Pharmacotherapeutics for advanced practice nurse prescribers 5th edition free pdf

Download Test Bank on Pharmacotherapeutics for Advanced Practice Nurse Prescribers, 5th Edition, Te and more Nursing Study Guides, Projects, Research in PDF only on Docsity! 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 2. The U.S. Drug Enforcement Administration 3. The State Board of Nursing for each state 4. The State Board of Pharmacy 2. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: 1. Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program. 2. Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care. 3. APRNs are less likely to prescribe narcotics and other controlled substances. 4. 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: 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 5. Nurse practitioner practice may thrive under health-care reform because of: 1. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes 2. The fact that nurse practitioners will be able to practice independently 3. The fact that nurse practitioners will have full reimbursement under health- care reform 4. 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 drugs given once daily. 4. 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? 1. 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. 17. 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: 1. 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 18. Once they have been metabolized by the liver, the metabolites may be: 1. More active than the parent drug 2. Less active than the parent drug 3. Totally “deactivated” so they are excreted without any effect 4. All of the above 19. 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 2. Chronic renal disease 3. Competition for a transport site by another drug 4. Unbinding a nonvolatile drug from plasma proteins 20. Steady state is: 1. The point on the drug concentration curve when absorption exceeds excretion 2. 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 4. All of the above 21. Two different pain medications are given together for pain relief. The drug—drug interaction is: 1. Synergistic 2. Antagonistic 3. Potentiative 4. 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 2. Iron-deficiency anemia 3. Both 1 and 2 4. Neither 1 nor 2 24. The time required for the amount of drug in the body to decrease by 50% is called: 1. Steady state 2. Half-life 3. Phase II metabolism 4. Reduced bioavailability time 25. An agonist activates a receptor and stimulates a response. When given frequently over time, the body may: 1. Upregulate the total number of receptors 2. Block the receptor with a partial agonist 3. Alter the drug’s metabolism 4. Downregulate the numbers of that specific receptor 26. Drug antagonism is best defined as an effect of a drug that: 1. Leads to major physiological and psychological dependence 2. Is modified by the concurrent administration of another drug 3. Cannot be metabolized before another dose is administered 4. 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.” 2. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.” 3. “The tablet may be crushed if you have any difficulty taking it.” 4. “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 2. Toxicity 3. Malabsorption 4. Deterioration 29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? 1. Sodium bicarbonate 2. Ascorbic acid 3. Salicylic acid 4. Glucose 30. Which of the following variables is a factor in drug absorption? 1. 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. 4. 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 3. Metabolized minimally 4. 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 4. Neither 1 nor 2 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: 1. After the second dose 2. After four to five half-lives 3. When the patient feels the full effect of the drug 4. One hour after IV administration 34. Upregulation or hypersensitization may lead to: 1. 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 8. Patient education regarding prescribed medication includes: 1. Instructions written at the high school reading level 2. Discussion of expected adverse drug reactions 3. How to store leftover medication such as antibiotics 4. 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 3. Ongoing provider visits 4. 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 4. 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: 1. Conflicts of interest and financial relationships should be disclosed by those providing education. 2. Providers should ban all pharmaceutical representatives from their office setting. 3. Drug samples should be used for patients who have the insurance to pay for them, to ensure the patient can afford the medication. 4. 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: 1. Strengthened with a new coding such as C+ or C- to discern when a drug is more or less toxic to the fetus 2. Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label 3. Eliminated, and replaced with a link to the National Library of Medicine TOXNET Web site for in-depth information regarding pregnancy concerns 4. Clarified to include information such as safe dosages in each trimester of pregnancy Chapter 3. Rational Drug Selection Answer Section MULTIPLE CHOICE 1. ANS: 2 PTS: 1 2. ANS: 2 PTS: 1 3. ANS: 3 PTS: 1 4. ANS: 3 PTS: 1 5. ANS: 2 PTS: 1 6. ANS: 4 PTS: 1 7. ANS: 2 PTS: 1 8. ANS: 2 PTS: 1 9. ANS: 4 PTS: 1 10. ANS: 3 PTS: 1 11. ANS: 1 PTS: 1 12. ANS: 2 PTS: 1 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 4. Pharmaceutical educational offerings 2. The U.S. Food and Drug Administration approval is required for: 1. Medical devices, including artificial joints 2. Over-the-counter vitamins 3. Herbal products, such as St John’s wort 4. Dietary supplements, such as Ensure 3. An Investigational New Drug is filed with the U.S. Food and Drug Administration: 1. 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 4. Phase IV clinical trials in the United States are also known as: 1. Human bioavailability trials 2. Post marketing research 3. Human safety and efficacy studies 4. The last stage of animal trials before the human trials begin 5. Off-label prescribing is: 1. 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 4. Regulated by the Drug Enforcement Administration 6. The U.S. Drug Enforcement Administration: 1. 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 7. Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration: 1. Are known teratogens during pregnancy 2. May not be refilled; a new prescription must be written 3. Have a low abuse potential 4. May be dispensed without a prescription unless regulated by the state 8. Precautions that should be taken when prescribing controlled substances include: 1. Faxing the prescription for a Schedule II drug directly to the pharmacy 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): 1. A 32-year-old male 2. A 22-year-old female 3. A 3-month-old female 4. A 48-year-old male 2. Infants and young children are at higher risk of ADRs due to: 1. Immature renal function in school-age children 2. Lack of safety and efficacy studies in the pediatric population 3. 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: 1. Having greater muscle mass than younger adults, leading to higher volume of distribution 2. The extensive studies that have been conducted on drug safety in this age group 3. The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect 4. 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: 1. A 2. B 3. C 4. D 5. Digoxin may cause a type A adverse drug reaction due to: 1. Idiosyncratic effects 2. Its narrow therapeutic index 3. Being a teratogen 4. Being a carcinogen 6. Sarah developed a rash after using a topical medication. This is a type allergic drug reaction. 1. I 2. II 3. III 4. IV 7. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n): 1. Cytotoxic hypersensitivity reaction 2. Immune complex hypersensitivity 3. Immediate hypersensitivity reaction 4. Delayed hypersensitivity reaction 8. Anaphylactic shock is a: 1. Type I reaction, called immediate hypersensitivity reaction 2. Type II reaction, called cytotoxic hypersensitivity reaction 3. Type III allergic reaction, called immune complex hypersensitivity 4. 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? 1. Type B 2. Type C 3. Type E 4. Type F 10. Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D reaction because they are known: 1. Teratogens 2. Carcinogens 3. To cause hypersensitivity reactions 4. 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. 1. Rapid 2. First-dose 3. Late 4. 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 4. Contact dermatitis from neomycin use 13. Drugs that are prone to cause adverse drug effects include: 1. Diuretics 2. Inhaled anticholinergics 3. Insulins 4. Stimulants 14. The U.S. Food and Drug Administration MedWatch system is activated when: 1. 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. 15. The Vaccine Adverse Events Reporting System is: 1. A mandatory reporting system for all health-care providers when they encounter an adverse vaccine event 2. A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events 3. Utilized to send out safety alerts regarding emerging vaccine safety issues 4. Activated when a vaccine has been proven to cause significant adverse effects 4. 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: 1. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele 2. Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele 3. Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 allele 4. 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: 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 ____ 10. Patients who have a poor metabolism phenotype will have: 1. Slowed metabolism of a prodrug into an active drug, leading to accumulation of prodrug 2. Accumulation of inactive metabolites of drugs 3. A need for increased dosages of medications 4. Increased elimination of an active drug ____ 11. 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 ____ 12. A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to: 1. Ensure the patient will not have increased adverse drug reactions to the tamoxifen 2. Identify potential drug-drug interactions that may occur with tamoxifen 3. Reduce the likelihood of therapeutic failure with tamoxifen treatment 4. 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 4. Affecting the gastrointestinal absorption of drugs 2. Food in the gastrointestinal tract affects drug absorption by: 1. Altering the pH of the colon, which decreases absorption 2. Competing with the drug for plasma proteins 3. Altering gastric emptying time 4. Altering the pH of urine 3. Food can alter the pH of the stomach, leading to: 1. Enhanced drug metabolism 2. Altered vitamin K absorption 3. Increased vitamin D absorption 4. Altered drug bioavailability 4. Fasting for an extended period can: 1. Increase drug absorption due to lack of competition between food and the drug 2. Alter the pH of the gastrointestinal tract, affecting absorption 3. 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: 1. Calcium 2. Magnesium 3. Iron 4. All of the above 6. A low-carbohydrate, high-protein diet may: 1. Increase drug-metabolizing enzymes 2. Decrease drug absorption from the GI tract 3. Alter drug binding to plasma proteins 4. Enhance drug elimination 7. Grapefruit juice contains furanocoumarins that have been found to: 1. Alter absorption of drugs through competition for binding sites 2. Inhibit CYP 3A4, leading to decreased first-pass metabolism of drugs 3. Alter vitamin K metabolism, leading to prolonged bleeding 4. Enhance absorption of calcium and vitamin D 8. Cruciferous vegetables may alter drug pharmacokinetics by: 1. Enhancing absorption of weakly acidic drugs 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 2. Oral vitamin K supplementation in the first 3 weeks of life 3. Formula containing vitamin K or breast milk 4. Oral vitamin K in the first 24 hours after birth 25. Symptoms of folate deficiency include: 1. Thinning of the hair 2. Bruising easily 3. Glossitis 4. 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 B12 2. Vitamin C 3. Folate 4. 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) 2. Teenage females 3. Teenage males 4. Preschoolers 28. Patients with iron deficiency will develop: 1. Hemolytic anemia 2. Megaloblastic anemia 3. Macrocytic-hypochromic anemia 4. 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 2. Anti-inflammatory effects 3. Total cholesterol-lowering effects 4. Effects on fasting blood sugar 30. There is enough preliminary evidence to recommend that children with autism receive which supplemental nutrient? 1. Vitamin B1 (thiamine) 2. Vitamin B2 (riboflavin) 3. Calcium 4. Omega-3 fatty acids 31. There is sufficient evidence to support the use of omega-3 fatty acids to treat the following disease(s): 1. Asthma 2. Autism 3. Arthritis 4. All of the above 32. It is reasonable to recommend supplementation with in the treatment of hyperlipidemia. 1. Omega-3 fatty acids 2. Probiotics 3. Plant sterols 4. Calcium 33. Probiotics are recommended to be co-administered when are prescribed: 1. Antacids 2. Antihypertensives 3. Antidiarrheals 4. Antibiotics 34. It is reasonable to add to a Helicobacter pylori treatment regimen to improve eradication rates of H. pylori. 1. Probiotics 2. Omega-3 fatty acids 3. Plant sterols 4. Fiber Chapter 7. Nutrition and Nutraceuticals Answer Section MULTIPLE CHOICE 1. ANS 4 PTS: 1 2. ANS 3 PTS: 1 3. ANS 4 PTS: 1 4. ANS 3 PTS: 1 5. ANS 4 PTS: 1 6. ANS 1 PTS: 1 7. ANS 2 PTS: 1 8. ANS 3 PTS: 1 9. ANS 1 PTS: 1 10. ANS 3 PTS: 1 11. ANS 3 PTS: 1 12. ANS 1 PTS: 1 13. ANS 1 PTS: 1 14. ANS 3 PTS: 1 15. ANS 4 PTS: 1 16. ANS 2 PTS: 1 17. ANS 2 PTS: 1 18. ANS 1 PTS: 1 19. ANS 2 PTS: 1 20. ANS 4 PTS: 1 21. ANS 4 PTS: 1 22. ANS 3 PTS: 1 23. ANS 4 PTS: 1 24. ANS 1 PTS: 1 25. ANS 3 PTS: 1 26. ANS 3 PTS: 1 27. ANS 2 PTS: 1 28. ANS 4 PTS: 1 29. ANS 2 PTS: 1 30. ANS 4 PTS: 1 31. ANS 2 PTS: 1 32. ANS 3 PTS: 1 33. ANS 4 PTS: 1 34. ANS 1 PTS: 1 Chapter 8. Herbal Therapies and Cannabis Answer Section MULTIPLE CHOICE 1. ANS: 3 PTS: 1 2. ANS: 2 PTS: 1 3. ANS: 2 PTS: 1 4. ANS: 2 PTS: 1 5. ANS: 1 PTS: 1 6. ANS: 4 PTS: 1 7. ANS: 2 PTS: 1 8. ANS: 3 PTS: 1 9. ANS: 1 PTS: 1 10. ANS: 3 PTS: 1 11. ANS: 4 PTS: 1 12. ANS: 2 PTS: 1 13. ANS: 1 PTS: 1 14. ANS: 3 PTS: 1 15. ANS: 3 PTS: 1 Chapter 9. Information Technology and Pharmacotherapeutics Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to: 1. Search for information using the most common search engines 2. Serve as content experts in developing, implementing, and evaluating information systems 3. Write programs to assure the integrity of health information 4. Use information technology to prescribe drugs 2. You are going to prescribe a drug and the electronic health record (EHR) alerts you that there is a potential drug–drug interaction. The alert is generated by: 1. The Food and Drug Administration MedWatch system 2. TOXNET, the National Institutes of Health alert system 3. The EHR clinical decision support system 4. Lexicomp, a commercial medication alert system 3. Which of the following is a primary benefit of the use of computerized provider order entry for patient medications? 1. Reduces time that prescribing drugs takes 2. Eliminates the need to chart drugs prescribed 3. Decreases prescribing and transcription errors 4. Helps keep the number of drugs prescribed to a minimum 4. A number of barriers and concerns exist before the goals of a safe and efficient information technology (IT) system can be realized. Which of the following is NOT a barrier to adoption and use of IT in prescribing drugs? 1. Cost of initial setup 2. Access to highly skilled experts 3. Compatibility between systems 4. Patient confidentiality risks 5. EHRs: 1. Are being discouraged by the Centers for Medicare and Medicaid Services due to cost issues 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 6. Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include: 1. Designing software so that only those who need the information can gain access 2. Requiring providers to log off at the end of the clinical day 3. Keeping a file of the login and password information for each provider in a secure place 4. Having patients sign informed consent documents to have their data on an EHR 7. Decision support systems often provide medication alerts that tell the prescriber: 1. Patient history data with a summary of their diagnoses 2. The usual dosage for the drug being prescribed 3. The patient’s latest laboratory values, such as potassium levels 4. Potential drug-to-drug interactions with other medications the patient is taking 8. 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 9. The use of information technology for quality improvement in pharmacotherapeutics includes: 1. Incorporating the use of “apps” into all patient encounters 2. Tracking data trends within the practice via the electronic health record database 3. Informing patients that they have access to their medication list via the Internet 4. Using macros for individualizing patient care management 10. The advantage of using information technology for patient education includes: 1. The ability to track the number of times you have given the patient the same instructions regarding their medication 2. Standardized and individualized patient education that is simultaneously recorded into the patient record 3. Easy access to private patient information specific to populations with a similar diagnosis 4. The ability to download and interpret patient information in multiple languages, easily and accurately 11. One barrier to use of the Internet for both prescribing and for patient teaching is: 1. Lack of free public access to the Internet 2. Age, with older adults rarely understanding how to use a computer 3. Web pages and hyperlinks may change, be deleted, or be replaced 4. Few Web sites with information about drugs are free 12. Information technology can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to: 1. Prioritize what is needed information and avoid spending time reading “interesting” information not central to the problem at hand 2. Integrate professional and personal searching so that the same browser does not need to be accessed repeatedly 3. Check e-mail frequently so that patient questions can be addressed promptly 4. Check for viruses, spyware, and malware 13. Data in the electronic health record that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review: 1. The patient’s current diagnosis and history 2. Drugs the patient is currently taking 3. Any recent previous encounter for the same problem as this visit and what was done 4. All of the above Chapter 10. Pharmacoeconomics Multiple Choice Identify the choice that best completes the statement or answers the question. 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 2. The direct costs of drug therapy include: 1. The actual cost of acquiring the medication 2. The loss of income due to illness 3. Pain and suffering due to inadequate drug therapy 4. The cost of a funeral associated with premature death 3. Indirect costs associated with drug therapy include: 1. The cost of diagnostic tests to monitor therapeutic levels 2. Health-care provider time to prescribe and educate the patient 3. Child-care expenses incurred while receiving therapy 4. Loss of wages while undergoing drug therapy 4. The intangible costs of drug therapy include: 1. Loss of wages while undergoing therapy 2. Inconvenience, pain, and suffering incurred with therapy 3. Cost of medical equipment in the laboratory used to monitor therapeutic drug levels 4. Cost of prescription drug coverage, such as Medicare Part D 5. When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis 6. Cost-effectiveness analysis compares two or more treatments or programs that are: 1. Not necessarily therapeutically equivalent 2. Considered equal in efficacy 3. Compared with the dollar value of the benefit received 4. Expressed in terms of patient preference or quality-adjusted life years 7. When the costs of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as: 1. Cost-minimization analysis 2. Cost-of-illness analysis 3. Cost-effectiveness analysis 4. Cost-benefit analysis 8. Mary has a two-tiered prescription benefit plan, which means: 1. She can receive differing levels of care based on whether she chooses an “in-plan” provider or not. 2. She is eligible for the new Medicare Part D “donut hole” reduction of costs program. 3. She pays a higher copay for brand-name drugs than for generic drugs. 4. She must always choose to be treated with generic drugs first. 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 10. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be: 1. Order cognitive testing to determine the source of his confusion. 2. Sit down with him and explain the whole Medicare Part D process. 3. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him. 4. Request his son come to the next appointment so you can explain the benefit to him. 11. The “donut hole” in Medicare Part D: 1. Will be totally eliminated with the federal health-care reform enacted in 2010 2. Refers to the period of time when annual individual drug costs are between $250 and $2,250 per year and drug costs are covered 75% 3. Refers to the period between when the annual individual drug costs are $2,970 and $4,750 and the patient pays 52.5% of the costs of brand name drugs (2013) 4. Has no effect on whether patients continue to fill their prescriptions during the coverage gap 12. Research has shown that when patients who are covered by Medicare Part D reach the “donut hole” in coverage they: 1. Ask for extra refills of medication to get them through the months of no coverage 2. Fill their prescriptions less frequently, including critical medications such as warfarin or a statin 3. Fill their critical medications, but hold off on filling less-critical medications 4. Demonstrate no change in their prescription filling pattern Chapter 10. Pharmacoeconomics Answer Section MULTIPLE CHOICE 1. ANS: 3 PTS: 1 2. ANS: 3 PTS: 1 3. ANS: 4 PTS: 1 4. ANS: 2 PTS: 1 5. ANS: 1 PTS: 1 6. ANS: 1 PTS: 1 7. ANS: 4 PTS: 1 8. ANS: 3 PTS: 1 9. ANS: 2 PTS: 1 10. ANS: 3 PTS: 1 11. ANS: 3 PTS: 1 12. ANS: 2 PTS: 1 15. Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes? 1. Histamine 2 blockers 2. Quinolones 3. Serotonin re-uptake inhibitors 4. All of the above 16. Alpha-beta blockers are especially effective to treat hypertension for which ethnic group? 1. White 2. Asian 3. African American 4. Native American 17. Bethanechol: 1. Increases detrusor muscle tone to empty the bladder 2. Decreases gastric acid secretion to treat peptic ulcer disease 3. Stimulates voluntary muscle tone to improve strength 4. Reduces bronchial airway constriction to treat asthma 18. Clinical dosing of Bethanechol: 1. Begins at the highest effective dose to obtain a rapid response 2. Starts at 5 mg to 10 mg PO and is repeated every hour until a satisfactory clinical response is achieved 3. Requires dosing only once daily 4. Is the same for both the oral and parenteral route 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 20. Anticholinesterase inhibitors are used to treat: 1. Peptic ulcer disease 2. Myasthenia gravis 3. Both 1 and 2 4. Neither 1 nor 2 21. Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic? 1. Donepezil 2. Memantine 3. Rivastigmine 4. Galantamine 22. Taking which drug with food maximizes it bioavailability? 1. Donepezil 2. Galantamine 3. Rivastigmine 4. Memantine 23. Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women? 1. Memantine 2. Pyridostigmine 3. Galantamine 4. Rivastigmine 24. There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include: 1. Dizziness and headache 2. Nausea 3. Decreased salivation 4. Fasciculations of voluntary muscles 25. Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily? 1. Tacrine 2. Donepezil 3. Memantine 4. Pyridostigmine 26. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine? 1. Vasodilation and decreased heart rate 2. Increased secretion of gastric acid and motility of the GI smooth muscle 3. Release of dopamine at the pleasure center 4. Stimulation of the locus coeruleus 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 28. Nicotine replacement therapy (NRT): 1. Is widely distributed in the body only when the gum products are used 2. Does not cross the placenta and so is safe for pregnant women 3. Delays healing of esophagitis and peptic ulcers 4. Has no drug interactions when a transdermal patch is used 29. Success rates for smoking cessation using NRT: 1. Are about the same regardless of the method chosen 2. Vary from 40% to 50% at 12 months 3. Both 1 and 2 4. Neither 1 nor 2 30. Cholinergic blockers are used to: 1. Counteract the extrapyramidal symptoms (EPS) effects of phenothiazines 2. Control tremors and relax smooth muscle in Parkinson’s disease 3. Inhibit the muscarinic action of ACh on bladder muscle 4. All of the above 31. Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions? 1. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action. 2. Additive antimuscarinic effects may occur with antihistamines. 3. Cholinergic blockers may decrease the sedative effects of hypnotics. 4. Cholinergic blockers are contraindicated with antipsychotics. 32. Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to: 1. Apply the transdermal disk at least 4 hours before the antiemetic effect is desired. 2. Swallow the tablet 1 hour before traveling where motion sickness is possible. 3. Place the tablet under the tongue and allow it to dissolve. 4. Change the transdermal disk daily for maximal effect. 33. You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia (BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is: 1. Continue the tamsulosin because the side effect will resolve with continued treatment. 2. Discontinue the tamsulosin and start doxazosin. 3. Have him double his fluid intake and stand more slowly. 4. Prescribe meclizine as needed for the dizziness. 34. You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice? 1. Donepezil 2. Tacrine 3. Doxazosin 4. Verapamil 35. A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause? 1. Acetaminophen 2. Estradiol 3. Donepezil 4. Bethanechol 36. Your patient calls for an appointment before going on vacation. Which medication should you ensure he has an adequate supply of before leaving to avoid life-threatening complications? 1. Carvedilol 2. Donepezil 3. Bethanechol 4. Tacrine 37. Activation of central alpha2 receptors results in inhibition of cardio acceleration and centers in the brain. Chapter 12. Drugs Affecting the Central Nervous System Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include: 1. Understanding that obesity is a contraindication to prescribing phentermine 2. Anorexiants may cause tolerance and should only be prescribed for 6 months 3. Patients should be monitored for postural hypotension 4. Renal function should be monitored closely while on anorexiants 2. Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John’s wort due to: 1. Additive respiratory depression risk 2. Additive effects affecting liver function 3. The risk of serotonin syndrome 4. The risk of altered cognitive functioning 3. Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for to be used for an episode of status epilepticus. 1. IV phenobarbital 2. Rectal diazepam (Diastat) 3. IV phenytoin (Dilantin) 4. Oral carbamazepine (Tegretol) 4. Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: 1. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment 2. For pedal edema throughout therapy 3. Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm 4. For vision changes, such as red-green blindness, at least annually 5. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include: 1. Dwayne hasn’t been taking his carbamazepine because it causes insomnia. 2. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance. 3. Dwayne was not originally prescribed the correct amount of carbamazepine. 4. Carbamazepine is probably not the right antiseizure medication for Dwayne. 6. Carbamazepine has a Black Box Warning due to life-threatening: 1. Renal toxicity, leading to renal failure 2. Hepatotoxicity, leading to liver failure 3. Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis 4. Cardiac effects, including supraventricular tachycardia 7. Long-term monitoring of patients who are taking carbamazepine includes: 1. Routine troponin levels to assess for cardiac damage 2. Annual eye examinations to assess for cataract development 3. Monthly pregnancy tests for all women of childbearing age 4. Complete blood count every 3 to 4 months 8. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for: 1. Increased seizure activity, as this drug may auto-induce seizures 2. Altered renal function, including renal failure 3. Blood dyscrasias, which are uncommon but possible 4. Central nervous system excitement, leading to insomnia 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 4. Decrease her dose to half then slowly titrate up the dose 10. Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be: 1. Tell her to increase her caloric intake to counter the effects of the topiramate. 2. Consult with a neurologist, as this is not a common adverse effect of topiramate. 3. Decrease her dose of topiramate. 4. Reassure her that this is a normal side effect of topiramate and continue to monitor her weight. 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 12. Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes: 1. He should not play sports due to the risk of increased seizures 2. He should monitor his temperature and ability to sweat in the heat while playing 3. Reminding him that he may need higher dosages of topiramate when exercising 4. Encouraging him to use sunscreen due to photosensitivity from topiramate 13. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her: 1. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures 2. To wear sunscreen due to photosensitivity from levetiracetam 3. To get an annual eye exam while on levetiracetam 4. To report weight loss if it occurs 14. Levetiracetam has known drug interactions with: 1. Combined oral contraceptives 2. Carbamazepine 3. Warfarin 4. Few, if any, drugs 15. Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes: 1. Reassuring her she has a viral infection and to call if she isn’t better in 4 or 5 days 2. Ruling out a hypersensitivity reaction that may lead to multi-organ failure 3. Rapid strep test and symptomatic care if strep test is negative 4. Observation only, with further assessment if she worsens 16. Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause: 1. Contraceptive failure 2. Excessive weight gain 3. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine 4. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed 17. The tricyclic antidepressants should be prescribed cautiously in patients with: 1. Eczema 2. Asthma 3. Diabetes 4. Heart disease 18. A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs): 1. He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex) 2. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce 3. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment 4. All of the above 19. Taylor is a 10-year-old child diagnosed with major depression. The appropriate first- line antidepressant for children is: 1. Fluoxetine 2. Fluvoxamine 3. Sertraline 4. Escitalopram 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: 2. Acetaminophen with hydrocodone (Vicodin) 3. Oxycodone (Oxycontin) 4. Oral morphine (Roxanol) 36. Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: 1. Slurred speech and insomnia 2. Bradycardia and confusion 3. Dizziness and orthostatic hypotension 4. Insomnia and decreased appetite 37. Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes: 1. ADHD symptoms 2. Routine height and weight checks 3. Amount of methylphenidate being used 4. All of the above 38. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor: 1. Blood pressure 2. Blood glucose levels 3. Urine ketone levels 4. Liver function Chapter 12. Drugs Affecting the Central Nervous System Answer Section MULTIPLE CHOICE 1. ANS 2 PTS: 1 2. ANS 3 PTS: 1 3. ANS 2 PTS: 1 4. ANS 1 PTS: 1 5. ANS 2 PTS: 1 6. ANS 3 PTS: 1 7. ANS 4 PTS: 1 8. ANS 3 PTS: 1 9. ANS 2 PTS: 1 10. ANS 4 PTS: 1 11. ANS 4 PTS: 1 12. ANS 2 PTS: 1 13. ANS 1 PTS: 1 14. ANS 4 PTS: 1 15. ANS 2 PTS: 1 16. ANS 3 PTS: 1 17. ANS 4 PTS: 1 18. ANS 4 PTS: 1 19. ANS 1 PTS: 1 20. ANS 1 PTS: 1 21. ANS 4 PTS: 1 22. ANS 2 PTS: 1 23. ANS 2 PTS: 1 24. ANS 1 PTS: 1 25. ANS 1 PTS: 1 26. ANS 3 PTS: 1 27. ANS 4 PTS: 1 28. ANS 2 PTS: 1 29. ANS 1 PTS: 1 30. ANS 3 PTS: 1 31. ANS 2 PTS: 1 32. ANS 4 PTS: 1 33. ANS 4 PTS: 1 34. ANS 1 PTS: 1 35. ANS 2 PTS: 1 36. ANS 4 PTS: 1 37. ANS 4 PTS: 1 38. ANS 1 PTS: 1 Chapter 13. Drugs Affecting the Cardiovascular and Renal Systems Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Ray has been diagnosed with hypertension and an angiotensin-converting enzyme inhibitor is determined to be needed. Prior to prescribing this drug, the NP should assess for: 1. Hypokalemia 2. Impotence 3. Decreased renal function 4. Inability to concentrate 2. Angiotensin-converting enzyme inhibitors are the drug of choice in treating hypertension in diabetic patients because they: 1. Improve insulin sensitivity 2. Improve renal hemodynamics 3. Reduce the production of angiotensin II 4. All of the above 3. A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response? 1. Swelling of the tongue or hoarseness are the most common symptoms. 2. It appears to be related to the decrease in aldosterone production. 3. Presence of a dry, hacky cough indicates a high risk for this adverse response. 4. Because it takes time to build up a blood level, it occurs after being on the drug for about 1 week. 4. Angiotensin-converting enzyme inhibitors are useful in a variety of disorders. Which of the following statements are true about both its usefulness in the disorder and the reason for its use? 1. Stable angina because it decreases the thickening of vascular walls due to decreased modified release. 2. Heart failure because it reduces remodeling of injured myocardial tissues. 3. Both 1 and 2 are true and the reasons are correct. 4. Both 1 and 2 are true but the reasons are wrong. 5. Neither 1 nor 2 are true. 5. Despite good blood pressure control, an NP might change a patient’s drug from an angiotensin-converting enzyme (ACE) inhibitor to an angiotensin II receptor blocker (ARB) because the ARB: 1. Is stronger than the ACE inhibitor 2. Does not produce a dry, hacky cough 3. Has no effect on the renal system 4. Reduces sodium and water retention 6. While taking an angiotensin II receptor blocker (ARB), patients need to avoid certain over-the-counter drugs without first consulting the provider because: 1. Cimetidine is metabolized by the CYP 3A4 isoenzymes 2. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels 3. Both 1 and 2 4. Neither 1 nor 2 1. It is a long-acting drug with potential for toxicity. 2. Nitrate tolerance can develop. 3. Orthostatic hypotension is a common adverse effect. 4. It must be taken with milk or food. 21. Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He complains of headaches after using his nitrate. An appropriate reply might be: 1. This is a parasympathetic response to the vasodilating effects of the drug. 2. Headaches are common side effects with these drugs. How severe are they? 3. This is associated with your smoking. Let’s work on having you stop smoking. 4. This is not related to your medication. Are you under a lot of stress? 22. In teaching about the use of sublingual nitroglycerine, the patient should be instructed: 1. To swallow the tablet with a full glass of water 2. To place one tablet under the tongue if chest pain occurs and allow it to dissolve 3. To take one tablet every 5 minutes until the chest pain goes away 4. That it should “burn” when placed under the tongue or it is no longer effective 23. Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: 1. Become a vegetarian because this disorder is associated with eating red meat. 2. Stop taking the drug if abdominal cramps and diarrhea develop. 3. Report muscle weakness or tenderness and dark urine to his provider immediately. 4. Expect “hot flash” sensations during the first 2 weeks of therapy. 24. Which of the following diagnostic studies would NOT indicate a problem related to a reductase inhibitor? 1. Elevated serum transaminase 2. Increased serum creatinine 3. Elevated creatinine kinase 4. Increased white blood cell counts 25. Because of the pattern of cholesterol synthesis, reductase inhibitors are given: 1. In the evening in a single daily dose 2. Twice daily in the morning and the evening 3. With each meal and at bedtime 4. In the morning before eating 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 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 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. 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 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 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 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 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 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 34. Direct renin inhibitors have the following properties. They: 1. Are primarily generic drugs 2. Are a renin-angiotensin-aldosterone system (RAAS) medication that is safe during pregnancy 3. Can be used with an angiotensin-converting enzyme and angiotensin II receptor blocker medications for stronger impact 4. “Shut down” the entire RAAS cycle 35. When comparing angiotensin-converting enzyme (ACE) and angiotensin II receptor blocker (ARB) medications, which of the following holds true? 1. Both have major issues with a dry, irritating cough 2. Both contribute to some retention of potassium 3. ARBs have a stronger impact on hypertension control than ACE medications 4. ARBs have stronger diabetes mellitus renal protection properties than ACE medications 36. What does the provider understand about the issue of “Diabetic Renal Protection” with angiotensin-converting enzyme (ACE) medications? Diabetes mellitus patients: 1. Have a reduced rate of renal progression, but still need to be discontinued when advanced renal issues present 2. Who start these medications never progress to renal nephropathy 3. With early renal dysfunction will see it reverse when on ACE medications 4. Without renal issues are the only ones who benefit from ACE protection 37. What dermatological issue is linked to Amiodarone use? 1. Increased risk of basal cell carcinoma 2. Flare up of any prior psoriasis problems 3. Development of plantar warts 4. Progressive change of skin tone toward a blue spectrum 38. Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with nitrates. Why? 1. Increased risk of priapism 2. Profound hypotension 3. Development of blue discoloration to the visual field 4. Inactivation of the ED medication effect 3. Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better 4. Order a theophylline level at the laboratory for him 8. Tiotropium bromide (Spiriva) is an inhaled anticholinergic: 1. Used for the treatment of chronic obstructive pulmonary disease (COPD) 2. Used in the treatment of asthma 3. Combined with albuterol for treatment of asthma exacerbations 4. Combined with fluticasone for the treatment of persistent asthma 9. Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes: 1. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day 2. Beclomethasone needs to be used every day to treat her asthma 3. Report any systemic side effects she is experiencing, such as weight gain 4. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation 10. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed: 1. Montelukast twice a day is started when there is an asthma exacerbation. 2. Patients may experience weight gain on montelukast. 3. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast. 4. Lethargy and hypersomnia may occur when taking montelukast. 11. Montelukast (Singulair) may be prescribed for: 1. A 6-year-old child with exercise-induced asthma 2. A 2-year-old child with moderate persistent asthma 3. An 18-month-old child with seasonal allergic rhinitis 4. None of the above; montelukast is not approved for use in children 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. 14. Patients with allergic rhinitis may benefit from a prescription of: 1. Fluticasone (Flonase) 2. Cetirizine (Zyrtec) 3. OTC cromolyn nasal spray (Nasalcrom) 4. Any of the above 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 16. First-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are: 1. More effective than first-generation antihistamines 2. Less sedating than the first-generation antihistamines 3. Prescription products, therefore are covered by insurance 4. Able to be taken with central nervous system (CNS) sedatives, such as alcohol 17. When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to: 1. Take the dimenhydrinate after they get nauseated 2. Drink lots of water while taking the dimenhydrinate 3. Take the dimenhydrinate 15 minutes before it is needed 4. Double the dose if one tablet is not effective 18. Decongestants such as pseudoephedrine (Sudafed): 1. Are Schedule III drugs in all states 2. Should not be prescribed or recommended for children under 4 years of age 3. Are effective in treating the congestion children experience with the common cold 4. May cause drowsiness in patients of all ages 19. Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population: 1. Older adults 2. Hypertensive patients 3. Infants 4. All of the above 20. Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be: 1. Oral pseudoephedrine 2. Oral phenylephrine 3. Nasal oxymetazoline 4. Nasal azelastine 21. The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-year- old child is: 1. Fluids and symptomatic care 2. Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids) 3. Guaifenesin and codeine syrup (Tussin AC) 4. Chlorpheniramine and dextromethorphan syrup (Nyquil for Kids) Chapter 14. Drugs Affecting the Respiratory System Answer Section MULTIPLE CHOICE 1. ANS: 4 PTS: 1 2. ANS: 2 PTS: 1 3. ANS: 2 PTS: 1 4. ANS: 3 PTS: 1 5. ANS: 4 PTS: 1 6. ANS: 2 PTS: 1 7. ANS: 3 PTS: 1 8. ANS: 1 PTS: 1 9. ANS: 2 PTS: 1 10. ANS: 3 PTS: 1 11. ANS: 2 PTS: 1 12. ANS: 4 PTS: 1 13. ANS: 3 PTS: 1 14. ANS: 4 PTS: 1 15. ANS: 1 PTS: 1 16. ANS: 2 PTS: 1 17. ANS: 3 PTS: 1 18. ANS: 2 PTS: 1 19. ANS: 4 PTS: 1 20. ANS: 3 PTS: 1 21. ANS: 1 PTS: 1 2. Neutropenia 3. Hypertension 4. Gout 15. The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that: 1. ESAs no longer be prescribed to patients with chronic renal failure 2. The risk of tumor development be explained to cancer patients on ESA therapy 3. Patients should no longer receive ESA therapy to prepare for allogenic transfusions 4. ESAs be prescribed only to patients younger than age 60 years 16. When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in: 1. 6 weeks if they are a cancer patient 2. 1 week if they have chronic renal failure 3. 2 weeks if they are taking it for allogenic transfusion 4. Each week throughout therapy 17. Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed: 1. Folic acid to prevent megaloblastic anemia 2. Iron, to start when the epogen starts 3. An antihypertensive to counter the adverse effects of epogen 4. Vitamin B12 to prevent pernicious anemia 18. Monitoring for a patient being prescribed iron for iron deficiency anemia includes: 1. Reticulocyte count 1 week after therapy is started 2. Complete blood count every 2 weeks throughout therapy 3. Hemoglobin level at 1 week of therapy 4. INR weekly throughout therapy 19. Patient education regarding taking iron replacements includes: 1. Doubling the dose if they miss a dose to maintain therapeutic levels 2. Taking the iron with milk or crackers if it upsets their stomach 3. Iron is best taken on an empty stomach with juice 4. Antacids such as Tums may help the upset stomach caused by iron therapy 20. Patients with pernicious anemia require treatment with: 1. Iron 2. Folic acid 3. Epogen alpha 4. Vitamin B12 21. The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is: 1. Hematocrit levels start to rise 2. Hemoglobin levels return to normal 3. Reticulocyte count begins to rise 4. Vitamin B12 levels return to normal 22. Patients who are beginning therapy with vitamin B12 need to be monitored for: 1. Hypertensive crisis that may occur in the first 36 hours 2. Hypokalemia that occurs in the first 48 hours 3. Leukopenia that occurs at 1 to 3 weeks of therapy 4. Thrombocytopenia that may occur at any time in therapy Chapter 15. Drugs Affecting the Hematological System Answer Section MULTIPLE CHOICE 1. ANS: 2 PTS: 1 2. ANS: 2 PTS: 1 3. ANS: 4 PTS: 1 4. ANS: 3 PTS: 1 5. ANS: 4 PTS: 1 6. ANS: 2 PTS: 1 7. ANS: 1 PTS: 1 8. ANS: 1 PTS: 1 9. ANS: 4 PTS: 1 10. ANS: 1 PTS: 1 11. ANS: 3 PTS: 1 12. ANS: 2 PTS: 1 13. ANS: 2 PTS: 1 14. ANS: 1 PTS: 1 15. ANS: 2 PTS: 1 16. ANS: 1 PTS: 1 17. ANS: 2 PTS: 1 18. ANS: 1 PTS: 1 19. ANS: 3 PTS: 1 20. ANS: 4 PTS: 1 21. ANS: 2 PTS: 1 22. ANS: 3 PTS: 1 4. All of the above 15. Rho(D) immune globulin (RhoGAM) is given to: 1. Infants born to women who are Rh positive 2. Sexual partners of Rh-positive women 3. Rh-negative women after a birth, miscarriage, or abortion 4. Rh-negative women at 36 weeks gestation 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 17. Diane may benefit from cyclosporine (Sandimmune). Cyclosporin may be prescribed to: 1. Treat rheumatoid arthritis 2. Treat patients with corn allergy 3. Pregnant patients 4. Treat patients with liver dysfunction 18. Azathioprine has significant adverse drug effects, including: 1. Hypertension 2. Hirsutism 3. Risk of cancer 4. Gingival hyperplasia 19. Pregnant women should receive the Tdap vaccine: 1. In the first trimester 2. Once every 10 years 3. In the third trimester of every pregnancy 4. Tdap is contraindicated in pregnancy 20. Children who should receive meningococcal conjugate vaccine (Hib-MenCY, MenHibrix) include: 1. Children traveling to the Haj 2. Infants, routinely at 2, 4, 6, and 12 to 15 months 3. Infants with functional asplenia (including sickle cell disease) 4. Two-year olds with complement deficiencies Chapter 16. Drugs Affecting the Immune System Answer Section MULTIPLE CHOICE 1. ANS: 3 PTS: 1 2. ANS: 1 PTS: 1 3. ANS: 4 PTS: 1 4. ANS: 3 PTS: 1 5. ANS: 4 PTS: 1 6. ANS: 4 PTS: 1 7. ANS: 2 PTS: 1 8. ANS: 2 PTS: 1 9. ANS: 4 PTS: 1 10. ANS: 4 PTS: 1 11. ANS: 1 PTS: 1 12. ANS: 2 PTS: 1 13. ANS: 4 PTS: 1 14. ANS: 1 PTS: 1 15. ANS: 3 PTS: 1 16. ANS: 4 PTS: 1 17. ANS: 2 PTS: 1 18. ANS: 4 PTS: 1 19. ANS: 3 PTS: 1 20. ANS: 3 PTS: 1 Chapter 17. Drugs Affecting the Gastrointestinal System Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first? 1. Patients with kidney stones 2. Pregnant patients 3. Patients with heartburn 4. Postmenopausal women 2. Patients taking antacids should be educated regarding these drugs, including letting them know that: 1. They may cause constipation or diarrhea 2. Many are high in sodium 3. They should separate antacids from other medications by 1 hour 4. All of the above 3. Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide: 1. Can be given to patients of all ages, including infants and children, for viral gastroenteritis 2. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea 3. Is the treatment of choice for the diarrhea associated with E. coli 0157 4. May be used in pregnancy and by lactating women 4. Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate: 1. May lead to toxicity if taken with aspirin 2. Is contraindicated in children with flu-like illness 3. Has antimicrobial effects against bacterial and viral enteropathogens 4. All of the above 5. Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food and water precautions as well as taking: 1. Loperamide four times a day throughout the trip 2. Bismuth subsalicylate with each meal and at bedtime 3. A prescription for diphenoxylate with atropine to use if she gets diarrhea 4. None of the above 6. Josie is a 5-year-old patient who presents to the clinic with a 48-hour history of nausea, vomiting, and some diarrhea. She is unable to keep fluids down and her weight is 4 pounds less than her last recorded weight. Besides IV fluids, her exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order for Josie? 1. Prochlorperazine (Compazine) 2. Meclizine (Antivert) 3. Promethazine (Phenergan) 4. Ondansetron (Zofran) Chapter 18. Drugs Affecting the Endocrine System: Pancreatic Hormones and Antidiabetic Drugs Multiple Choice Identify the choice that best completes the statement or answers the question. 1. Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss are: 1. Cortical bones 2. Femoral neck bones 3. Cervical vertebrae 4. Pelvic bones 2. Bisphosphonates treat or prevent osteoporosis by: 1. Inhibiting osteoclastic activity 2. Fostering bone resorption 3. Enhancing calcium uptake in the bone 4. Strengthening the osteoclastic proton pump 3. Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs? 1. Selective estrogen receptor modulators 2. Aspirin 3. Glucocorticoids 4. Calcium supplements 4. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, and amylase components, but the drug is prescribed in units of: 1. Lipase 2. Protease 3. Amylase 4. Pancreatin 5. Brands of pancreatic enzyme replacement drugs are: 1. Bioequivalent 2. About the same in cost per unit of lipase across brands 3. Able to be interchanged between generic and brand-name products to reduce cost 4. None of the above 6. When given subcutaneously, how long until neutral protamine Hagedorn insulin begins to take effect (onset of action) after administration? 1. 15 to 30 minutes 2. 60 to 90 minutes 3. 3 to 4 hours 4. 6 to 8 hours 7. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include: 1. “Fruity” breath odor and rapid respiration 2. Diarrhea, abdominal pain, weight loss, and hypertension 3. Dizziness, confusion, diaphoresis, and tachycardia 4. Easy bruising, palpitations, cardiac dysrhythmias, and coma 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 9. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true? 1. Optimal time of preprandial injection is 15 minutes. 2. Duration of action is increased when the dose is increased. 3. It is compatible with neutral protamine Hagedorn insulin. 4. It has no pronounced peak. 10. The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done: 1. The initial dose of glargine is reduced by 20% to avoid hypoglycemia. 2. The initial dose of glargine is 2 to 10 units per day. 3. Patients who have been on high doses of NPH will need tests for insulin antibodies. 4. Obese patients may require more than 100 units per day. 11. When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research? 1. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia. 2. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents. 3. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins. 4. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime. 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 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 14. The action of “gliptins” is different from other antidiabetic agents because they: 1. Have a low risk for hypoglycemia 2. Are not associated with weight gain 3. Close ATP-dependent potassium channels in the beta cell 4. Act on the incretin system to indirectly increase insulin production 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 16. GLP-1 agonists: 1. Directly bind to a receptor in the pancreatic beta cell 2. Have been approved for monotherapy 3. Speed gastric emptying to decrease appetite 4. Can be given orally once daily 17. Avoid concurrent administration of exenatide with which of the following drugs? 1. Digoxin 2. Warfarin 3. Lovastatin 4. All of the above 18. Administration of exenatide is by subcutaneous injection: 1. 30 minutes prior to the morning meal 2. 60 minutes prior to the morning and evening meal 3. 15 minutes after the evening meal 4. 60 minutes before each meal daily 19. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report: 1. Tinnitus and decreased salivation 2. Fever and sore throat 3. Hypocalcemia and osteoporosis 4. Laryngeal edema and difficulty swallowing 20. Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for: 1. Excessive sedation 2. Tachycardia and angina 3. Weight gain 4. Cold intolerance 21. Which of the following is not an indication that growth hormone supplements should be discontinued? 1. Imaging indication of epiphyseal closure 2. Growth curve increases have plateaued 3. Complaints of mild bone pain 4. Achievement of anticipated height goals 22. Besides osteoporosis, IV bisphosphonates are also indicated for: 1. Paget’s Disease Chapter 19. Drugs Affecting the Endocrine System: Pituitary, Thyroid, and Adrenal Drugs Multiple Choice Identify the choice that best completes the statement or answers the question. _____ 1. The nurse is teaching the patient, newly diagnosed with Graves’ disease, about the normal functioning of the thyroid gland. What hormone will the nurse tell the patient controls production and release of thyroid hormones? 1. Thyrotropin-releasing hormone (TRH) 2. Thyroid-stimulating hormone (TSH) 3. Tetraiodothyronine 4. Triiodothyronine Ans: 2 Thyroid hormone production and release are regulated by the anterior pituitary hormone called thyroid-stimulating hormone (TSH). The secretion of TSH is regulated by thyrotropin-releasing hormone (TRH), a hypothalamic regulating factor. Tetraiodothyronine and triiodothyronine are thyroid hormones produced by the thyroid gland because of TSH stimulation. _____2. A child is diagnosed with hypothyroidism. The nurse anticipates an order for the drug of choice when treating children, which is what? 1. Liothyronine (Cytomel) 2. Liotrix (Thyrolar) 3. Levothyroxine (Synthroid) 4. Methimazole (Tapazole) Ans: 3 Levothyroxine is the drug of choice in children because of its predictable bioavailability and reliability. Liothyronine and liotrix tend to have more adverse effects and, although they can be used in children, are not the drugs of choice. Methimazole is an antithyroid drug and is used to treat hyperthyroidism. _____3. A patient is at risk for thrombosis formation and is taking an oral anticoagulant. The patient has been newly diagnosed with hypothyroidism and placed on levothyroxine (Synthroid). What will the nurse monitor the patient for? 1. Tachycardia 2. Elevated body temperature 3. Increased time spent sleeping 4. Increased bruising and bleeding Ans: 4 The effectiveness of an oral anticoagulant is increased if it is used in combination with a thyroid hormone. This may lead to increased bleeding and the need to decrease the dosage of the oral anticoagulant. Tachycardia would be found with hyperthyroidism and the effect of levothyroxine is not increased with the drug combination. Increased time spent sleeping would indicate lowering of thyroid function and the treatment should increase thyroid function. Increased body temperature is associated with hyperthyroidism. _____4. The nurse is providing patient teaching regarding the administration of levothyroxine (Synthroid). What is the nurse’s priority teaching point? 1. Take the medication after breakfast. 2. Take the medication with a full glass of water. 3. Remain in the upright position for 30 minutes after administering. 4. Take the medication before going to bed at night. Ans: 2 The patient should be instructed to take the medication with a full glass of water to help prevent difficulty swallowing and esophageal atresia. The medication should be taken on an empty stomach before breakfast. There is no need to maintain an upright position. The medication should be taken as a single daily dose before breakfast each day to ensure consistent therapeutic levels. _____5. The nurse instructs the patient with a new prescription to treat hyperthyroidism and includes the importance of regular lab studies to monitor for bone marrow suppression, which can be an adverse effect of this drug. What drug is the nurse teaching the patient about? 1. Methimazole (Tapazole) 2. Propylthiouracil (PTU) 3. Sodium iodide I131 (Generic) 4. Potassium iodide (Thyro-Block) Ans: 1 Methimazole is associated with bone marrow suppression, so the patient using this drug must have frequent blood tests to monitor for this effect. Propylthiouracil is associated with GI effects. The most common adverse effect of sodium iodide I131 and potassium iodide is hypothyroidism. Other effects of these two drugs include metallic taste and burning in the mouth, sore teeth and gums, diarrhea, cold symptoms, stomach upset, stained teeth, rash, and the development of goiter. _____6. A patient is seen in the clinic and diagnosed with hyperthyroidism. Potassium iodide is prescribed. The nurse reviews the patient’s medical record before administering the drug. What assessment finding would cause the nurse to alter the plan of care? 1. A daily walk of 3 miles a day 2. A low fat, low sodium diet 3. A bowel movement every 2 to 3 days 4. Digoxin 0.125 mg daily Ans: 4 Potassium iodide will cause the patient to move from hyperthyroidism to hypothyroidism, thus altering the patient’s metabolism. Digoxin has a small margin of safety that could be altered by a change in thyroid function. The patient will need to be monitored carefully for an alteration in digoxin effects that may include an increased heart rate, arrhythmia, or reduced cardiac output. A daily walk of 3 miles, a low fat, low sodium diet, and a bowel movement every 2 to 3 days are important for maintenance of a healthy lifestyle but would not alter the plan of care. _____7. A patient with Pagets disease calls the clinic and tells the nurse that she is experiencing flushing of the face and hands and a rash. The patient states that she is taking calcitonin, salmon (Calcimar) for her Pagets disease. What is the nurses best response? 1. We expected this to happen. Just ignore it and please do not worry about it. 2. You will need to see the doctor immediately. Come in as soon as possible. 3. This is a common adverse effect of your medication that will lessen with time. 4. This is a serious adverse effect. Stop taking the drug and see the doctor today. Ans: 3 The most common adverse effects seen with this drug include flushing of the face and hands, rash, nausea and vomiting, urinary frequency, and local inflammation at the site of injection. Many of these adverse effects lessen with time, the duration varying with each individual patient. Although it is an expected adverse effect, the nurse needs to provide more teaching instead of simply telling the patient to ignore it and to not worry. The patient does not need to be seen and this is not a serious adverse effect. _____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? _____ 13. The nurse provides teaching regarding levothyroxine to a 55-year-old patient diagnosed with Hashimotos disease. What statement made by the patient does the nurse interpret to mean that the drug teaching had been understood? 1. I can take this medication at any time of day. 2. I should take this medication on an empty stomach in the morning. 3. I may take this with a sip of water in the morning. 4. If I feel nauseated, I may take this drug with an antacid. Ans: 2 Adults who require thyroid replacement therapy need to understand that this will be a lifelong need. An established routine of taking the tablet first thing in the morning may help the patient comply with the drug regimen. The drug should be taken on an empty stomach with a full glass of water. Antacids would slow or prevent absorption of the hormone replacement, so the patient should be corrected. _____ 14. The nurse, developing a care plan for a patient diagnosed with hypothyroidism, creates what appropriate nursing diagnosis? 1. Imbalanced nutrition: Less than body requirements 2. Ineffective thermoregulation: Excess or ineffective airway clearance 3. Decreased cardiac output 4. Ineffective airway clearance Ans: 3 Decreased cardiac output is related to hypothyroidism. Hyperthyroidism results in increased caloric needs and the nursing diagnosis of Imbalanced nutrition: Less than body requirements. Thyroid dysfunction would not normally result in Ineffective thermoregulation: Excess or ineffective airway clearance. _____ 15. The nurse is caring for a 5-year-old child diagnosed with hypothyroidism whose mother voices skepticism about giving the child drugs. In explaining the need for medication, what will the nurse tell this mother could result if her daughters condition remains untreated so she can make an informed decision? 1. Mental retardation 2. Renal dysfunction 3. Immune deficiency 4. Paralytic ileus Ans: 1 Children who are born without a thyroid gland or who have a nonfunctioning gland develop a condition called cretinism. If untreated, these children will have poor growth and development and mental retardation because of the lack of thyroid hormone stimulation. The child would not be at increased risk of renal dysfunction, immune deficiency, or paralytic ileus. _____ 16. A patient is diagnosed with a simple goiter and asks the nurse what caused it. What is the nurses best response? 1. A goiter is the result of too much thyroxine. 2. A goiter is the result of a chloride deficiency. 3. A goiter is the result of too much TSH. 4. A goiter is the result of an iodine deficiency. Ans: 3 Goiter (enlargement of the thyroid gland) is an effect of hyperthyroidism, which occurs when the thyroid is overstimulated by thyroid stimulating hormone (TSH). This can happen if the thyroid gland does not produce sufficient thyroid hormones to turn off the hypothalamus and anterior pituitary. In the body’s attempt to produce the needed amount of thyroid hormone, the thyroid is continually stimulated by increasing levels of TSH. There is a deficiency of thyroxine. It is not related to chloride or iodine deficiencies. _____ 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? 1. Elevated TSH, elevated T3, and reduced T4 levels 2. Reduced TSH, elevated T3 and T4 levels 3. Elevated TSH, reduced T3 and T4 levels 4. Reduced TSH, T3, and T4 levels Ans: 3 TSH levels would be elevated to stimulate increased thyroid hormone secretion whereas T4 and T3 will be low, which indicates the need for a higher dosage of medication. If TSH level is low, it would indicate a reduction in dosage would be needed, particularly if T3 and T4 levels are elevated. _____ 18. A patient presents at the clinic with complaints of weight loss despite an increased appetite. The nurse assesses this patient for what? 1. Chronic thyroiditis 2. Hypercalcemia 3. Hypothyroidism 4. Hyperthyroidism Ans: 4 Hyperthyroidism is manifested by increased metabolism and energy usage. It is not manifested by chronic thyroiditis, hyperglycemia, or hypothyroidism. _____ 19. What patient will the nurse assess most closely for secondary hyperparathyroidism? 1. The 12-year-old patient with hypothyroidism 2. The 68-year-old patient with chronic renal failure 3. The 35-year-old patient with diabetes mellitus 4. The 48-year-old patient with hyperthyroidism Ans: 2 Secondary hyperparathyroidism occurs most frequently in patients with chronic renal failure. Primary hyperparathyroidism occurs more often in women between 60 and 70 years of age. Although hyperparathyroidism can occur at any age, the patient with diabetes or thyroid disorder would not be at higher risk for the disorder. _____ 20. What drug would the nurse appropriately administer to the patient to treat hypothyroidism? 1. Teriparatide 2. Methimazole 3. Propylthiouracil 4. Levothyroxine Ans: 4 Levothyroxine (Synthroid, Levoxyl, Levothroid), a synthetic salt of thyroxine, is the most frequently used replacement hormone to treat hypothyroidism because of its predictable bioavailability and reliability. Propylthiouracil and methimazole would be used to treat hyperthyroidism; teriparatide is an antihypocalcemic agent. _____ 21. The nurse is caring for a patient with a history of myocardial infarction and adequate caloric intake. _____ 26. The nurse tells the patient his or her serum calcium level is elevated and the patient asks what controls calcium levels in the body. What is the nurses best response? 1. Renin 2. Parathyroid hormone (PTH) 3. Thyroid-stimulating hormone (TSH) 4. Epoetin Ans: 2 PTH is the most important regulator of serum calcium levels in the body. Renin controls blood pressure, epoetin stimulates production of red blood cells, and TSH stimulates thyroid hormone secretion. _____ 27. The nurse is caring for a patient diagnosed with hyperparathyroidism who asks the nurse why parathyroid hormone (PTH) is important. The nurse explains that PTH performs what actions in the body? (Select all that apply.) 1. Stimulation of osteoclasts 2. Increased intestinal absorption of calcium 3. Stimulation of calcitriol production 4. Increased excretion of calcium from kidneys 5. Decreased retention of vitamin D Ans: 1, 2, 3 PTH has many actions, including stimulation of osteoclasts or bone cells to release calcium from the bone, increased intestinal absorption of calcium, increased calcium reabsorption from the kidneys, and stimulation of cells in the kidney to produce calcitriol. PTH increases absorption of calcium from the kidney and increases retention of vitamin D. _____ 28. The nurse is teaching the patient how to take his newly prescribed alendronate and includes what teaching points? (Select all that apply.) 1. Take the drug in the morning. 2. Wait 60 minutes before eating breakfast. 3. Take the drug with a full glass of water. 4. Remain upright for 30 minutes after taking the medication. 5. Eat a breakfast high in calcium after taking the medication. Ans: 1, 3, 4 Alendronate, ibandronate, and risedronate need to be taken on arising in the morning, with a full glass of water, fully 30 minutes before any other food or beverage, and the patient must then remain upright for at least 30 minutes; taking the drug with a full glass of water and remaining upright for at least 30 minutes facilitates delivery of the drug to the stomach. These drugs should not be given to anyone who is unable to remain upright for 30 minutes after taking the drug because serious esophageal erosion can occur. There is no need to eat a high-calcium breakfast, although the patient should make certain of adequate calcium intake. _____ 29. The nurse is caring for an asthmatic patient prescribed zoledronic acid. What important question should the nurse ask this patient? 1. Can you take aspirin without experiencing any bad effects? 2. Are you taking theophylline to treat your asthma? 3. Do you have a history of diarrhea? 4. Are you taking digoxin? Ans: 1 Zoledronic acid should be used cautiously in aspirin-sensitive asthmatic patients. Gastrointestinal (GI) distress may increase if bisphosphonates are combined with aspirin; this combination should, therefore, be avoided if possible. There is no drug interaction between theophylline and zoledronic acid or between digoxin and zoledronic acid. A history of diarrhea would not impact the ability to administer zoledronic acid. _____ 30. The nurse is caring for a pediatric patient with hypercalcemia. What condition would the nurse suspect is causing this altered serum calcium level? 1. Radiation injury 2. Malignancy 3. Kidney failure 4. Hypothyroidism Ans: 2 Hypercalcemia is relatively rare in children, although it may be seen with certain malignancies. It would not result from a radiation injury, which would be more likely to affect the thyroid gland and it would not be caused by kidney failure or hypothyroidism. _____ 31. The nurse is caring for a patient who takes alendronate. What lab studies would the nurse assess regularly? 1. Serum iodine 2. Serum potassium 3. Serum calcium 4. Serum iron Ans: 3 Alendronate and risedronate are commonly used drugs for osteoporosis and calcium lowering. Serum calcium levels need to be monitored carefully with any of the drugs that affect calcium levels. Administration of alendronate would not require monitoring of iodine, potassium, or iron levels. _____ 32. The patient, newly prescribed cinacalcet hydrochloride (Sensipar), asks the nurse how this drug works. What is the nurses best response? 1. It slows or blocks bones resorption of calcium. 2. It promotes entry of calcium into bone. 3. It balances the effects of parathyroid hormone to lower serum calcium levels. 4. It increases the receptors sensitivity to extracellular calcium. Ans: 2 Cinacalcet hydrochloride is a calcimimetic drug that increases the sensitivity of the calcium-sensing receptor to activation by extracellular calcium. In increasing the receptors sensitivity, cinacalcet lowers parathyroid hormone (PTH) levels, causing a concomitant decrease in serum calcium levels. Bisphosphonates act to slow or block bone resorption; by doing this, they help to lower serum calcium levels, but they do not inhibit normal bone formation and mineralization. Calcitonins balance the effects of PTH by reducing calcium levels. Cinacalcet does not promote entry of calcium into the bone. 4. Androgens 9. Women who have migraines with an aura should not be prescribed estrogen because of: 1. The interaction between triptans and estrogen, limiting migraine therapy choices 2. An increased incidence of migraines with the use of estrogen 3. An increased risk of stroke occurring with estrogen use 4. Patients with migraines may be prescribed estrogen without any concerns 10. A 22-year-old woman receives a prescription for oral contraceptives. Education for this patient includes: 1. Counseling regarding decreasing or not smoking while taking oral contraceptives 2. Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive 3. Advising that she may miss two pills in a row and not be concerned about pregnancy 4. Recommending that her next follow-up visit is in 1 year for a refill and annual exam 11. A 19-year-old female is a nasal Staph aureus carrier and is placed on 5 days of rifampin for treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications? 1. Separate the oral ingestion of the rifampin and oral contraceptive by at least an hour. 2. Both medications are best tolerated if taken on an empty stomach. 3. She should use a back-up method of birth control such as condoms for the rest of the current pill pack. 4. If she gets nauseated with the medications, she should call the office for an antiemetic prescription. 12. A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her symptoms with the lowest adverse effects she should be prescribed: 1. Low-dose oral estrogen 2. A low-dose estrogen/progesterone combination 3. A vaginal estradiol ring 4. Vaginal progesterone cream 13. Shana is receiving her first medroxyprogesterone (Depo Provera) injection. Shana will need to be monitored for: 1. Depression 2. Hypertension 3. Weight loss 4. Cataracts 14. When prescribing medroxyprogesterone (Depo Provera) injections, essential education would include advising of the following potential adverse drug effects: 1. Hypertension and dysuria 2. Depression and weight gain 3. Abdominal pain and constipation 4. Orthostatic hypotension and dermatitis 15. The medroxyprogesterone (Depo Provera) injection has a Black Box Warning due to: 1. The potential development of significant hypertension 2. Increased risk of strokes 3. Decreased bone density 4. The risk of a life-threatening rash such as Stevens-Johnson 16. Shana received her first medroxyprogesterone (Depo Provera) injection 6 weeks ago and calls the clinic with a concern that she has been having a light “period” off and on since receiving her Depo shot. What would be the management of Shana? 1. Reassurance that some spotting is normal the first few months of Depo and it should improve. 2. Schedule an appointment for an exam as this is not normal. 3. Prescribe 4 weeks of estrogen to treat the abnormal vaginal bleeding. 4. Order a pregnancy test and suggest she use a back-up method of contraception until she has her next shot. 17. William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He should be screened for before prescribing sildenafil. 1. Renal dysfunction 2. Unstable coronary artery disease 3. Benign prostatic hypertrophy 4. History of priapism 18. Men who are prescribed sildenafil (Viagra) need ongoing monitoring for: 1. Development of chest pain or dizziness 2. Weight gain 3. Priapism 4. Renal function 19. Men who are prescribed an erectile dysfunction drug such as sildenafil (Viagra) should be warned about the risk for: 1. Impotence when combined with antihypertensives 2. Fatal hypotension if combined with nitrates 3. Weight gain if combined with antidepressants 4. All of the above 20. Androgens are indicated for: 1. Symptomatic treatment for male deficiency 2. Female libido, endometriosis, and postmenopausal symptoms 3. Increased muscle mass 4. Symptomatic treatment in both sexes for cancer and HIV 5. 1, 2, and 4 6. All of the above 21. Long-term use of androgens requires specific laboratory monitoring of: 1. Glucose, calcium, testosterone, and thyroid function 2. Calcium, testosterone, PSA, and liver function 3. Calcium, testosterone, PSA, liver function, glucose, and lipids 4. CBC, testosterone, PSA, and thyroid level 22. Effects of estrogen include: 1. Regulation of the menstrual cycle 2. Maintenance of bone density by increasing bone reabsorption 3. Maintenance of the normal structure of the skin and blood vessels 4. A and C 5. All of the above 23. Absolute contraindications that clinicians must consider when initiating estrogen therapy include: 1. Undiagnosed dysfunctional uterine bleeding 2. Deep vein or arterial thromboemboli within the prior year 3. Endometriosis 4. 1 and 2 5. All of the above 24. Patients taking hormonal contraceptives and hormone replacement therapy need to take the drug daily at the same time to prevent: 1. Nausea 2. Breakthrough bleeding 3. Breast tenderness 4. Pregnancy