The primary care NP sees a 65-year-old patient in October. The patient has a history of COPD and has not had any vaccines for more than 20 years. The NP should administer:

Correct Answer: D

Rationale: The correct answer is D because adults over 65 with COPD need PPV 23, annual influenza, and TdaP every 10 years. Choice A is incorrect (misses PPV 23). Choice B is wrong (misses TdaP). Choice C is inaccurate (Td less comprehensive than TdaP).

Correct Answer: B

Rationale: Choice B is correct because drug antagonism occurs when one drug's effect is altered (usually reduced) by another, a classic interaction like beta blockers countering adrenaline. Choice A is incorrect as dependence isn't antagonism. Choice C is wrong because metabolism timing isn't the definition. Choice D is incorrect since it's a consequence, not the defining feature.

Correct Answer: C

Rationale: Choice C is correct because bioavailability—the fraction of drug reaching systemic circulation—directly influences dosing and efficacy, a key pharmacokinetic factor. Choice A is incorrect as therapeutic index is a pharmacodynamic measure of safety. Choice B is wrong because minimum effective concentration guides response, not prescribing mechanics. Choice D is incorrect since ease of titration is a practical, not pharmacokinetic, factor.

Correct Answer: B

Rationale: Choice B is correct because a genetic variation (e.g., CYP2C9 or VKORC1 polymorphism) increasing warfarin sensitivity means less drug is needed to achieve anticoagulation, so the dose should be decreased to avoid bleeding risks. Choice A is incorrect as increasing the dose would heighten toxicity. Choice C is wrong because holding it entirely risks under-treatment, not adjustment. Choice D is incorrect since unchanged dosing ignores the genetic impact.

Correct Answer: B

Rationale: Choice B is correct because Schedule II drugs, like opioids, have high abuse potential and strict rules, including no refills—new prescriptions are required each time. Choice A is incorrect as teratogenicity isn't a Schedule II criterion. Choice C is wrong because they have high, not low, abuse potential. Choice D is incorrect since they require prescriptions, not optional state regulation.

Correct Answer: D

Rationale: Choice D is correct because acetaminophen, aspirin, and codeine all require weight-based dosing in children to ensure safety and efficacy, as pediatric pharmacokinetics vary by body weight. Choice A is incorrect alone as it's one example. Choice B is wrong by itself because aspirin, though avoided, uses weight when needed. Choice C is incorrect solo since codeine also requires it despite restrictions.

Correct Answer: D

Rationale: Choice D is correct because reconciliation (reviewing meds), deprescribing (stopping unneeded drugs), and education (improving adherence) all reduce polypharmacy risks, per clinical guidelines. Choice A is incorrect alone as it's one strategy. Choice B is wrong by itself because deprescribing is just part. Choice C is incorrect solo since education is only one approach.

Correct Answer: D

Rationale: Choice D is correct because aspirin (antiplatelet), warfarin (anticoagulant), and ibuprofen (NSAID) all increase bleeding risk, especially in the elderly with fragile vessels, per studies. Choice A is incorrect alone as it's one drug. Choice B is wrong by itself because warfarin is just part. Choice C is incorrect solo since ibuprofen is only one agent.

Correct Answer: B

Rationale: Choice B is correct because aspirin irritates the stomach lining and inhibits prostaglandins, worsening peptic ulcers, per GI recommendations. Choice A is incorrect as acetaminophen is safe for ulcers. Choice C is wrong because ibuprofen, while risky, is less avoided than aspirin. Choice D is incorrect since only aspirin is the primary concern.