is about to begin hormone therapy to manage menopausal symptoms.

Which statement by the patient indicates an understanding of the teaching?

1. "I will need a progestin and estrogen combination since I have had a hysterectomy."

2. "Because I am not at risk for uterine cancer, I can take hormones indefinitely."

3. "I should take the lowest effective dose for the shortest time needed."

4. "I can take estrogen to reduce my risk of cardiovascular disease."

3. "I should take the lowest effective dose for the shortest time needed"

Correct! For patients who have undergone a hysterectomy, progestin is unnecessary; estrogen-only preparations still carry an increased risk of breast cancer and should be taken in the lowest effective dose for the shortest time possible. Even though uterine cancer is no longer a possibility, breast cancer is still a risk. Studies have shown no protection against coronary heart disease but there is an increased risk of stroke and breast cancer with estrogen.

A patient is taking a combination oral contraceptive (OC) and tells the nurse that she is planning to undergo knee replacement surgery in two months.

What should the nurse recommend for this patient?

1. The patient should ask her provider about an OC with less progestin.

2. The patient should request an OC containing less estrogen after surgery.

3. The patient should discuss an alternative method of birth control prior to surgery.

4. The patient should take the OC at bedtime after her surgery to reduce side effects.

3. The patient should discuss an alternative method of birth control prior to surgery

Correct! Patients taking an OC who undergo surgery in which immobilization increases the risk of postoperative thrombosis should stop taking the OC at least four weeks prior to surgery. The patient should discuss an alternate method of birth control with her provider. Estrogen, not progestin, increases the risk of thrombosis. The OC containing estrogen should be stopped four weeks prior to surgery. Taking the OC at bedtime does not decrease the risk.

True or False

Raloxifene is a selective estrogen receptor modifier. Its use in osteoporosis has some benefit, but not without risks. According to a black box warning in its package insert, its use should be limited in patients with estrogen receptor-positive breast cancer.

False

Raloxifene has a black box warning for venous thromboembolism and stroke because it is a selective estrogen receptor modifier

Progesterone is contraindicated in women who have what?

Undergone a hysterectomy

A 50-year-old postmenopausal patient who has had a hysterectomy has moderate to severe vasomotor symptoms and is discussing estrogen therapy (ET) with the provider. The patient is concerned about the adverse effects of ET.

What should the provider tell the patient?

1. "Transdermal preparations have fewer side effects."

2. "An intravaginal preparation may be best for her."

3. "An estrogen-progesterone product will reduce side effects."

4. "Side effects of ET are uncommon among women her age."

1. Transdermal preparations have fewer side effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than oral preparations do

Correct! Transdermal preparations of estrogen have fewer adverse effects, use lower doses of estrogen, and have less fluctuation of estrogen levels than oral preparations do. Progesterone is contraindicated in women who have undergone a hysterectomy. Intravaginal preparations are most useful for treating local estrogen deficiencies such as vaginal and vulvar atrophy. Side effects of ET are the same at the patient's age as for other women using ET.

A provider is teaching a male adult patient about the use of testosterone gel.

Which statement by the patient indicates an understanding of the teaching?

1. "I should apply this to my forearms and neck after showering."

2. "I should not let my child touch the gel to prevent behavioral problems."

3. "I should not swim or bathe after applying the gel for three to four hours."

4. "I should keep treated areas exposed to the air so they can dry."

2. "I should not let my child touch the gel to prevent behavioral problems"

Correct! Testosterone administered via gels can be transferred to others by skin-to-skin contact. In children, virilization can occur as well as aggressive behaviors. The gel should be applied to clean, dry skin on the upper arms, shoulders, or abdomen and should be covered with clothing. Swimming and bathing are allowed five to six hours after application.

A patient with erectile dysfunction is prescribed tadalafil 2.5 mg daily.

Which medication history finding would indicate the need to discontinue this prescription?

1. Carvedilol 6.25 mg twice daily

2. Nitro-tab 0.4 mg sublingual as needed

3. Labetalol 25 mg twice daily

4. Nitrofurantoin 100 mg daily

2. Nitro-tab 0.4 sublingual as needed

Use of PDE5 inhibitors is contraindicated in patients receiving nitrate preparations due to the risk of profound hypotension

Correct! Use of PDE5 inhibitors is contraindicated in patients receiving nitrate preparations due to the risk of profound hypotension. Labetalol is administered for hypertension. Carvedilol is administered for chronic heart failure. Tadalafil should be used with caution in these patients but may still be administered. Nitrofurantoin is an antimicrobial that does not affect tadalafil administration.

Which phosphodiesterase type 5 (PDE5) inhibitor offers the most flexibility in dosing due to its longer duration of effect?

1. Sildenafil

2. Avanafil

3. Tadalafil

4. Vardenafil

3. Tadalafil

Correct! Tadalafil may be taken up to 36 hours before sexual activity.

What is a potential advantage of the alprostadil intracavernous injections compared to the phosphodiesterase type 5 (PDE5) inhibitors?

1. Quicker onset of action

2. Fewer side effects

3. Improved efficacy

4. Number of doses allowed per 24 hours

1. Quicker onset of action

Correct! Erections typically occur within 5 to 20 minutes after alprostadil injections. PDE5 inhibitors take at least 30 minutes for onset.

A patient receiving doxazosin presents for a routine evaluation.

Which assessment finding would be most concerning?

1. Dizziness when standing

2. Blood pressure 96/58

3. Diminished ejaculate volume

4. Increased nasal congestion

BP of 96/58

Correct! Hypotension, dizziness, and nasal congestion are all adverse effects of doxazosin, an alpha1-adrenergic antagonist. However, hypotension would be the most concerning because it can lead to inadequate peripheral tissue perfusion. Diminished ejaculate volume is seen with the administration of 5-alpha reductase inhibitors, not with doxazosin administration.

Which vitamin B deficiency is associated with cheilosis, glossitis, vascularization of the cornea, and itchy dermatitis of the scrotum and vulva?

1. Niacin (nicotinic acid)

2. Pyridoxine (vitamin B6)

3. Thiamine (vitamin B1)

4. Riboflavin (vitamin B2)

4. Riboflavin (vitamin B2)

Correct! Riboflavin deficiency produces the symptoms described and can be treated with riboflavin supplements. The signs listed do not indicate deficiencies of niacin, pyridoxine, or thiamine.

A patient who is known to be a heavy drinker is brought to the emergency department with ataxia and confusion. The patient cannot remember the events of the previous day. The examination reveals nystagmus, and the patient reports having double vision.

Which vitamin should the provider order for this patient?

1. Nicotinic acid (niacin) PO

2. Intramuscular pyridoxine (vitamin B6)

3. Ascorbic acid (vitamin C) IV

4. Intravenous thiamine (vitamin B1)

4. IV thiamine (Vitamin B1)

Correct! Alcoholics who are malnourished have a form of thiamine deficiency called Wernicke-Korsakoff syndrome, which is characterized by nystagmus, diplopia, ataxia, confusion, and short-term memory loss. Parenteral thiamine is indicated for treatment. Ascorbic acid is given to treat a vitamin C deficiency, which leads to scurvy. Pyridoxine is given for vitamin B6 deficiency, also common in alcoholics, but this patient does not have the symptoms of seborrheic dermatitis and peripheral neuropathy. Nicotinic acid is used for niacin deficiency, which is characterized by severe dry, rough skin.

A patient appears malnourished. The patient's folic acid levels are low, and vitamin B12 levels are normal.

What should this patient's treatment include?

1. A diet high in folic acid

2. Oral folic acid and vitamin B12

3. Intramuscular folic acid

4. Oral folic acid supplements

1. A diet high in folic acid

Correct! If a folic acid deficiency is caused by a poor diet, it should be corrected with dietary measures, not supplements. Intramuscular or oral supplements of folic acid are not indicated. Vitamin B12 is not recommended.

A patient is admitted to the hospital. The patient's initial laboratory results reveal megaloblastic anemia. The patient complains of tingling of the hands and appears confused.

What should the provider suspect in this patient?

1. Iron deficiency anemia

2. Celiac disease

3. Folic acid deficiency

4. Vitamin B12 deficiency

4. Vitamin B12 Deficiency

Correct. When patients present with megaloblastic anemia, it is essential to distinguish between a folic acid deficiency and a vitamin B12 deficiency. If neurologic deficits are observed, a vitamin B12 deficiency is more likely to be the cause. This patient does not have signs of celiac disease. Iron deficiency anemia would be indicated by low hemoglobin and hematocrit.

A patient will begin taking immunosuppressant drugs for rheumatoid arthritis (RA).

Which dietary supplement should this patient avoid?

1. Feverfew

2. Glucosamine

3. Black cohosh

4. Echinacea

4. Echinacea

Correct! Echinacea stimulates the immune system, so it should not be used in patients with autoimmune diseases such as RA; it also compromises the effectiveness of immunosuppressive drugs. Black cohosh, feverfew, and glucosamine are not contraindicated in patients with RA.

A patient admitted to the emergency department with abdominal pain tells the provider he has been taking kava.

Which action should be the provider's priority at this time?

1. Assess breath sounds and respiratory effort

2. Review liver function studies

3. Monitor cardiovascular status

4. Review complete blood count results

4. Review liver function studies

Correct! Kava can cause severe liver injury and, in some cases, require liver transplantation. This patient has abdominal pain, which can be the result of liver damage, so liver function tests should be reviewed. Kava does not affect the respiratory system, the cardiovascular system, or the blood-forming organs.

A patient who will begin combination estrogen-progestin therapy (EPT) for menopause asks the nurse why she cannot take an estrogen-only preparation. The patient has not had a hysterectomy, has a slightly increased risk of cardiovascular disease, and has mild osteopenia.

What response from the provider about progestin is correct?

1. "Progestin decreases your risk of endometrial cancer."

2. "Progestin lowers your risk of myocardial infarction (MI)."

3. "Progestin prevents deep vein thrombosis (DVT)."

4. "Progestin increases bone resorption to prevent fractures."

1. Progestin decreases your risk of endometrial cancer

Correct! In patients who still have a uterus, progestin is necessary to reduce the risk of endometrial carcinoma. Progestins do not have effects on bone density and do not decrease the risk of MI or DVT.

An adolescent female patient with multiple sexual partners asks a nurse about birth control methods. The patient tells the nurse she tried oral contraceptives once but often forgot to take her pills.

The nurse should recommend discussing which contraceptive method with the provider?

1. Progestin-only oral contraceptives

2. Tubal ligation and condoms

3. An intrauterine device with a spermicide

4. DMPA (Depo-Provera) and condoms

4. Depo-Provera and condoms

Correct! This patient has demonstrated a previous history of nonadherence, so a long-acting contraceptive would be more effective for her. Because she has multiple sexual partners, she should use a condom for protection against STDs. An IUD is not indicated for her. Patients with multiple sexual partners who use IUDs are at greater risk for STDs. Tubal ligation carries surgical risks and is not recommended to be used by young women because it is irreversible. Progestin-only oral contraceptives must be taken every day.

An adult male patient will begin androgen therapy for testicular failure.

Which statement by the patient indicates understanding of the treatment regimen?

1. "My libido may improve while I am taking this medication."

2. "Taking this drug may lead to the development of prostate cancer."

3. "This will restore fertility, so I can have a child."

4. "I will need to have X-rays of my hands and feet every six months."

1. "My lipido may improve while I am taking this medication"

Correct! Treatment with androgen replacement therapy in patients with testicular failure helps restore libido. A side effect of androgens is premature epiphyseal closure; this is not a concern in adults, so radiographs to evaluate this are not indicated. Androgens can promote the growth of prostate cancer when it occurs, but they do not cause it. Androgens do not restore fertility.

Which finding would indicate that terazosin has been effective for a patient with benign prostatic hyperplasia (BPH)?

1. Decreased prostate size

2. Improved urinary hesitation

3. Increased urinary frequency

4. Decreased serum prostate-specific antigen levels

2. Improved urinary hesitation

Correct! Terazosin is an alpha1-adrenergic antagonist. These medications relax the smooth muscles of the bladder neck to improve urinary symptoms experienced with BPH. They do not decrease the size of the prostate. Increased urinary frequency is a sign of worsening BPH, not improvement.

A patient who takes nonsteroidal anti-inflammatory drugs (NSAIDs) for arthritis asks the provider what can be done to prevent ulcers.

Which medication should the provider discuss with the patient?

Proton pump inhibitors

Pts taking NSAIDs should also use proton pump inhibitors for ulcer prophylaxis

A patient is diagnosed with peptic ulcer disease (PUD). The patient is otherwise healthy. The provider learns that the patient does not smoke and that he drinks one or two glasses of wine with meals once a week.

Which drugs should the provider prescribe?

Amoxicillin, clarithromycin, omeprazole

Regimen recommended for the t of PUD is 2 abx and an antisecretory agent

A long-term patient of yours recently had stents placed in her left anterior descending artery (LAD). Her cardiologist put her on clopidogrel. She has been taking omeprazole for years for acid indigestion, and her cardiologist told her it has a drug interaction with her new medication. She agrees to change drugs for her heartburn.

What drug should the provider prescribe?

Famotidine (pepsid) 2 mg QD

Famotidine suppresses acid production by blocking the H2A pathway

A patient reports taking an oral bisacodyl laxative for several years. The provider has suggested discontinuing the laxative, but the patient is unsure how to do this.

What should the provider tell the patient to do?

Stop taking the laxative immediately and expect no stool for several days

A provider is taking a history on a clinic patient who reports being constipated. Upon further questioning, the provider learns that the patient's last stool was four days ago; that it was of normal, soft consistency; and that the patient defecated without straining. The patient's abdomen is not distended, and bowel sounds are present. The patient reports usually having a stool every one to two days.

What should the provider do?

Ask about recent food and fluid intake

Constipation cannot only be defined by the frequency of bowel movements because this varies from one individual to another.

Constipation is defined in terms of a variety of symptoms, including hard stools, infrequent stools, excessive straining, prolonged effort, and unsuccessful or incomplete defecation

Common cause of constipation is diet

A patient who has traveler's diarrhea asks the provider about using loperamide to stop the symptoms.

What should the provider tell the patient about this drug?

Loperamide use may prolong symptoms by slowing peristalsis

Loperamide is a nonspecific antidiarrheal that slows peristalsis, which may delay transit of the causative organism and prolong the infection

Insulin glargine is prescribed for a hospitalized patient who has diabetes.

When should this drug be administered?

Once daily at bedtime

Insulin glargine is indicated for once-daily SQ administration to tx adults and children with type 1 DM and adults with type 2 DM

Once-daily injection should be given at bedtime

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension.

Why should this be a concern?

Beta-blockers can mask the symptoms of hypoglycemia

BB can delay awareness of and response to hypoglycemia by masking signs associated with stimulation of the sympathetic nervous system (Tachycardia, palpitations) that hypoglycemia normally causes.

BB impairs glycogenolysis, which is one means by which the body can counteract a fall in blood glucose: therefore can worsen insulin-induced hypoglycemia

The provider assesses a newly diagnosed patient for short-term complications of diabetes.

What should this assessment include?

Eval of hyperglycemia, hypoglycemia, and ketoacidosis are all short-term complications

Long term complications are: arterial insufficiency, atherosclerosis, peripheral neuropathy

Which agent works to reduce hyperglycemia in people with T1DM by increasing endogenous GLP-1?

Saxagliptin

What is dulaglutide?

A GLP-1 receptor agonist

What is empagliflozin?

SGLT2 inhibitor

What is exenatide?

GLP-1 receptor agonist

A patient with type 1 diabetes is eating breakfast at 7:30 AM. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient's blood sugar level is 317 mg/dL.

Which formulation of insulin should be prepared to be administered?

Lispro

Regular insulin (Lispro) is indicated for sliding scale coverage and with that high of a BS it is indicated to give

A patient arrives in the emergency department with a heart rate of 128 beats per minute and a temperature of 105°F. The patient's skin feels hot and moist. The free T4 level is 4 ng/dL, the free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits per mL.

What should the provider caring for this patient order?

Prophylthiouracil (PTU)

Used for pts experiencing thyroid storm like this pt

A patient has been taking levothyroxine for several years and reports that for the past two weeks, the drug does not seem to work as well as before.

What should the provider do?

Ask the pt when the prescription was last refilled

Not all levothyroxine preparations have the same drug bioavailability; therefore, if a pt is experiencing differing effects, the pharmacist may have switched brands. Asking a pt about a recent refill may help explain why the drug has different effects

A healthcare professional is teaching a patient who will begin taking methimazole for Graves' disease about the medication.

Which statement by the patient indicates understanding of the teaching?

"I should report a sore throat or fever to my provider if either occurs"

Agranulocytosis (leukopenia low WBCs increased for infection)

is rare but can occur with methimazole, so pts should report signs of infection like sore throat or fever

Which statement by a patient about to begin taking orlistat for weight loss therapy indicates an understanding of this drug's actions?

"If I take a bulk-forming laxative, I can reduce the incidence of fecal incontinence"

Orlistat (Lipase inhibitor) reduces fat absorption, stools often are fatty or oily, and fecal incontinence can occur. Bulk-forming laxatives can help with this side effect

A patient who has received a prescription for orlistat for weight loss asks the provider how the drug works.

What should the provider tell the patient about orlistat?

"it works by reducing the body's absorption of fats"

Lipase inhibitors like Orlistat, work by altering the absorption of fat; if triglycerides are not broken down, they cannot be absorbed

Which drug could you prescribe for weight loss without a DEA registration?

One containing buproprion and naltrexone: botht are not controlled substances

Are phentermine, lorcaserin, topiramate CIV (schedule 4) controlled substances?

Yes

A patient has been taking senna for several days, and the provider notes that the urine is yellowish-brown.

What should the provider know about this symptom?

It is an expected, harmless effect of senna

Systemic absorption of senna, followed by renal excretion, may impart a harmless yellowish-brown or pink color to the urine

A healthcare professional is discussing the use of immunosuppressants for the treatment of inflammatory bowel disease (IBD) with a group of nursing students.

Which statement by a student indicates understanding of the teaching?

"Cyclosporine can be used to induce remission of IBD"

Can be given IV to induce rapid remission of IBD

Which statement is correct about the contrast between acarbose and miglitol?

Miglitol has not been associated with hepatic dysfunction

Acarbose has been associated with hepatic dysfunction

A patient with type 1 diabetes who takes insulin reports taking propranolol for hypertension.

Why should the provider be concerned?

The BB can mask the symptoms of hypoglycemia

BB can delay awareness of and response to hypoglycemia by masking signs associated with the stimulation of the sympathetic nervous system that hypoglycemia normally causes. BB also impair glycogenolysis, which is one means by which the body can counteract a fall in bs. BB can worsen insulin-induced hypoglycemia

A patient in her twenties with Graves' disease who takes methimazole tells her provider that she is trying to conceive and asks about disease management during pregnancy.

How should the provider respond?

Discuss changing to propylthiouracil (PTU) from now until her second trimester

Methimazole is not safe during the 1st trimester of pregnancy because it is associated with neonatal hypothyroidism, goiter, and cretinism; however, it is safe in the second and third trimesters

A patient has a free T4 level of 0.6 ng/dL and a free T3 level of 220 pg/dL. The patient asks the provider what these laboratory values mean.

How should the provider respond?

"We will need to obtain a TSH level to better evaluate your diagnosis"

A free T4 level of less than 0.9 and a free T3 level less than 230 are consistent with hypothyroidism, but measurement of the thyroid-stimulating hormone (TSH) level is necessary to distinguish primary and secondary hypothyroidism

A patient will begin taking phentermine and topiramate to help with weight loss and asks the provider why the second ingredient is necessary.

Which is the correct response by the provider?

"Topiramate helps produce feelings of satiety to augment the drug effects"

Topiramate is an antiseizure medication that acts to induce a sense of satiety in patients taking the combination product

A provider is teaching a patient who is about to begin drug therapy with orlistat. The patient, whose BMI is 28, has hypertension and type 2 diabetes mellitus.

Which statement by the patient indicates understanding of the teaching?

"I will need to take a multivitamin containing fat-soluble vitamins every day"

Orlistat works by reducing fat absorption, fat-soluble vitamins are not absorbed as well. Patients taking orlistat should also take a multivitamin containing vitamins A, D, E, and K (all fat-soluble vitamins)

An older adult patient with severe gastroesophageal reflux disease (GERD) has had only minimal relief using a histamine2-receptor antagonist (H2RA). The patient is to begin taking omeprazole.

What should the provider teach this patient?

Long-term therapy may be needed

PPIs like omeprazole are much better than H2RA (Histamine2-receptor antagonists) for treating GERD. For pts with severe GERD, long-term maintenance therapy is recommended

A patient is diagnosed with Zollinger-Ellison syndrome.

Which medication should the provider order for this patient?

Ranitidine

A 45-year-old woman with a family history of osteoporosis is requesting to begin a vitamin D supplement. Her current vitamin D level is 20 ng/mL.Which dosage of vitamin D is appropriate for this patient?

600 IU/day

A 16-year-old female presents to a clinic to discuss contraception. She would like to start an oral contraceptive and has no contraindications for estrogen. She also asks an advanced practice registered nurse (APRN) if there is anything she can take to help with her acne.Which FDA-approved medication will specifically manage both issues?

Drospirenone

Fourth-generation combined oral contraceptive. Also indicated for tx of acne

An advanced practice registered nurse (APRN) is treating a 37-year-old female who is requesting birth control. The APRN prescribes a combination oral contraceptive.Which item is an absolute contraindication for the classification of medication the APRN is prescribing?

Smoking

Smoking when using birth control is a contraindication due to the possibility of the pt developing thrombosis

A patient is highly interested in pursuing the use of supplements in addition to more traditional medical treatments for a variety of problems. The advanced practice registered nurse (APRN) has a concern about only one of the items that was mentioned by the patient due to its low efficacy.Which item is of concern to the APRN?

Ginkgo biloba for prevention of dementia

Failed to prevent dementia in trials so it has low efficacy

A 43-year-old male has type 2 diabetes, hypertension, depression, and obesity. He is currently on the following medications: 50 mg losartan qd, 1000 mg metformin bid, atorvastatin 20 mg, and escitalopram 10 mg. The patient has previously tried liraglutide but only lost 6.5 lbs. During his visit he says, "I'm just so frustrated with my weight. Nothing seems to work, and I don't know what to do."His vital signs are as follows:BP: 134/88HR: 80SpO2: 98%T: 98.7Height: 6'Weight: 325 lbs.In addition to discussing therapeutic lifestyle modifications such as diet and exercise, the team dietitian and therapist are helping with behavioral changes.Which treatment plan addition is appropriate for this patient?

Discuss bariatric surgery

Because the pt has failed both lifestyle changes and use of medications, bariatric surgery is of last resort

A 48-year-old patient is diagnosed with type 2 diabetes. The patient's initial HbA1c level is 7.5, and the serum creatinine level is 1.0 mg/dL. Which first-line medication is indicated for this patient?

Metformin

First-line tx for DM2 with normal renal function

A patient presents to a clinic with a history of chronic liver disease and hepatic encephalopathy. An advanced practice registered nurse (APRN) has noticed that the patient has an elevated ammonia level.

Which laxative should the APRN prescribe to enhance intestinal excretion of this substance?

Lactulose

Enhances the intestinal excretion of ammonia

An advanced practice registered nurse (APRN) diagnosed a patient with Helicobacter pylori (H. pylori) and is reviewing medications to treat this condition. The APRN decides to use tetracycline as one of the antibiotics to treat this condition.Why should this medication be avoided in pregnant women and children?

Stains developing teeth

Can stain developing teeth and would therefore not be used for children

A patient refilled a long-standing levothyroxine prescription at the pharmacy. The pills are usually white, but this time they are yellow. The bottle has the correct dose and directions on it, but the generic manufacturer is different. When the patient questions the situation, the patient is told that the previous generic formulation is no longer available. The patient contacts an advanced practice registered nurse (APRN) for assistance.

How should the APRN advise this patient?

The pt should take the new generic levothyroxine at the originally prescribed dose and return in 6 weeks for a retest of TSH and an adjustment of the dose as indicated

With any change in the formula, the pt should follow up with a PCP. If needed, pt should come back to check the levels of medication in the bloodstream as with levothyroxine

A nursing student asks for clarification on the differences between the mechanisms of spontaneous mutation and conjugation in acquired resistance of microbes.

Which statement is correct?

Spontaneous mutation leads to resistance to only one antimicrobial agent

A patient receiving a cephalosporin develops a secondary intestinal infection caused by Clostridium difficile.

What is an appropriate treatment for this patient?

Discontinuing the cephalosporin and beginning flagyl

A patient is diagnosed with a lung infection caused by Pseudomonas aeruginosa. The culture and sensitivity report shows sensitivity to all aminoglycosides. The provider knows that the rate of resistance to gentamicin is common in this hospital.

Which medication should the provider be expected to order?

Amikacin

When resistance to gentamicin and tobramycin is common, amikacin is the drug of choice for the initial treatment of aminoglycoside-sensitive infections

A child with otitis media has had three ear infections in the past year. The child has just completed a ten-day course of amoxicillin with no improvement. The parent asks the provider why this drug is not working because it has worked in the past.

What should the provider tell the patient?

"The bacteria have synthesized penicillinase"

Beta-lactamases are enzymes that cleave the beta-lactam ring and render the PCN inactive (amoxicillin)

Pt will need to start augmentin

A patient who is taking acetaminophen for pain wants to know why it does not cause gastrointestinal upset as other over-the-counter pain medications do.

Which property of acetaminophen is the most likely explanation for this?

It has minimal effects at peripheral sites

Tylenol central effects

NSAIDs peripheral effects

A patient who has arthritis has been taking ibuprofen and a glucocorticoid medication. The patient reports having tarry stools but denies gastric pain.

Which action by the provider is correct?

Prescribing an antiulcer medication

Glucocorticoid therapy, especially when combined with NSAIDs, can increase the risk of gastric ulcer and possibly bleeding

A patient will begin taking hydroxychloroquine for rheumatoid arthritis. The patient is currently taking high-dose NSAIDs and methotrexate.

What should the patient be taught about hydroxychloroquine?

An eye exam is necessary at the beginning of therapy with this drug

Can cause retinal damage - eye exam at the onset of treatment as well as every 6 months during treatment

A patient with gout who has increasingly frequent acute gouty attacks will begin receiving allopurinol and colchicine.

Which statement should be included when teaching the patient about this drug regimen?

"You will take both drugs initially and then stop taking colchicine"

Colchicine is used for prophylaxis when urate-lowering drugs (allopurinal) are initiated because gouty episodes often increase during this time.

A postmenopausal patient develops osteoporosis. The patient asks the provider about medications to treat this condition. The provider learns that the patient has a family history of breast cancer.

Which medication should the provider discuss with the patient?

Raloxifene

Can preserve bone mineral density while protecting against breast and endometrial cancers

Which of the following antibiotics is in a class of drugs known for ototoxicity?

Gentamicin

Aminoglycoside abx which as a class are known to cause ototoxicity

What is the role of oral corticosteroids in the treatment of rheumatoid arthritis?

Short-term therapy for flares in pts with established disease - slows the progression of erosions

What is a recommended strategy for patients to do prior to injecting disease-modifying antirheumatic drugs (DMARDs) to decrease the pain of the injection?

Allow injection to come to room temperature

DMARDs are refrigerated

Which traditional disease-modifying antirheumatic drug (DMARD) may be the best option in a pregnant patient with rheumatoid arthritis?

Hydroxychloroquine

Which of the following is false about methotrexate?

SQ use requires folic acid replacement of 1 mg per day

Folic acid replacement can be used to reduce side effects of methotrexate - PO and SQ

Replacement is common but it is not required

For which antibiotic is time above the minimum inhibitory concentration (MIC) most important?

Cefpodoxime

MIC is most important for beta-lactam abx:

1. cephalosporins

2. carbapenems

3. penicillins

4. glycopeptides

A 75-year-old male is diagnosed with osteomyelitis in his left foot.

Which microbe should be targeted for appropriate pharmacotherapy in this situation?

Staphylococcus aureus

A 45-year-old patient with a diagnosis of blastomycosis is in a clinic for treatment.

Which antifungal should be prescribed for this patient?

Itraconazole

A 26-year-old patient presents with sneezing, itching of the eyes and nose, and rhinorrhea. It is determined that the patient has mild seasonal allergies. The patient leads an active lifestyle and wants to take something that does not cause drowsiness.

Which oral antihistamine should an advanced practice registered nurse recommend?

Fexofenadine

2nd gen antihistamine

A 58-year-old male patient presents to a clinic with rheumatoid arthritis (RA). An advanced practice registered nurse plans to prescribe leflunomide to treat this condition.Which laboratory screening test is recommended prior to starting this medication?

TB

leflunomide may increase risk for serious infection - drug is immunosuppressive and can suppress the bone marrow