Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank, Exams of Pharmacology

Download Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank and more Exams Pharmacology in PDF only on Docsity! Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank MN 553-Final review Acute Pain 6. Which of the following statements is true about acute pain? 1. Somatic pain comes from body surfaces and is only sharp and well-localized. 2. Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates. 3. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site. 4. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area. 7. One of the main drug classes used to treat acute pain is NSAIDs. They are used because: 1. They have less risk for liver damage than acetaminophen. 2. Inflammation is a common cause of acute pain. 3. They have minimal GI irritation. 4. Regulation of blood flow to the kidney is not affected by these drugs. 10. The goal of treatment of acute pain is: 1. Pain at a tolerable level where the patient may return to activities of daily living 2. Reduction of pain with a minimum of drug adverse effects 3. Reduction or elimination of pain with minimum adverse reactions 4. Adequate pain relief without constipation or nausea from the drugs 13. Pathological similarities and differences between acute pain and chronic pain include: 1. Both have decreased levels of endorphins. 2. Chronic pain has a predominance of C-neuron stimulation. 3. Acute pain is most commonly associated with irritation of peripheral nerves. 4. Acute pain is diffuse and hard to localize. Allopurinol 17. Which antigout medication is used to treat chronic tophaceous gout? a. Allopurinol (Zyloprim) b. Colchicine c. Probenecid (Benemid) d. Sulfinpyrazone (Anturane) 18. The nurse is assessing a patient who has gout who will begin taking allopurinol (Zyloprim). The nurse reviews the patient’s medical record and will be concerned about which laboratory result? a. Elevated BUN and creatinine b. Increased serum uric acid c. Slight increase in the white blood count d. Increased serum glucose 19. The nurse provides teaching for a patient who will begin taking allopurinol. Which statement by the Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank patient indicates understanding of the teaching? a. I should increase my vitamin C intake. b. I will get yearly eye exams. c. I will increase my protein intake. d. I will limit fluids to prevent edema. 3. Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes: Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 6. Patients who have angina, regardless of class, who are also diabetic, should be on: 1. Nitrates 2. Beta blockers 3. ACE inhibitors 4. Calcium channel blockers 7. Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct. 1. Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload. 2. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload. 3. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply. 4. Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function. 8. Nitrates are especially helpful for patients with angina who also have: 1. Heart failure 2. Hypertension 3. Both 1 and 2 4. Neither 1 nor 2 9. Beta blockers are especially helpful for patients with exertional angina who also have: 1. Arrhythmias 2. Hypothyroidism 3. Hyperlipidemia 4. Atherosclerosis 10. Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use? 1. These drugs are useful for immediate symptom relief when the patient is certain it is angina. 2. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away. 3. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5minutes for no more than two doses. If chest pain is still not relieved, call 911. 4. All of the above 12. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because: 1. Nitrates increase MOS and beta blockers increase MOD. 2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out. 3. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease. 4. All of the above 13. Drug choices to treat angina in older adults differ from those of younger adults only in: 1. Consideration of risk factors for diseases associated with and increased in aging 2. The placement of drug therapy as a treatment choice before lifestyle changes are tried 3. The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult 4. Those with higher risk for silent myocardial infarction Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 15. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT: 1. Patients often require multiple drugs 2. A large number of angina patients are older adults on fixed incomes 3. Generic formulations may be cheaper but are rarely bioequivalent Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Lack of drug selectivity may result in increased adverse reactions 16. Situations that suggest referral to a specialist is appropriate include: 1. When chronic stable angina becomes unpredictable in its characteristics and precipitating factors 2. When a post-myocardial infarction patient develops new-onset angina 3. When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina 4. All of the above 17. The rationale for prescribing calcium blockers for angina can be based on the need for: 1. Increased inotropic effect in the heart 2. Increasing peripheral perfusion 3. Keeping heart rates high enough to ensure perfusion of coronary arteries 4. Help with rate control 18. Medications are typically started for angina patients when: 1. The first permanent EKG changes occur 2. The start of class I or II symptoms 3. The events trigger a trip to the emergency department 4. When troponin levels become altered 19. The most common cause of angina is: 1. Vasospasm of the coronary arteries 2. Atherosclerosis 3. Platelet aggregation 4. Low systemic oxygen 20. Ranolazine is used in angina patients to: 1. Dilate plaque-filled arteries 2. Inhibit platelet aggregation 3. Restrict late sodium flow in the myocytes 4. Induce vasoconstriction in the periphery to open coronary vessels 21. When is aspirin (ASA) used in angina patients? 1. All angina patients should be taking ASA unless it is contraindicated for allergy or other medical reasons. 2. ASA should only be used in men. 3. ASA has no role in angina, but is useful in MI prevention. 4. The impact of ASA is best at the time of an angina attack. 6. Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common medication practices seen in the elderly including: 1. Use of another person’s medications 2. Hoarding medications 3. Changing his medication regimen without telling his provider 4. All of the above Angioedema 3. A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants? 1. Change dose to every other day dosing for a week 2. Reduce dose by 50% for 3 to 4 days 3. Reduce dose by 50% every other day Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life 11. The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason? 1. They have become tolerant of the medication, which is characterized by the need for higher and higher doses. 2. They are a drug seeker. 3. They are suicidal. 4. They only need additional counseling on lifestyle modification. 12. What “onset of action” symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor? 1. They will have insomnia for a week. 2. They can feel a bit of nausea, but this resolves in a week. 3. They will have an “onset seizure” but this is considered normal. 4. They will no longer dream. 13. Which of the following should not be taken with a selective serotonin reuptake inhibitor? 1. Aged blue cheese 2. Grapefruit 3. Alcohol 4. Green leafy vegetables 14. Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)? 1. It has a shorter half-life and withdrawal syndrome has a faster onset without taper. 2. It has the longest half-life and the withdrawal syndrome has a faster onset. 3. It is quasi-addictive in the dopaminergic reward system. 4. It is the most activating of SSRI medications and will cause the person to have sudden deep sadness 15. The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the best response? 1. This is a good idea because this class of medications generally makes people sleepy. 2. Have you noticed that you are having more sleep issues since you started that? 3. This a good way to remember to take your daily medications because it is near your toothbrush. 4. This is a good plan because you can eat grapefruit if there is 8–12 hours difference in the time each are ingested. 20. Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes: 1. SSRIs may take 2 to 6 weeks before she will have maximum drug effects. 2. Red-green color blindness may occur and should be reported. 3. If she experiences dry mouth or heart rates greater than 80, she should stop taking the drug immediately. 4. She should eat lots of food high in fiber to prevent constipation. 21. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be: 1. Fluoxetine (Prozac) 2. Paroxetine (Paxil) Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Amitriptyline (Elavil) 4. Duloxetine (Cymbalta) Aspirin Toxicity 7. Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which she would Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 10. Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: 1. Symptoms are severe 2. Patient has not responded to other therapies 3. Patient has concurrent hypertension 4. Left ventricular dysfunction is diagnosed 11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with: 1. Angina 2. Coronary artery disease 3. Both 1 and 2 4. Neither 1 nor 2 12. To prevent life-threatening events from rapid withdrawal of a beta blocker: 1. The dosage interval should be increased by 1 hour each day. 2. An alpha blocker should be added to the treatment regimen before withdrawal. 3. The dosage should be tapered over a period of weeks. 4. The dosage should be decreased by one-half every 4 days . 13. Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose? 1. Dizziness 2. Increased heart rate 3. Nervousness and shakiness 4. Diaphoresis 16. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? 1. White 2. Asian 3. African American 4. Native American 8. Nonselective beta blockers and alcohol create serious drug interactions with insulin because they: 1. Increase blood glucose levels 2. Produce unexplained diaphoresis 3. Interfere with the ability of the body to metabolize glucose 4. Mask the signs and symptoms of altered glucose levels 5. Sadie was prescribed betaxolol ophthalmic drops by her ophthalmologist to treat her glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because: 1. There may be an antagonistic reaction between the two. 2. The additive effects may include bradycardia. 3. They may potentiate each other and cause respiratory depression. 4. The additive effects may cause metabolic acidosis. Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 9. Beta blockers are especially helpful for patients with exertional angina who also have: 1. Arrhythmias 2. Hypothyroidism 3. Hyperlipidemia 4. Atherosclerosis 12. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank because: 1. Nitrates increase MOS and beta blockers increase MOD. 2. Their additive effects permit lower doses of both drugs and their adverse reactions cancel each other out. 3. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease. 4. All of the above 7. Stage B patients should have beta blockers added to their heart failure treatment regimen when: 1. They have an ejection fraction less than 40% 2. They have had a recent MI 3. Both 1 and 2 4. Neither 1 nor 2 9. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true? 1. Diuretics reduce preload associated with fluid retention. 2. Diuretics can be used earlier than stage C when the goal is control of hypertension. 3. Diuretics may produce problems with electrolyte imbalances and abnormal glucose and lipid metabolism. 4. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB). 13. ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy? 1. Diuretics 2. ARBs 3. Beta blockers 4. Nitrates 4. Beta blockers treat hypertension because they: 1. Reduce peripheral resistance 2. Vasoconstrict coronary arteries 3. Reduce norepinephrine 4. Reduce angiotensin II production 5. Which of the following disease processes could be made worse by taking a nonselective beta blocker? 1. Asthma 2. Diabetes 3. Both might worsen 4. Beta blockade does not affect these disorders 6. Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include: 1. Heart failure 2. Angina 3. Myocardial infarction 4. Dyslipidemia Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. They only work with bisphosphonates if daily intake is restricted. 29. The nurse is caring for an asthmatic patient prescribed zoledronic acid. What important question should the nurse ask this patient? A) Can you take aspirin without experiencing any bad effects? B) Are you taking theophylline to treat your asthma? Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank C) Do you have a history of diarrhea? D) Are you taking digoxin? 11. Sallie has been diagnosed with osteoporosis and is asking about the “once a month” pill to treat her condition. How do bisphosphonates treat osteoporosis? 1. By selectively activating estrogen pathways in the bone 2. By reducing bone resorption by inhibiting parathyroid hormone (PTH) 3. By reducing bone resorption and inhibiting osteoclastic activity 4. By increasing PTH production 17. IV forms of bisphosphonates are used for all the following except: 1. Severe gastric irritation with oral forms 2. Known cancer mets into the bone 3. Persons with advancing renal dysfunction 4. Progression of bone loss on oral formulations 18. What is the established frequency of repeating DEXA imaging after stating bisphosphonates? 1. Every 2 years 2. Every 5 years 3. There is no evidence-based time line for monitoring after the first 2 years 4. There need to be annual exams 8. The nurse is teaching the patient with a new prescription for ibandronate (Boniva) how to take the medication. Which instruction provided by the nurse is correct? A) Take 150 mg once a month on the same day of the month. B) Take 70 mg once a week on the same day of the week. C) Take 400 mg/d. D) Take 3 mg once per month on the same day of the month. 10. The nurse is providing care for a man diagnosed with osteoporosis. What drug will the nurse administer that is the only drug approved for treatment in men? A) Etidronate (Didronel) B) Pamidronate (Aredia) C) Tiludronate (Skelid) D) Alendronate (Fosamax) 28. The nurse is teaching the patient how to take his newly prescribed alendronate and includes what teaching points? (Select all that apply.) A) Take the drug in the morning. B) Wait 60 minutes before eating breakfast. C) Take the drug with a full glass of water. D) Remain upright for 30 minutes after taking the medication. E) Eat a breakfast high in calcium after taking the medication. 31. The nurse is caring for a patient who takes alendronate. What lab studies would the nurse assess regularly? A) Serum iodine B) Serum potassium Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank C) Serum calcium D) Serum iron 13. The drug recommended as primary prevention of osteoporosis in women over age 70 years is: 1. Alendronate (Fosamax) 2. Ibandronate (Boniva) 3. Calcium carbonate Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Sterols 4. Bile acid-binding resins 11. Monitoring of a patient who is on a lipid-lowering drug includes: 1. Fasting total cholesterol every 6 months 2. Lipid profile with attention to serum LDL 6 to 8 weeks after starting therapy, then again in 6 weeks 3. Complete blood count, C-reactive protein, and erythrocyte sedimentation rate after 6 weeks of therapy 4. All of the above 31. Because of their site of action, bile acid sequestering resins: 1. Should be administered separately from other drugs by at least 4 hours 2. May increase the risk for bleeding 3. Both 1 and 2 4. Neither 1 nor 2 8. Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels. What is the appropriate treatment for a pregnant woman? 1. A statin 2. Niacin 3. Fibric acid derivative 4. Bile acid-binding resins 30. Felicity has been prescribed colestipol to treat her hyperlipidemia. Unlike other anti-lipidemics, this drug: 1. Blocks synthesis of cholesterol in the liver 2. Exchanges chloride ions for negatively charged acids in the bowel 3. Increases HDL levels the most among the classes 4. Blocks the lipoprotein lipase pathway 32. Colestipol comes in a powdered form. The patient is taught to: 1. Take the powder dry and follow it with at least 8 ounces of water 2. Take it with a meal to enhance its action on fatty food 3. Mix the powder with 4 to 6 ounces of milk or fruit juice 4. Take after the evening meal to coincide with cholesterol synthesis 28. Dulcea has type 2 diabetes and a high triglyceride level. She has gemfibrozil prescribed to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug? 1. Reactive airway disease/asthma 2. Inflammatory bowel disease 3. Allergy to aspirin 4. Gallbladder disease 29. Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric acid derivative such as gemfibrozil with which of the following is not recommended? The drug and the reason must both be correct for the answer to be correct. Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 1. Reductase inhibitors, due to an increased risk for rhabdomyolysis 2. Bile-acid sequestering resins, due to interference with folic acid absorption 3. Grapefruit juice, due to interference with metabolism 4. Niacin, due to decreased gemfibrozil activity 26. Janice has elevated LDL, VLDL, and triglyceride levels. Niaspan, an extended-release form of niacin, is chosen to treat her hyperlipidemia. Due to its metabolism and excretion, which of the Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank following laboratory results should be monitored? 1. Serum alanine aminotransferase 2. Serum amylase 3. Serum creatinine 4. Phenylketonuria 27. Niaspan is less likely to cause which side effect that is common to niacin? 1. Gastrointestinal irritation 2. Cutaneous flushing 3. Dehydration 4. Headaches Chronic PPI 8. Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: 1. Iron deficiency anemia, vitamin B12 and calcium deficiency 2. Folate and magnesium deficiency 3. Elevated uric acid levels leading to gout 4. Hypokalemia and hypocalcemia 10. Long-term use of proton pump inhibitors may lead to: 1. Hip fractures in at-risk persons 2. Vitamin B6 deficiency 3. Liver cancer 4. All of the above Cluster headaches 13. James has been diagnosed with cluster headaches. Appropriate acute therapy would be: 1. Butalbital and aspirin (Fiorinal) 2. Meperidine IM (Demerol) 3. Oxygen 100% for 15 to 30 minutes 4. Indomethacin (Indocin) 14. Preventative therapy for cluster headaches includes: 1. Massage or relaxation therapy 2. Ergotamine nightly before bed 3. Intranasal lidocaine four times a day during “clusters” of headaches 4. Propranolol (Inderal) daily Community acquired pneumonia 10. To prevent further development of antibacterial resistance it is recommended that fluoroquinolones be reserved for treatment of: 1. Urinary tract infections in young women 2. Upper respiratory infections in adults 3. Skin and soft tissue infections in adults 4. Community-acquired pneumonia in patients with comorbidities 1. The most common bacterial pathogen in community-acquired pneumonia is: Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 1. They can cut an adult ibuprofen tablet in half to give Josefina. 2. The ibuprofen dose can be doubled for severe pain. 3. Josefina needs to be well-hydrated while taking ibuprofen. 4. Ibuprofen is completely safe in children with no known adverse effects. 2. Conjunctivitis in a child that is accompanied by acute otitis media is treated with: 1. Sulfacetamide 10% ophthalmic solution (Bleph-10) Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 2. Bacitracin/polymyxin B (Polysporin) ophthalmic drops 3. Ciprofloxacin (Ciloxan) ophthalmic drops 4. High-dose oral amoxicillin 8. Myles is a 2-year-old patient who has been diagnosed with acute otitis media. He is afebrile and has not been treated with antibiotics recently. First-line treatment for his otitis media would include: 1. Azithromycin 2. Amoxicillin 3. Ceftriaxone 4. Trimethoprim/sulfamethoxazole 9. Alyssa is a 15-month-old patient who has been on amoxicillin for 2 days for acute otitis media. She is still febrile and there is no change in her tympanic membrane examination. What would be the plan of care for her? 1. Continue the amoxicillin for the full 10 days. 2. Change the antibiotic to azithromycin. 3. Change the antibiotic to amoxicillin/clavulanate. 4. Change the antibiotic to trimethoprim/sulfamethoxazole. 10. A child that may warrant “watchful waiting” instead of prescribing an antibiotic for acute otitis media includes patients who: 1. Are low risk with temperature of less than 39oC or 102.2oF 2. Have reliable parents with transportation 3. Are older than age 2 years 4. All of the above 11. Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should be educated about: 1. Using decongestants to provide faster symptom relief 2. Providing adequate pain relief for at least the first 24 hours 3. Using complementary treatments for acute otitis media, such as garlic oil 4. Administering an antihistamine/decongestant combination (Dimetapp) so the child can sleep better 8. 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 administer 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 Constipation 10. Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year- old child would be: 1. PEG 3350 (Miralax) 2. Bisacodyl (Dulcolax) suppository Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Docusate (Colace) suppository 4. Polyethylene glycol electrolyte solution 11. Methylnaltrexone is used to treat constipation in: 1. Patients with functional constipation 2. Patients with irritable bowel syndrome-associated constipation Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Electrolytes every 3 months 4. Developmental variation in renal function has what impact on prescribing for infants and children? 1. 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. 14. You are reviewing the data from several meta-analyses that addressed the most common causes of adverse drug reactions in the older adult. Which of the following would you find to be decreased and the most common cause of these problems in older adults? 1. Body fat content 2. Liver function 3. Renal function/clearance 4. Plasma albumin levels Diphenhydramine 19. Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects? 1. Levothyroxine 2. Prilosec 3. Dulcolax 4. Diphenhydramine 15. Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for: 1. Urinary retention 2. Cardiac output 3. Peripheral edema 4. Skin rash 17. Topical diphenhydramine (Benadryl) is available OTC to treat itching. Patients or parents should be instructed regarding the use of topical diphenhydramine that: 1. For maximum effectiveness in treating itching, combine topical with oral diphenhydramine. 2. Topical diphenhydramine is the treatment of choice in treating poison ivy or poison oak. 3. Topical diphenhydramine should not be used in children younger than age 2 years. 4. When applying topical diphenhydramine, apply the cream liberally to all areas that itch. Diuretics 13. Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include: 1. Antihypertensives, diuretics, and digoxin 2. Antidiarrheals, antihistamines, and omeprazole 3. Penicillin antibiotic class and benzodiazepines 4. None of the above 33. The choice of diuretic to use in treating hypertension is based on: 1. Presence of diabetes with loop diuretics being used for these patients 2. Level of kidney function with a thiazide diuretic being used for an estimated glomerular filtration rate higher Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank than the mid-40mL/min range 3. Ethnicity with aldosterone antagonists best for African Americans and older adults 4. Presence of hyperlipidemia with higher doses needed for patients with LDL above 130 mg/dL Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 9. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true? 1. Diuretics reduce preload associated with fluid retention. 2. Diuretics can be used earlier than stage C when the goal is control of hypertension. 3. Diuretics may produce problems with electrolyte imbalances and abnormal glucose and lipid metabolism. 4. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB). 1. Because primary hypertension has no identifiable cause, treatment is based on interfering with the physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because they: 1. Increase renin secretion 2. Decrease the production of aldosterone 3. Deplete body sodium and reduce fluid volume 4. Decrease blood viscosity 2. Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also need to receive the following supplement: 1. Potassium 2. Calcium 3. Magnesium 4. Phosphates 3. All patients with hypertension benefit from diuretic therapy, but those who benefit the most are: 1. Those with orthostatic hypertension 2. African Americans 3. Those with stable angina 4. Diabetics 10. If not chosen as the first drug in hypertension treatment, which drug class should be added as a second step because it will enhance the effects of most other agents? 1. ACE inhibitors 2. Beta blockers 3. Calcium channel blockers 4. Diuretics 16. Which diuretic agents typically do not need potassium supplementation? 1. The loop diuretics 2. The thiazide diuretics 3. The aldosterone inhibitors 4. They all need supplementation 19. What educational points concerning fluid intake must be covered with diuretic prescriptions? 1. Fluid should be restricted when on them. 2. Fluids should contain at least one salty item daily. 3. Fluid intake should remain near normal for optimal performance. 4. Avoidance of potassium-rich fluids is encouraged. Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank TB-9. Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be: 1. Increase her dose 2. Assess for suicidal ideation 3. Discontinue the medication immediately Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Decrease her dose to half then slowly titrate up the dose 11. Monitoring of a patient on gabapentin to treat seizures includes: 1. Routine therapeutic drug levels every 3 to 4 months 2. Assessing for dermatologic reactions, including Steven’s Johnson 3. Routine serum electrolytes, especially in hot weather 4. Recording seizure frequency, duration, and severity 29. Drugs used to treat diabetic peripheral neuropathy include: 1. Metoclopramide 2. Cholinergic agonists 3. Cardioselective beta blockers 4. Gabapentin GERD 7. Jim presents with complaints of “heartburn” that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be: 1. Omeprazole (Prilosec) twice a day 2. Ranitidine (Zantac) twice a day 3. Famotidine (Pepcid) once a day 4. Metoclopramide (Reglan) four times a day 9. Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for: 1. Megaloblastic anemia 2. Osteoporosis 3. Hypertension 4. Strokes 1. Gastroesophageal reflux disease may be aggravated by the following medication that affects lower esophageal sphincter (LES) tone: 1. Calcium carbonate 2. Estrogen 3. Furosemide 4. Metoclopramide 2. Lifestyle changes are the first step in treatment of gastroesophageal reflux disease (GERD). Food or drink that may aggravate GERD include: 1. Eggs 2. Caffeine 3. Chocolate 4. Soda pop 3. Metoclopramide improves gastroesophageal reflux disease symptoms by: 1. Reducing acid secretion 2. Increasing gastric pH 3. Increasing lower esophageal tone Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Decreasing lower esophageal tone 4. Antacids treat gastroesophageal reflux disease by: 1. Increasing lower esophageal tone 2. Increasing gastric pH 3. Inhibiting gastric acid secretion 4. Increasing serum calcium level Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 12. Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic control. Advantages of these drugs include: 1. Better reduction in glucose levels than other classes 2. Less weight gain than sulfonylureas 3. Low risk for hypoglycemia 4. Can be given twice daily Heart failure 10. Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the: 1. Symptoms are severe 2. Patient has not responded to other therapies 3. Patient has concurrent hypertension 4. Left ventricular dysfunction is diagnosed 14. Combined alpha-beta antagonists are used to reduce the progression of heart failure because they: 1. Vasodilate the peripheral vasculature 2. Decrease cardiac output 3. Increase renal vascular resistance 4. Reduce atherosclerosis secondary to elevated serum lipoproteins 12. Larry has heart failure, which is being treated with digoxin because it exhibits: 1. Negative inotropism 2. Positive chronotropism 3. Both 1 and 2 4. Neither 1 nor 2 13. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring for this combination includes: 1. Hemoglobin 2. Serum potassium 3. Blood urea nitrogen 4. Serum glucose 16. Rodrigo has been prescribed procainamide after a myocardial infarction. He is monitored for dyspnea, jugular venous distention, and peripheral edema because they may indicate: 1. Widening of the area of infarction 2. Onset of congestive heart failure 3. An electrolyte imbalance involving potassium 4. Renal dysfunction 8. Nitrates are especially helpful for patients with angina who also have: Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 1. Heart failure 2. Hypertension 3. Both 1 and 2 4. Neither 1 nor 2 Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 1. Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors? 1. Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently. 2. Reduced formation of cross-bridges so that contractile force decreases. 3. Activation of the sympathetic nervous system that increases heart rate and preload. 4. Decreased renal blood flow that decreases oxygen supply to the kidneys. 2. One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include: 1. Myocardial ischemia and injury secondary to myocardial infarction 2. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction 3. Increased demands of the heart beyond its ability to adapt secondary to anemia 4. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension 3. The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as stage: 1. A 2. B 3. C 4. D 4. Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is: 1. Chest x-rays that show cephalization and measure heart size 2. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction 3. Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate staging for end-organ damage 4. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction 5. Treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with: 1. Drugs for hypertension and hyperlipidemia, if they exist 2. Lifestyle management including diet, exercise, and smoking cessation only 3. Angiotensin-converting enzyme (ACE) inhibitors to directly affect the heart failure only 4. No drugs are used in this early stage 6. Class I recommendations for stage A heart failure include: 1. Aerobic exercise within tolerance levels to prevent the development of heart failure 2. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention 3. Beta blockers for all patients regardless of cardiac history 4. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias 7. Stage B patients should have beta blockers added to their heart failure treatment regimen when: 1. They have an ejection fraction less than 40% 2. They have had a recent MI 3. Both 1 and 2 4. Neither 1 nor 2 8. Increased life expectancy for patients with heart failure has been associated with the use of: 1. ACE inhibitors, especially when started early in the disease process Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Retapamulin (Altabax) 4. Oral cephalexin (Keflex) 11. The most cost-effective treatment for two or three impetigo lesions on the face is: 1. Mupirocin ointment 2. Retapamulin (Altabax) ointment Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Topical clindamycin solution 4. Oral amoxicillin/clavulanate (Augmentin) Inhaled beta-agonist/inhaled corticosteroids 3. Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all? 1. Betamethasone, an inhaled corticosteroid 2. Salmeterol, an inhaled long-acting beta-agonist 3. Albuterol, a short-acting beta-agonist 4. Montelukast, a leukotriene modifier 12. The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include: 1. Albuterol 2. MMR vaccine 3. Insulin 4. None of the above 13. When educating patients who are starting on inhaled corticosteroids, the provider should tell them that: 1. They need to get any live vaccines before starting the medication. 2. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective. 3. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush. 4. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids. 6. The first-line therapy for mild-persistent asthma is: 1. High-dose montelukast 2. Theophylline 3. Low-dose inhaled corticosteroids 4. Long-acting beta-2-agonists 8. Asthma exacerbations at home are managed by the patient by: 1. Increasing frequency of beta-2-agonists and contacting their provider 2. Doubling inhaled corticosteroid doses 3. Increasing frequency of beta-2-agonists 4. Starting montelukast (Singulair) 10. Pregnant patients with asthma may safely use throughout their pregnancy. 1. Oral terbutaline 2. Prednisone 3. Inhaled corticosteroids (budesonide) 4. Montelukast (Singulair) 12. Medications used in the management of patients with chronic obstructive pulmonary disease (COPD) include: 1. Inhaled beta-2-agonists 2. Inhaled anticholinergics (ipratropium) 3. Inhaled corticosteroids 4. All of the above Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 13. Patients with a COPD exacerbation may require: 1. Doubling of inhaled corticosteroid dose 2. Systemic corticosteroid burst 3. Continuous inhaled beta-2-agonists 4. Leukotriene therapy Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Breastfed infants should receive iron supplementation of: 1. 3 mg/kg per day 2. 6 mg/kg per day 3. 1 mg/kg per day 4. Breastfed babies do not need iron supplementation 4. Valerie presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia would be: 1. 18 mg/day of iron supplementation 2. 6 mg/kg per day of iron supplementation 3. 325 mg ferrous sulfate per day 4. 325 mg ferrous sulfate tid 5. Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be: 1. 18 mg/day of iron supplementation 2. 6 mg/kg per day of elemental iron 3. 325 mg ferrous sulfate per day 4. 325 mg ferrous sulfate tid 6. Monitoring for a patient taking iron to treat iron deficiency anemia is: 1. Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started 2. Complete blood count every 4 weeks throughout treatment 3. Annual complete blood count 4. Reticulocyte count in 4 weeks 7. Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include: 1. Take the iron with milk if it upsets her stomach. 2. Antacids may help with the nausea and GI upset caused by iron. 3. Increase fluids and fiber to treat constipation. 4. Iron is best tolerated if it is taken at the same time as her other medications. Loading dose 6. 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. Rapidly achieves drug levels in the therapeutic range 2. Requires four- to five-half-lives to attain 3. Is influenced by renal function 4. Is directly related to the drug circulating to the target tissues Long term antifungals 24. Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: 1. Platelet count 2. BUN and creatinine 3. White blood cell count 4. AST, ALT, alkaline phosphatase, and bilirubin Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank Metformin 12. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: 1. Substitutes for insulin usually secreted by the pancreas 2. Decreases glycogenolysis by the liver Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Increases the release of insulin from beta cells 4. Decreases peripheral glucose utilization 13. Prior to prescribing metformin, the provider should: 1. Draw a serum creatinine to assess renal function 2. Try the patient on insulin 3. Tell the patient to increase iodine intake 4. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions 15. Sitagliptin has been approved for: 1. Monotherapy in once-daily doses 2. Combination therapy with metformin 3. Both 1 and 2 4. Neither 1 nor 2 9. The drug of choice for type 2 diabetics is metformin. Metformin: 1. Decreases glycogenolysis by the liver 2. Increases the release of insulin from beta cells 3. Increases intestinal uptake of glucose 4. Prevents weight gain associated with hyperglycemia 10. Before prescribing metformin, the provider should: 1. Draw a serum creatinine level to assess renal function. 2. Try the patient on insulin. 3. Prescribe a thyroid preparation if the patient needs to lose weight. 4. All of the above 11. Sulfonylureas may be added to a treatment regimen for type 2 diabetics when lifestyle modifications and etformin are insufficient to achieve target glucose levels. Sulfonylureas have been moved to Step 2 therapy because they: 1. Increase endogenous insulin secretion 2. Have a significant risk for hypoglycemia 3. Address the insulin resistance found in type 2 diabetics 4. Improve insulin binding to receptors 19. The drugs recommended by the American Academy of Pediatrics for use in children with diabetes (depending upon type of diabetes) are: 1. Metformin and insulin 2. Sulfonylureas and insulin glargine 3. Split-mixed dose insulin and GPL-1 agonists 4. Biguanides and insulin lispro 22. Ethnic groups differ in their risk for and presentation of diabetes. Hispanics: 1. Have a high incidence of obesity, elevated triglycerides, and hypertension 2. Do best with drugs that foster weight loss, such as metformin 3. Both 1 and 2 4. Neither 1 nor 2 33. Bart is a patient is a 67-year-old male with T2 DM. He is on glipizide and metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you Bart does not follow his meal plan or exercise regularly, and hasn’t checked his BG for 1 week. A random glucose is Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 16. Tuberculin purified protein derivative: 1. Is administered to patients who are known tuberculin-positive reactors 2. May be administered to patients who are on immunosuppressives 3. May be administered 2 to 3 weeks after an MMR or varicella vaccine 4. May be administered the same day as the MMR and/or varicella vaccine Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank Nicotine gum 27. Nicotine gum products are: 1. Chewed to release the nicotine and then swallowed for a systemic effect 2. “Parked” in the buccal area of the mouth to produce a constant amount of nicotine release 3. Bound to exchange resins so the nicotine is only released during chewing 4. Approximately the same in nicotine content as smoking two cigarettes 5. Instructions for the use of nicotine gum include: 1. Chew the gum quickly to get a peak effect. 2. The gum should be “parked” in the buccal space between chewing. 3. Acidic drinks such as coffee help with the absorption of the nicotine. 4. The highest abstinence rates occur if the patient chews the gum when he or she is having cravings. Nonadherence 14. Lack of adherence to blood pressure management is very common. Reasons for this lack of adherence include: 1. Lifestyle changes are difficult to achieve and maintain. 2. Adverse drug reactions are common and often fall into the categories more associated with nonadherence. 3. Costs of drugs and monitoring with laboratory tests can be expensive. 4. All of the above 8. 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. Religious differences: A patient’s belief system that is not congruent with the treatment regimen presents high risk for nonadherence 9. 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 3. Be the least concentrated form of the medication 4. Be administered 3 or 4 times a day Opiates 4. Narcotics are exogenous opiates. They act by: 1. Inhibiting pain transmission in the spinal cord 2. Attaching to receptors in the afferent neuron to inhibit the release of substance P 3. Blocking neurotransmitters in the midbrain 4. Increasing beta-lipoprotein excretion from the pituitary gland 8. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? 1. All opiates are scheduled drugs which require a DEA license to prescribe. 2. Opiates stimulate only mu receptors for the control of pain. 3. Most of the adverse effects of opiates are related to mu receptor stimulation. Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Naloxone is an antagonist to opiates. 9. If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use? 1. NSAIDs, opiates, corticosteroids 2. Low-dose opiates, salicylates, increased dose of opiates Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. 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. Peak drug level 8. Phenytoin requires that a trough level be drawn. Peak and trough levels are done: 1. When the drug has a wide therapeutic range 2. When the drug will be administered for a short time only 3. When there is a high correlation between the dose and saturation of receptor sites 4. To determine if a drug is in the therapeutic range 9. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: 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 Pharmaceuticals for children act 2. The Best Pharmaceuticals for Children Act: 1. Includes a pediatric exclusivity rule which extends the patent on drugs studied in children 2. Establishes a committee that writes guidelines for pediatric prescribing 3. Provides funding for new drug development aimed at children 4. Encourages manufacturers specifically to develop pediatric formulations Pharmacoeconomics 1. Pharmacoeconomics is: 1. The study of the part of the U.S. economy devoted to drug use 2. The study of the impact of prescription drug costs on the overall economy 3. The analysis of the costs and consequences of any health-care-related treatment or service 4. The analysis of the clinical efficacy of the drug Pharmacokinetics in men and women 3. A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women? 1. Body temperature varies between men and women. 2. Muscle mass is greater in women. 3. Percentage of fat differs between genders. 4. Proven subjective factors exist between the genders. 4. Gender differences between men and women in pharmacokinetics include: 1. More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites 2. Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution 3. Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Slower organ blood flow rates so drugs tend to take longer to be excreted 15. Which of the following holds true for the pharmacokinetics of women? 1. Gastric emptying is faster than that of men. 2. Organ blood flow is the same as that of men. 3. Evidence is strong concerning renal differences in elimination. Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Medications that involve binding globulins are impacted by estrogen levels. Phosphodiesterase type 5 7. When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra) patients should be screened for use of: 1. Statins 2. Nitrates 3. Insulin 4. Opioids 8. 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 9. Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include: 1. Diabetics 2. Those who have had an acute myocardial infarction in the past 6 months 3. Patients who are deaf 4. Patients under age 60 years of age 10. Monitoring of male patients who are using phosphodiesterase type 5 (PDE-5) inhibitors includes: 1. Serum fasting glucose levels 2. Cholesterol and lipid levels 3. Blood pressure 4. Complete blood count Poor health outcomes in vulnerable populations Prescribing 3. Clinical judgment in prescribing includes: 1. Factoring in the cost to the patient of the medication prescribed 2. Always prescribing the newest medication available for the disease process 3. Handing out drug samples to poor patients 4. Prescribing all generic medications to cut costs 4. Criteria for choosing an effective drug for a disorder include: 1. Asking the patient what drug they think would work best for them 2. Consulting nationally recognized guidelines for disease management 3. Prescribing medications that are available as samples before writing a prescription 4. Following U.S. Drug Enforcement Administration guidelines for prescribing 1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Regulated by the Drug Enforcement Administration 8. Precautions that should be taken when prescribing controlled substances include: 1. Faxing the prescription for a Schedule II drug directly to the pharmacy 2. Using tamper-proof paper for all prescriptions written for controlled drugs Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Keeping any pre-signed prescription pads in a locked drawer in the clinic 4. Using only numbers to indicate the amount of drug to be prescribed 9. Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy lists: 1. Increases the complexity of the Pharmacoeconomics of prescribing for the individual patient 2. Increases compliance by reducing the financial burden of drug costs to the patient 3. Is not sound prescribing practice due to the inferiority of the generic products 4. Will increase the overall cost of drugs to the system due to the ease of overprescribing less-expensive drugs Prescriptive authority 1. Nurse practitioner prescriptive authority is regulated by: 1. The National Council of State Boards of Nursing 2. The U.S. Drug Enforcement Administration 3. The State Board of Nursing for each state 4. The State Board of Pharmacy PUD with H. pylori 11. An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is: 1. Histamine2 receptor antagonists for 4 to 8 weeks 2. Proton pump inhibitor bid for 12 weeks until healing is complete 3. Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days 4. Proton pump inhibitor bid and levofloxacin for 14 days 12. Treatment failure in patients with peptic ulcer disease associated with H. pylori may be because of: 1. Antimicrobial resistance 2. An ineffective antacid 3. Overuse of proton pump inhibitors 4. All of the above 13. If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is: 1. Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days 2. Test H. pylori for resistance to common treatment regimens 3. Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days 4. Proton pump inhibitor and levofloxacin for 14 days 14. After H. pylori treatment is completed, the next step in peptic ulcer disease therapy is: 1. Testing for H. pylori eradication with a serum ELISA test 2. Endoscopy by a specialist 3. A proton pump inhibitor for 8 to 12 weeks until healing is complete 4. All of the above Ringworm treatment 6. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank foot) would be: 1. OTC topical azole (clotrimazole, miconazole) 2. Oral terbinafine 3. Oral griseofulvin microsize 4. Nystatin cream or ointment Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 1. Discontinue the statin and change to a fibric acid derivative. 2. Discontinue the statin and change to ezetimibe. 3. Continue the statin and add in ezetimibe. 4. Refer him to a specialist in managing patients with recalcitrant hyperlipidemia. 12. Before starting therapy with a statin, the following baseline laboratory values should be evaluated: 1. Complete blood count 2. Liver function (ALT/AST) and creatine kinase 3. C-reactive protein 4. All of the above 13. When starting a patient on a statin, education would include: 1. If they stop the medication their lipid levels will return to pretreatment levels. 2. Medication is a supplement to diet therapy and exercise. 3. If they have any muscle aches or pain, they should contact their provider. 4. All of the above 14. Omega 3 fatty acids are best used to help treat: 1. High HDL 2. Low LDL 3. High triglycerides 4. Any high lipid value 15. When are statins traditionally ordered to be taken? 1. At bedtime 2. At noon 3. At breakfast 4. With the evening meal 16. Which the following persons should not have a statin medication ordered? 1. Someone with 3 first- or second-degree family members with history of muscle issues when started on statins 2. Someone with high lipids, but low BMI 3. Premenopausal woman with recent history of hysterectomy 4. Prediabetic male with known metabolic syndrome 17. Fiber supplements are great options for elderly patients who have the concurrent problem of: 1. End-stage renal failure on fluid restriction 2. Recurrent episodes of diarrhea several times a day 3. Long-term issues of constipation 4. Needing to take multiple medications around the clock every 2 hours 18. What is considered the order of statin strength from lowest effect to highest? 1. Lovastatin, Simvastatin, Rosuvastatin 2. Rosuvastatin, Lovastatin, Atorvastatin Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Atorvastatin, Rosuvastatin, Simvastatin 4. Simvastatin, Atorvastatin, Lovastatin Syphyllis 2. The drug of choice for treatment of primary or secondary syphilis is: 1. Ceftriaxone IM 2. Benzathine penicillin G IM Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 3. Oral azithromycin 4. Oral ciprofloxacin 3. The drug of choice for treatment of early latent or tertiary syphilis is: 1. Ceftriaxone IM 2. Benzathine penicillin G IM 3. Oral azithromycin 4. Oral ciprofloxacin 4. Demione is a 24-year-old patient who is 32 weeks pregnant and has tested positive for syphilis. The best treatment for her would be: 1. IM ceftriaxone 2. IM benzathine penicillin G 3. Oral azithromycin 4. Any of the above 10. Jamie was treated for chancroid. Follow-up testing after treatment of chancroid would be: 1. Syphilis and HIV testing at 3-month intervals 2. Chancroid-specific antigen test every 3 months 3. Urine testing for Haemophilus ducreyi in 3 to 6 months for test of cure 4. Annual HIV testing if engaging in high-risk sexual behavior Tamoxifen 19. What is the duration of SERM use for menopausal issues? 1. It matches the 5 years for estrogen products 2. The bone health impact allows long-term use 3. The increased risk of breast cancer encourages tapering as soon as possible 4. The abnormal lipid profile contributes to an early termination as soon as hot flashes no longer occur 20. Why are SERMS generally not ordered for women early into menopause? 1. The rapid onset of severe hot flashes can be unbearable. 2. The bone remodeling effect results in osteoporosis. 3. They tend to induce intermittent spotting. 4. They create more risk with breast cancer than they are worth. Testosterone replacement 1. Men who use transdermal testosterone gel (AndroGel) should be advised to avoid: 1. Washing their hands after applying the gel 2. Wearing occlusive clothing while using the gel 3. Exposure to estrogens while using the gel 4. Skin-to-skin contact with pregnant women while using the gel 21. Long-term use of androgens requires specific laboratory monitoring of: 1. Glucose, calcium, testosterone, and thyroid function Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 2. Development of significant diarrhea 3. Risk of kernicterus 4. Adverse effects on bone growth 13. If a patient with H. pylori-positive peptic ulcer disease fails first-line therapy, the second-line treatment is: 1. Proton pump inhibitor bid plus metronidazole plus tetracycline plus bismuth subsalicylate for 14 days Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 2. Test H. pylori for resistance to common treatment regimens 3. Proton pump inhibitor plus clarithromycin plus amoxicillin for 14 days 4. Proton pump inhibitor and levofloxacin for 14 days TSH 1. The nurse is teaching the patient, newly diagnosed with Gravess disease, about the normal functioning of the thyroid gland. What hormone will the nurse tell the patient controls production and release of thyroid hormones? A) Thyrotropin-releasing hormone (TRH) B) Thyroid-stimulating hormone (TSH) C) Tetraiodothyronine D) Triiodothyronine 16. A patient is diagnosed with a simple goiter and asks the nurse what caused it. What is the nurses best response? A) A goiter is the result of too much thyroxine. B) A goiter is the result of a chloride deficiency. C) A goiter is the result of too much TSH. D) A goiter is the result of an iodine deficiency. 17. The patient with hypothyroidism takes levothyroxine daily and has triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) levels drawn in the laboratory to check appropriateness of prescribed dosage. What results would the nurse analyze as indicating the need for a higher dosage of medication? A) Elevated TSH, elevated T3, and reduced T4 levels B) Reduced TSH, elevated T3 and T4 levels C) Elevated TSH, reduced T3 and T4 levels D) Reduced TSH, T3, and T4 levels 3. After starting a patient with Grave’s disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every: 1. 1 to 2 weeks 2. 3 to 4 weeks 3. 2 to 3 months 4. 6 to 9 months 7. Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every: 1. 2 weeks 2. 4 weeks 3. 2 months 4. 6 months 14. Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true? 1. Screening TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to remain above 5.0. Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 2. Screening values are much narrower than the acceptable range used to keep a person stable on hormone replacement. 3. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10. 4. Screening values are between 5 and 10, and therapeutic values are greater than 10. Tuberculosis Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank a. Adding pyrazinamide b. Changing to ethambutol c. Increasing oral fluid intake d. Taking pyridoxine (B6) 8. The nurse is teaching a patient about rifampin. Which statement by the patient indicates understanding of the teaching? a. I should not wear soft contact lenses while taking rifampin. b. I will need regular eye examinations while taking this drug. c. I will report orange urine to my provider immediately. d. I understand that renal toxicity is a common adverse effect. ANS: A 9. A patient who has completed the first phase of a three-drug regimen for tuberculosis has a positive sputum acid- bacilli test. The nurse will tell the patient that a. drug resistance has probably occurred. b. it may be another month before this test is negative. c. the provider will change the pyrazinamide to ethambutol. d. there may be a need to remain in the first phase of therapy for several weeks. ANS: B 12. A patient will begin taking streptomycin as part of the medication regimen to treat tuberculosis. Before administering this medication, the nurse will review which laboratory values in the patients medical record? a. Complete blood count (CBC) with differential white cell count b. Blood urea nitrogen (BUN) and creatinine c. Potassium and magnesium levels d. Serum fasting glucose 1. A client is being treated for tuberculosis. Which medications are used to treat this condition? (Select all that apply.) a. Streptomycin sulfate b. Amoxicillin (Amoxil) c. Ethambutol (Myambutol) d. Gentamicin (Garamycin) e. Rifabutin (Mycobutin) f. Ethionamide (Trecator-SC) g. Pyrazinamide 1. Drug resistant tuberculosis (TB) is defined as TB that is resistant to: 1. Fluoroquinolones 2. Rifampin and isoniazid 3. Amoxicillin 4. Ceftriaxone Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 2. Goals when treating tuberculosis include: 1. Completion of recommended therapy 2. Negative purified protein derivative at the end of therapy 3. Completely normal chest x-ray 4. All of the above 3. The principles of drug therapy for the treatment of tuberculosis include: Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 1. Patients are treated with a drug to which M. tuberculosis is sensitive. 2. Drugs need to be taken on a regular basis for a sufficient amount of time. 3. Treatment continues until the patient’s purified protein derivative is negative. 4. All of the above 4. Isabella has confirmed tuberculosis and is placed on a 6-month treatment regimen. The 6-month regimen consists of: 1. Two months of four-drug therapy (INH, rifampin, pyrazinamide, and ethambutol) followed by Four months of INH and rifampin 2. Six months of INH with daily pyridoxine throughout therapy 3. Six months of INH, rifampin, pyrazinamide, and ethambutol 4. Any of the above 5. Kaleb has extensively resistant tuberculosis (TB). Treatment for extensively resistant TB would include: 1. INH, rifampin, pyrazinamide, and ethambutol for at least 12 months 2. INH, ethambutol, kanamycin, and rifampin 3. Treatment with at least two drugs to which the TB is susceptible 4. Levofloxacin 6. Lila is 24 weeks pregnant and has been diagnosed with tuberculosis (TB). Treatment regimens for a pregnant patient with TB would include: 1. Streptomycin 2. Levofloxacin 3. Kanamycin 4. Pyridoxine 7. Bilal is a 5-year-old patient who has been diagnosed with tuberculosis. His treatment would include: 1. Pyridoxine 2. Ethambutol 3. Levofloxacin 4. Rifabutin 8. Ezekiel is a 9-year-old patient who lives in a household with a family member newly diagnosed with tuberculosis (TB). To prevent Ezekiel from developing TB he should be treated with: 1. 6 months of Isoniazid (INH) and rifampin 2. 2 months of INH, rifampin, pyrazinamide, and ethambutol, followed by 4 months of INH 3. 9 months of INH 4. 12 months of INH 9. Leonard is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes: 1. Monthly sputum cultures 2. Monthly chest x-ray 3. Bronchoscopy every 3 months 4. All of the above URI in children 21. The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-year-old child is: Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Ciprofloxacin 5. Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection? 1. Juanita, a 28-year-old pregnant woman 2. Sally, a 16-year-old healthy adolescent 3. Jamie, a 24-year-old female Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 4. Suzie, a 26-year-old diabetic 6. Nicole is a 4-year-old female with a febrile urinary tract infection (UTI). She is generally healthy and has no drug allergies. Appropriate initial therapy for her UTI would be: 1. Azithromycin 2. Trimethoprim/sulfamethoxazole 3. Ceftriaxone 4. Ciprofloxacin 7. Monitoring for a healthy, nonpregnant adult patient being treated for a urinary tract infection is: 1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. “Test of cure” urinary analysis at completion of therapy 4. Follow-up urine culture 2 months after completion of therapy 8. Monitoring for a child who has had a urinary tract infection is: 1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. “Test of cure” urinary analysis at completion of therapy 4. Follow-up urine culture 2 months after completion of therapy 9. Monitoring for a pregnant woman who has had a urinary tract infection is: 1. Symptom resolution in 48 hours 2. Follow-up urine culture at completion of therapy 3. “Test of cure” urinary analysis at completion of therapy 4. Follow-up urine culture every 2 weeks until delivery 10. Along with an antibiotic prescription, lifestyle education for a nonpregnant adult female who has had a urinary tract infection includes: 1. Increasing her intake of vitamin C-containing orange juice 2. Voiding 10 to 15 minutes after intercourse 3. Avoiding ingesting urinary irritants, such as asparagus 4. All of the above 11. Lisa is a healthy nonpregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be: 1. Sixteen ounces per day of cranberry juice cocktail will prevent UTIs. 2. 100% cranberry juice or cranberry juice extract may decrease UTIs in some patients. 3. There is no evidence that cranberry juice helps prevent UTIs. 4. Cranberry juice only works to prevent UTIs in children. Vit B12 20. Vitamin B12 deficiency may lead to: 1. Hair loss Pharmacotherapeutics For Advanced Practice Nurse Prescribers: 4th Edition – TestBank 2. Insomnia 3. Dry scales on the scalp 4. Numbness and tingling of the hands 20. Patients with pernicious anemia require treatment with: 1. Iron 2. Folic acid