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Pharmacotherapeutics for Advanced Practice Nurse Prescribers , 5th edition Woo Robinson Test Bank

Chapter 1. The Role of the Nurse Practitioner as Prescriber

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Nurse practitioner prescriptive authority is regulated by:
   1. The National Council of State Boards of Nursing

The U.S. Drug Enforcement Administration

The State Board of Nursing for each state

4. The State Board of Pharmacy
5. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber

include:

Nurses know more about Pharmacology than other prescribers because they take it

both in their basic nursing program and in their APRN program.

Nurses care for the patient from a holistic approach and include the patient in

decision making regarding their care.

APRNs are less likely to prescribe narcotics and other controlled substances.

APRNs are able to prescribe independently in all states, whereas a physician’s

assistant needs to have a physician supervising their practice.

3. Clinical judgment in prescribing includes:

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

Prescribing all generic medications to cut costs

4. Criteria for choosing an effective drug for a disorder include:

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
5. Nurse practitioner practice may thrive under health-care reform because of:

The demonstrated ability of nurse practitioners to control costs and improve patient

outcomes

The fact that nurse practitioners will be able to practice independently

The fact that nurse practitioners will have full reimbursement under health-

care reform

The ability to shift accountability for Medicaid to the state level

Chapter 1. The Role of the Nurse Practitioner as Prescriber

Answer Section

MULTIPLE CHOICE

1. ANS: 3 PTS: 1

2. ANS: 2 PTS: 1

3. ANS: 1 PTS: 1

4. ANS: 2 PTS: 1

5. ANS: 1 PTS: 1

Chapter 2. Review of the Basic Principles of Pharmacology

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to

prescribing because:

Distribution of drugs to target tissue may be affected.

The solubility of the drug will not match the site of absorption.

There will be less free drug available to generate an effect.

4. Drugs bound to albumin are readily excreted by the kidneys.
5. Drugs that have a significant first-pass effect:
6. Must be given by the enteral (oral) route only

Bypass the hepatic circulation

Are rapidly metabolized by the liver and may have little if any desired action

Are converted by the liver to more active and fat-soluble forms

3. The route of excretion of a volatile drug will likely be the:
   1. Kidneys
   2. Lungs

Bile and feces

Skin

4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage

reservoir of the drug. Storage reservoirs:

1. Assure that the drug will reach its intended target tissue

Are the reason for giving loading doses

Increase the length of time a drug is available and active

Are most common in collagen tissues

5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:
   1. Propensity to go to the target receptor
   2. Biological half-life
   3. Pharmacodynamics

Safety and side effects

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

Requires four- to five-half-lives to attain

Is influenced by renal function

Is directly related to the drug circulating to the target tissues

7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect

is the:

1. Minimum adverse effect level

Peak of action

3. Onset of action

Therapeutic range

8. Phenytoin requires that a trough level be drawn. Peak and trough levels are done:
   1. When the drug has a wide therapeutic range

When the drug will be administered for a short time only

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
5. 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

Concentration will produce an adverse response

Time between doses must be shortened

4. Duration of action of the drug is too long
5. Drugs that are receptor agonists may demonstrate what property?
6. Irreversible binding to the drug receptor site

Upregulation with chronic use

Desensitization or downregulation with continuous use

4. Inverse relationship between drug concentration and drug action
5. Drugs that are receptor antagonists, such as beta blockers, may cause:
6. Downregulation of the drug receptor

An exaggerated response if abruptly discontinued

Partial blockade of the effects of agonist drugs

An exaggerated response to competitive drug agonists

12. Factors that affect gastric drug absorption include:
    1. Liver enzyme activity
    2. Protein-binding properties of the drug molecule
    3. Lipid solubility of the drug

Ability to chew and swallow

13. Drugs administered via IV:

Need to be lipid soluble in order to be easily absorbed

2. Begin distribution into the body immediately
3. Are easily absorbed if they are nonionized

May use pinocytosis to be absorbed

14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:

The sum of the effects of each drug individually

2. Greater than the sum of the effects of each drug individually
3. Less than the effect of each drug individually

Not predictable, as it varies with each individual

15. Which of the following statements about bioavailability is true?

Bioavailability issues are especially important for drugs with narrow therapeutic

ranges or sustained-release mechanisms.

All brands of a drug have the same bioavailability.

Drugs that are administered more than once a day have greater bioavailability than

drugs given once daily.

Combining an active drug with an inert substance does not affect bioavailability.

16. Which of the following statements about the major distribution barriers (blood-brain

or fetal-placental) is true?

Water soluble and ionized drugs cross these barriers rapidly.

2. The blood-brain barrier slows the entry of many drugs into and from brain cells.
3. The fetal-placental barrier protects the fetus from drugs taken by the mother.
4. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women.
5. Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of

these types of reactions is to:

Inactivate prodrugs before they can be activated by target tissues

2. Change the drugs so they can cross plasma membranes
3. Change drug molecules to a form that an excretory organ can excrete
4. Make these drugs more ionized and polar to facilitate excretion
5. Once they have been metabolized by the liver, the metabolites may be:

More active than the parent drug

Less active than the parent drug

Totally “deactivated” so they are excreted without any effect

4. All of the above
5. All drugs continue to act in the body until they are changed or excreted. The ability of the body to

excrete drugs via the renal system would be increased by:

1. Reduced circulation and perfusion of the kidney

Chronic renal disease

Competition for a transport site by another drug

4. Unbinding a nonvolatile drug from plasma proteins
5. Steady state is:
6. The point on the drug concentration curve when absorption exceeds excretion

When the amount of drug in the body remains constant

3. When the amount of drug in the body stays below the minimum toxic

concentration

All of the above

21. Two different pain medications are given together for pain relief. The drug—drug interaction is:
    1. Synergistic
    2. Antagonistic

Potentiative

Additive

22. Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:
    1. Reducing the dosage of one of the drugs
    2. Scheduling their administration at different times
    3. Prescribing a third drug to counteract the adverse reaction of the combination
    4. Reducing the dosage of both drugs
23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements.

Which of the following would reduce or inhibit this process?

1. Protein malnutrition

Iron-deficiency anemia

Both 1 and 2

4. Neither 1 nor 2
5. The time required for the amount of drug in the body to decrease by 50% is called:
6. Steady state

Half-life

Phase II metabolism

4. Reduced bioavailability time
5. An agonist activates a receptor and stimulates a response. When given frequently over time,

the body may:

1. Upregulate the total number of receptors

Block the receptor with a partial agonist

Alter the drug’s metabolism

4. Downregulate the numbers of that specific receptor
5. Drug antagonism is best defined as an effect of a drug that:
6. Leads to major physiological and psychological dependence

Is modified by the concurrent administration of another drug

Cannot be metabolized before another dose is administered

Leads to a decreased physiological response when combined with another drug

27. Instructions to a client regarding self-administration of oral enteric-coated tablets should include

which of the following statements?

1. “Avoid any other oral medicines while taking this drug.”

“If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”

“The tablet may be crushed if you have any difficulty taking it.”

“To achieve best effect, take the tablet with at least 8 ounces of fluid.”

28. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of

the drugs could possibly result in:

1. Disintegration

Toxicity

Malabsorption

4. Deterioration
5. Which of the following substances is the most likely to be absorbed in the intestines rather than

in the stomach?

1. Sodium bicarbonate

Ascorbic acid

Salicylic acid

4. Glucose
5. Which of the following variables is a factor in drug absorption?

The smaller the surface area for absorption, the more rapidly the drug is absorbed.

2. A rich blood supply to the area of absorption leads to better absorption.
3. The less soluble the drug, the more easily it is absorbed.

Ionized drugs are easily absorbed across the cell membrane.

31. An advantage of prescribing a sublingual medication is that the medication is:
    1. Absorbed rapidly
    2. Excreted rapidly

Metabolized minimally

Distributed equally

32. 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

Neither 1 nor 2

33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:

After the second dose

2. After four to five half-lives
3. When the patient feels the full effect of the drug

One hour after IV administration

34. Upregulation or hypersensitization may lead to:

Increased response to a drug

2. Decreased response to a drug
3. An exaggerated response if the drug is withdrawn
4. Refractoriness or complete lack of response

Chapter 2. Review of the Basic Principles of Pharmacology

Answer Section

Chapter 3. Rational Drug Selection

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because:
   1. Drugs given in liquid form are less irritating to the stomach.
   2. A 6-year-old child may have problems swallowing a pill.
   3. Liquid forms of medication eliminate the concern for first-pass effect.

Liquid ibuprofen does not have to be dosed as often as the tablet form.

2. In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A

because it:

Has serious side effects and it is not being used for a life-threatening condition

2. Will be taken twice daily and will be taken at home
3. Is expensive, but covered by health insurance

None of these are important in choosing a drug

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?

Body temperature varies between men and women.

2. Muscle mass is greater in women.
3. Percentage of fat differs between genders.

Proven subjective factors exist between the genders.

4. The first step in the prescribing process according to the World Health Organization is:

Choosing the treatment

Educating the patient about the medication

Diagnosing the patient’s problem

Starting the treatment

5. Treatment goals in prescribing should:
   1. Always be curative

Be patient-centered

Be convenient for the provider

Focus on the cost of therapy

6. The therapeutic goals when prescribing include(s):

Curative

2. Palliative
3. Preventive

All of the above

7. When determining drug treatment, the NP prescriber should:

Always use evidence-based guidelines

2. Individualize the drug choice for the specific patient
3. Rely on his or her experience when prescribing for complex patients
4. Use the newest drug on the market for the condition being treated

8. Patient education regarding prescribed medication includes:
   1. Instructions written at the high school reading level

Discussion of expected adverse drug reactions

How to store leftover medication such as antibiotics

Verbal instructions always in English

9. Passive monitoring of drug effectiveness includes:
   1. Therapeutic drug levels
   2. Adding or subtracting medications from the treatment regimen

Ongoing provider visits

Instructing the patient to report if the drug is not effective

10. Pharmacokinetic factors that affect prescribing include:
    1. Therapeutic index
    2. Minimum effective concentration
    3. Bioavailability

Ease of titration

11. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical

promotion, the following recommendations have been made by the Institute of Medicine:

Conflicts of interest and financial relationships should be disclosed by those

providing education.

Providers should ban all pharmaceutical representatives from their office setting.

Drug samples should be used for patients who have the insurance to pay for them,

to ensure the patient can afford the medication.

Providers should only accept low-value gifts, such as pens and pads of paper, from

the pharmaceutical representative.

12. Under new U.S. Food and Drug Administration labeling, Pregnancy Categories will be:

Strengthened with a new coding such as C+ or C- to discern when a drug is more

or less toxic to the fetus

Changed to incorporate a pregnancy risk summary and clinical considerations

on the drug label

Eliminated, and replaced with a link to the National Library of Medicine TOXNET

Web site for in-depth information regarding pregnancy concerns

Clarified to include information such as safe dosages in each trimester

of pregnancy

Chapter 3. Rational Drug Selection

Answer Section

Chapter 4. Legal and Professional Issues in Prescribing

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. The U.S. Food and Drug Administration regulates:
   1. Prescribing of drugs by MDs and NPs
   2. The official labeling for all prescription and over-the-counter drugs
   3. Off-label recommendations for prescribing

Pharmaceutical educational offerings

2. The U.S. Food and Drug Administration approval is required for:

Medical devices, including artificial joints

2. Over-the-counter vitamins
3. Herbal products, such as St John’s wort

Dietary supplements, such as Ensure

3. An Investigational New Drug is filed with the U.S. Food and Drug Administration:

When the manufacturer has completed phase III trials

2. When a new drug is discovered
3. Prior to animal testing of any new drug entity
4. Prior to human testing of any new drug entity
5. Phase IV clinical trials in the United States are also known as:

Human bioavailability trials

Post marketing research

Human safety and efficacy studies

4. The last stage of animal trials before the human trials begin
5. Off-label prescribing is:

Regulated by the U.S. Food and Drug Administration

2. Illegal by NPs in all states (provinces)
3. Legal if there is scientific evidence for the use

Regulated by the Drug Enforcement Administration

6. The U.S. Drug Enforcement Administration:

Registers manufacturers and prescribers of controlled substances

2. Regulates NP prescribing at the state level
3. Sanctions providers who prescribe drugs off-label
4. Provides prescribers with a number they can use for insurance billing
5. Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration:

Are known teratogens during pregnancy

May not be refilled; a new prescription must be written

Have a low abuse potential

4. May be dispensed without a prescription unless regulated by the state
5. Precautions that should be taken when prescribing controlled substances include:
6. Faxing the prescription for a Schedule II drug directly to the pharmacy

2. Using tamper-proof paper for all prescriptions written for controlled drugs
3. Keeping any pre-signed prescription pads in a locked drawer in the clinic

Using only numbers to indicate the amount of drug to be prescribed

9. Strategies prescribers can use to prevent misuse of controlled prescription drugs include:
   1. Use of chemical dependency screening tools
   2. Firm limit-setting regarding prescribing controlled substances
   3. Practicing “just say no” to deal with patients who are pushing the provider to

prescribe controlled substances

All of the above

10. Behaviors predictive of addiction to controlled substances include:
    1. Stealing or borrowing another patient’s drugs
    2. Requiring increasing doses of opiates for pain associated with malignancy
    3. Receiving refills of a Schedule II prescription on a regular basis

Requesting that only their own primary care provider prescribe for them

11. Medication agreements or “Pain Medication Contracts” are recommended to be used:

Universally for all prescribing for chronic pain

2. For patients who have repeated requests for pain medication
3. When you suspect a patient is exhibiting drug-seeking behavior

For patients with pain associated with malignancy

12. A prescription needs to be written for:

Legend drugs

2. Most controlled drugs
3. Medical devices
4. All of the above

Chapter 4. Legal and Professional Issues in Prescribing

Answer Section

Chapter 5. Adverse Drug Reactions

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. Which of the following patients would be at higher risk of experiencing adverse drug reactions

(ADRs):

A 32-year-old male

2. A 22-year-old female
3. A 3 - month-old female

A 48-year-old male

2. Infants and young children are at higher risk of ADRs due to:

Immature renal function in school-age children

2. Lack of safety and efficacy studies in the pediatric population

Children’s skin being thicker than adults, requiring higher dosages of topical

medication

4. Infant boys having a higher proportion of muscle mass, leading to a higher volume

of distribution

3. The elderly are at high risk of ADRs due to:

Having greater muscle mass than younger adults, leading to higher volume of

distribution

The extensive studies that have been conducted on drug safety in this age group

The blood-brain barrier being less permeable, requiring higher doses to achieve

therapeutic effect

Age-related decrease in renal function

4. The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic

doses is type:

A

B

C

4. D

5. Digoxin may cause a type A adverse drug reaction due to:

Idiosyncratic effects

Its narrow therapeutic index

Being a teratogen

4. Being a carcinogen
5. Sarah developed a rash after using a topical medication. This is a type allergic drug reaction.

1. I

2. II

III

IV

7. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n):

Cytotoxic hypersensitivity reaction

Immune complex hypersensitivity

Immediate hypersensitivity reaction

4. Delayed hypersensitivity reaction
5. Anaphylactic shock is a:

Type I reaction, called immediate hypersensitivity reaction

2. Type II reaction, called cytotoxic hypersensitivity reaction
3. Type III allergic reaction, called immune complex hypersensitivity

Type IV allergic reaction, called delayed hypersensitivity reaction

9. James has hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a

corticosteroid) use. He is at risk for what type of adverse drug reaction?

Type B

2. Type C
3. Type E

Type F

10. Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a

type D reaction because they are known:

Teratogens

2. Carcinogens
3. To cause hypersensitivity reactions

Hypothalamus-pituitary-adrenal axis suppressants

11. A 24-year-old male received multiple fractures in a motor vehicle accident that required significant

amounts of opioid medication to treat his pain. He is at risk for a adverse drug reaction when he no

longer requires the opioids.

Rapid

2. First-dose

Late

Delayed

12. An example of a first-dose reaction that may occur includes:
    1. Orthostatic hypotension that does not occur with repeated doses
    2. Purple glove syndrome with phenytoin use
    3. Hemolytic anemia from ceftriaxone use

Contact dermatitis from neomycin use

13. Drugs that are prone to cause adverse drug effects include:

Diuretics

2. Inhaled anticholinergics
3. Insulins

Stimulants

14. The U.S. Food and Drug Administration MedWatch system is activated when:

There is an adverse event to a vaccine.

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.

15. The Vaccine Adverse Events Reporting System is:

A mandatory reporting system for all health-care providers when they encounter

an adverse vaccine event

A voluntary reporting system that health-care providers or consumers may use to

report vaccine adverse events

Utilized to send out safety alerts regarding emerging vaccine safety issues

Activated when a vaccine has been proven to cause significant adverse effects

Chapter 5. Adverse Drug

Reactions Answer Section

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Chapter 6. An Introduction to Pharmacogenetics

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Genetic polymorphisms account for differences in metabolism, including:

Poor metabolizers, who lack a working enzyme

Intermediate metabolizers, who have one working, wild-type allele and one mutant allele

Extensive metabolizers, with two normally functioning alleles

All of the above

____ 2. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:

A need to monitor drugs metabolized by 2D6 for toxicity

Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin

reuptake inhibitors

Decreased conversion of codeine to morphine by CYP 2D

The need for lowered dosages of drugs, such as beta blockers

____ 3. Rifampin is a nonspecific CYP450 inducer that may:

Lead to toxic levels of rifampin and must be monitored closely

Cause toxic levels of drugs, such as oral contraceptives, when coadministered

Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure

Cause nonspecific changes in drug metabolism

____ 4. Inhibition of P-glycoprotein by a drug such as quinidine may lead to:

Decreased therapeutic levels of quinidine

Increased therapeutic levels of quinidine

Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for

absorption and elimination

Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for

absorption and elimination

____ 5. Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

Toxic levels of warfarin building up

Decreased response to warfarin

Increased risk for significant drug interactions with warfarin

Less risk of drug interactions with warfarin

____ 6. Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required

prior to prescribing warfarin.

True

False

____ 7. Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to

prescribing:

Erythromycin

Digoxin

Cetuximab

Rifampin

____ 8. 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:

Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the

HLA-B*1502 allele

Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele

Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele

Patients who have the HLA-B*1502 allele being more likely to have a resistance to

carbamazepine

____ 9. A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is

inactivated by the body may lead to:

Decreased effectiveness of irinotecan in the treatment of cancer

Increased adverse drug reactions, such as neutropenia

Delayed metabolism of the prodrug irinotecan into the active metabolite SN- 38

Increased concerns for irinotecan being carcinogenic

____ 10. Patients who have a poor metabolism phenotype will have:

Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug

Accumulation of inactive metabolites of drugs

A need for increased dosages of medications

Increased elimination of an active drug

____ 11. Ultra-rapid metabolizers of drugs may have:

To have dosages of drugs adjusted downward to prevent drug accumulation

Active drug rapidly metabolized into inactive metabolites, leading to potential therapeutic

failure

Increased elimination of active, nonmetabolized drug

Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug

____ 12. A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for

breast cancer to:

Ensure the patient will not have increased adverse drug reactions to the tamoxifen

Identify potential drug-drug interactions that may occur with tamoxifen

Reduce the likelihood of therapeutic failure with tamoxifen treatment

Identify poor metabolizers of tamoxifen

Chapter 6. An Introduction to Pharmacogenetics

Answer Section

MULTIPLE CHOICE

1. ANS: 4 PTS: 1
2. ANS: 2 PTS: 1
3. ANS: 3 PTS: 1
4. ANS: 4 PTS: 1
5. ANS: 2 PTS: 1
6. ANS: 2 PTS: 1
7. ANS: 3 PTS: 1
8. ANS: 3 PTS: 1
9. ANS: 2 PTS: 1
10. ANS: 1 PTS: 1
11. ANS: 2 PTS: 1
12. ANS: 3 PTS: 1

Chapter 7. Nutrition and Nutraceuticals

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. The most frequent type of drug-food interaction is food:
   1. Causing increased therapeutic drug levels
   2. Affecting the metabolism of the drug
   3. Altering the volume of distribution of drugs

Affecting the gastrointestinal absorption of drugs

2. Food in the gastrointestinal tract affects drug absorption by:

Altering the pH of the colon, which decreases absorption

2. Competing with the drug for plasma proteins
3. Altering gastric emptying time

Altering the pH of urine

3. Food can alter the pH of the stomach, leading to:

Enhanced drug metabolism

2. Altered vitamin K absorption
3. Increased vitamin D absorption
4. Altered drug bioavailability
5. Fasting for an extended period can:

Increase drug absorption due to lack of competition between food and the drug

Alter the pH of the gastrointestinal tract, affecting absorption

Cause vasoconstriction, leading to decreased drug absorption

4. Shrink the stomach, causing decreased surface area for drug absorption
5. Tetracycline needs to be given on an empty stomach because it chelates with:

Calcium

2. Magnesium
3. Iron

All of the above

6. A low-carbohydrate, high-protein diet may:

Increase drug-metabolizing enzymes

2. Decrease drug absorption from the GI tract
3. Alter drug binding to plasma proteins
4. Enhance drug elimination
5. Grapefruit juice contains furanocoumarins that have been found to:

Alter absorption of drugs through competition for binding sites

Inhibit CYP 3A4, leading to decreased first-pass metabolism of drugs

Alter vitamin K metabolism, leading to prolonged bleeding

4. Enhance absorption of calcium and vitamin D
5. Cruciferous vegetables may alter drug pharmacokinetics by:
6. Enhancing absorption of weakly acidic drugs

2. Altering CYP 3A4 activity, leading to elevated levels of drugs, such as the statins

Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by

CYP 1A2

4. Decreasing first-pass metabolism of drugs
5. Milk and other foods that alkalinize the urine may:

Result in basic drugs being reabsorbed in the renal tubule

2. Increase the elimination of basic drugs in the urine
3. Decrease the elimination of acidic drugs

Not alter drug elimination due to the minimal change in urine pH

10. Antacids such as calcium carbonate (Tums) can reduce the absorption of which of the following

nutrients?

Protein

2. Calcium
3. Iron
4. Vitamin K
5. Phenytoin decreases folic acid absorption by:

Altering the pH of the stomach

Increasing gastric emptying time

Inhibiting intestinal enzymes required for folic acid absorption

4. Chelation of the folic acid into inactive ingredients
5. Patients taking warfarin need to be educated about the vitamin K content of foods to avoid

therapeutic failure. Foods high in vitamin K that should be limited to no more than one serving per

day include:

Spinach

2. Milk
3. Romaine lettuce

Cauliflower

13. The American Dietetic Association has recommended the use of specific nutritional supplements in

the following population(s):

400 IU per day of vitamin D in all infants and children

2. 1,000 IU per day of vitamin D for all pregnant women
3. 60 mg per day of iron for all adults over age 50 years

All of the above

14. The American Dietetic Association recommends pregnant women take a supplement including:

1,000 IU daily of vitamin D

2. 2.4 mcg/day of vitamin B 12
3. 600 mcg/day of folic acid

8 mg/day of iron

15. The American Heart Association and the American Dietetic Association recommend a minimum

daily fiber intake of for cardiovascular health:

1. 10 mg/day
2. 15 mg/day
3. 20 mg/day
4. 25 mg/day

16. Which of the following vitamin or mineral supplements may by teratogenic if a pregnant woman

takes more than the recommended amount?

Iron

2. Vitamin A
3. Vitamin B 6

Vitamin C

17. Vitamin B 2 (riboflavin) may be prescribed to:
    1. Decrease the incidence of beriberi
    2. Reduce headaches and migraines

Prevent pernicious anemia

Treat hyperlipidemia

18. Isoniazid (INH) may induce a deficiency of which vitamin?

1. B 6

2. C

3. D

E

19. Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B 6

(pyridoxine) to prevent:

Beriberi

2. Peripheral neuropathy
3. Rickets

Megaloblastic anemia

20. Vitamin B 12

deficiency may lead to:

1. Hair loss

Insomnia

Dry scales on the scalp

4. Numbness and tingling of the hands
5. Smokers are at risk for vitamin C deficiency. It is recommended that smokers take vitamin

C supplement.

1. 100 mg/day
2. 500 mg/day
3. 1,000 mg/day
4. 35 mg/day more than nonsmokers
5. There is strong evidence to support that adequate vitamin C intake prevents:
6. The common cold

Breast cancer

Scurvy

4. All of the above
5. Adequate vitamin D is needed for:
6. Absorption of calcium from the gastrointestinal tract

Regulation of serum calcium levels

Regulation of serum phosphate levels

4. All of the above

24. Newborns are at risk for early vitamin K deficiency bleeding and the American Academy

of Pediatrics recommends that all newborns receive:

1. IM vitamin K (phytonadione) within 24 hours of birth

Oral vitamin K supplementation in the first 3 weeks of life

Formula containing vitamin K or breast milk

4. Oral vitamin K in the first 24 hours after birth
5. Symptoms of folate deficiency include:
6. Thinning of the hair

Bruising easily

Glossitis

Numbness and tingling of the hands and feet

26. A patient with a new onset of systolic ejection murmur should be assessed for which nutritional

deficiency?

1. Vitamin B 12

Vitamin C

Folate

Niacin

27. According to the 2003-2006 National Health and Nutrition Examination Survey study of dietary

intake, the group at highest risk for inadequate calcium intake was:

1. The elderly (over age 60 years)

Teenage females

Teenage males

Preschoolers

28. Patients with iron deficiency will develop:
    1. Hemolytic anemia

Megaloblastic anemia

Macrocytic-hypochromic anemia

Microcytic-hypochromic anemia

29. There is evidence that dietary supplementation or adequate intake of fish oils and omega- 3

fatty acids have well-documented:

1. Concern for developing cardiac dysrhythmias

Anti-inflammatory effects

Total cholesterol-lowering effects

Effects on fasting blood sugar

30. There is enough preliminary evidence to recommend that children with autism receive which

supplemental nutrient?

1. Vitamin B 1 (thiamine)
2. Vitamin B 2 (riboflavin)
3. Calcium
4. Omega-3 fatty acids
5. There is sufficient evidence to support the use of omega-3 fatty acids to treat the

following disease(s):

Asthma

2. Autism