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NR565/ NR 565
AdvancedPharmacologyCareoftheFundamentals
Midterm Exam Questions and Verified Answers
Chamberlain
- A patient's nutritional intake and laboratory results reflect hypoalbumine- mia. This is critical to prescribing because: Ans>>Distribution of drugs to target tissue may be affected
- Drugs that have a significant first-pass effect: Ans>>Are rapidly metabolized by the liver and may have little if any desired action
- The route of excretion of a volatile drug will likely be the: Ans>> Lungs
- Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs
2 / Ans>> Increase the length of time a drug is available and active
- The NP chooses to give cephalexin every 8 hours based on knowledge of the drug's Ans>> Biological half-life
- Azithromycin dosing requires that the first day's dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose Ans>> Rapidly achieves drug levels in the therapeutic range
- The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the Ans>> Onset of action
- Phenytoin requires that a trough level be drawn. Peak and trough levels are done Ans>> To determine if a drug is in the therapeutic range
- A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the Ans>> Concentration will produce and adverse response
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- Which of the following statements about the major distribution barriers (blood-brain or
5 / fetal-placental) is true Ans>> The blood-brain barrier slows the entry of many drugs into and from brain cells
- Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: Ans>>Change drug molecules to a form that an excretory organ can excrete
- Once they have been metabolized by the liver, the metabolites may be Ans>> All of the above
- All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by Ans>> Unbinding a non- volatile drug from plasma proteins
- Steady state is Ans>> When the amount of drug in the body remains constant
- Two different pain medications are given together for pain relief. The drug—drug interaction is Ans>> Additive
- Actions taken to reduce drug—drug interaction problems
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- Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach Ans>> Sodium bicarbonate
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- Which of the following variables is a factor in drug absorption Ans>> A rich blood supply to the area of absorption leads to better absorption.
- An advantage of prescribing a sublingual medication is that the medication is Ans>> Absorbed rapidly
- Drugs that use CYP 3A4 isoenzymes for metabolism may Ans>> Both 1 and 2
- Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state Ans>> After four to five half-lives
- Upregulation or hypersensitization may lead to Ans>> An exaggerated response if the drug is withdrawn
- Prescribing for women during their childbearing years requires constant awareness of the possibility of: 1. Pregnancy unless the women is on birth control 2. Risk for silent bacterial or viral infections of the genitalia 3. High risk for developmental disorders in their infants 4. Decreased risk for abuse during this time: 2
- Intimate partner violence is a serious public health problem. It should be screened for: 1. At every encounter within the health-care system 2. When a women is being seen for symptoms of depression 3. Throughout pregnancy
- If a sexually transmitted disease is diagnosed: 1
- Because of their longer life expectancy, women are more
10 / methods that include progesterone
- Fostering the intake of iron mainly in green and leafy vegetables: 2
- Hot flashes are often a concern during menopause. Which of the fol- lowing may help in reducing them? 1. Drink one caffeinated liquid per day 2. Take progesterone supplementation 3. Exercise 20-40 minutes/day 4. Increase intake of carrots, yams, and soy products: 4
- Factors common in women that can affect adherence to a treatment regimen include all of the following EXCEPT: 1. Number of drugs taken: Women tend to take fewer drugs over longer periods of time 2. Fear that medications can cause disease: Information obtained from social networks may be inaccurate for a specific woman 3. Nutritional status: Worries about possible weight gain from a given drug may result in nonadherence 4. Re- ligious differences: A patient's belief system that is not congruent with the treatment regimen presents high risk for nonadherence: 1
- Dysmenorrhea is one of the most common gynecological complaints in young women. The first line of drug treatment for this disorder is: 1. Oral contraceptive pills 2. Caffeine 3. NSAIDs 4. Aspirin: 3
- Premenstrual dysphoric disorder (PMDD) occurs in a fairly small num- ber of patients. Theories of the pathology behind PMDD that are supported in research include: 1. Altered
11 / sensitivity in the serontonic system 2. Inhibition of the cyclooxygenase system 3. Fluctuations of the gonadal hormones 4. All of these are theories supported by research: 1
- Treatment of PMDD that affects all or most of the symptoms includes:
- Tryptophan up to 6 g/d 2. Vitamin E 200-400 mg/d 3. Evening primrose oil 500 mg/d 4. Fluoxetine 20 mg/d: 4
- Women are now the fastest growing population with HIV infection and AIDS. HIV-infected women: 1. Are less likely to become pregnant or to carry a pregnancy to term 2. Have higher rates of cervical dysplasia and HPV-concurrent infections 3. Are most often over 35 years of age 4. Most often come from Asian and Caucasian ethnic groups: 2
- Maternal-to-child transmission of HIV infection during pregnancy may be prevented by: 1. Use of antiviral drugs such as zidovudine 2. Use of condoms during intercourse
- Both 1 and 2 4. Neither 1 nor 2: 1
- Erroneous information about LGBTQ individuals can lead to failure to give accurate advice to them as patients. Which of the following statements is true about lesbians: 1. Lesbians cannot contract a sexually transmitted infection from their female partner. 2. Screening for cervical cancer is not required.
- Lesbians as a group are less likely to have health-care insurance.
13 / concerns?
- They cannot contract an STI from another woman. 2. Pap smears are not required to screen for cervical cancer. 3. Lesbian women have a tendency to be frequent clinic visitors. 4. The health risks associated with smoking, alcohol, and depression are higher than in the heterosexual population.: 4
- The factor that has the greatest effect on males developing male sexual characteristics is: 1. Cultural beliefs 2. Effective male role models 3. Adequate intake of testosterone in the diet 4. Androgen production: 4
- When assessing a male for hypogonadism prior to prescribing testos- terone replacement, serum testosterone levels are drawn: 1. Without regard to time of day 2. First thing in the morning 3. Late afternoon 4. In the evening: 2
- Some research supports that testosterone replacement therapy may be indicated in which of the following diagnoses in men? 1. Age-related decrease in cognitive functioning
- Metabolic syndrome 3. Decreased muscle mass in aging men
- All of the above: 4
- The goal of testosterone replacement therapy is: 1. Absence of all hypogonadism symptoms 2. Testosterone levels in the mid-normal range 1 week after an injection 3 .Testosterone levels in the mid-normal range just prior
14 / to the next injection 4. Avoidance of high serum testosterone levels during therapy: 2
- While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are: 1. Hemoglobin 14 g/dl or hematocrit 39% 2. Hemoglobin 11.5 g/dl or hematocrit 31% 3. Hemoglobin 13 g/dl or hematocrit 38% 4. Hemoglobin 17.5 g/dl or hematocrit 54%: 4
- Monitoring of an older male patient on testosterone replacement in- cludes: 1. Oxygen saturation levels at every visit 2. Serum cholesterol and lipid profile every 3 to 6 months
- Digital rectal prostate screening exam at 3 and 6 months after starting therapy 4. Bone mineral density at 3 months and 6 months after starting therapy: 3
- When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be screened for use of: 1. Statins
- Nitrates 3. Insulin 4. Opioids: 2
- Men who are prescribed phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction should be educated regarding the adverse effects of the drug which include: 1. Hearing loss 2. Hypotension 3. Delayed ejaculation 4. Dizziness: 1
- Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include: 1.
16 / hood. 2. Children should always be prescribed lower than adult doses per weight due to low enzyme activity until puberty. 3. Children should always be prescribed higher than adult doses per weight due to high enzyme activity.
- Prescribing dosages will vary based on the developmental activity of each enzyme, at times requiring lower than adult doses and other times higher than adult doses based on the age of the child.: 4
- Developmental variation in renal function has what impact on prescrib- ing for infants and children?
- Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months. 2. Higher doses of water soluble drugs may need to be prescribed because of increased renal excretion. 3. Renal excretion rates have no impact on prescribing. 4. Parents need to be instructed on whether drugs are renally excreted or not.: 1
- Topical corticosteroids are prescribed cautiously in young children be- cause: 1. They may cause an intense hypersensitivity reaction 2. Of hypothal- amic-pituitary-adrenal axis suppression 3. Corticosteroids are less effective in young children 4. Young children may accumulate corticosteroids, leading to toxic levels: 2
- Liza is breastfeeding her 2-month-old son and has an infection that requires an antibiotic. What drug factors
17 / influence the effect of the drug on the infant? 1. Maternal drug levels 2. Half-life 3. Lipid-solubility 4. All of the above: 4
- Drugs that are absolutely contraindicated in lactating women include: 1. Selective serotonin reuptake inhibitors 2. Antiepileptic drugs such as carba- mazepine 3. Antineoplastic drugs such as methotrexate 4. All of the above: 3
- Zia is a 4-month-old patient with otitis media. Education of his parents regarding administering oral antibiotics to an infant includes: 1. How to ad- minister an oral drug using a medication syringe 2. Mixing the medication with a couple of ounces of formula and putting it in a bottle 3. Discontinuing the antibiotic if diarrhea occurs 4. Calling for an antibiotic change if the infant chokes and sputters during administration: 1
- To increase adherence in pediatric patients a prescription medication should: 1. Have a short half-life 2. Be the best tasting of the effective drugs
- Be the least concentrated form of the medication 4. Be administered 3 or 4 times a day: 2
- Janie is a 5-month-old breastfed infant with a fever. Treatment for her fever may include: 1. "Baby" aspirin 2. Acetaminophen suppository 3. Ibuprofen suppository 4. Alternating acetaminophen and ibuprofen: 2
19 / (Climara). What as- sessment finding does the nurse report immediately to the provider? a. Breast tenderness b. Headaches c. Red, swollen calf d. Swollen ankles: ANS: C A red, swollen calf could be a manifestation of a deep vein thrombosis, a known side effect of estrogen. The nurse reports this finding immediately. The other manifestations are also side effects of estrogen, but do not need to be reported as a priority.
- A transgender client taking spironolactone (Aldactone) is in the internal medicine clinic reporting heart palpitations. What action by the nurse takes priority? a. Draw blood to test serum potassium. b. Have the client lie down. c. Obtain a STAT electrocardiogram (ECG). d. Take a set of vital signs.: ANS: C Spironolactone is a potassium-sparing diuretic, and hyperkalemia can cause cardiac dysrhythmias. The nurses priority is to obtain an ECG, then to facilitate a serum potassium level being drawn. Having the client lie down and obtaining vital signs are also important care measures, but do not take priority.
- The nurse is teaching a transgender client about the medication gosere- lin (Zoladex). What action by the client indicates good understanding? a. Takes a manual blood pressure b. Administers a subcutaneous injection c. Prepares an implanted port for IV insertion d. States that the axillary area will
20 / be clothed: ANS: B Goserelin is administered via subcutaneous injection. The other actions are not related to self-management while on this medication.
- A client is preparing for gender reassignment surgery and will transition from male to female. The client is worried about the voice not sounding feminine enough. What action by the nurse is best? a. Ask if the client has considered vocal cord surgery to change the voice. b. Refer the client for vocal therapy with speech-language pathology. c. Teach the client that there will be no effect on the clients voice. d. Tell the client that the use of hormones will eventually change the voice.: ANS: B Male-to-female clients can consult with a speech-language pathologist for vocal training to help with intonation and pitch. While vocal surgery is possible, it may not be the best first option due to cost and invasiveness. Telling the client there will be no change to the voice does not give the client information to address the concern. While the hormones this client is taking will not affect the voice, simply stating that fact does not help the client manage this issue.
- A client has returned from the postanesthesia care unit after a vagino- plasty. What comfort measure does the nurse provide for this client? a. Apply ice to the perineum. b. Elevate the legs on pillows. c. Position the client on the left side. d. Raise the head of the bed.: ANS: A Ice is applied to the perineum to reduce pain and discomfort. Elevating the legs on pillows is not recommended after a lengthy procedure in the lithotomy position,
