NURS 615 Exam 1: Pharmacology and Antibiotic Resistance, Exams of Nursing

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NURS 615 EXAM 1 LATEST 2024 QUESTIONS AND

DETAILED ANSWERS AGRADE

According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:

1. The belief among African Americans that prayer is more powerful than drugs
2. Poor compliance on the part of the African American patient
3. The genetic predisposition for illness found among African Americans
4. Discrimination, cultural barriers, and lack of access to health care - ANSWER✔✔4. Discrimination, cultural barriers, and lack of access to health care The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:
5. Increased CYP 2D6 activity, leading to rapid metabolism of some drugs
6. Largely unknown due to lack of studies of this population
7. Rapid metabolism of alcohol, leading to increased tolerance
8. Decreased elimination of opioids, leading to increased risk for addiction - ANSWER✔✔2. Largely unknown due to lack of studies of this population Pharmacokinetics among Asians are universal to all the Asian ethnic groups.

1. True
2. False - ANSWER✔✔2. False Alterations in drug metabolism among Asians may lead to:
3. Slower metabolism of antidepressants, requiring lower doses
4. Faster metabolism of neuroleptics, requiring higher doses
5. Altered metabolism of omeprazole, requiring higher doses
6. Slower metabolism of alcohol, requiring higher doses - ANSWER✔✔1. Slower metabolism of antidepressants, requiring lower doses Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:
7. Require acetylization in order to metabolize drugs
8. Are unable to tolerate higher doses of some drugs that require acetylization
9. May have a toxic reaction to drugs that require acetylization
10. Require higher doses of drugs metabolized by acetylization to achieve efficacy - ANSWER✔✔4. Require higher doses of drugs metabolized by acetylization to achieve efficacy Hispanic native healers (curanderas):
11. Are not heavily utilized by Hispanics who immigrate to the United States

1. Get a new patent for the over-the-counter form of the drug
2. Lower the costs because most prescription benefit plans do not cover generics
3. Market the drug to a whole new population, as they are able to market to patients instead of just providers
4. Continue to make large profits from their blockbuster brand-name drug - ANSWER✔✔4. Continue to make large profits from their blockbuster brand-name drug New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do.
5. True
6. False - ANSWER✔✔1. True The ailment that generates the greatest over-the-counter annual drug sales is:
7. Constipation
8. Cough and colds
9. Heartburn
10. Acute and chronic pain - ANSWER✔✔2. Cough and colds Common over-the-counter pain relievers such as acetaminophen or ibuprofen:
11. Are always safer for the patient than prescription pain medication
12. Are harmful if taken in higher than recommended amounts

3. Have minimal interaction with prescription medications
4. Should never be given to children unless recommended by their provider - ANSWER✔✔2. Are harmful if taken in higher than recommended amounts When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of:
5. His appropriately only telling you about his regularly prescribed medications
6. His hiding information regarding his inappropriate use of aspirin from you
7. A common misconception that intermittently taken over-the counter medications are not an important part of his drug history
8. A common misuse of over-the-counter aspirin - ANSWER✔✔3. A common misconception that intermittently taken over-the counter medications are not an important part of his drug history The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:
9. Requires all providers to screen their patients for methamphetamine use
10. Restricts the prescribing of amphetamines to U.S. citizens
11. Requires a prescription be written for all methamphetamine precursors in all states
12. Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales - ANSWER✔✔4. Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:

3. Parents of young children insisting on preventive antibiotics so they don't miss work when their child is sick
4. Immunosuppression from the multiple vaccines they receive in the first 2 years of life

• ANSWER✔✔2. The fact that children this age are more likely to be in daycare and exposed to pathogens from other children Providers should use an antibiogram when prescribing. An antibiogram is:

1. The other name for the Centers for Disease Control guidelines for prescribing antibiotics
2. An algorithm used for prescribing antibiotics for certain infections
3. The reference also known as the Pink Book, published by the Centers for Disease Control
4. A chart of the local resistance patterns to antibiotics developed by laboratories - ANSWER✔✔4. A chart of the local resistance patterns to antibiotics developed by laboratories There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because:
5. Renal excretion is similar in both classes of drugs.
6. When these drug classes are metabolized in the liver they both produce resistant enzymes.
7. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase- producing organisms.

4. There is not an issue with cross-resistance between the penicillins and cephalosporins. - ANSWER✔✔3. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms. Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. An appropriate antibiotic to prescribe would be:
5. Penicillin VK, because his rash does not sound like a serious rash
6. Amoxicillin
7. Cefadroxil (Duricef)
8. Azithromycin - ANSWER✔✔4. Azithromycin Sarah is a 25-year-old female who is 8 weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?
9. Ciprofloxacin (Cipro)
10. Amoxicillin (Trimox)
11. Doxycycline
12. Trimethoprim-sulfamethoxazole (Septra) - ANSWER✔✔2. Amoxicillin (Trimox) Pong-tai is a 12-month-old child who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to:

4. Azithromycin 1 gram 1 hour before the procedure - ANSWER✔✔1. None, no antibiotic is required for dental procedures To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of:
5. Urinary tract infections in young women
6. Upper respiratory infections in adults
7. Skin and soft tissue infections in adults
8. Community-acquired pneumonia in patients with comorbidities - ANSWER✔✔4. Community-acquired pneumonia in patients with comorbidities Fluoroquinolones have a Black Box Warning regarding ________ even months after treatment.
9. Renal dysfunction
10. Hepatic toxicity
11. Tendon rupture
12. Development of glaucoma - ANSWER✔✔3. Tendon rupture Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?
13. Encourage increased fluids and fiber.

2. Assess her for pseudomembranous colitis.
3. Advise her to eat yogurt daily to help restore her gut bacteria.
4. Start her on an antidiarrheal medication. - ANSWER✔✔2. Assess her for pseudomembranous colitis. Nurse practitioner prescriptive authority is regulated by:
5. The National Council of State Boards of Nursing
6. The U.S. Drug Enforcement Administration
7. The State Board of Nursing for each state
8. The State Board of Pharmacy - ANSWER✔✔3. The State Board of Nursing for each state The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include:
9. Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program.
10. Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care.
11. APRNs are less likely to prescribe narcotics and other controlled substances.
12. APRNs are able to prescribe independently in all states, whereas a physician's assistant needs to have a physician supervising their practice. - ANSWER✔✔2. Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care.

4. The ability to shift accountability for Medicaid to the state level - ANSWER✔✔1. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes A patient's nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because:
5. Distribution of drugs to target tissue may be affected.
6. The solubility of the drug will not match the site of absorption.
7. There will be less free drug available to generate an effect.
8. Drugs bound to albumin are readily excreted by the kidneys. - ANSWER✔✔1. Distribution of drugs to target tissue may be affected. Drugs that have a significant first-pass effect:
9. Must be given by the enteral (oral) route only
10. Bypass the hepatic circulation
11. Are rapidly metabolized by the liver and may have little if any desired action
12. Are converted by the liver to more active and fat-soluble forms - ANSWER✔✔3. 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:
13. Kidneys

2. Lungs
3. Bile and feces
4. Skin - ANSWER✔✔2. Lungs Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs:
5. Assure that the drug will reach its intended target tissue
6. Are the reason for giving loading doses
7. Increase the length of time a drug is available and active
8. Are most common in collagen tissues - ANSWER✔✔3. 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:
9. Propensity to go to the target receptor
10. Biological half-life
11. Pharmacodynamics
12. Safety and side effects - ANSWER✔✔2. 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:

1. Concentration will produce therapeutic effects
2. Concentration will produce an adverse response
3. Time between doses must be shortened
4. Duration of action of the drug is too long - ANSWER✔✔2. Concentration will produce an adverse response Drugs that are receptor agonists may demonstrate what property?
5. Irreversible binding to the drug receptor site
6. Upregulation with chronic use
7. Desensitization or downregulation with continuous use
8. Inverse relationship between drug concentration and drug action - ANSWER✔✔3. Desensitization or downregulation with continuous use Drugs that are receptor antagonists, such as beta blockers, may cause:
9. Downregulation of the drug receptor
10. An exaggerated response if abruptly discontinued
11. Partial blockade of the effects of agonist drugs
12. An exaggerated response to competitive drug agonists - ANSWER✔✔2. An exaggerated response if abruptly discontinued Factors that affect gastric drug absorption include:

1. Liver enzyme activity
2. Protein-binding properties of the drug molecule
3. Lipid solubility of the drug
4. Ability to chew and swallow - ANSWER✔✔3. Lipid solubility of the drug Drugs administered via IV:
5. Need to be lipid soluble in order to be easily absorbed
6. Begin distribution into the body immediately
7. Are easily absorbed if they are nonionized
8. May use pinocytosis to be absorbed - ANSWER✔✔2. Begin distribution into the body immediately When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:
9. The sum of the effects of each drug individually
10. Greater than the sum of the effects of each drug individually
11. Less than the effect of each drug individually
12. Not predictable, as it varies with each individual - ANSWER✔✔2. Greater than the sum of the effects of each drug individually Which of the following statements about bioavailability is true?

2. Change the drugs so they can cross plasma membranes
3. Change drug molecules to a form that an excretory organ can excrete
4. Make these drugs more ionized and polar to facilitate excretion - ANSWER✔✔3. Change drug molecules to a form that an excretory organ can excrete Once they have been metabolized by the liver, the metabolites may be:
5. More active than the parent drug
6. Less active than the parent drug
7. Totally "deactivated" so they are excreted without any effect
8. All of the above - ANSWER✔✔4. 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:
9. Reduced circulation and perfusion of the kidney
10. Chronic renal disease 3 Competition for a transport site by another drug
11. Unbinding a nonvolatile drug from plasma proteins - ANSWER✔✔4. Unbinding a nonvolatile drug from plasma proteins Steady state is:

1. The point on the drug concentration curve when absorption exceeds excretion
2. When the amount of drug in the body remains constant
3. When the amount of drug in the body stays below the minimum toxic concentration
4. All of the above - ANSWER✔✔2. 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:
5. Synergistic
6. Antagonistic
7. Potentiative
8. Additive - ANSWER✔✔4. Additive Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:
9. Reducing the dosage of one of the drugs
10. Scheduling their administration at different times
11. Prescribing a third drug to counteract the adverse reaction of the combination
12. Reducing the dosage of both drugs - ANSWER✔✔3. Prescribing a third drug to counteract the adverse reaction of the combination