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ADVANCED PHARMACY| NR565 |MIDTERM PROBLEMS WITH ANSWERS, Exams of Nursing

Texas State UniversityNursing

ADVANCED PHARMACY| NR565 |MIDTERM PROBLEMS WITH ANSWERS ADVANCED PHARMACY| NR565 |MIDTERM PROBLEMS WITH ANSWERS

Typology: Exams

2025/2026

Available from 03/14/2026

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ADVANCED PHARMACY| NR565 |
MIDTERM PROBLEMS WITH
ANSWERS
·· Which schedule drugs can APRNs prescribe? - Correct answer
Schedule II-V
· Who determines and regulates prescriptive authority? - Correct answer
Nurse practitioner scope of practice is determined by state practice and
licensure laws.
· How does limited prescriptive authority impact patients within the
healthcare system? - Correct answer limited authority creates problems
for the patient. The patient is not able to get the care they need
· What are the key responsibilities of prescribing? - Correct answer 1. Be
prudent and deliberate in your decision-making process
2. Have a documented provider-patient relationship with the person for
whom you are prescribing
3. Do not prescribe medications for family or friends or for yourself
4. Document a thorough history and physical examination in your records
5.Include any discussions you have with the patient regarding risk factors,
side effects, or therapy options
6. Have a documented plan regarding drug monitoring or titration, if
applicable
· What should be used to make prescribing decisions? - Correct answer
Pharmakinetiscs and Pharmodynamics of older adults - Correct answer
drug accumulation secondary to reduced renal function
polypharmacy (the use of five or more medications daily)
greater severity of illness
presence of comorbidities
use of drugs that have a low therapeutic index (e.g., digoxin)
increased individual variation secondary to altered pharmacokinetics
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ADVANCED PHARMACY| NR565 |

MIDTERM PROBLEMS WITH

ANSWERS

·· Which schedule drugs can APRNs prescribe? - Correct answer Schedule II-V · Who determines and regulates prescriptive authority? - Correct answer Nurse practitioner scope of practice is determined by state practice and licensure laws. · How does limited prescriptive authority impact patients within the healthcare system? - Correct answer limited authority creates problems for the patient. The patient is not able to get the care they need · What are the key responsibilities of prescribing? - Correct answer 1. Be prudent and deliberate in your decision-making process

  1. Have a documented provider-patient relationship with the person for whom you are prescribing
  2. Do not prescribe medications for family or friends or for yourself
  3. Document a thorough history and physical examination in your records 5.Include any discussions you have with the patient regarding risk factors, side effects, or therapy options
  4. Have a documented plan regarding drug monitoring or titration, if applicable · What should be used to make prescribing decisions? - Correct answer Pharmakinetiscs and Pharmodynamics of older adults - Correct answer drug accumulation secondary to reduced renal function polypharmacy (the use of five or more medications daily) greater severity of illness presence of comorbidities use of drugs that have a low therapeutic index (e.g., digoxin) increased individual variation secondary to altered pharmacokinetics

inadequate supervision of long-term therapy poor patient adherence

  • Correct answer · Beer's Criteria - Correct answer •potentially Inappropriate Medication (PIM) use in older adults •PIM use in older adults due to medication-disease or medication- syndrome interactions that may exacerbate the disease or syndrome •medications to be used cautiously in older adults •clinically significant drug interactions that should be avoided in older adults •medications to be avoided or dosage decreased in the presence of impaired kidney function in older adults (American Geriatric Society Beers Criteria Update Expert Panel, 2019) CYP450 - Correct answer Many medications are metabolized through the liver enzyme system called cytochrome P450 (CYP450). Metabolization can be inhibited or induced by drugs and once this happens drug-drug interactions can occur. VISA credit card dept Inhibits Spending on CK and GQ - Correct answer Valproate I-soniazid S-ulfamids A-miodarone C-hloramphenical Ketoconazole G-rapefruit Juice Q-uinidine CYP450 Inhibitors - Correct answer - Decreases the CYP450 which keeps the medication in your body longer which can cause toxicity CYP450 INDUCERS - Correct answer Increase CYP450 to work faster causes Drugs to leave your body faster.
  • Increased hepatic metabolism for some drugs.
  • Decreased tone and mobility of bowel
  • Increased drug absorption. •During what trimester is a pregnant woman most at risk for adverse drug reactions with potential long-term consequences? - Correct answer 1 trimester •What are some medications that we know to be teratogenic? - Correct answer •Antiepileptic drugs, antimicrobials such as tetracyclines and fluoroquinolones, vitamin A in large doses, some anticoagulants, and hormonal medications such as diethylstilbestrol (DES). •How can we as healthcare providers decrease the likelihood of a elderly patient experiencing an adverse drug reaction? - Correct answer •- obtaining a thorough drug history that includes over-the-counter medications •considering pharmacokinetic and pharmacodynamic changes due to age •monitoring the patient's clinical response and plasma drug levels •using the simplest regimen possible •monitoring for drug-drug interactions and iatrogenic illness •periodically reviewing the need for continued drug therapy •encouraging the patient to dispose of old medications •taking steps to promote adherence and to avoid drugs on the Beers list Why do Nitrates need to be taken no later than 4 pm? - Correct answer Need nitrate free interval so tolerance doesn't develop •What are the nine factors that impact the outcome of medication according to Rosenthal & Burcham? - Correct answer •Gender and race •Genetics and pharmacogenomics •Variability in absorption •placebo effect •Tolerance •patho •age •bodyweight

•What is the difference between NP practice authority and prescriptive authority? - Correct answer Practice authority refers to the nurse practitioner's ability to practice without physician oversight, whereas prescriptive authority refers to the nurse practitioner's authority to prescribe medications independently and without limitations. •Who regulates prescription authority? - Correct answer The regulation of prescriptive authority is under the jurisdiction of a health professional board. This may be the State Board of Nursing, the State Board of Medicine, or the State Board of Pharmacy, as determined by each state. Although the federal government controls drug regulation, it has no control over prescriptive authority. •What is scope of practice determined by? - Correct answer Nurse practitioner scope of practice is determined by state practice and licensure laws. •What is full-practice authority? - Correct answer Nurse practitioners have the autonomy to evaluate patients, diagnose, order and interpret tests, initiate and manage treatments and prescribe medications, including controlled substances without physician oversight. •What is reduced practice authority? - Correct answer Nurse practitioners are limited in at least one element of practice. The state requires a formal collaborative agreement with an outside health discipline for the nurse practitioner to provide patient care. What is restricted practice authority? - Correct answer Nurse practitioners are limited in at least one element of practice by requiring supervision, delegation, or team management by an outside health discipline for the nurse practitioner to provide patient care. What is a dose for Lortab - Correct answer Acute pain: 5/325 mg IR every 4-6 h Severe, chronic pain: 20 mg ER every 24 h What is the dose for Lisinopril for only Hypertension - Correct answer Starting dose=10 mg/daily

What are some of the adverse effects of Colchicine - Correct answer Bone marrow suppression Abdominal pain Nausea Vomiting Diarrhea What concurrent use of opioids and what type of medications or substances should be avoided and WHY - Correct answer 1. Alcohol

  1. Benzos
  2. CNS Depresents.
  3. Antihistamines What are the classic triad signs of Opioid overdose - Correct answer 1. Resp. Depression leads to coma
  4. Pinpoint pupils
  5. Miosis how antagonists work - Correct answer Prevention of release from the presynaptic neuron Occupation and blocking of the receptor site How does Fentanyl compare to Morphine - Correct answer It is 100 times more stronger than Morphine Fentanyl is metabylized in the ________ by_______ which cause fentanyl levels to increase by ____________ inhibitors. - Correct answer 1. Liver
  6. CYP3A
  7. CYP3A what IS METADONE USE FOR - Correct answer 1. Opiods use disorder. What level of pain is Codeine prescribed for - Correct answer Mild to Moderate pain. What does the 10 % of Codiene convert to - Correct answer Morphine.

What is the Black Box Warning for Hydrocodone - Correct answer Think about what it contains(Tylenol) so it can cause HEPATOTOXICITY Do agonist/Antagonist have a high or low level for abouse and what population is this used for? - Correct answer 1. Lower potential

  1. Used for Opoiod Use Disorder What are some examples of Agonist-Antagonist medication - Correct answer Bupreinorphine Butophanol Nalbuphine Why should you wait from switching a pt. from Oxycodone to Buprenorphine - Correct answer 1. It will cause withdrawls
  2. You need to wait to start them on Buprenorphine What drug should be avoided for pt. taking Tramadol - Correct answer 1. Benzos, Alcohol, and CNS depressant(MAOIs,SSRI)
  3. It can cause the patient to go into Hypertensive Crisis
  4. Be avoided in patients with Neurological disorders particularly epilepsy What level of pain is Tramadol used for - Correct answer Moderate to Severe What schedule of drug is Tramadol Classified as and why - Correct answer Schedule IV because of a small posibility of additition and withdraws for people that overdose. What Goverment Branch declared the opioid crisis a public health emergency - Correct answer Health and Human Services (HHS) What is the top prioties of the Health and Human Services - Correct answer 1. Improve access to treatment and recovery services
  5. Promote use of overdose reversing drugs
  6. Strenthen understanding of the epidemic through better public health Surveillance
  7. Provide support for cutting edge research on pain and addiction
  8. Advancing better management for pain management.

Dehydration Auto toxicity Drug interaction with Lasix - Correct answer Digoxin Lithium What medicaton will we prescribe with Loop Diurect to prevent an electrolyte imbalance - Correct answer Potassium Sparing diuretics'. What is a name of Thiazide Diurectic - Correct answer HTZ or also called Microzide WHAT IS THE MOA for Microzide - Correct answer Reabsorbing of Na in the Distal Conduluant Tubule What are Thiazide diaretic use to treat - Correct answer 1st choice for Hypertension without any other morbidities. What is the MOA of Aldactone or Spiroaldactone - Correct answer Blocks action of Aldosterone in the distal Nephrone Removes Na in Urine What is Spirolactone use to treat - Correct answer What are some Adverse effects to Spiroalctone - Correct answer HYPER K Dysrhythmia Gynomastatiod Mensural irregulates Deepening of the voice in women Black Box warning for Spiroalctone - Correct answer Tumors in rats Chronic Toxicity Black box warning for Triamterene and Amiloride(K sparing diurectics - Correct answer HYPER K

What are the action of Angiotension II - Correct answer 1. Vasoconstriction

  1. Release of Aldosterone What is the action of Aldosterone - Correct answer Na+ resorbtion, K+ excretion Are drugs that block the RASS SAFE IN PREGNANCY - Correct answer Only in the 1st Trimester DO NOT USE IN 2ND and 3RD Trimester What is the name of an Ace Inhibiter {prils} - Correct answer Lisinopril What is the MOA of ACE inhibitors? - Correct answer These agents inhibit the angiotensin converting enzyme (ACE), preventing the convesion of angiotensin I (AngI) to angiotensin II (AngII) , a potent vasoconstrictor. What is the Adverse Reaction to ACE inhibitors - Correct answer Cough Angioedema- occurs anytime When is the only time you would not give ACE inhibitors - Correct answer Bilateral renal Stenosis ACE inhibitors can be benificial in which population? - Correct answer At risk for end stage renal disease Diabetic What baseline data and monitoring for ACE Inhibitors - Correct answer GFR, Creatinine etc 2-4 weeks after starting Angiortension Receptor Blockers are used for treatment of what ARBS - Correct answer Heart Failure Diabetic MI and Stroke prevention If someone develops a cough with ACE Inhibitors they can switch to - Correct answer ARBS

A-Fib,flutter What is the most common adverse affects of Calcium Chanel Blockers - Correct answer Gingaval Hypoplasia(tell them to get a soft tootbrush) AV block 2nd and 3rd degree Heart Block CONSTAPATION!! Verapamil, increase the the plasma level of what medication by 60 % - Correct answer Digoxin What should patients avoid taking while on Calcium Channel Blockers - Correct answer GRAPEFRUIT JUICE Can nefedipine be used to treat disrhythmias - Correct answer NO- because it does not have an effect on the heart reflex tachycardia can develop with which Calcium Channel Blockers - Correct answer Pro cardia (Nefedipine) What is the use for a Vasodilator? - Correct answer Hypertention Crisis Heart Failure What education should we provide - Correct answer Orthostatic Hypotension Change position slowly Adverse effects of Hydralazine - Correct answer Reflex tachycardia- if this happens give a beta blockers Increased blood volume Systemic lupus erythematosus-like syndrome(joint/muscle pain) Headache, dizziness, weakness, and fatigue What is minoxidil used for? - Correct answer severe hypertension What is the unique Adverse effects of Minoxidil - Correct answer Hair Growth

What is the difference between primary and secondary Hypertension - Correct answer Primary- No cause to there hypertension Secondary- There is a cause to their hypertension What test can be done on pt. with Hypertension - Correct answer CNP, Kidney function, What are the three system that regulate Blood Pressure - Correct answer The Kidney systematic nervous system RASS For general population what medication is used to treat Hypertension - Correct answer 1. Thiazides- Improve morbitiy and mortality Must have a good GFR to work that is why we don't use the ACE and ARBS What is initial treatment for CKD - Correct answer 1. ACE inhibitor first- protect the kidney

  1. ARBS- Hypertention medicaton avoided in Heart Failure - Correct answer Calcium Channel Blockers- because it reduces cardiac output Hypertention medication avoided in DIABETES - Correct answer Thiazides- because they increase blood sugar Beta blockers- mask hypoglycemia First Choise antihyperten. for African American - Correct answer 1- Thiazide
  2. Calcium Channel Blockers First line of medicaiton for Pregnancy - Correct answer Labetelol Methodopa Nearly all antihypertension can interfere with what - Correct answer SEXUAL FUNCTION

Quinidine Verapamil optimal digoxin range - Correct answer 0.5-0. What are medication used to treat Dysrhythmias - Correct answer 1. Calcium Channel Blockers

  1. Digoxine
  2. Quinadine
  3. Amiodarone Black box for QuINADINE - Correct answer Atrial Flutter and Atrial Fib Black box for Mexiletine - Correct answer Life threatening arrhythmia black box amiodarone - Correct answer Pulmonary Toxicity Amiodarone can increase level of what drug - Correct answer Coumadin Digoxin Statins- Which potassium Channel Blockers should not be taken with Grapefruit juice of any of the cyp3A4 and why - Correct answer AMIODARONE increase What are lab values for Total Cholesterol and LDL - Correct answer Total Cholesterol less than 200 LDL less than 110 Are Statins safe to use in pregnancy - Correct answer If you have to you can use Fibraze or Athesthamide Names of HMG-CoA reductase inhibitors - Correct answer Statins How is Metabolic Syndrome Diagnosed - Correct answer 3 of the following 5:
  1. Elevated waist circumference
  1. High TG
  2. Low HDL
  3. High fasting blood glucose
  4. High blood pressure > 130/ What time of day should Statins be given and why - Correct answer Night Adverse effects of Statin - Correct answer rhamdomyolysis, myoglobinuria Don't drink Grapefruit What medication should be used with Statins because they raise statin levels - Correct answer Antifungal Drugs Pedcolizone Grapefruit Juice Basline before starting a Statin - Correct answer Blood Pressure Lipid Pannel CK levels Fibrates are contra in patient with - Correct answer Liver injury can cause cancer Gal Stones What can Triger stable Angina - Correct answer Physical Exercise Strenous activity Large Meals What is variant angina cause by - Correct answer Coronary spasm Medication to treat Angina - Correct answer 1. Nitro
  1. Beta Blockers
  2. calcium Channel Blockers Adverse effects of Nitro - Correct answer headache, orthostatic hypotension, reflex tachycardia How can we prevent Nitro Tolerance - Correct answer Give 8 hour breaks