Pharmacotherapeutics for Advanced Practice Nurse Prescribers: Questions and Answers, Exams of Pharmacology

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Pharmacotherapeutics for Advanced Practice

Nurse Prescribers Questions and Answers.

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 answer 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 answer 1 Drugs that are prone to cause adverse drug effects include:
9. Diuretics
10. Inhaled anticholinergics
11. Insulins
12. Stimulants - Correct answer 3 The U.S. Food and Drug Administration MedWatch system is activated when:
13. There is an adverse event to a vaccine.

2. The patient has a severe reaction that is noted in the "Severe Reaction" section in the medication label.
3. A lactating woman takes a medication that is potentially toxic to the breastfeeding infant.
4. An adverse event or serious problem occurs with a medication that is not already identified on the label. - Correct answer 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 answer 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
10. Mobility
11. Social support
12. Sexual practices - Correct answer 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?

3. Increasing the number of people who have access to care
4. Treating a wider range of disorders - Correct answer 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.
7. Ralph consistently keeps his follow-up appointments to check his blood pressure.
8. All of the above show that he is adherent to the drug regimen. - Correct answer 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:
9. Has a short half-life so that missing one dose has limited effect
10. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down
11. Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as nausea and dizziness
12. Must be taken no more than twice a day - Correct answer 3 Factors in chronic conditions that contribute to nonadherence include:
13. The complexity of the treatment regimen
14. 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 answer 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 answer 2 Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:
9. With a longer half-life so that missed doses produce a longer taper on the drug curve
10. In oral formulations that are more easily taken
11. That do not require frequent monitoring
12. Combined with patient education about the need to adhere even when symptoms are absent - Correct answer 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?
13. Have the patient purchase a pill container with compartments for daily or multiple times-per-day dosing.
14. Match the clinic appointment to the next time the drug is to be refilled.

1. Social
2. Financial
3. Health system
4. All of the above - Correct answer 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 answer 4 Ethnic differences have been found in drug:
9. Absorption
10. Hepatic metabolism
11. Filtration at the glomerulus
12. Passive tubular reabsorption - Correct answer 2 The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all:
13. Hospitals
14. Clinics that serve the poor
15. Organizations that receive federal funds
16. Clinics that serve ethnic minorities - Correct answer 3

According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care:

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 answer 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 answer 4 The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:
9. Increased CYP 2D6 activity, leading to rapid metabolism of some drugs
10. Largely unknown due to lack of studies of this population
11. Rapid metabolism of alcohol, leading to increased tolerance
12. Decreased elimination of opioids, leading to increased risk for addiction - Correct answer 2 Pharmacokinetics among Asians are universal to all the Asian ethnic groups.
13. True

1. Poor metabolizers, who lack a working enzyme
2. Intermediate metabolizers, who have one working, wild-type allele and one mutant allele
3. Extensive metabolizers, with two normally functioning alleles
4. All of the above - Correct answer 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 answer 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
11. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure
12. Cause nonspecific changes in drug metabolism - Correct answer 3 Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
13. Decreased therapeutic levels of quinidine
14. Increased therapeutic levels of quinidine

3. Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination
4. Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination - Correct answer 4 Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
5. Toxic levels of warfarin building up
6. Decreased response to warfarin
7. Increased risk for significant drug interactions with warfarin
8. Less risk of drug interactions with warfarin - Correct answer 2 Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.
9. True
10. False - Correct answer 2 Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:
11. Erythromycin
12. Digoxin
13. Cetuximab
14. Rifampin - Correct answer 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:

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 answer 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
7. Reduce the likelihood of therapeutic failure with tamoxifen treatment
8. Identify poor metabolizers of tamoxifen - Correct answer 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.
9. 10
10. 5
11. 38
12. 70 - Correct answer 3 A potential harmful effect on patients who take some herbal medication is:
13. Constipation
14. Lead poisoning
15. Diarrhea

4. Life-threatening rash - Correct answer 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 answer 2 Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe:
9. Herbs which are yang in nature
10. Herbs that are yin in nature
11. Ginger
12. Golden seal - Correct answer 2 According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient's illness will:
13. Get worse
14. Get better
15. Not be adequately treated
16. Need additional herbs to treat the yan - Correct answer 1

The standard dosage of St John's wort for the treatment of mild depression is:

1. 300 mg daily
2. 100 mg three times a day
3. 300 mg three times a day
4. 600 mg three times a day - Correct answer 3 Patients need to be instructed regarding the drug interactions with St John's wort, including:
5. MAO inhibitors
6. Serotonin reuptake inhibitors
7. Over-the-counter cough and cold medications
8. All of the above - Correct answer 4 Ginseng, which is taken to assist with memory, may potentiate:
9. Aricept
10. Insulin
11. Digoxin
12. Propranolol - Correct answer 2 Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include:
13. Antihypertensives, diuretics, and digoxin
14. Antidiarrheals, antihistamines, and omeprazole

3. Penicillin antibiotic class and benzodiazepines
4. None of the above - Correct answer 1 Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to:
5. Respiratory depression
6. Cardiac disturbance
7. Salicylates poisoning
8. Life-threatening rashes - Correct answer 3 The role of the NP in the use of herbal medication is to:
9. Maintain competence in the prescribing of common herbal remedies
10. Recommend common over-the-counter herbs to patients
11. Educate patients and guide them to appropriate sources of care
12. Encourage patients to not use herbal therapy due to the documented dangers - Correct answer 3 Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to:
13. Search for information using the most common search engines
14. Serve as content experts in developing, implementing, and evaluating information systems
15. Write programs to assure the integrity of health information
16. Use information technology to prescribe drugs - Correct answer 2

2. Allow for all patient data to be centralized in one location for access by multiple providers
3. Use macros and templates to individualize care
4. Use standardized software to facilitate interoperability between systems - Correct answer 2 Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include:
5. Designing software so that only those who need the information can gain access
6. Requiring providers to log off at the end of the clinical day
7. Keeping a file of the login and password information for each provider in a secure place
8. Having patients sign informed consent documents to have their data on an EHR - Correct answer 1 Decision support systems often provide medication alerts that tell the prescriber:
9. Patient history data with a summary of their diagnoses
10. The usual dosage for the drug being prescribed
11. The patient's latest laboratory values, such as potassium levels
12. Potential drug-to-drug interactions with other medications the patient is taking - Correct answer 4 Prescribers have been shown to override a medication alert about a patient's allergies when:

1. The history showed that the patient had tolerated the medication in the past
2. The benefit outweighed the risk
3. The medication was therapeutically appropriate and needed
4. All of the above - Correct answer 4 The use of information technology for quality improvement in pharmacotherapeutics includes:
5. Incorporating the use of "apps" into all patient encounters
6. Tracking data trends within the practice via the electronic health record database
7. Informing patients that they have access to their medication list via the Internet
8. Using macros for individualizing patient care management - Correct answer 2 The advantage of using information technology for patient education includes:
9. The ability to track the number of times you have given the patient the same instructions regarding their medication
10. Standardized and individualized patient education that is simultaneously recorded into the patient record
11. Easy access to private patient information specific to populations with a similar diagnosis
12. The ability to download and interpret patient information in multiple languages, easily and accurately - Correct answer 2 One barrier to use of the Internet for both prescribing and for patient teaching is: