Pharmacotherapeutics for Advanced Practice Nurse Prescribers Exams 2024-25, Exams of Nursing

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Practice Nurse Prescribers Exams 2024-

Drugs that use CYP 3A4 isoenzymes for metabolism may:

1. Induce the metabolism of another drug
2. Inhibit the metabolism of another drug
3. Both 1 and 2
4. Neither 1 nor 2 - Correct Answers ✅ 3 Medication agreements or "Pain Medication Contracts" are recommended to be used:
5. Universally for all prescribing for chronic pain
6. For patients who have repeated requests for pain medication
7. When you suspect a patient is exhibiting drug-seeking behavior
8. For patients with pain associated with malignancy - Correct Answers ✅ 1

Practice Nurse Prescribers Exams 2024-

Drugs that are prone to cause adverse drug effects include:

1. Diuretics
2. Inhaled anticholinergics
3. Insulins
4. Stimulants - Correct Answers ✅ 3 The U.S. Food and Drug Administration MedWatch system is activated when:
5. There is an adverse event to a vaccine.
6. The patient has a severe reaction that is noted in the "Severe Reaction" section in the medication label.
7. A lactating woman takes a medication that is potentially toxic to the breastfeeding infant.

Practice Nurse Prescribers Exams 2024-

4. An adverse event or serious problem occurs with a medication that is not already identified on the label. - Correct Answers ✅ 4 The Vaccine Adverse Events Reporting System is:
5. A mandatory reporting system for all health-care providers when they encounter an adverse vaccine event
6. A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events
7. Utilized to send out safety alerts regarding emerging vaccine safety issues
8. Activated when a vaccine has been proven to cause significant adverse effects - Correct Answers ✅ 2 A comprehensive assessment of a patient should be holistic when trying to determine competence in drug administration. Which of the following factors would the NP omit from this type of assessment?
9. Financial status

Practice Nurse Prescribers Exams 2024-

2. Mobility
3. Social support
4. Sexual practices - Correct Answers ✅ 4 Elena Vasquez's primary language is Spanish, and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed?
5. Use correct medical terminology because Spanish has a Latin base.
6. Use a family member who speaks more English to act as an interpreter.
7. Use a professional interpreter or a reliable staff member who can act as an interpreter.
8. Use careful, detailed explanations. - Correct Answers ✅ 3 Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug?

Practice Nurse Prescribers Exams 2024-

1. Stand facing him and speak slowly and clearly.
2. Speak in low tones or find a provider who has a lower voice.
3. Write down the instructions as well as speaking them.
4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. - Correct Answers ✅ 4 Which of the following factors may adversely affect a patient's adherence to a therapeutic drug regimen?
5. Complexity of the drug regimen
6. Patient perception of the potential adverse effects of the drugs
7. Both 1 and 2
8. Neither 1 nor 2 - Correct Answers ✅ 3

Practice Nurse Prescribers Exams 2024-

The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which of the following system variables creates such a barrier?

1. Increasing copayments for care
2. Unrestricted formularies for drugs, including brand names
3. Increasing the number of people who have access to care
4. Treating a wider range of disorders - Correct Answers ✅ 1 Ralph's blood pressure remains elevated despite increased doses of his drug. The NP is concerned that he might not be adhering to his treatment regimen. Which of the following events would suggest that he might not be adherent?
5. Ralph states that he always takes the drug "when I feel my pressure is going up."
6. Ralph contacts his NP to discuss the need to increase the dosage.

Practice Nurse Prescribers Exams 2024-

3. Ralph consistently keeps his follow-up appointments to check his blood pressure.
4. All of the above show that he is adherent to the drug regimen. - Correct Answers ✅ 1 Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that:
5. Has a short half-life so that missing one dose has limited effect
6. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down
7. Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as nausea and dizziness
8. Must be taken no more than twice a day - Correct Answers ✅ 3 Factors in chronic conditions that contribute to nonadherence include:

Practice Nurse Prescribers Exams 2024-

1. The complexity of the treatment regimen
2. The length of time over which it must be taken
3. Breaks in the usual daily routine, such as vacations and weekends
4. All of the above - Correct Answers ✅ 4 While patient education about their drugs is important, information alone does not necessarily lead to adherence to a drug regimen. Patients report greater adherence when:
5. The provider spent a lot of time discussing the drugs with them
6. Their concerns and specific area of knowledge deficit were addressed
7. They were given written material, such as pamphlets, about the drugs
8. The provider used appropriate medical and pharmacological terms - Correct Answers ✅ 2

Practice Nurse Prescribers Exams 2024-

Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:

1. With a longer half-life so that missed doses produce a longer taper on the drug curve
2. In oral formulations that are more easily taken
3. That do not require frequent monitoring
4. Combined with patient education about the need to adhere even when symptoms are absent - Correct Answers ✅ 1 Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less likely the patient will adhere to it. Which of the following interventions will NOT improve adherence?
5. Have the patient purchase a pill container with compartments for daily or multiple times-per-day dosing.
6. Match the clinic appointment to the next time the drug is to be refilled.

Practice Nurse Prescribers Exams 2024-

3. Write prescriptions for new drugs with shorter times between refills.
4. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug. - Correct Answers ✅ 4 Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:
5. Older adults and those on fixed incomes
6. Patients with chronic illnesses
7. Patients with copayments for drugs on their insurance
8. Patients on public assistance - Correct Answers ✅ 1 Providers have a responsibility for determining the best plan of care, but patients also have responsibilities. Patients the provider can be assured will carry through on these responsibilities include those who:
9. Are well-educated and affluent

Practice Nurse Prescribers Exams 2024-

2. Have chronic conditions
3. Self-monitor drug effects on their symptoms
4. None of the above guarantee adherence - Correct Answers ✅ 4 Monitoring adherence can take several forms, including:
5. Patient reports from data in a drug diary
6. Pill counts
7. Laboratory reports and other diagnostic markers
8. All of the above - Correct Answers ✅ 4 Factors that explain and predict medication adherence include:
9. Social

Practice Nurse Prescribers Exams 2024-

2. Financial
3. Health system
4. All of the above - Correct Answers ✅ 4 Cultural factors that must be taken into account when prescribing include(s):
5. Who the decision maker is in the family regarding health-care decisions
6. The patient's view of health and illness
7. Attitudes regarding the use of drugs to treat illness
8. All of the above - Correct Answers ✅ 4 Ethnic differences have been found in drug:
9. Absorption

Practice Nurse Prescribers Exams 2024-

2. Hepatic metabolism
3. Filtration at the glomerulus
4. Passive tubular reabsorption - Correct Answers ✅ 2 The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all:
5. Hospitals
6. Clinics that serve the poor
7. Organizations that receive federal funds
8. Clinics that serve ethnic minorities - Correct Answers ✅ 3 According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care:

Practice Nurse Prescribers Exams 2024-

1. May be a bilingual family member
2. May be a bilingual nurse or other health-care provider
3. Must be a professionally trained medical interpreter
4. Must be an employee of the organization - Correct Answers ✅ 3 According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:
5. The belief among African Americans that prayer is more powerful than drugs
6. Poor compliance on the part of the African American patient
7. The genetic predisposition for illness found among African Americans
8. Discrimination, cultural barriers, and lack of access to health care - Correct Answers ✅ 4

Practice Nurse Prescribers Exams 2024-

The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:

1. Increased CYP 2D6 activity, leading to rapid metabolism of some drugs
2. Largely unknown due to lack of studies of this population
3. Rapid metabolism of alcohol, leading to increased tolerance
4. Decreased elimination of opioids, leading to increased risk for addiction - Correct Answers ✅ 2 Pharmacokinetics among Asians are universal to all the Asian ethnic groups.
5. True
6. False - Correct Answers ✅ 2 Alterations in drug metabolism among Asians may lead to:

Practice Nurse Prescribers Exams 2024-

1. Slower metabolism of antidepressants, requiring lower doses
2. Faster metabolism of neuroleptics, requiring higher doses
3. Altered metabolism of omeprazole, requiring higher doses
4. Slower metabolism of alcohol, requiring higher doses - Correct Answers ✅ 1 Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:
5. Require acetylization in order to metabolize drugs
6. Are unable to tolerate higher doses of some drugs that require acetylization
7. May have a toxic reaction to drugs that require acetylization
8. Require higher doses of drugs metabolized by acetylization to achieve efficacy - Correct Answers ✅ 4

Practice Nurse Prescribers Exams 2024-

Hispanic native healers (curanderas):

1. Are not heavily utilized by Hispanics who immigrate to the United States
2. Use herbs and teas in their treatment of illness
3. Provide unsafe advice to Hispanics and should not be trusted
4. Need to be licensed in their home country in order to practice in the United States - Correct Answers ✅ 2 Genetic polymorphisms account for differences in metabolism, including:
5. Poor metabolizers, who lack a working enzyme
6. Intermediate metabolizers, who have one working, wild-type allele and one mutant allele
7. Extensive metabolizers, with two normally functioning alleles

Practice Nurse Prescribers Exams 2024-

4. All of the above - Correct Answers ✅ 4 Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
5. A need to monitor drugs metabolized by 2D6 for toxicity
6. Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors
7. Decreased conversion of codeine to morphine by CYP 2D
8. The need for lowered dosages of drugs, such as beta blockers - Correct Answers ✅ 2 Rifampin is a nonspecific CYP450 inducer that may:
9. Lead to toxic levels of rifampin and must be monitored closely
10. Cause toxic levels of drugs, such as oral contraceptives, when coadministered

Practice Nurse Prescribers Exams 2024-

3. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
4. Cause nonspecific changes in drug metabolism - Correct Answers ✅ 3 Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
5. Decreased therapeutic levels of quinidine
6. Increased therapeutic levels of quinidine
7. Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
8. Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination - Correct Answers ✅ 4 Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

Practice Nurse Prescribers Exams 2024-

1. Toxic levels of warfarin building up
2. Decreased response to warfarin
3. Increased risk for significant drug interactions with warfarin
4. Less risk of drug interactions with warfarin - Correct Answers ✅ 2 Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.
5. True
6. False - Correct Answers ✅ 2 Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:
7. Erythromycin
8. Digoxin

Practice Nurse Prescribers Exams 2024-25

3. Cetuximab
4. Rifampin - Correct Answers ✅ 3 Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to:
5. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele
6. Increased risk for drug interactions in Asian patients with the HLA- B*1502 allele
7. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele
8. Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine - Correct Answers ✅ 3 A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:

Practice Nurse Prescribers Exams 2024-25

1. Decreased effectiveness of irinotecan in the treatment of cancer
2. Increased adverse drug reactions, such as neutropenia
3. Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38
4. Increased concerns for irinotecan being carcinogenic - Correct Answers ✅ 2 Patients who have a poor metabolism phenotype will have:
5. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug
6. Accumulation of inactive metabolites of drugs
7. A need for increased dosages of medications
8. Increased elimination of an active drug - Correct Answers ✅ 1

Practice Nurse Prescribers Exams 2024-25

Ultra-rapid metabolizers of drugs may have:

1. To have dosages of drugs adjusted downward to prevent drug accumulation
2. Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic failure
3. Increased elimination of active, nonmetabolized drug
4. Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug - Correct Answers ✅ 2 A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:
5. Ensure the patient will not have increased adverse drug reactions to the tamoxifen
6. Identify potential drug-drug interactions that may occur with tamoxifen

Practice Nurse Prescribers Exams 2024-25

3. Reduce the likelihood of therapeutic failure with tamoxifen treatment
4. Identify poor metabolizers of tamoxifen - Correct Answers ✅ 3 A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products.
5. 10
6. 5
7. 38
8. 70 - Correct Answers ✅ 3 A potential harmful effect on patients who take some herbal medication is:
9. Constipation

Practice Nurse Prescribers Exams 2024-25

2. Lead poisoning
3. Diarrhea
4. Life-threatening rash - Correct Answers ✅ 2 A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains:
5. Coumadin, which may lead to bleeding problems
6. Coumarin, which can cause liver and kidney damage
7. Cinnamic aldehyde, which is toxic to the kidney
8. Cinnamate eugenol, which is toxic to the liver - Correct Answers ✅ 2