Pharmacological Management of Chronic Conditions, Exams of Pharmacology

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PHARM Exam Questions with Answers Tested and Verified Latest Updates

1. Thiazide diuretics and loops diuretics have different primary indications because of which

important difference between them? Thiazide diuretics and loops diuretics affect different ions. Loop diuretics have more adverse effects. Thiazide diuretics require luminal perfusion to reach their active site. Thiazide diuretics and loop diuretics have significantly different interactions.- : Thiazide diuretics require luminal perfusion to reach their active site

2. Which of the following statements about beta-adrenergic blockers is cor- rect?

All beta-adrenergic blockers are cardioselective, blocking only beta1 recep- tors. Some beta-adrenergic blockers are cardioselective, blocking only beta1 re- ceptors; others are not and also block beta2 receptors in smooth muscle. All beta1-adrenergic blockers lose their selectivity at high doses. Some beta1-adrenergic blockers increase their selectivity at high doses.: - Some beta-adrenergic blockers are cardioselective, blocking only beta1 receptors; others are not and also block beta receptors in smooth muscle.

3. During diuretic therapy, levels of which electrolyte should be monitored?

Potassium Calcium Chloride

Magnesium: Potassium

4. The beta-adrenergic antagonist nebivolol:

Decreases nitric oxide release. Is not approved for hypertension. Is highly cardioselective. Is not cardioselective.: Is highly cardioselective.

5. Which of the following agents is beta1 selective?

Atenolol Carvedilol Labetalol Nadolol: Atenolol

6. During diuretic therapy, which of the following should be monitored?

Renal function Red blood cell count Glucose level Prolactin level: Renal function

7. Which type of diuretic is available only for oral use?

Thiazide diuretics Loop diuretics Potassium-sparing diuretics All diuretics: Potassium-sparing diuretics

8. Which of the following best characterizes the mechanism of action of diuret- ics?

Diuretics increase renal permeability to water. Diuretics change the resting potential of renal smooth muscle. Diuretics inhibit the transport of ions across the tubular membrane. Diuretics decrease the osmolarity of urine.: Diuretics inhibit the transport of ions across the tubular membrane.

9. Which of the following is a mechanism of action of beta-adrenergic block- ers?

Preventing sympathetic stimulation of the heart Causing renin release from the glomerulus Increasing outflow and water retention in the kidney Preventing parasympathetic stimulation of the heart: Preventing sympathetic stimulation of the heart

10. Which of the following statements about angiotensin II receptor blockers is correct?

Adverse effects are common. Concomitant use of drugs containing iron should be avoided. Renal alterations are less common than with ACE inhibitors. Cough is a common side effect.: Renal alterations are less common than with ACE inhibitors.

11. When prescribing angiotensin-converting enzyme (ACE) inhibitors, the advanced practice

nurse may anticipate all of the following except: Neutropenia. Angioedema. Hypokalemia.

A transient increase in blood urea nitrogen (BUN) and creatinine (Cr).: Hy- pokalemia.

12. The HCN channel blocker ivabradine (Corlanor) is contraindicated for CHF patients with:

LVEF of <35%. Atrial fibrillation. Resting heart rate of >70 bpm. SBP >90 mm Hg.: Atrial fibrillation.

13. The only absolute contraindication to ACE inhibitor use is:

Hypertension with congestive heart failure. Hypertension with diabetes mellitus. Bilateral renal artery stenosis. Intolerance of diuretics.: Bilateral renal artery stenosis.

14. The baseline laboratory evaluation of patients taking ACE inhibitors should include:

Red blood cell count. Urine protein. Potassium level. Magnesium level.: Urine protein.

15. Angiotensin II stimulates the release of which hormone that causes sodi- um and water

retention in the kidneys? Aldosterone Progesterone Deoxycorticosterone

Adrenocorticotrophic hormone: Aldosterone

16. When considering the use of valsartan/sacubitril (Entresto) for congestive heart failure, the NP

considers all of the following except: There are few significant drug-drug interactions. This combination promotes diuresis and vasodilation. The medication must be discontinued during pregnancy. Hyperkalemia and cough are common adverse effects.: There are few signifi- cant drug-drug interactions.

17. The renin inhibitor, aliskiren, can significantly reduce the activity of:

Thiazide diuretics. Loop diuretics. Niacin. Fluoroquinolones.: Loop diuretics.

18. Which of the following agents attenuates the hypotensive effects of ACE inhibitors?

Nonsteroidal antiinflammatory agents (NSAIDS) Selective serotonin reuptake inhibitors (SSRIs) Statins Anticoagulants: Nonsteroidal antiinflammatory agents (NSAIDS)

19. The most common adverse effects of calcium channel blockers are:

Related to decreased cardiac contractility. Variable, depending on the patient's ethnicity. Exacerbated in patients also taking beta-adrenergic antagonists. Related to

vasodilation.: Related to vasodilation.

20. Which of the following drug classes is not recommended for the initial treatment of

hypertension in the general non-Black population? Thiazide-type diuretics Angiotensin-converting enzyme (ACE) inhibitors Calcium channel blockers Beta-adrenergic blockers: Beta-adrenergic blockers

21. Which of the following is recommended as prophylaxis in patients at high risk of a first

myocardial infarction episode? Low-dose aspirin Warfarin Prasugrel Digoxin: Low-dose aspirin

22. Which of the following agents should be considered in the initial treat- ment of hypertension

in the general Black population, including those with diabetes? Angiotensin II receptor blockers Calcium- channel blockers ACE inhibitors Clonidine: Calcium-channel blockers

23. A potential adverse effect associated with the use of phosphodiesterase inhibitors is:

Angioedema. Bronchospasm.

Renal dysfunction. Hypotension.: Hypotension.

24. Which of the following is a mechanism of action of calcium channel block- ers?

Increasing the influx of calcium ions into vascular smooth muscle cells, causing vascular constriction Decreasing cardiac contractility by inhibiting calcium movement into the sarcomere (contractile unit of muscle) Inhibiting the sympathetic effects of epinephrine and norepinephrine Vasodilating the coronary arteries: Decreasing cardiac contractility by inhibiting calcium movement into the sarcomere (contractile unit of muscle)

25. Which of the following conditions is a contraindication to thiazide diuret- ics?

Gout Peripheral arterial disease Congestive heart failure (CHF) Diabetes: Gout

26. A patient with significant chronic CHF remains symptomatic despite thera- py with ACE

inhibitors and beta-adrenergic antagonists. Before adding digox- in, the advanced practice nurse should remember that: Quinidine may decrease digoxin levels. Nonsteroidal antiinflammatory agents may lead to hyperkalemia. Laxatives may potentiate hypokalemia. Digoxin and diuretics should not be prescribed together.: Laxatives may poten- tiate hypokalemia.

27. Which of the following agents should be used as an initial or add-on treat- ment to improve

kidney outcomes in patients in the general adult population who have chronic kidney disease and hypertension regardless of race or diabetes status?

ACE inhibitors Calcium channel blockers Nitrates Beta-adrenergic blockers: ACE inhibitors

28. Which of the following should be the first class of drugs prescribed for a patient in

decompensated, symptomatic CHF? Nitrates ACE inhibitors Beta-adrenergic antagonists Loop diuretics: Loop diuretics

29. Which of the following is an action of nitrates?

Vasodilating coronary arteries Increasing preload Contracting arteries Increasing afterload: Vasodilating coronary arteries

30. During triacylglycerol transport, once chylomicrons are in the circulation,

cholesterol transfers proteins to the chylomicrons. HDL LDL Triglycerides VLDL: HDL

31. Which of the following is a characteristic of very low density lipoprotein (VLDV)?

Water-soluble transport for synthesized lipids Result of breakdown of IDL in plasma Water-soluble transport for ingested lipids Lipid fuel source, ingested or synthesized: Water-soluble transport for synthe- sized lipids

32. Fat-soluble vitamins include all of the following except:

A.

C.

E.

K.: C.

33. Which of the following is a water-soluble transport for ingested lipids?

Cholesterol Chylomicron Triacylglycerols IDL: Chylomicron

34. are the major dietary lipid.

Glycerophospholipids Saccharolipids Sphingolipids Triacylglycerols: Triacylglycerols

35. F

atty acids (triacylglycerol precursors) are synthesized in the liver with as the main precursor.

Bile acids Dietary glucose Lipoprotein lipase Protein: Dietary glucose

36. A major function of bile salts is:

Emulsification of dietary fat. Enzymatic breakdown of fatty acids. Neutralize pH of gastric contents. Increase reabsorption of water-soluble vitamins.: Emulsification of dietary fat.

37. Cholesterol is obtained either by diet or is synthesized by a pathway that occurs in most body

cells but to a greater extent in the cells of which two organs? Intestines and pancreas Liver and intestines Liver and pancreas Stomach and intestines: Liver and intestines

38. During the fed state, free fatty acids are converted to triacylglycerol and stored in:

The liver. Muscle cells. Adipose tissue. The pancreas.: Adipose tissue.

39. The free cholesterol pool of the liver is supplied primarily by which of the following

mechanisms? Ingested cholesterol is transported there by proteins Synthesized cholesterol is returned there by way of HDL Intracellular synthesis via the HMG-CoA reductase pathway Ingested cholesterol is transported there by acetyl CoA: Intracellular synthesis via the HMG-CoA reductase pathway

40. After bile acid salts are ejected into the gut, what happens to them after they have served their

purpose? They are reabsorbed from the gut and recycled. They are excreted as an essential component of undigested products. They are metabolized to inert forms. They bind to fat-soluble vitamins and are stored in adipose tissue.: They are reabsorbed from the gut and recycled.

41. The primary purpose of HMG-CoA reductase inhibitors is to:

Decrease circulating LDL levels. Increase circulating HDL levels. Decrease triacylglycerol levels. Increase triacylglycerol levels.: Decrease circulating LDL levels.

42. Which class of lipid-lowering agent interferes with absorption of fat-solu- ble vitamins?

Selective cholesterol-absorption inhibitors Bile acid sequestrants

HMG-CoA reductase inhibitors Fibric acid derivatives: Bile acid sequestrants

43. Which agent may cause flushing?

Niacin Bile acid sequestrants HMG-CoA reductase inhibitors Fibric acid derivatives: Niacin

44. When prescribing HMG-CoA reductase inhibitors, the nurse practitioner should:

Ensure that the patient is neither pregnant nor planning pregnancy. Advise the patient to pretreat with ASA 325 mg to reduce adverse effects. Rule out diabetes as it may promote hyperglycemia. Counsel the patient that it may inhibit the absorption of fat-soluble vitamins.- : Ensure that the patient is neither pregnant nor planning pregnancy.

45. While the mechanism of action of niacin is unknown, this agent decreases

synthesis of by the liver. Chylomicron HDL IDL VLDL: VLDL

46. When considering the use of PCSK9 inhibitors (alirocumab and evolocum- ab), the NP considers

all of the following except: Can result in approximately 50% reduction in LDL.

Can be useful for patients with clinical ASCVD who need additional LDL-low- ering after maximal statin therapy. To date, there is no major concern with serious adverse events. Can be used as a relatively inexpensive adjunct to statin therapy.: Can be used as a relatively inexpensive adjunct to statin therapy.

47. Which of the following is a mechanism of action of fibric acid derivatives?

Increases activity of lipoprotein lipase Promotes lipolysis of triacylglycerols stored in adipose tissue Blocks catabolism of VLDL and triacylglycerols Blocks endothelial receptor production of lipoprotein lipase (LPL): Increases activity of lipoprotein lipase

48. Which of the following is a true statement regarding HMG-CoA reductase therapy?

Prescribers should be aware that many drugs in this class are CYP3A4 sub- strates. Significant vasomotor flushing may be relieved by using sustained-release preparations. They are only safe in the 1st and 2nd trimester of pregnancy. An HDL of <40 mg/dL is an indication for therapy in patients with two or more cardiac risk factors.: Prescribers should be aware that many drugs in this class are CYP3A substrates.

49. Niacin should not be used in patients with:

Dementia. Hyperglycemia.

HIV.

Pancreatitis.: Hyperglycemia.

50. Which of the following is the drug of choice for anticoagulation in the patient with heparin-

induced thrombocytopenia? Warfarin Clopidogrel Argatroban Enoxaparin: Argatroban

51. Which of the following statements describes the primary difference be- tween direct factor Xa

inhibitors and indirect factor Xa inhibitors? Direct factor Xa inhibitors inhibit primary clotting; indirect factor Xa inhibitors inhibit secondary clotting. Use of direct factor Xa inhibitors requires laboratory monitoring; use of indi- rect factor Xa inhibitors does not require laboratory monitoring. Direct factor Xa inhibitors are administered orally; indirect factor Xa inhibitors are administered parenterally. Direct factor Xa inhibitors act directly on thrombin; indirect factor Xa inhibitors use antithrombin III as a mediator.: Direct factor Xa inhibitors act directly on thrombin; indirect factor Xa inhibitors use antithrombin III as a mediator.

52. Which phase of the clotting process is affected by activated Factor X (Factor Xa)

inhibitors? Primary hemostasis

Secondary hemostasis Clot control Clot dissolution: Secondary hemostasis

53. Primary hemostasis is characterized by:

Activation of factor X. Formation of a fibrin clot. Platelet aggregation and adhesion. Mobilization of tissue plasminogen activator.: Platelet aggregation and adhe- sion.

54. Which of the following laboratory tests is used to monitor the effects of low molecular weight

heparin (LMWH)? Activated partial thromboplastin time International normalized ratio Anti-Xa assay Prothrombin time: Anti-Xa assay

55. The primary adverse effects of heparin and warfarin are related to:

Bleeding. Impaired protein binding. Neutropenia. Agranulocytosis.: bleeding

56. Secondary hemostasis is characterized by:

Inactivation of factor X. Formation of a fibrin clot. Platelet aggregation and adhesion. Mobilization of tissue plasminogen activator.: Formation of a fibrin clot.

57. Which of the following is indicated for cerebrovascular accident (CVA) and embolic risk

reduction in nonvalvular atrial fibrillation? Argatroban Bivalirudin Clopidogrel Dabigatran: Dabigatran

58. Peripheral neuropathy and priapism is possible adverse effect of:

Heparin. Warfarin. Clopidogrel. Prasugrel.: Heparin.

59. Antithrombin III, which limits clotting to the injured site, is greatly potenti- ated by:

Aspirin (ASA). Heparin. Thrombin inhibitors. Warfarin.: Heparin.

60. The laboratory evaluation for a patient taking warfarin should include which of the

following tests?

Activated partial thromboplastin time Anti-Xa assay Blood glucose level International normalized ratio: International normalized ratio

61. Which platelet inhibitor is indicated for a patient who has had a cerebrovas- cular accident (CVA)

or transient ischemic attack (TIA) while on aspirin (ASA) therapy? Dipyridamole and ASA (Aggrenox) Prasugrel (Effient) Ticlopidine (Ticlid) Clopidogrel (Plavix): Dipyridamole and ASA (Aggrenox)

62. Warfarin is susceptible to drug-drug interactions because of which of its features?

Protein binding CYP inhibition Hydrophilia Lipophobicity: Protein binding

63. Used in patients with unstable angina and patients undergoing percuta- neous transluminal

coronary angioplasty (PTCA) and stent placement, glyco- protein IIb/IIIa inhibitors are potent: Platelet inhibitors. Thrombolytics. Thrombin inhibitors. Antithrombin III inhibitors.: Platelet inhibitors.

64. The mechanism of action of warfarin is:

Inhibiting the conversion of prothrombin to thrombin. Decreasing the synthesis of clotting factors VIII, IX, and X. Suppressing fibrinogen activation. Promoting tissue release of plasminogen activator.: Inhibiting the conversion of prothrombin to thrombin.

65. Which of the following statements about prasugrel (Effient) is true?

Prasugrel is less effective than clopidogrel (Plavix) for CVA prevention. Prasugrel is a strong substrate of CYP450 2C19. Prasugrel is not indicated for a patient with a previous CVA or TIA. Prasugrel is the preferred platelet aggregate inhibitor in patients older than 75 years of age.: Prasugrel is not indicated for a patient with a previous CVA or TIA.

66. What is the primary advantage of selective serotonin reuptake inhibitors (SSRI) over

heterocyclics in the management of depression? SSRIs do not have negative cardiovascular effects. SSRIs do not cause sexual dysfunction. SSRIs are less expensive. SSRIs are not sedating.: SSRIs do not have negative cardiovascular effects.

67. Citalopram

(Celexa) should not be prescribed greater than mg daily due to potential prolongation of the QT interval. 10 20

80: 40

68. When using venlafaxine HCl (Effexor) at high doses, it is recommended to monitor the patient

for: AST/ALT elevation. Renal dysfunction. Hypothyroidism. Hypertension.: Hypertension.

69. When considering discontinuing SNRI therapy, the NP recognizes that the medication should be

titrated down over a period of at least: 2 weeks. 4 weeks. 2 months. 4 months.: 4 weeks.

70. In addition to treating depression, SSRIs are also effective in treating all of the following except:

Panic disorder. Bulimia. Neuropathic pain. Obsessive compulsive disorder.: Neuropathic pain.

71. Which of the following statements is false regarding serotonin syndrome?

There is greater risk with SSRI agents with short half-lives.

There is greater risk in patients taking multiple serotonergic agents. Mild forms of serotonin syndrome can cause agitation, tremors, and increased blood pressure. Serotonin syndrome can often lead to life-threatening seizures.: There is greater risk with SSRI agents with short half-lives.

72. While deciding among the classes of antidepressants, the nurse practi- tioner knows that

serotonin norepinephrine reuptake inhibitors (SNRIs) are primarily indicated for those patients: Allergic to TCAs. =65 years of age. Who are pregnant. Unresponsive to SSRIs.: Unresponsive to SSRIs.

73. A likely cause of depression is due to diminished activity of:

Norepinephrine. Serotonin. Acetylcholine. Both norepinephrine and serotonin.: Both norepinephrine and serotonin.

74. Anticholinergic action due to SSRI use is caused indirectly through:

Norepinephrine down-regulation. Dopamine upregulation. Dopamine down-regulation. Monoamine oxidase inhibition.: Dopamine upregulation.

75. When selecting a SSRI to treat depression with concomitant anxiety and insomnia, it is useful

to select an agent with a: Short half-life. Long half-life. Greater sedating properties. Greater activating properties.: Greater sedating properties.

76. The first choice of drug class for managing chronic anxiety is:

TCA.

Benzodiazepines. SNRI. SSRI.: SSRI.

77. A variety of drugs are available to manage Parkinson's disease. Which of the following should

only be given to patients who are also taking levodopa? MAO-B inhibitors Dopamine receptor agonists Anticholinergics COMT inhibitors: NOT Dopamine receptor agonists OR COMT inhibitors

78. Which of the anti-Parkinsonian agents requires hepatic enzyme monitor- ing for the first year?

COMT inhibitors Dopamine agonists MAO-

B inhibitors Levodopa/carbidopa (Sinemet): COMT inhibitors

79. Which neurotransmitter is the primary inhibitory neurotransmitter in the central nervous

system? GABA Glutamate Dopamine Norepinephrine: GABA

80. Parkinson's disease occurs when there is a loss of dopaminergic neurons in the basal ganglia.

Most pharmacologic agents act to increase levels of endogenous dopamine or stimulate dopamine receptors. As a result, which of the following adverse effects may be anticipated with most classes? Orthostatic hypotension and palpitations Confusion and flushing Diarrhea and urinary retention Flushing and near syncope: Orthostatic hypotension and palpitations

81. The anti-epileptic drugs (AEDs) can produce a variety of adverse effects. Which of the following

is a particular concern with carbamazepine (Tegretol)? Drug rash Gingival hyperplasia HLA- B1502 sensitivity Nausea: HLA-B1502 sensitivity

82. A patient presents to your office complaining of fatigue and nausea. She has seizure disorder

managed with phenytoin (Dilantin) 200 mg bid. While evaluating her fatigue, you appreciate that she is bradycardic and obtain a phenytoin level. The level is 40 mcg/mL. The half-life of phenytoin is averaged at 22 hours. As the NP, you know that: In zero order kinetics, you cannot predict the rate of elimination. At high levels, phenytoin saturates its route of elimination. The higher the level, the more rapid the rate of metabolism. In 22 hours the level will be 20 mcg/mL.: NOT In 22 hours the level will be 20 mcg/mL. OR In zero order kinetics, you cannot predict the rate of elimination.

83. Quetiapine fumurate (Seroquel), cimetidine (Tagamet), and SSRIs may all be used to manage:

Depression. Anxiety. Insomnia. Hypersexuality.: Hypersexuality.

84. When managing

patients who are taking for seizure dis- order, the nurse practitioner must be aware that it is capable of autoinduction. Phenytoin (Dilantin) Carbamazepine (Tegretol) Gabapentin (Neurontin) Lorazepam (Ativan): Carbamazepine (Tegretol)

85. Many pharmacologic agents used to manage chronic seizure disorder are classified as:

Dopamine antagonists. Norepinephrine reuptake inhibitors. GABA agonists. Glutamate agonists.: GABA agonists.

86. The proton pump is best described as:

The positive feedback mechanism of GI motility. A physiologic mechanism not manageable by drug therapy. A mechanism by which chyme is neutralized. An active transport pump contained within the parietal cells.: An active trans- port pump contained within the parietal cells.

87. In considering the use of probiotics for the management of diarrhea, the NP realizes all of the

following are accurate except: Promotes the growth of beneficial organisms in the intestines. Are most effective when used concomitantly with an oral antimicrobial. Inhibits the growth of harmful bacteria. Promotes water reabsorption in the intestines.: Are most effective when used concomitantly with an oral antimicrobial.

88. Which of the following drugs used to manage vomiting may cause ex- trapyramidal effects?

Metoclopramide. Ondansetron HCl. Cyclizine.