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NEW QUESTION 23
A 59-year-old patient with a diagnosis of deep vein thrombosis is anticoagulated with enoxaparin 1 mg/kg every 12 hours and warfarin 5 mg daily. On the third day of therapy, his INR
= 2.2. The patient is symptomatically improved. Which of the following is the most appropriate management of this patient?
- A. Continue enoxaparin and warfarin.
- B. Discontinue enoxaparin and increase warfarin.
- C. Discontinue enoxaparin and continue warfarin.
- D. Continue enoxaparin and hold Warfarin.
Answer: D
NEW QUESTION 24
A patient presents a first-time prescription for exenatide subcutaneously twice daily. Which of the following information should the pharmacotherapy specialist present during patient counseling?
- A. The most common side effect is nausea, which usually decreases over time.
- B. Dose size should be adjusted according to the size of each meal.
- C. The drug should be discarded 60 days after first use, even if some remains in the pen.
- D. The drug should be taken within 60 minutes after eating the morning and evening meals.
Answer: D
NEW QUESTION 25
With regard to the privacy rule of the Health Insurance Portability and Accountability Act (HIPAA), which of the following statements is correct with regard to the use or disclosure of Protected Health Information (PHI) in clinical research?
- A. If the data are being used for preparatory research, no written authorization or waiver is required.
- B. If the data being used do not include the patient's name or health record number, no authorization or waiver is required.
- C. A researcher may use or disclose PHI if the individual patient has provided verbal consent.
- D. A researcher may use or disclose PHI if the individual patient has provided written authorization or if a Waiver has been obtained from an IRB.
Answer: D
NEW QUESTION 26
An 18-year-old patient presents with abrasions on the hands, knees, and shoulder from a recent bicycle accident. Gram-staining of surgical incision and drainage specimens reveals Gram positive cocci in chains. The patient has necrotizing fasciitis and develops bronchospasms after being given penicillin. Which intravenous antibiotic would be best to use in place of penicillin?
- A. Ciprofloxacin
- B. Clindamycin
- C. Sulfamethoxazole/trimethoprim
- D. Ceftriaxone
Answer: B
NEW QUESTION 27
A 71-year-old patient presents for a hospital follow-up visit after a recent inpatient stay for an exacerbation of COPD, the fourth such stay in the past year. The patient's home medication regimen includes albuterol/ipratropium by inhaler, theophylline, and extended release guaifenesin. The latest FEV1 value in a one-second test was 40% of the predicted value; o2 Sat was 90%. Which of the following is the most appropriate management strategy for this patient?
- A. A trail of montelukast
- B. A trail of systemic corticosteroids
- C. A trial of inhaled corticosteroids
- D. A trail of home oxygen therapy
Answer: C
NEW QUESTION 28
A 53-year-old patient is admitted to the hospital with diarrhea. He has been experiencing five unformed stools daily for 2 days. The patient had a previous admission 6 weeks ago for C.
difficile diarrhea, which was treated successfully with oral metronidazole. Stool tests are again positive for C. difficile toxin A.
On presentation, his vital signs are: BP 128/86 mm Hg, HR 75 bpm, RR 14 bpm, and T37.8°C.
WBC count shows 12,300 cells/ul (80% neutrophils-segs, 10% neutrophils-bands), serum creatinine 1.2 mg/dL, and albumin 3.4 g/dL. The patient has no evidence of colitis, toxic megacolon, or perforation on imaging studies of the abdomen.
What is the most appropriate treatment recommendation for this patient?
- A. Metronidazole 500mg orally three times daily
- B. Vancomycin 125mg orally four times daily
- C. Vancomycin 125 mg orally four times daily plus metronidazole 500 mg three times daily intravenously
- D. Rifaximin 550mg orally three times daily
Answer: A
NEW QUESTION 29
A 76-year-old man has his first visit with a pharmacotherapy specialist for the management of his anticoagulation. The patient states that he started warfarin last week as instructed by his physician. He is able to explain the reason that he was started on anticoagulation therapy.
During the interview, some of the specialist's questions go unanswered or are answered inappropriately. For example, when asked if he has had any bleeding, the patient states that his breathing is fine.
Which will most likely be a barrier to the effective education of this patient?
- A. Cultural differences
- B. Hearing impairment
- C. Ability to afford medication
- D. Lack of readiness to change
Answer: B
NEW QUESTION 30
A clinical trial is being designed to evaluate the efficacy of an intermediate-acting niacin preparation in a population with regard to amelioration of coronary artery disease risk.
Bioethical considerations would restrict recruitment of subjects with poorly controlled diabetes mellitus, recent gastroduodenal ulcer disease, or hyperuricemia. Which principle would consider these patients to be ineligible for enrollment?
- A. Autonomy
- B. Beneficence
- C. Equipoise
- D. Justice
Answer: A
NEW QUESTION 31
A pharmacotherapy specialist is the anticoagulation clinic manager at a for-profit institution.
One of the internal medicine physicians in this institution is interested in submitting a research grant application to the National Institutes of Health (NIH) to study the effectiveness of low- intensity warfarin therapy on prevention of recurrent venous thromboembolism in patients.
This was the subject of the PREVENT trial.
With regard to the grant application, the pharmacotherapy specialist should inform the physician about which of the following restrictions?
- A. The NIH provides grants only to nonprofit organizations.
- B. NIH-funded research can take place only on the campus.
- C. The NIH funds only novel research.
- D. The NIH funds only studies involving drugs that have not yet been FDA-approved.
Answer: A
NEW QUESTION 32
A patient taking warfarin is seen in the clinic today and prescribed a 2-Week course of fluconazole for a fungal infection. Before the patient receives the first dose of fluconazole, the pharmacotherapy specialist should ensure that:
- A. The fluconazole prescription is changed to ketoconazole.
- B. The fluconazole dose is administered at least 2 hours after the Warfarin dose.
- C. The warfarin dose is empirically increased during fluconazole therapy.
- D. An INR is obtained initially and monitored during fluconazole therapy.
Answer: D
NEW QUESTION 33
The Healthcare Effectiveness Data and Information Set (HEDIS) measures health plan performance on important dimensions of care and service. The benchmarks used for quality of care are derived from goals established by the:
- A. Joint Commission.
- B. National Committee for Quality Assurance.
- C. Centers for Medicare and Medicaid Services.
- D. National Quality Forum.
Answer: B
NEW QUESTION 34
A 35-year-old Woman is diagnosed with pustular psoriasis, which covers 35% of her body. She has tried high-potency topical steroid creams and topical coal tar with ultraviolet B treatments in the past, with no effect. Which of the following is the best therapeutic option for this patient?
- A. Halobetasol
- B. Anthralin
- C. Calcipotriene
- D. Methotrexate
Answer: D
NEW QUESTION 35
The results of a drug-use evaluation study by the P & T Committee reveal that 15 prescribers are using an antibiotic inappropriately. Which of the following is the most effective strategy for improving the drug therapy?
- A. Meeting in a seminar with the prescribers to review the results of the study
- B. Including the results of the study and educational material in a newsletter distributed to the medical staff
- C. Meeting individually with the prescribers to review the results of the study and review educational material
- D. Sending the prescriber's a letter with the results of the study and educational material
Answer: A
NEW QUESTION 36
A patient is admitted to the hospital after a motor vehicle collision. The patient takes methadone
40 mg once daily for management of an opiate addiction. The remainder of the patient's medical history is unremarkable. The medical resident caring for the patient wants to order methadone but Expresses concern related to the Substance Abuse and Mental Health Services Administration (SAMHSA) regulations.
What is the appropriate action?
- A. Order methadone 40 mg once daily if the medical resident is a registered opioid treatment program (OTP) practitioner.
- B. Order methadone 40 mg once daily if the patient shows signs of withdrawal.
- C. Order methadone 40 mg once daily during inpatient treatment.
- D. Order morphine at equivalent dose as an alternative management.
Answer: C
NEW QUESTION 37
A study is conducted comparing two antibiotics for the treatment of UTIs. The results after 7 days of therapy demonstrated that Drug A was superior to Drug B in eradicating bacteria from the urine and eliminating signs and symptoms of infections. The investigators concluded that Drug A was significantly superior to Drug B (p<0.05). In subsequent studies, however, the two drugs were equivalent in efficacy.
Which one of the following types of error apparently occurred in the first study?
- A. Beta error
- B. Regression to the mean
- C. Type ||
- D. Type |
Answer: D
NEW QUESTION 38
A pharmacotherapy specialist is contemplating Writing a case report on a suspected penicillin induced neutropenia in a patient who received intravenous penicillin G for treatment of infective endocarditis. The specialist has established a temporal relationship between the period of medication administration and the onset of neutropenia, and has excluded other potential causes of the adverse effect.
Which of the following is the most appropriate next step in composing the case report?
- A. Collect all pertinent patient information, including past medical history, laboratory data, medication history, and consent.
- B. Generate ideas and wording for the patient case summary portion of the report.
- C. Perform a comprehensive literature search to identify existing literature describing neutropenia in penicillin-treated patients.
- D. Describe the incidence, severity, and outcome of penicillin-induced neutropenia for the introduction section of the report.
Answer: C
NEW QUESTION 39
A 45-year-old patient develops neutropenia, fever, headache, meningismus, and lethargy after induction chemotherapy for acute lymphocytic leukemia. A lumbar puncture reveals 1,000 total nucleated cells with elevated CSF protein with gram stain showing Gram-positive rods. Which of the following is the best initial empiric therapy for this patient?
- A. Ceftriaxone
- B. Ampicillin and cefotaxime
- C. Ampicillin
- D. Ceftazidime and gentamicin
Answer: A
NEW QUESTION 40
A population study of gentamicin pharmacokinetics in 425 neonates reported the following correlation by least-squares linear regression between gestational age and gentamicin clearance:
r2 = 0.35, p = 0.0001. Which of the following is the most appropriate interpretation of these data?
- A. A significant correlation exists between gestational age and gentamicin clearance, with gestational age accounting for 65% of the variability in gentamicin clearance.
- B. A significant correlation exists between gestational age and gentamicin clearance, with gestational age accounting for 59% of the variability of gentamicin clearance.
- C. A correlation coefficient of less than 0.8 essentially means no significant relationship exists between gestational age and gentamicin clearance in neonates.
- D. A significant correlation exists between gestational age of newborns and gentamicin clearance, but gestational age accounts for only 35% of the variability in clearance.
Answer: D
NEW QUESTION 41
A mother mistakenly gives her 2-year-old child 1 tablespoon of albuterol sulfate (2 mg/5mL) instead of 1 teaspoon. The child experiences no harm from the extra amount. Which statement is correct?
- A. This is not an error since the mother is not a healthcare professional.
- B. This is only an error if the child had experienced harm.
- C. This is considered a medication error.
- D. This is only an error if the labeling or directions were wrong.
Answer: C
NEW QUESTION 42
To correct the development of metabolic acidosis in patients receiving standard TPN solutions, which of the following is the best therapeutic intervention?
- A. Decrease the potassium and increase the calcium.
- B. Decrease the chloride and increase the acetate.
- C. Hyperventilate the patient to produce hypocapnia.
- D. Decrease the phosphate and add bicarbonate.
Answer: D
NEW QUESTION 43
In a clinical trial, when would "intention to treat" analysis be most appropriate?
- A. Phase || trial
- B. Small sample size
- C. High drop-out rate
- D. Crossover design
Answer: B
NEW QUESTION 44
Which of the following pharmacoeconomic analyses incorporates patient preferences regarding health?
- A. Cost-benefit
- B. Cost-minimization
- C. Cost-effectiveness
- D. Cost-utility
Answer: A
NEW QUESTION 45
A 47-year-old patient with end-stage renal disease undergoing hemodialysis has an HCT of 23% and exhibits anginal symptoms. Upon further Workup, no evidence of occult bleeding is found.
In addition to antianginal therapy, which of the following is the most appropriate initial treatment for this patient's anemia?
- A. Oral iron
- B. Iron dextran
- C. Subcutaneous erythropoietin
- D. Two units of PRBCs
Answer: D
NEW QUESTION 46
A 51-year-old male patient reports waking up in the middle of the night and being unable to go back to sleep, but he has no problem falling asleep. The patient says he feels exhausted most days of the Week at Work. His physician prescribes zolpidem 3.5 mg sublingually as needed.
What is the most appropriate counseling point about zolpidem for this patient?
- A. It may be taken for middle-of-the-night awakenings.
- B. It should be taken with a full glass of water.
- C. It should be taken shortly before bedtime.
- D. It is unlikely to cause sleep during driving.
Answer: C
NEW QUESTION 47
A 60-year-old man is admitted to the CCU with an acute anterior wall Ml. Therapy with amiodarone is initiated. The man's concurrent medications include Warfarin, furosemide, and enalapril. Which of the following baseline laboratory land clinical data, in addition to thyroid and liver function tests, should be obtained prior to initiation of amiodarone therapy in this patient?
- A. FEV1 and baseline electroencephalogram
- B. Spirometry and 24-hour urine for creatinine clearance
- C. Chest X-ray
- D. Fasting blood glucose
Answer: A
NEW QUESTION 48
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