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MSN 611 Clinical Pharm & Intervention for APRNs
MSN 611 Final EXAM LATEST 2024/2025 FALL
/SPRING COMPLETE QUESTION AND ANSWER
(100% GUARANTEED PASS)
A 55-year-old man presents with a 1-month history of insomnia and fatigue. He states that he has been unable to complete work tasks and no longer enjoys his hobbies or going out with friends. He also reports a decreased appetite and bouts of crying. The patient has a past medical history of seizures, hypothyroidism, diabetes mellitus, and asthma. His blood pressure is 110/75 mm Hg, and his heart rate is 75 bpm. The clinician prescribes venlafaxine. Which of the following conditions requires caution when using venlafaxine in this patient? Seizures A 34-year-old woman has been troubled by migraine headaches that typically occur 5 to 6 times monthly. Treatment of the headaches when they occur is moderately successful. She asks whether there is anything she can do to reduce the frequency with which these headaches occur. She also has been troubled by long-standing mood issues, with episodes that are weeks long where she feels sad. What therapy might be recommended that can both reduce the frequency of her migraine attacks and may also be useful in improving her mood? Venlafaxine A patient is diagnosed with metabolic acidosis. His medication record shows that he is prescribed diclofenac, atenolol, albuterol, and topiramate. Which of these medications is most likely responsible for the patient's condition? Topiramate
MSN 611 Clinical Pharm & Intervention for APRNs A 60-year-old man is brought to the emergency department after an episode of syncope. The patient was watching television when he felt light-headed and lost consciousness. He regained consciousness after a minute spontaneously. The patient's past medical history is significant for hypertension, diabetes, and peripheral neuropathy. His medications include metformin, hydrochlorothiazide, and amitriptyline. ECG in the emergency department shows a QT interval of 480 ms. What is the mechanism of action of the drug responsible for this patient's symptoms and ECG findings? Blocking the reuptake of both serotonin and norepinephrine neurotransmitters A 23-year-old man recently started taking a new medication for a long-standing history of hallucinations, poor eye contact, flat affect, and poor work performance. After six days of using this medication, this patient presents to the emergency department with acute neck stiffness. On exam, his head is rotated to the left and flexed in a fixed position. The medication used by this patient mainly works by blocking which of the following receptor? Dopamine receptor A 40-year-old man is brought to the emergency department due to a severe headache for the past hour. His symptoms started 2 hours after having dinner with his family. On further questioning, his wife reveals that they had pizza and red wine for dinner. On physical exam, he appears anxious and tremulous. Medical history includes atypical depression being treated with phenelzine. He does not smoke or use illicit drugs. Which of the following Is the most likely finding? Hypertension
MSN 611 Clinical Pharm & Intervention for APRNs GABA-A receptor agonist A 26 - year-old woman is brought to the emergency department with an acute severe headache. Her partner reports that it started 6 hours ago and that she vomited several times at home. The patient is holding her hands over her eyes and reports severe unilateral retroorbital throbbing pain. She has no significant past medical history and takes no regular medications. Her vital signs are within normal limits. There is no gross neurological deficit on examination of the cranial nerves and limbs. Given the most likely diagnosis, what is the mechanism of action of the best drug for the acute treatment of this patient's condition? Cerebral vasoconstriction A 42-year-old man presents with a 6-month history of severe, throbbing headaches that are generally unilateral, worsened by light and sound, and occur biweekly and occasionally interrupt his workday. He has no significant improvement with ibuprofen, naproxen, or acetaminophen. Vital signs are blood pressure 139/80 mmHg, heart rate 82 bpm, respiratory rate 14 breaths/min, and temperature 98.0 F (36.7 C). Physical examination is normal. Which of the following effects is caused by the most appropriate treatment option? Constriction of cerebral blood vessels. A 20-year-old woman presents with a severe headache. She is G2P1 at 32 weeks gestation. Her blood pressure is 201/98 mm Hg. A urine dipstick shows 3+ protein. Preparations are made for an emergency cesarean section. She is started on a continuous intravenous infusion of magnesium sulfate for the prevention of seizures. What is a severe, yet preventable, complication of continuous intravenous magnesium sulfate therapy? Respiratory depression
MSN 611 Clinical Pharm & Intervention for APRNs A 55-year-old man presents with difficulty passing urine and suprapubic discomfort for the past 2 days. His symptoms are progressively worsening. The patient's past medical history is significant for depression, and he was recently started on a new medication due to refractory symptoms. The physical examination reveals tachycardia, a dry mouth, and suprapubic fullness. What is the class of medication that is responsible for this patient's presenting symptoms? Tricyclic antidepressants A 17-year-old female presents for a follow-up on major depressive disorder therapy with venlafaxine. The mother and patient state that the patient's symptoms have improved. She has been performing better at school, enjoying activities with her friends, and going to the gym every day. However, the patient has trouble falling asleep. The mother states that she gives her daughter a cough medication, dextromethorphan, to make her drowsy and help her fall asleep. The mother and patient ask if they should be concerned about the use of dextromethorphan. What is the best response to their question? There is an increased risk of serotonin syndrome if dextromethorphan is used with venlafaxine. A 25-year-old woman presents with severe acute asthma exacerbation. She inadequately responds to a combination of nebulized albuterol, inhaled ipratropium, prednisone, and oxygen. The clinical team decides to administer intravenous magnesium. While placing the order, the clinician receives an alert for potential overdose with this medication. Which of the following symptoms is most likely to occur if there is an overdose? Muscle weakness
MSN 611 Clinical Pharm & Intervention for APRNs A 32-year-old woman with schizophrenia is currently treated with haloperidol. The patient was brought to the emergency department by her mother with symptoms of confusion, diaphoresis, agitation, muscular rigidity, and tachycardia with elevated white blood count and creatine phosphokinase. Which of the following conditions is the patient most likely experiencing? Neuroleptic malignant syndrome A 50-year-old man presents with crushing substernal chest pain. Vital signs are temperature 98.6 °F (37 °C), heart rate 98 bpm, blood pressure 80/55 mm Hg, and respiratory rate 20 breaths/min. On physical examination, chest auscultation demonstrated no abnormal findings. He was diagnosed with a myocardial infarction. Following initial emergency management for the ischemic event, dobutamine is administered to counter hypotension. Which of the following accurately explains the main role of dobutamine in achieving hemodynamic stability? Predominant beta-1 receptor activity A 67-year-old man comes to the emergency department due to an acute episode of confusion, dizziness, and diaphoresis for the past three hours. A detailed history reveals that the patient took a sex-enhancing drug he ordered online. He took the drug four hours ago and started to feel dizzy soon after. His past medical history is significant for hypertension, ischemic heart disease, and diabetes mellitus. He claims to be very compliant with his medication and never misses a dose. Vital signs show a blood pressure of 80/40 mmHg, pulse of 105 bpm, respiratory rate of 18 breaths/min, and a temperature of 37 C (98.6 F). Examination of the abdomen reveals a soft, non- tender abdomen with no masses on deep palpation. Cardiopulmonary examination shows no pertinent findings as well. Emergency treatment with intravenous normal saline is started, and the patient stabilizes. What is the likely mechanism of action of the drug? Inhibition of phosphodiesterase 5
MSN 611 Clinical Pharm & Intervention for APRNs A 22-year-old patient with type 1 diabetes mellitus receives 12 units of regular insulin and 26 units of NPH insulin subcutaneously daily. Which of the following is an appropriate instruction for this patient regarding her new prescription? Roll the NPH insulin bottle between the palms of the hands before drawing it up. Which of the following is an adverse effect of administering the drug of choice in anaphylactic shock? Hypertension Which of the following is the most likely consequence of the rapid administration of high-dose intravenous epinephrine? Tachycardia A 60-year-old man suddenly falls to the ground while walking. Chest compressions are immediately performed, and he is placed on a Lucas device en route to the emergency department. Upon reaching the emergency department, a cardiac monitor is attached, showing a heart rate of 44 bpm and unrecordable blood pressure. His pulses are still not palpable. What is the first drug this patient should receive? Epinephrine
MSN 611 Clinical Pharm & Intervention for APRNs Tamoxifen A 50-year-old male presents to the clinic complaining of numbness in the hands and feet. He also complains of an increased urinary frequency. On presentation, he is afebrile, has a pulse rate of 76 bpm, a blood pressure of 130/80 mmHg, and a respiratory rate of 14 breaths/min. A detailed physical examination does not reveal any significant findings. He has a hemoglobin of 13 g/dl, a total leukocyte count of 4800/mm^3, and a platelet count of 280,000/mm^3. His blood sugar levels are 288 mg/dl, 2 hours postprandial. He was diagnosed with hypertension two years ago, and his medical record shows he is compliant with medications. He is planning to be put on oral hypoglycemic treatment with metformin. He is also prescribed atorvastatin for vascular disease prevention; which acts by which of the following mechanisms? HMG-CoA reductase inhibition A 65-year-old man presents to the office for a follow-up. He had a stent placed in his right coronary artery two years ago for unstable angina. He reports that he exercises regularly and is compliant with a heart-healthy diet. His current medications include atorvastatin 80 mg daily for dyslipidemia. The lipid profile shows total cholesterol is 195 mg/dL, HDL is 33 mg/dL, LDL is 110 mg/dL, and triglycerides are 120 mg/dL. Which of the following has been shown to improve cardiovascular outcomes when added to statins for secondary prevention? Ezetimibe
MSN 611 Clinical Pharm & Intervention for APRNs A 16-year-old girl presents with a decreased level of consciousness and abdominal pain. Her mother says that she vomited twice before coming to the hospital. She has no known medical history, and this is the first time to have these symptoms. Her family history is significant for diabetes in her mother and 2 uncles. Her glucose level is 574 mg/dL, creatinine 0.8 mg/dL, potassium 3.7 mEq/L, sodium 137 mEq/L, and white blood count 12700/microL. Her urine dipstick shows glucose 4+ and ketones 3+. She is given normal saline. She is also given an infusion of the next appropriate medication. Which of the following side effects is most likely to occur with this infusion? Hypokalemia A 45-year-old man presents for follow-up after a diagnosis of diabetes mellitus type 2 and initiation of metformin 3 months ago. He says he would like to discontinue the metformin because of its adverse effects. He feels embarrassed at work because of metformin-associated diarrhea and has been feeling nauseous most days. The patient confirms that he followed the metformin titration regimen provided by the clinician and is currently taking metformin IR 1000 mg twice daily with meals. What is the most appropriate next step in treatment? Discontinue metformin IR and start metformin extended-release A patient is rushed to the emergency department with an apparent drug overdose. His presentation includes tachycardia, palpitations, and chest pain. An IV beta-blocker is ordered to stabilize cardiac activity. Which of the following drugs is the most likely culprit for this overdose? Levothyroxine
MSN 611 Clinical Pharm & Intervention for APRNs A 60-year-old woman presents with joint pain and swelling in her hands. She says the pain is typically worst in the mornings when she wakes up and improves during the day. She has no past medical history and takes no medications. On examination, she has warm, tender swelling of the metacarpophalangeal joints bilaterally. She is prescribed a drug that is neither a non-steroidal anti-inflammatory or corticosteroid. What is the class of the drug that has most likely been prescribed? Disease-modifying anti-rheumatic A 60-year old man is brought to the emergency department after an episode of syncope. The patient was watching television when he felt lightheaded and lost consciousness. He does not remember any abnormal body movements associated with the episode and he regained consciousness after a minute. However, the patient is still feeling lightheaded. The physical examination of the patient shows a pulse rate of 45/min and a blood pressure of 100/60 mmHg. Emergency department ECG reveals sinus bradycardia. The patient is given oxygen support and is started on an IV medication that will block which of the following receptors to improve this patient's heart rate? Cholinergic receptors Adalimumab is being considered for a 39-year-old woman with a long-standing history of chronic plaque psoriasis who recently immigrated from Pakistan. What baseline investigation must be performed before initiating therapy? Mantoux tuberculin skin test
MSN 611 Clinical Pharm & Intervention for APRNs A 54-year-old woman presents to the clinic complaining of fatigue for 3 months. The patient also has occasional abdominal pain and nausea for the past several months. The patient's past medical history includes diabetes managed with diet and exercise, hypertension treated with lisinopril, rheumatoid arthritis treated with methotrexate. Vital signs are within normal limits. Physical examination shows a pale obese woman. Lab work has been ordered. Which of the following is the most likely cause of this patient's symptoms? Folic acid deficiency A 72-year-old male with a past medical history of hypothyroidism and hyperlipidemia presents with acute onset weakness to his right upper and lower extremities and slurring of his speech. His symptoms all began about 2.5 hours ago. He takes no blood thinners and had no inciting trauma or events. His vitals show a blood pressure of 170/100 mmHg with a heart rate of 86 bpm and a respiratory rate of 15 breaths per minute. His physical examination shows significant slurring of speech and 3/5 strength in the upper and lower extremities on the right. He is sent for computed tomography (CT) scan for concern of an ischemic stroke, which reveals no active bleeding. His point of care glucose shows 30 mg/dL, his platelet count is 200,000 per microliter and an INR of 1.1. Which of the following excludes him from consideration of alteplase at this time? His abnormal glucose testing excludes him. A 35-year-old female patient diagnosed with rheumatoid arthritis visits a rheumatology clinic. Her provider is considering prescribing a disease-modifying antirheumatic drug. Her past medication history reveals an allergic reaction to sulfa containing antibiotics. She is not planning to be pregnant. She prefers an oral drug than an injection. Which of the following drugs is most likely suitable for her? Methotrexate
MSN 611 Clinical Pharm & Intervention for APRNs NMDA A 50-year-old female patient presents to the clinic for constipation for the past two weeks. She describes her stool as hard, bullet-like. The patient had no recent medical history. The patient does not smoke but drinks alcohol socially. Her blood pressure is 110/70 mmHg, her pulse rate is 70 beats per minute, and her temperature is 37.5 C (99.5 F). Physical examination is within normal. What is the first treatment plan for her constipation? Add fiber to her diet and increase water intake A 45-year-old woman presents with a runny nose with white mucus discharge, itchiness, and watery eyes. The patient is taking diphenhydramine, which is helping but makes her very sleepy at work. What is the next step in management? Stop diphenhydramine and start loratadine 10mg orally once daily. What is the advantage of loperamide over atropine/diphenoxylate? No opiate effects at normal doses A mother brings her son, who has asthma. She would like to know if she can give her child acetaminophen. She has heard reports that it may worsen asthma. What is the current consensus on acetaminophen and asthma? Acetaminophen does not worsen asthma
MSN 611 Clinical Pharm & Intervention for APRNs A 42 year-old-male patient is brought to the emergency department after having been thrown off his motorbike after which his lower extremities were crushed by a passing semi-truck. His vital signs are stable although the patient is unconscious and has significant crush injuries to his bilateral lower extremities below the knees. It is decided to intubate the patient to protect his airway. Which drug is contraindicated in this scenario? Succinylcholine A 78-year-old man presents to the emergency department after being found to have ingested several packets of acetaminophen at home. His son brings the empty packets, and it is calculated that he ingested 12 grams of acetaminophen approximately 3 hours ago. The patient is currently stable. What is the most appropriate treatment for this patient's overdose? N-acetylcysteine A 65-year-old man presents to the clinic due to constipation for the past 2 weeks. He describes his stool as hard, bullet-like. The patient had a past medical history of hypertension and diabetes mellitus for the past 4 years, and he takes his medication as prescribed. His medications include lisinopril and metformin. The patient has a 10- pack-year smoking history and drinks alcohol socially. His blood pressure is 140/ mmHg, pulse rate 70/minute, and the temperature is 37.5°C. Physical examination is unremarkable. A medication that allows the passage of water and fat into the stool mass is prescribed to the patient. Which of the following best identifies this medication? Docusate
MSN 611 Clinical Pharm & Intervention for APRNs A 44-year-old female with a past medical history significant for hypertension is brought to the emergency department by ambulance for altered mental status and diaphoresis. The patient had a right knee arthroscopy under general anesthesia five days ago, which was complicated by postoperative nausea and vomiting. Family members state that she was treated with multiple medications to stop vomiting. She was discharged the same day of surgery and had been recovering uneventfully at home. She takes hydrochlorothiazide for hypertension, which is well-controlled. She has been taking acetaminophen for pain at home as prescribed by her surgeon. Vital signs show a blood pressure of 150/90 mmHg, pulse 110/min, respiratory rate 18/min, temperature 101.4 F, and SpO2 97% on room air. A physical exam is significant for tachycardia, diaphoresis, muscle rigidity, and mild confusion (able to state her name, location, but not date). Labs are drawn and show a leukocytosis, elevated CPK, and mild transaminitis. The patient is diagnosed with neuroleptic malignant syndrome (NMS) and is admitted to the wards for further monitoring and treatment. What is the likely etiology of NMS in this patient? Promethazine A 33-year-old patient presents to the emergency department with a two-day history of nausea and vomiting. The initial workup includes a urine pregnancy test, which is negative. The patient reports a medical history of depression and anxiety, for which she takes sertraline, as well as chronic pain, for which she takes tramadol. The patient is started on intravenous ondansetron. Which of the following may occur? Serotonin syndrome A 50-year-old woman presents to the clinic with new-onset bowel symptoms. She is straining to have a bowel motion and describes her stools as hard and pellet-like. She had a hip fracture repair 2-weeks ago and is on oral morphine for pain control. She is a 10-pack-year smoker and consumes alcohol occasionally. She is afebrile, and her vitals are stable. The abdominal exam is unremarkable. Of the following, what is the mechanism of action of the medication that could have avoided this patient's problem?
MSN 611 Clinical Pharm & Intervention for APRNs Decreases the surface tension of the stool-water interface and facilitates stool passage A 17-year-old boy with a heart rate of 110 bpm and blood pressure of 100/60 mm Hg requires emergency surgery after he is diagnosed with appendicitis. The clinician uses an agent for induction for his appendectomy, which is often used in patients with asthma. Which of the following side effects of this particular agent may require prophylactic treatment? Nausea and vomiting A 58-year-old man is brought to the emergency department with confusion and slow breathing. His wife found him on the floor and was unable to arouse him. His wife says he has been unable to get any relief lately and thinks he may be using more medication than prescribed. He has had terminal colon cancer for two years and was about to enter palliative care. He is currently taking transdermal fentanyl patches, opioids, and an oxygen tank. His blood pressure is 100/60 mm Hg, and his respiratory rate is 8 breaths/min. He has pinpoint pupils and is difficult to arouse. What is the mechanism of the drug that should be administered first? Antagonizes opioid effects by competing for the μ opiate receptor sites A 50-year-old man presents to the clinic with epigastric pain that began four months ago. He has a history of obesity, drinks three beers per night and has a 30-pack-year smoking history, and currently smokes one pack per day. His vital signs are blood pressure 120/70 mmHg, heart rate 75/min, and temperature 37.0°C (98.6°F). The physical exam is non-contributory. Inhibition of which of the following mediators will most likely resolve the patient's chief complaint? Histamine
