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

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Test Bank Pharmacotherapeutics for Advanced Practice Nurse Prescribers 5th Edition Woo Robinson Chapter 1. The Role of the Nurse PractitionerMultiple ChoiceIdentify the choice that best completes the ... statement or answers the question.1. Nurse practitioner prescriptive authority is regulatedby:1.The National Council of State Boards of Nursing2.The U.S. Drug Enforcement Administration3.The State Board of Nursing for each state4.The State Board of Pharmacy2. The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriberinclude:1.Nurses know more about Pharmacology than other prescribers because they take itboth in their basic nursing program and in their APRN program.2.Nurses care for the patient from a holistic approach and include the patient indecision making regarding their care.3.APRNs are less likely to prescribe narcotics and other controlled substances.4.APRNsare able to prescribe independently in all states, whereas a physician’sassistant needs to have a physician supervising their practice.3. Clinical judgment in prescribingincludes:1.Factoring in the cost to the patient of the medication prescribed2.Always prescribing the newest medication available for the disease process3.Handing out drug samples to poor patients4.Prescribing all generic medications to cut costs4. Criteria for choosing an effective drug for a disorderinclude:1.Asking the patient what drug they think would work best for them2.Consulting nationally recognized guidelines for disease management3.Prescribing medications that are available as samples before writing a prescription4.Following U.S. Drug Enforcement Administration guidelines for prescribing5. Nurse practitioner practice may thrive under health-care reform becauseof:1.The demonstrated ability of nurse practitioners to control costs and improve patientoutcomes2.The fact that nurse practitioners will be able to practice independently3.The fact that nurse practitioners will have full reimbursement under health-carereform4.The ability to shift accountability for Medicaid to the state level Chapter 2. Review of Basic Principles of PharmacologyMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribingbecause:1.Distribution of drugs to target tissue may be affected.2.The solubility of the drug will not match the site of absorption.3.There will be less free drug available to generate an effect.4.Drugs bound to albumin are readily excreted by the kidneys.2. Drugs that have a significant first-passeffect:1.Must be given by the enteral (oral) route only2.Bypass the hepatic circulation3.Are rapidly metabolized by the liver and may have little if any desired action4.Are converted by the liver to more active and fat-soluble forms3. The route of excretion of a volatile drug will likely bethe:1.Kidneys2.Lungs3.Bile and feces4.Skin4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storagereservoirs:1.Assure that thedrug will reach its intended target tissue2.Are the reason for giving loading doses3.Increase the length of time a drug is available and active4.Are most common in collagen tissues5. The NP chooses to give cephalexin every 8 hours based on knowledge of thedrug’s:1.Propensity to go to the target receptor2.Biological half-life3.Pharmacodynamics4.Safety and side effects 6. Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loadingdose:1.Rapidly achieves drug levels in the therapeutic range2.Requires four-to five-half-lives to attain3.Is influenced by renal function4.Is directly related to the drug circulating tothe target tissues7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:1.Minimum adverse effect level2.Peak of action 3.Onset of action4.Therapeutic range8. Phenytoin requires that a trough level be drawn. Peak and trough levels aredone:1.When the drug has a wide therapeutic range2.When the drug will be administered for a short time only3.When there is a high correlation between the dose and saturation of receptor sites4.To determine if a drug is in the therapeutic range9. A laboratory result indicates that the peak level for a drug is above the minimum toxicconcentration.This means that the:1.Concentration will produce therapeuticeffects2.Concentration will produce an adverse response3.Time between doses must be shortened4.Duration of action of the drug is too long10. Drugs that are receptor agonists may demonstrate whatproperty?1.Irreversible binding to the drug receptor site2.Upregulation with chronic use3.Desensitization or downregulation with continuous use4.Inverse relationship between drug concentration and drug action11. Drugs that are receptor antagonists, such as beta blockers, maycause:1.Downregulation of the drug receptor2.An exaggerated response if abruptly discontinued3.Partial blockade of the effects of agonist drugs4.An exaggerated response to competitive drug agonists12. Factors that affect gastric drug absorptioninclude:1.Liver enzyme activity2.Protein-binding properties of the drug molecule3.Lipid solubility of the drug4.Ability to chew and swallow13. Drugs administered viaIV:1.Need to be lipid soluble in order to be easily absorbed2.Begin distribution into the body immediately3.Are easily absorbed if they are nonionized4.May use pinocytosis to be absorbed14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugsis:1.The sum of the effects of each drug individually2.Greater than the sum of the effects of each drug individually3.Less than the effect of each drug individually4.Not predictable, as it varies with each individual15. Which of the following statements about bioavailability istrue?1.Bioavailability issues are especially important for drugs with narrow therapeuticranges or sustained-release mechanisms.www.testbanktank.com 2.All brands of a drug have the same bioavailability.3.Drugs that are administered more than once a day have greater bioavailability thandrugs 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) istrue?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 isto:1.Inactivate prodrugs before they can be activated by target tissues2.Change the drugs so they can cross plasma membranes3.Change drug molecules to a form that an excretory organ can excrete4.Make these drugs more ionized and polar to facilitate excretion18. Once they have been metabolized by the liver, the metabolites maybe:1.More active than the parent drug2.Less active than the parent drug3.Totally “deactivated” so they are excreted without any effect4.Allof the above19. 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 increasedby:1.Reduced circulation and perfusion of the kidney2.Chronic renal disease3.Competition for a transport site by another drug4.Unbinding a nonvolatile drug from plasma proteins20. Steady stateis:1.The point on the drug concentration curve when absorption exceeds excretion2.When the amount of drug in the body remains constant3.When the amount of drug in the body stays below the minimum toxicconcentration4.All of the above21. Two different pain medications are given together for pain relief. The drug—drug interactionis:1.Synergistic2.Antagonistic3.Potentiative4.Additive22. Actions taken to reduce drug—drug interaction problems include all of the followingEXCEPT:1.Reducing the dosage of one of the drugs2.Scheduling their administration at different times3.Prescribing a third drug to counteract the adverse reaction of the combinationwww.testbanktank.com 4.Reducing the dosage of both drugs23. Phase I oxidative-reductive processes of drug metabolism require certain nutritionalelements.Which of the following would reduce or inhibit this process?1.Protein malnutrition2.Iron-deficiency anemia3.Both 1 and 24.Neither 1 nor 224. The time required for the amount of drug in the body to decrease by 50% iscalled:1.Steady state2.Half-life3.Phase II metabolism4.Reduced bioavailability time25. An agonist activates a receptor and stimulates a response. When given frequently over time, the body may:1.Upregulate the total number of receptors2.Block the receptor with apartial agonist3.Alter the drug’s metabolism4.Downregulate the numbers of that specific receptor26. Drug antagonism is best defined as an effect of a drugthat:1.Leads to major physiological and psychological dependence2.Is modified by the concurrent administration of another drug3.Cannot be metabolized before another dose is administered4.Leads to a decreased physiological response when combined with another drug27. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the followingstatements?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 resultin:1.Disintegration2.Toxicity3.Malabsorption4.Deterioration29. Which of the following substances is the most likely to be absorbed in the intestines rather than in thestomach?1.Sodium bicarbonate2.Ascorbic acid3.Salicylic acid4.Glucosewww.testbanktank.com 30. Which of the following variables is a factor in drugabsorption?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 betterabsorption.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 medicationis:1.Absorbed rapidly2.Excreted rapidly3.Metabolized minimally4.Distributed equally32. Drugs that use CYP 3A4 isoenzymes for metabolismmay:1.Induce the metabolism of another drug2.Inhibit the metabolism of another drug3.Both 1 and 24.Neither 1 nor 233. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steadystate:1.After the second dose2.After four to five half-lives3.When the patient feels the full effect of the drug4.One hour after IV administration34. Upregulation or hypersensitization may leadto:1.Increased response to a drug2.Decreased response to a drug3.An exaggerated response if the drug is withdrawn4.Refractoriness or complete lack of resp Chapter 3. Rational Drug SelectionMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old childbecause:1.Drugs given in liquid form are less irritating to the stomach.2.A 6-year-old child may have problems swallowing a pill.3.Liquid forms of medication eliminate the concern for first-pass effect.4.Liquid ibuprofen does not have to be dosed as often as the tablet form.2. In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it:1.Has serious side effects and it is not being used for a life-threatening condition2.Will be taken twice daily and will be taken at home3.Is expensive, but covered by health insurance4.None of these are important in choosing a drug3. A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men andwomen?1.Body temperature varies between men and women.2.Muscle mass is greater in women.3.Percentage of fat differs between genders.4.Proven subjective factors exist between the genders.4. The first step in the prescribing process according to the World Health Organizationis: 1.Choosing the treatment2.Educating the patient about the medication3.Diagnosing the patient’s problem4.Starting the treatment5. Treatment goals in prescribingshould:1.Always be curative2.Be patient-centered3.Be convenient for the provider4.Focus on the cost of therapy6. The therapeutic goals when prescribinginclude(s):1.Curative2.Palliative3.Preventive4.All of the above7. When determining drug treatment the NP prescribershould:1.Always use evidence-based guidelines2.Individualize the drug choice for the specific patient3.Rely on his or her experience when prescribing for complex patients4.Use the newest drug on the market for the condition being treated 8. Patient education regarding prescribed medicationincludes:1.Instructions written at the high school reading level2.Discussion of expected adverse drug reactions3.How to store leftover medication such as antibiotics4.Verbal instructions always in English9. Passive monitoring of drug effectivenessincludes:1.Therapeutic drug levels2.Adding or subtracting medications from the treatment regimen3.Ongoing provider visits4.Instructing the patient to report if the drug is not effective10. Pharmacokinetic factors that affect prescribinginclude:1.Therapeutic index2.Minimum effective concentration3.Bioavailability4.Ease of titration11. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute ofMedicine:1.Conflicts of interest and financial relationships should be disclosed by thoseproviding 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, fromthe pharmaceutical representative.12. Under new U.S. Food and Drug Administration labeling, Pregnancy Categories willbe:1.Strengthened with a new coding such as C+ or C-to discern when a drug is moreor less toxic to the fetus2.Changed to incorporate a pregnancy risk summary and clinical considerations onthe drug label3.Eliminated, and replaced with a link to the National Library of Medicine TOXNETWeb site for in-depth information regarding pregnancy concerns4.Clarified to include information such as safe dosages in each trimester ofpregnancywww.testbanktank.com Chapter 3. Rational Drug Selection Answer SectionMULTIPLE CHOICE1. ANS:2PTS:12. ANS:2PTS:13. ANS:3PTS:14. ANS:3PTS:15. ANS:2PTS:16. ANS:4PTS:17. ANS:2PTS:18. ANS:2PTS:19. ANS:4PTS:110. ANS:3PTS:111. ANS:1PTS:112. ANS:2PTS:1Chapter 4. Legal and Professional Issues in PrescribingMultiple ChoiceIdentify the choice that best completes the statement or answers the question.1. The U.S. Food and Drug Administrationregulates:1.Prescribing of drugs by MDs and NPs2.The official labeling for all prescription and over-the-counter drugs3.Off-label recommendations for prescribing4.Pharmaceutical educational offerings2. The U.S. Food and Drug Administration approval is requiredfor:1.Medical devices, including artificial joints2.Over-the-counter vitamins3.Herbal products, such as St John’s wort4.Dietary supplements, such as Ensure3. An InvestigationalNew Drug is filed with the U.S. Food and DrugAdministration:1.When the manufacturer has completed phase III trials2.When a new drug is discovered3.Prior to animal testing of any new drug entity4.Prior to human testing of any new drug entity4. Phase IV clinical trials in the United States are also knownas:1.Human bioavailability trials2.Postmarketing research3.Human safety and efficacy studies4.The last stage of animal trials before the human trials beginwww.testbanktank.com 5. Off-label prescribingis:1.Regulated by the U.S. Food and Drug Administration2.Illegal by NPs in all states (provinces)3.Legal if there is scientific evidence for the use4.Regulated by the Drug Enforcement Administration6. The U.S. Drug EnforcementAdministration:1.Registers manufacturers and prescribers of controlled substances2.Regulates NP prescribing at the state level3.Sanctions providers who prescribe drugs off-label4.Provides prescribers with a number they can use for insurance billing7. Drugs that are designated Schedule II by the U.S. Drug EnforcementAdministration:1.Are known teratogens during pregnancy2.May not be refilled; a new prescription must be written3.Have a low abuse potential4.May be dispensed without a prescription unless regulated by the state8. Precautions that should be taken when prescribing controlled substancesinclude: 1.Faxing the prescription for a Schedule II drug directly to the pharmacy2.Using tamper-proof paper for all prescriptions written for controlled drugs3.Keeping any pre-signed prescription pads in a locked drawer in the clinic4.Using only numbers to indicate the amount of drug to be prescribed9. Strategies prescribers can use to prevent misuse of controlled prescription drugsinclude:1.Use of chemical dependency screening tools2.Firm limit-setting regarding prescribing controlled substances3.Practicing “just say no” to deal with patients who are pushing the provider toprescribe controlled substances4.All of the above10. Behaviors predictive of addiction to controlled substancesinclude:1.Stealing or borrowing another patient’s drugs2.Requiring increasing doses of opiates for pain associated with malignancy3.Receiving refills of a Schedule II prescription on a regular basis4.Requesting that only their own primary care provider prescribe for them11. Medication agreements or “Pain Medication Contracts” are recommended to beused:1.Universally for allprescribing for chronic pain2.For patients who have repeated requests for pain medication3.When you suspect a patient is exhibiting drug-seeking behavior4.For patients with pain associated with malignancy12. A prescription needs to be writtenfor:1.Legend drugs2.Most controlled drugs3.Medical devices4.All of the above Chapter 4. Legal and Professional Issues in Prescribing Answer SectionMULTIPLE CHOICE1. ANS:2PTS:12. ANS:1PTS:13. ANS:4PTS:14. ANS:2PTS:15. ANS:3PTS:16. ANS:1PTS:17. ANS:2PTS:18. ANS:2PTS:19. ANS:4PTS:110. ANS:1PTS:111. ANS:1PTS:112. ANS:4PTS:1Chapter 5. Adverse Drug ReactionsMultiple ChoiceIdentify the choice that best completes thestatement 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 male2.A 22-year-old female3.A 3-month-old female4.A 48-year-old male2. Infants and young children are at higher risk of ADRs dueto:1.Immature renal function in school-age children2.Lack of safety and efficacy studies in the pediatric population3.Children’s skin being thicker than adults, requiring higher dosages of topicalmedication4.Infant boys having a higher proportion of muscle mass, leading to a higher volumeof distribution3. The elderly are at high risk of ADRs dueto:1.Having greater muscle mass than younger adults, leading to higher volume ofdistribution2.The extensive studies that have been conducted on drug safety in this age group3.The blood-brain barrier being less permeable, requiring higher doses to achievetherapeutic effect4.Age-related decrease in renal function4. The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic doses istype: 1.A2.B3.C4.D5. Digoxin may cause a type A adverse drug reaction dueto:1.Idiosyncratic effects2.Its narrow therapeutic index3.Beinga teratogen4.Being a carcinogen6. Sarah developed a rash after using a topical medication. This is a type allergic drugreaction.1.I2.II3.III4.IV7. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia isa(n): 1.Cytotoxic hypersensitivity reaction2.Immune complex hypersensitivity3.Immediate hypersensitivity reaction4.Delayed hypersensitivity reaction8. Anaphylactic shock isa:1.Type I reaction, called immediate hypersensitivity reaction2.Type II reaction, called cytotoxic hypersensitivity reaction3.Type III allergic reaction, called immune complex hypersensitivity4.Type IV allergic reaction, called delayed hypersensitivity reaction9. Jameshas hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a corticosteroid) use. He is at risk for what type of adverse drugreaction?1.Type B2.Type C3.Type E4.Type F10. Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D reaction because they areknown:1.Teratogens2.Carcinogens3.To cause hypersensitivity reactions4.Hypothalamus-pituitary-adrenal axis suppressants11. 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 aadverse drug reaction when he no longer requires theopioids.1.Rapid2.First-dose3.Late4.Delayed12. An example of a first-dose reaction that may occurincludes:1.Orthostatic hypotension that does not occur with repeated doses2.Purple glove syndrome with phenytoin use3.Hemolytic anemia from ceftriaxone use4.Contact dermatitis from neomycin use13. Drugs that are prone to cause adverse drug effectsinclude:1.Diuretics2.Inhaled anticholinergics3.Insulins4.Stimulants14. The U.S. Food and Drug Administration MedWatch system is activatedwhen:1.There is an adverse event to a vaccine.2.The patient has a severe reaction that is noted in the “Severe Reaction” section inthe medication label. 3.A lactating woman takes a medication that is potentially toxic to the breastfeedinginfant.4.An adverse event or serious problem occurs with a medication that is not alreadyidentified on the label.15. The Vaccine Adverse Events Reporting Systemis:1.A mandatory reporting system for all health-care providers when they encounter anadverse vaccine event2.A voluntary reporting system that health-care providers or consumers may use toreport vaccine adverse events3.Utilized to send out safety alerts regarding emerging vaccine safety issues4.Activated when a vaccine has been proven to cause significant adverse effects [Show More]

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