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NR 508 Midterm study questions
Chapter 1. The Role of the Nurse Practitioner
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Nurse practitione
...
TestBankWorld.org
NR 508 Midterm study questions
Chapter 1. The Role of the Nurse Practitioner
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 levelTestBankWorld.org
Chapter 1. The Role of the Nurse Practitioner
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: 1TestBankWorld.org
Chapter 2. Review of Basic Principles of Pharmacology
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to
prescribing because:
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-pass effect:
1. Must be given by the enteral (oral) route only
2. Bypass the hepatic circulation
3. Are rapidly metabolized by the liver and may have little if any desired action
4. Are converted by the liver to more active and fat-soluble forms
____ 3. The route of excretion of a volatile drug will likely be the:
1. Kidneys
2. Lungs
3. Bile and feces
4. Skin
____ 4. Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage
reservoir of the drug. Storage reservoirs:
1. Assure that the drug will reach its intended target tissue
2. Are the reason for giving loading doses
3. Increase the length of time a drug is available and active
4. Are most common in collagen tissues
____ 5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:
1. Propensity to go to the target receptor
2. Biological half-life
3. Pharmacodynamics
4. Safety and side effects
____ 6. Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the
prescription. This is considered a loading dose. A loading dose:TestBankWorld.org
1. Rapidly achieves drug levels in the therapeutic range
2. Requires four- to five-half-lives to attain
3. Is influenced by renal function
4. Is directly related to the drug circulating to the target tissues
____ 7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect
is the:
1. Minimum adverse effect level
2. Peak of action
3. Onset of action
4. Therapeutic range
____ 8. Phenytoin requires that a trough level be drawn. Peak and trough levels are done:
1. When the drug has a wide therapeutic range
2. When the drug will be administered for a short time only
3. When there is a high correlation between the dose and saturation of receptor sites
4. To determine if a drug is in the therapeutic range
____ 9. A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration.
This means that the:
1. Concentration will produce therapeutic effects
2. Concentration will produce an adverse response
3. Time between doses must be shortened
4. Duration of action of the drug is too long
____ 10. Drugs that are receptor agonists may demonstrate what property?
1. Irreversible binding to the drug receptor site
2. Upregulation with chronic use
3. Desensitization or downregulation with continuous use
4. Inverse relationship between drug concentration and drug action
____ 11. Drugs that are receptor antagonists, such as beta blockers, may cause:
1. Downregulation of the drug receptor
2. An exaggerated response if abruptly discontinued
3. Partial blockade of the effects of agonist drugs
4. An exaggerated response to competitive drug agonists
____ 12. Factors that affect gastric drug absorption include:
1. Liver enzyme activity
2. Protein-binding properties of the drug molecule
3. Lipid solubility of the drug
4. Ability to chew and swallow
____ 13. Drugs administered via IV:
1. Need to be lipid soluble in order to be easily absorbed
2. Begin distribution into the body immediately
3. Are easily absorbed if they are nonionized
4. May use pinocytosis to be absorbedTestBankWorld.org
____ 14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:
1. The sum of the effects of each drug individually
2. Greater than the sum of the effects of each drug individually
3. Less than the effect of each drug individually
4. Not predictable, as it varies with each individual
____ 15. Which of the following statements about bioavailability is true?
1. Bioavailability issues are especially important for drugs with narrow therapeutic
ranges or sustained-release mechanisms.
2. All brands of a drug have the same bioavailability.
3. Drugs that are administered more than once a day have greater bioavailability than
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 fetalplacental) 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 aboveTestBankWorld.org
____ 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:TestBankWorld.org
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 responseTestBankWorld.org
Chapter 2. Review of Basic Principles of Pharmacology
Answer Section
MULTIPLE CHOICE
1. ANS: 1 PTS: 1
2. ANS: 3 PTS: 1
3. ANS: 2 PTS: 1
4. ANS: 3 PTS: 1
5. ANS: 2 PTS: 1
6. ANS: 1 PTS: 1
7. ANS: 3 PTS: 1
8. ANS: 4 PTS: 1
9. ANS: 2 PTS: 1
10. ANS: 3 PTS: 1
11. ANS: 2 PTS: 1
12. ANS: 3 PTS: 1
13. ANS: 2 PTS: 1
14. ANS: 2 PTS: 1
15. ANS: 1 PTS: 1
16. ANS: 2 PTS: 1
17. ANS: 3 PTS: 1
18. ANS: 4 PTS: 1
19. ANS: 4 PTS: 1
20. ANS: 2 PTS: 1
21. ANS: 4 PTS: 1
22. ANS: 3 PTS: 1
23. ANS: 4 PTS: 1
24. ANS: 2 PTS: 1
25. ANS: 4 PTS: 1
26. ANS: 2 PTS: 1
27. ANS: 4 PTS: 1
28. ANS: 2 PTS: 1
29. ANS: 1 PTS: 1
30. ANS: 2 PTS: 1
31. ANS: 1 PTS: 1
32. ANS: 3 PTS: 1
33. ANS: 2 PTS: 1
34. ANS: 3 PTS: 1TestBankWorld.org
Chapter 3. Rational Drug Selection
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because:
1. Drugs given in liquid form are less irritating to the stomach.
2. A 6-year-old child may have problems swallowing a pill.
3. Liquid forms of medication eliminate the concern for first-pass effect.
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 condition
2. Will be taken twice daily and will be taken at home
3. Is expensive, but covered by health insurance
4. None of these are important in choosing a drug
____ 3. A client asks the NP about the differences in drug effects between men and women. What is known
about the differences between the pharmacokinetics of men and women?
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 Organization is:
1. Choosing the treatment
2. Educating the patient about the medication
3. Diagnosing the patient’s problem
4. Starting the treatment
____ 5. Treatment goals in prescribing should:
1. Always be curative
2. Be patient-centered
3. Be convenient for the provider
4. Focus on the cost of therapy
____ 6. The therapeutic goals when prescribing include(s):
1. Curative
2. Palliative
3. Preventive
4. All of the above
____ 7. When determining drug treatment the NP prescriber should:
1. Always use evidence-based guidelines
2. Individualize the drug choice for the specific patient
3. Rely on his or her experience when prescribing for complex patientsTestBankWorld.org
4. Use the newest drug on the market for the condition being treated
____ 8. Patient education regarding prescribed medication includes:
1. Instructions written at the high school reading level
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
pregnancyTestBankWorld.org
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: 1TestBankWorld.org
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. Postmarketing 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 stateTestBankWorld.org
____ 8. Precautions that should be taken when prescribing controlled substances include:
1. Faxing the prescription for a Schedule II drug directly to the pharmacy
2. Using tamper-proof paper for all prescriptions written for controlled drugs
3. Keeping any pre-signed prescription pads in a locked drawer in the clinic
4. Using only numbers to indicate the amount of drug to be prescribed
____ 9. Strategies prescribers can use to prevent misuse of controlled prescription drugs include:
1. Use of chemical dependency screening tools
2. Firm limit-setting regarding prescribing controlled substances
3. Practicing “just say no” to deal with patients who are pushing the provider to
prescribe controlled substances
4. All of the above
____ 10. Behaviors predictive of addiction to controlled substances include:
1. Stealing or borrowing another patient’s drugs
2. Requiring increasing doses of opiates for pain associated with malignancy
3. Receiving refills of a Schedule II prescription on a regular basis
4. Requesting that only their own primary care provider prescribe for them
____ 11. Medication agreements or “Pain Medication Contracts” are recommended to be used:
1. Universally for all prescribing for chronic pain
2. For patients who have repeated requests for pain medication
3. When you suspect a patient is exhibiting drug-seeking behavior
4. For patients with pain associated with malignancy
____ 12. A prescription needs to be written for:
1. Legend drugs
2. Most controlled drugs
3. Medical devices
4. All of the aboveTestBankWorld.org
Chapter 4. Legal and Professional Issues in Prescribing
Answer Section
MULTIPLE CHOICE
1. ANS: 2 PTS: 1
2. ANS: 1 PTS: 1
3. ANS: 4 PTS: 1
4. ANS: 2 PTS: 1
5. ANS: 3 PTS: 1
6. ANS: 1 PTS: 1
7. ANS: 2 PTS: 1
8. ANS: 2 PTS: 1
9. ANS: 4 PTS: 1
10. ANS: 1 PTS: 1
11. ANS: 1 PTS: 1
12. ANS: 4 PTS: 1TestBankWorld.org
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. IVTestBankWorld.org
____ 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.TestBankWorld.org
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 effectsTestBankWorld.org
Chapter 5. Adverse Drug Reactions
Answer Section
MULTIPLE CHOICE
1. ANS: 3 PTS: 1
2. ANS: 2 PTS: 1
3. ANS: 4 PTS: 1
4. ANS: 2 PTS: 1
5. ANS: 2 PTS: 1
6. ANS: 4 PTS: 1
7. ANS: 1 PTS: 1
8. ANS: 1 PTS: 1
9. ANS: 2 PTS: 1
10. ANS: 2 PTS: 1
11. ANS: 3 PTS: 1
12. ANS: 1 PTS: 1
13. ANS: 3 PTS: 1
14. ANS: 4 PTS: 1
15. ANS: 2 PTS: 1TestBankWorld.org
Chapter 6. Factors That Foster Positive Outcomes
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. A comprehensive assessment of a patient should be holistic when trying to determine competence in
drug administration. Which of the following factors would the NP omit from this type of
assessment?
1. Financial status
2. Mobility
3. Social support
4. Sexual practices
____ 2. Elena Vasquez’s primary language is Spanish, and she speaks very limited English. Which technique
would be appropriate to use in teaching her about a new drug you have just prescribed?
1. Use correct medical terminology because Spanish has a Latin base.
2. Use a family member who speaks more English to act as an interpreter.
3. Use a professional interpreter or a reliable staff member who can act as an
interpreter.
4. Use careful, detailed explanations.
____ 3. Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that
he understands teaching about his drug?
1. Stand facing him and speak slowly and clearly.
2. Speak in low tones or find a provider who has a lower voice.
3. Write down the instructions as well as speaking them.
4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds.
____ 4. Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug
regimen?
1. Complexity of the drug regimen
2. Patient perception of the potential adverse effects of the drugs
3. Both 1 and 2
4. Neither 1 nor 2
____ 5. The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which
of the following system variables creates such a barrier?
1. Increasing copayments for care
2. Unrestricted formularies for drugs, including brand names
3. Increasing the number of people who have access to care
4. Treating a wider range of disorders
____ 6. Ralph’s blood pressure remains elevated despite increased doses of his drug. The NP is concerned
that he might not be adhering to his treatment regimen. Which of the following events would suggest
that he might not be adherent?
1. Ralph states that he always takes the drug “when I feel my pressure is going up.”
2. Ralph contacts his NP to discuss the need to increase the dosage.TestBankWorld.org
3. Ralph consistently keeps his follow-up appointments to check his blood pressure.
4. All of the above show that he is adherent to the drug regimen.
____ 7. Nonadherence is especially common in drugs that treat asymptomatic conditions, such as
hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug
that:
1. Has a short half-life so that missing one dose has limited effect
2. Requires several dosage titrations so that missed doses can be replaced with lower
doses to keep costs down
3. Has a tolerability profile with fewer of the adverse effects that are considered
“irritating,” such as nausea and dizziness
4. Must be taken no more than twice a day
____ 8. Factors in chronic conditions that contribute to nonadherence include:
1. The complexity of the treatment regimen
2. The length of time over which it must be taken
3. Breaks in the usual daily routine, such as vacations and weekends
4. All of the above
____ 9. While patient education about their drugs is important, information alone does not necessarily lead
to adherence to a drug regimen. Patients report greater adherence when:
1. The provider spent a lot of time discussing the drugs with them
2. Their concerns and specific area of knowledge deficit were addressed
3. They were given written material, such as pamphlets, about the drugs
4. The provider used appropriate medical and pharmacological terms
____ 10. Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%.
To improve adherence in this population, prescribe drugs:
1. With a longer half-life so that missed doses produce a longer taper on the drug
curve
2. In oral formulations that are more easily taken
3. That do not require frequent monitoring
4. Combined with patient education about the need to adhere even when symptoms
are absent
____ 11. Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less
likely the patient will adhere to it. Which of the following interventions will NOT improve
adherence?
1. Have the patient purchase a pill container with compartments for daily or multiple
times-per-day dosing.
2. Match the clinic appointment to the next time the drug is to be refilled.
3. Write prescriptions for new drugs with shorter times between refills.
4. Give the patient a clear drug schedule that the provider devises to fit the
characteristic of the drug.
____ 12. Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially
important include:TestBankWorld.org
1. Older adults and those on fixed incomes
2. Patients with chronic illnesses
3. Patients with copayments for drugs on their insurance
4. Patients on public assistance
____ 13. Providers have a responsibility for determining the best plan of care, but patients also have
responsibilities. Patients the provider can be assured will carry through on these responsibilities
include those who:
1. Are well-educated and affluent
2. Have chronic conditions
3. Self-monitor drug effects on their symptoms
4. None of the above guarantee adherence
____ 14. Monitoring adherence can take several forms, including:
1. Patient reports from data in a drug diary
2. Pill counts
3. Laboratory reports and other diagnostic markers
4. All of the above
____ 15. Factors that explain and predict medication adherence include:
1. Social
2. Financial
3. Health system
4. All of the aboveTestBankWorld.org
Chapter 6. Factors That Foster Positive Outcomes
Answer Section
MULTIPLE CHOICE
1. ANS: 4 PTS: 1
2. ANS: 3 PTS: 1
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5. ANS: 1 PTS: 1
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11. ANS: 4 PTS: 1
12. ANS: 1 PTS: 1
13. ANS: 4 PTS: 1
14. ANS: 4 PTS: 1
15. ANS: 4 PTS: 1TestBankWorld.org
Chapter 9. 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 DTestBankWorld.org
____ 8. Cruciferous vegetables may alter drug pharmacokinetics by:
1. Enhancing absorption of weakly acidic drugs
2. Altering CYP 3A4 activity, leading to elevated levels of drugs, such as the statins
3. Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by
CYP 1A2
4. Decreasing first-pass metabolism of drugs
____ 9. Milk and other foods that alkalinize the urine may:
1. Result in basic drugs being reabsorbed in the renal tubule
2. Increase the elimination of basic drugs in the urine
3. Decrease the elimination of acidic drugs
4. Not alter drug elimination due to the minimal change in urine pH
____ 10. Antacids such as calcium carbonate (Tums) can reduce the absorption of which of the following
nutrients?
1. Protein
2. Calcium
3. Iron
4. Vitamin K
____ 11. Phenytoin decreases folic acid absorption by:
1. Altering the pH of the stomach
2. Increasing gastric emptying time
3. Inhibiting intestinal enzymes required for folic acid absorption
4. Chelation of the folic acid into inactive ingredients
____ 12. Patients taking warfarin need to be educated about the vitamin K content of foods to avoid
therapeutic failure. Foods high in vitamin K that should be limited to no more than one serving per
day include:
1. Spinach
2. Milk
3. Romaine lettuce
4. Cauliflower
____ 13. The American Dietetic Association has recommended the use of specific nutritional supplements in
the following population(s):
1. 400 IU per day of vitamin D in all infants and children
2. 1,000 IU per day of vitamin D for all pregnant women
3. 60 mg per day of iron for all adults over age 50 years
4. All of the above
____ 14. The American Dietetic Association recommends pregnant women take a supplement including:
1. 1,000 IU daily of vitamin D
2. 2.4 mcg/day of vitamin B12
3. 600 mcg/day of folic acid
4. 8 mg/day of ironTestBankWorld.org
____ 15. The American Heart Association and the American Dietetic Association recommend a minimum
daily fiber intake of ______ for cardiovascular health:
1. 10 mg/day
2. 15 mg/day
3. 20 mg/day
4. 25 mg/day
____ 16. Which of the following vitamin or mineral supplements may by teratogenic if a pregnant woman
takes more than the recommended amount?
1. Iron
2. Vitamin A
3. Vitamin B6
4. Vitamin C
____ 17. Vitamin B2 (riboflavin) may be prescribed to:
1. Decrease the incidence of beriberi
2. Reduce headaches and migraines
3. Prevent pernicious anemia
4. Treat hyperlipidemia
____ 18. Isoniazid (INH) may induce a deficiency of which vitamin?
1. B6
2. C
3. D
4. E
____ 19. Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B6 (pyridoxine)
to prevent:
1. Beriberi
2. Peripheral neuropathy
3. Rickets
4. Megaloblastic anemia
____ 20. Vitamin B12 deficiency may lead to:
1. Hair loss
2. Insomnia
3. Dry scales on the scalp
4. Numbness and tingling of the hands
____ 21. Smokers are at risk for vitamin C deficiency. It is recommended that smokers take _______ vitamin
C supplement.
1. 100 mg/day
2. 500 mg/day
3. 1,000 mg/day
4. 35 mg/day more than nonsmokers
____ 22. There is strong evidence to support that adequate vitamin C intake prevents:
1. The common coldTestBankWorld.org
2. Breast cancer
3. Scurvy
4. All of the above
____ 23. Adequate vitamin D is needed for:
1. Absorption of calcium from the gastrointestinal tract
2. Regulation of serum calcium levels
3. Regulation of serum phosphate levels
4. All of the above
____ 24. Newborns are at risk for early vitamin K deficiency bleeding and the American Academy of
Pediatrics recommends that all newborns receive:
1. IM vitamin K (phytonadione) within 24 hours of birth
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. Niacine
____ 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 effectsTestBankWorld.org
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. FiberTestBankWorld.org
Chapter 9. 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
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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: 1TestBankWorld.org
Chapter 12. 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 analysisTestBankWorld.org
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 patternTestBankWorld.org
Chapter 12. 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: 1TestBankWorld.org
Chapter 13. Over-the-Counter Medications
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Michael asks you about why some drugs are over-the-counter and some are prescription. You
explain that in order for a drug to be approved for over-the-counter use the drug must:
1. Be safe and labeled for appropriate use
2. Have a low potential for abuse or misuse
3. Be taken for a condition the patient can reliably self-diagnose
4. All of the above
____ 2. In the United States, over-the-counter drugs are regulated by:
1. No one. There is no oversight for over-the-counter medications.
2. The U.S. Food and Drug Administration Center for Drug Evaluation and Research
3. The U.S. Drug Enforcement Administration
4. MedWatch
____ 3. As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to
over-the-counter status in order to:
1. Get a new patent for the over-the-counter form of the drug
2. Lower the costs because most prescription benefit plans do not cover generics
3. Market the drug to a whole new population, as they are able to market to patients
instead of just providers
4. Continue to make large profits from their blockbuster brand-name drug
____ 4. New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New
Drug Application process, just as prescription drugs do.
1. True
2. False
____ 5. The ailment that generates the greatest over-the-counter annual drug sales is:
1. Constipation
2. Cough and colds
3. Heartburn
4. Acute and chronic pain
____ 6. Common over-the-counter pain relievers such as acetaminophen or ibuprofen:
1. Are always safer for the patient than prescription pain medication
2. Are harmful if taken in higher than recommended amounts
3. Have minimal interaction with prescription medications
4. Should never be given to children unless recommended by their provider
____ 7. When obtaining a drug history from Harold, he gives you a complete list of his prescription
medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his
arthritis flare ups. This is an example of:
1. His appropriately only telling you about his regularly prescribed medicationsTestBankWorld.org
2. His hiding information regarding his inappropriate use of aspirin from you
3. A common misconception that intermittently taken over-the counter medications
are not an important part of his drug history
4. A common misuse of over-the-counter aspirin
____ 8. The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:
1. Requires all providers to screen their patients for methamphetamine use
2. Restricts the prescribing of amphetamines to U.S. citizens
3. Requires a prescription be written for all methamphetamine precursors in all states
4. Restricts the sales of drugs that contain methamphetamine precursors, including a
daily and 30-day limit on sales
____ 9. When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:
1. Not to take their regularly prescribed medications while on these antibiotics
2. Regarding the need for lots of acidic foods and juices, such as orange juice, to
enhance absorption
3. Not to take antacids while on these medications, as the antacid decreases
absorption
4. That there are no drug interactions with these antibioticsTestBankWorld.org
Chapter 13. Over-the-Counter Medications
Answer Section
MULTIPLE CHOICE
1. ANS: 4 PTS: 1
2. ANS: 2 PTS: 1
3. ANS: 4 PTS: 1
4. ANS: 1 PTS: 1
5. ANS: 2 PTS: 1
6. ANS: 2 PTS: 1
7. ANS: 3 PTS: 1
8. ANS: 4 PTS: 1
9. ANS: 3 PTS: 1TestBankWorld.org
Chapter 14. Drugs Affecting the Autonomic Nervous System
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic
hyperplasia. Doxazosin has been chosen to treat his hypertension because it:
1. Increases peripheral vasoconstriction
2. Decreases detrusor muscle contractility
3. Lowers supine blood pressure more than standing pressure
4. Relaxes smooth muscle in the bladder neck
____ 2. To reduce potential adverse effects, patients taking a peripherally acting alpha1 antagonist should do
all of the following EXCEPT:
1. Take the dose at bedtime
2. Sit up slowly and dangle their feet before standing
3. Monitor their blood pressure and skip a dose if the pressure is less than 120/80
4. Weigh daily and report weight gain of greater than 2 pounds in one day
____ 3. John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should:
1. Not miss a dose or stop taking the drug because of potential rebound hypertension
2. Increase fiber in the diet to treat any diarrhea that may occur
3. Reduce fluid intake to less than 2 liters per day to prevent fluid retention
4. Avoid sitting for long periods, as this can lead to deep vein thrombosis
____ 4. Clonidine has several off-label uses, including:
1. Alcohol and nicotine withdrawal
2. Post-herpetic neuralgia
3. Both 1 and 2
4. Neither 1 nor 2
____ 5. Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is
atenolol. Beta blockers treat hypertension by:
1. Increasing heart rate to improve cardiac output
2. Reducing vascular smooth muscle tone
3. Increasing aldosterone-mediated volume activity
4. Reducing aqueous humor production
____ 6. Which of the following adverse effects are less likely in a beta1-selective blocker?
1. Dysrhythmias
2. Impaired insulin release
3. Reflex orthostatic changes
4. Decreased triglycerides and cholesterol
____ 7. Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed nadolol.
You do his annual laboratory work and find a CrCl of 25 ml/min. What action should you take
related to his nadolol?TestBankWorld.org
1. Extend the dosage interval.
2. Decrease the dose by 75%.
3. Take no action because this value is expected in the older adult.
4. Schedule a serum creatinine level to validate the CrCl value.
____ 8. Beta blockers are the drugs of choice for exertional angina because they:
1. Improve myocardial oxygen supply by vasodilating the coronary arteries
2. Decrease myocardial oxygen demand by decreasing heart rate and vascular
resistance
3. Both 1 and 2
4. Neither 1 nor 2
____ 9. Adherence to beta blocker therapy may be affected by their:
1. Short half-lives requiring twice daily dosing
2. Tendency to elevate lipid levels
3. Effects on the male genitalia, which may produce impotence
4. None of the above
____ 10. Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment
should be initiated when the:
1. Symptoms are severe
2. Patient has not responded to other therapies
3. Patient has concurrent hypertension
4. Left ventricular dysfunction is diagnosed
____ 11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious
consequences of rapid withdrawal are those with:
1. Angina
2. Coronary artery disease
3. Both 1 and 2
4. Neither 1 nor 2
____ 12. To prevent life-threatening events from rapid withdrawal of a beta blocker:
1. The dosage interval should be increased by 1 hour each day.
2. An alpha blocker should be added to the treatment regimen before withdrawal.
3. The dosage should be tapered over a period of weeks.
4. The dosage should be decreased by one-half every 4 days.
____ 13. Beta blockers are prescribed for diabetics with caution because of their ability to produce
hypoglycemia and block the common symptoms of it. Which of the following symptoms of
hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible
decreased blood glucose?
1. Dizziness
2. Increased heart rate
3. Nervousness and shakiness
4. Diaphoresis
____ 14. Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:TestBankWorld.org
1. Vasodilate the peripheral vasculature
2. Decrease cardiac output
3. Increase renal vascular resistance
4. Reduce atherosclerosis secondary to elevated serum lipoproteins
____ 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. GalantamineTestBankWorld.org
____ 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 usedTestBankWorld.org
____ 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. EstradiolTestBankWorld.org
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 cardioacceleration and
______________ centers in the brain.
1. Vasodilation
2. Vasoconstriction
3. Cardiovascular
4. RespiratoryTestBankWorld.org
Chapter 14. Drugs Affecting the Autonomic Nervous System
Answer Section
MULTIPLE CHOICE
1. ANS: 4 PTS: 1
2. ANS: 3 PTS: 1
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28. ANS: 3 PTS: 1
29. ANS: 2 PTS: 1
30. ANS: 4 PTS: 1
31. ANS: 1 PTS: 1
32. ANS: 2 PTS: 1
33. ANS: 2 PTS: 1
34. ANS: 1 PTS: 1
35. ANS: 4 PTS: 1
36. ANS: 1 PTS: 1
37. ANS: 2 PTS: 1TestBankWorld.org
Chapter 15. 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 failureTestBankWorld.org
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 levetiracetamTestBankWorld.org
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. EscitalopramTestBankWorld.org
____ 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:
1. Fluoxetine (Prozac)
2. Paroxetine (Paxil)
3. Amitriptyline (Elavil)
4. Duloxetine (Cymbalta)
____ 22. Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to
medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his
schizophrenia symptoms, the patient should be assessed by his primary care provider:
1. For excessive weight loss
2. With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal
symptoms (EPS)
3. Monthly for tolerance to the haloperidol
4. Only by the mental health provider, as most NPs in primary care do not care for
mentally ill patients
____ 23. Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:
1. Reduce the chance of tardive dyskinesia
2. Potentiate the effects of the drug
3. Reduce the tolerance that tends to occur
4. Increase central nervous system (CNS) depression
____ 24. Patients who are prescribed olanzapine (Zyprexa) should be monitored for:
1. Insomnia
2. Weight gain
3. Hypertension
4. Galactorrhea
____ 25. A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for
common side effects, including:
1. Bradykinesia, akathisia, and agitation
2. Excessive weight gain
3. Hypertension
4. Potentially fatal agranulocytosis
____ 26. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of
dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is:
1. Chlordiazepoxide (Librium)TestBankWorld.org
2. Clonazepam (Klonopin)
3. Alprazolam (Xanax)
4. Oxazepam (Serax)
____ 27. A patient with anxiety and depression may respond to:
1. Duloxetine (Cymbalta)
2. Fluoxetine (Prozac)
3. Oxazepam (Serax)
4. Buspirone (Buspar) and an SSRI combined
____ 28. When prescribing temazepam (Restoril) for insomnia, patient education includes:
1. Take temazepam nightly approximately 15 minutes before bedtime.
2. Temazepam should not be used more than three times a week for less than 3
months.
3. Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep
better.
4. Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of
temazepam.
____ 29. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because:
1. Zolpidem should be taken just before going to bed.
2. Zolpidem may cause dry mouth and constipation.
3. Patients may need to double the dose for effectiveness.
4. They should stop drinking alcohol at least 30 minutes before taking zolpidem.
____ 30. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic
range, it is important to recognize symptoms of toxicity, such as:
1. Orthostatic hypotension
2. Agitation and irritability
3. Drowsiness and nausea
4. Painful urination and abdominal distention
____ 31. Tom is taking lithium for bipolar disorder. He should be taught to:
1. Take his lithium with food
2. Eat a diet with consistent levels of salt (sodium)
3. Drink at least 2 quarts of water if he is in a hot environment
4. Monitor blood glucose levels
____ 32. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice
would you give her?
1. Valproate is safe during all trimesters of pregnancy.
2. She can get pregnant while taking valproate, but she should take adequate folic
acid.
3. Valproate is not safe at any time during pregnancy.
4. Valproate is a known teratogen, but may be taken after the first trimester if
necessary.TestBankWorld.org
____ 33. When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions
to the patient should include:
1. The medication may cause sedation and they should not drive.
2. Constipation is a common side effect and they should increase fluids and fiber.
3. Patients should not take any other acetaminophen-containing medications at the
same time.
4. All of the above
____ 34. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The
appropriate first-line medication would be:
1. Ibuprofen (Advil)
2. Acetaminophen with hydrocodone (Vicodin)
3. Oxycodone (Oxycontin)
4. Oral morphine (Roxanol)
____ 35. Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate
first-line medication would be:
1. Ibuprofen (Advil)
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 functionTestBankWorld.org
Chapter 15. 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
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31. ANS: 2 PTS: 1
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34. ANS: 1 PTS: 1
35. ANS: 2 PTS: 1
36. ANS: 4 PTS: 1
37. ANS: 4 PTS: 1
38. ANS: 1 PTS: 1TestBankWorld.org
Chapter 28. Chronic Stable Angina and Low-Risk Unstable Angina
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Angina is produced by an imbalance between myocardial oxygen supply (MOS) and demand
(MOD) in the myocardium. Which of the following drugs help to correct this imbalance by
increasing MOS?
1. Calcium channel blockers
2. Beta blockers
3. Angiotensin-converting-enzyme (ACE) inhibitors
4. Aspirin
____ 2. Not all chest pain is caused by myocardial ischemia. Noncardiac causes of chest pain include:
1. Pulmonary embolism
2. Pneumonia
3. Gastroesophageal reflux
4. All of the above
____ 3. The New York Heart Association and the Canadian Cardiovascular Society have described grading
criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or
climbing stair after meals is class:
1. I
2. II
3. III
4. IV
____ 4. Patients at high risk for developing significant coronary heart disease are those with:
1. LDL values between 100 and 130
2. Systolic blood pressure between 120 and 130
3. Class III angina
4. Obesity
____ 5. To reduce mortality, all patients with angina, regardless of class, should be on:
1. Aspirin 81 to 325 mg/d
2. Nitroglycerin sublingually for chest pain
3. ACE inhibitors or angiotensin receptor blockers
4. Digoxin
____ 6. Patients who have angina, regardless of class, who are also diabetic, should be on:
1. Nitrates
2. Beta blockers
3. ACE inhibitors
4. Calcium channel blockersTestBankWorld.org
____ 7. Management of all types and grades of angina includes the use of lifestyle modification to reduce
risk factors. Which of these modifications are appropriate for which reason? Both the modification
and the reason for it must be true for the answer to be correct.
1. Lose at least 10 pounds of body weight. Excessive weight increases cardiac
workload.
2. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases
blood volume and cardiac workload.
3. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of
potassium to improve contractility and oxygen supply.
4. Intake a moderate amount of alcohol. Moderate intake has been shown by research
to improve cardiac function.
____ 8. Nitrates are especially helpful for patients with angina who also have:
1. Heart failure
2. Hypertension
3. Both 1 and 2
4. Neither 1 nor 2
____ 9. Beta blockers are especially helpful for patients with exertional angina who also have:
1. Arrhythmias
2. Hypothyroidism
3. Hyperlipidemia
4. Atherosclerosis
____ 10. Rapid-acting nitrates are important for all angina patients. Which of the following are true
statements about their use?
1. These drugs are useful for immediate symptom relief when the patient is certain it
is angina.
2. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes
away.
3. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5
minutes for no more than two doses. If chest pain is still not relieved, call 911.
4. All of the above
____ 11. Isosorbide dinitrate is a long-acting nitrate given twice daily. The schedule for administration is 7
a.m. and 2 p.m. because:
1. Long-acting forms have a higher risk for toxicity.
2. Orthostatic hypotension is a common adverse effect.
3. It must be taken with milk or food.
4. Nitrate tolerance can develop.
____ 12. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina
because:
1. Nitrates increase MOS and beta blockers increase MOD.
2. Their additive effects permit lower doses of both drugs and their adverse reactions
cancel each other out.
3. They address the pathology of patients with exertional angina who have fixedTestBankWorld.org
atherosclerotic coronary heart disease.
4. All of the above
____ 13. Drug choices to treat angina in older adults differ from those of younger adults only in:
1. Consideration of risk factors for diseases associated with and increased in aging
2. The placement of drug therapy as a treatment choice before lifestyle changes are
tried
3. The need for at least three drugs in the treatment regimen because of the
complexity of angina in the older adult
4. Those with higher risk for silent myocardial infarction
____ 14. Which of the following drugs has been associated with increased risk for myocardial infarction in
women?
1. Aspirin
2. Beta blockers
3. Estrogen replacement
4. Lipid-lowering agents
____ 15. Cost of antianginal drug therapy should be considered in drug selection because of all of the
following EXCEPT:
1. Patients often require multiple drugs
2. A large number of angina patients are older adults on fixed incomes
3. Generic formulations may be cheaper but are rarely bioequivalent
4. Lack of drug selectivity may result in increased adverse reactions
____ 16. Situations that suggest referral to a specialist is appropriate include:
1. When chronic stable angina becomes unpredictable in its characteristics and
precipitating factors
2. When a post-myocardial infarction patient develops new-onset angina
3. When standard therapy is not successful in improving exercise tolerance or
reducing the incidence of angina
4. All of the above
____ 17. The rationale for prescribing calcium blockers for angina can be based on the need for:
1. Increased inotropic effect in the heart
2. Increasing peripheral perfusion
3. Keeping heart rates high enough to ensure perfusion of coronary arteries
4. Help with rate control
____ 18. Medications are typically started for angina patients when:
1. The first permanent EKG changes occur
2. The start of class I or II symptoms
3. The events trigger a trip to the emergency department
4. When troponin levels become altered
____ 19. The most common cause of angina is:
1. Vasospasm of the coronary arteries
2. AtherosclerosisTestBankWorld.org
3. Platelet aggregation
4. Low systemic oxygen
____ 20. Ranolazine is used in angina patients to:
1. Dilate plaque-filled arteries
2. Inhibit platelet aggregation
3. Restrict late sodium flow in the myocytes
4. Induce vasoconstriction in the periphery to open coronary vessels
____ 21. When is aspirin (ASA) used in angina patients?
1. All angina patients should be taking ASA unless it is contraindicated for allergy or
other medical reasons.
2. ASA should only be used in men.
3. ASA has no role in angina, but is useful in MI prevention.
4. The impact of ASA is best at the time of an angina attack.TestBankWorld.org
Chapter 28. Chronic Stable Angina and Low-Risk Unstable Angina
Answer Section
MULTIPLE CHOICE
1. ANS: 3 PTS: 1
2. ANS: 4 PTS: 1
3. ANS: 2 PTS: 1
4. ANS: 3 PTS: 1
5. ANS: 1 PTS: 1
6. ANS: 3 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
16. ANS: 4 PTS: 1
17. ANS: 4 PTS: 1
18. ANS: 2 PTS: 1
19. ANS: 2 PTS: 1
20. ANS: 3 PTS: 1
21. ANS: 1 PTS: 1TestBankWorld.org
Chapter 36. Heart Failure
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart failure
because they have more than one action to address the pathological changes in this disorder. Which
of the following pathological changes in heart failure is NOT addressed by ACE inhibitors?
1. Changes in the structure of the left ventricle so that it dilates, hypertrophies, and
uses energy less efficiently.
2. Reduced formation of cross-bridges so that contractile force decreases.
3. Activation of the sympathetic nervous system that increases heart rate and preload.
4. Decreased renal blood flow that decreases oxygen supply to the kidneys.
____ 2. One of the three types of heart failure involves systolic dysfunction. Potential causes of this most
common form of heart failure include:
1. Myocardial ischemia and injury secondary to myocardial infarction
2. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction
3. Increased demands of the heart beyond its ability to adapt secondary to anemia
4. Slower filling rate and elevated systolic pressures secondary to uncontrolled
hypertension
____ 3. The American Heart Association and the American College of Cardiology have devised a
classification system for heart failure that can be used to direct treatment. Patients with symptoms
and underlying disease are classified as stage:
1. A
2. B
3. C
4. D
____ 4. Diagnosis of heart failure cannot be made by symptoms alone because many disorders share the
same symptoms. The most specific and sensitive diagnostic test for heart failure is:
1. Chest x-rays that show cephalization and measure heart size
2. Two-dimensional echocardiograms that identify structural anomalies and cardiac
dysfunction
3. Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate
staging for end-organ damage
4. Measurement of brain natriuretic peptide to distinguish between systolic and
diastolic dysfunction
____ 5. Treatments for heart failure, including drug therapy, are based on the stages developed by the
ACC/AHA. Stage A patients are treated with:
1. Drugs for hypertension and hyperlipidemia, if they exist
2. Lifestyle management including diet, exercise, and smoking cessation only
3. Angiotensin-converting enzyme (ACE) inhibitors to directly affect the heart failure
onlyTestBankWorld.org
4. No drugs are used in this early stage
____ 6. Class I recommendations for stage A heart failure include:
1. Aerobic exercise within tolerance levels to prevent the development of heart
failure
2. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention
3. Beta blockers for all patients regardless of cardiac history
4. Treatment of thyroid disorders, especially if they are associated with
tachyarrhythmias
____ 7. Stage B patients should have beta blockers added to their heart failure treatment regimen when:
1. They have an ejection fraction less than 40%
2. They have had a recent MI
3. Both 1 and 2
4. Neither 1 nor 2
____ 8. Increased life expectancy for patients with heart failure has been associated with the use of:
1. ACE inhibitors, especially when started early in the disease process
2. All beta blockers regardless of selectivity
3. Thiazide and loop diuretics
4. Cardiac glycosides
____ 9. Stage C patients usually require a combination of three to four drugs to manage their heart failure. In
addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following
statements about diuretics is NOT true?
1. Diuretics reduce preload associated with fluid retention.
2. Diuretics can be used earlier than stage C when the goal is control of hypertension.
3. Diuretics may produce problems with electrolyte imbalances and abnormal glucose
and lipid metabolism.
4. Diuretics from the potassium-sparing class should be used when using an
angiotensin receptor blocker (ARB).
____ 10. Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with:
1. Ejection fractions above 40%
2. An audible S3
3. Mitral stenosis as a primary cause for heart failure
4. Renal insufficiency
____ 11. Which of the following classes of drugs is contraindicated in heart failure?
1. Nitrates
2. Long-acting dihydropyridines
3. Calcium channel blockers
4. Alpha-beta blockers
____ 12. Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years
old). The drug of choice for this population is:
1. Aldosterone antagonists
2. EplerenoneTestBankWorld.org
3. ACE inhibitors
4. ARBs
____ 13. ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy
is best done by a specialist, which of the following drug classes is considered to be safe, at least in
the later parts of pregnancy?
1. Diuretics
2. ARBs
3. Beta blockers
4. Nitrates
____ 14. Heart failure is a chronic condition that can be adequately managed in primary care. However,
consultation with or referral to a cardiologist is appropriate when:
1. Symptoms markedly worsen or the patient becomes hypotensive and has syncope
2. There is evidence of progressive renal insufficiency or failure
3. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta
blocker, and a diuretic
4. Any of the above
____ 15. ACE inhibitors are a foundational medication in HF. Which group of patients cannot take them
safely?
1. Elderly patients with reduced renal clearance
2. Pregnant women
3. Women under age 30
4. 1 and 2
____ 16. What assessment that can be done at home is the most reliable for making decisions to change HF
medications?
1. Weight
2. BP
3. Heart rate
4. Serum Glucose
____ 17. Evidence is strong that the timing of HF interventions are best initiated when:
1. The person enters stage C
2. The person has functional disabilities
3. At the earliest indication
4. When stage IV is determined
____ 18. HF patients frequently take more than one drug. When are anticoagulants typically used?
1. When the patient enters stage III
2. Only in cases of diastolic failure
3. When there is concurrent A Fib
4. In all cases
____ 19. What can chest x-rays contribute to the diagnosis and management of HF?
1. They have no role.
2. They can give very precise pictures of pulmonary fluid status.TestBankWorld.org
3. They provide an idea of general cardiac size and pulmonary great vessel
distribution.
4. They can confirm the diagnosis.TestBankWorld.org
Chapter 36. Heart Failure
Answer Section
MULTIPLE CHOICE
1. ANS: 3 PTS: 1
2. ANS: 1 PTS: 1
3. ANS: 3 PTS: 1
4. ANS: 2 PTS: 1
5. ANS: 1 PTS: 1
6. ANS: 4 PTS: 1
7. ANS: 3 PTS: 1
8. ANS: 1 PTS: 1
9. ANS: 4 PTS: 1
10. ANS: 2 PTS: 1
11. ANS: 3 PTS: 1
12. ANS: 3 PTS: 1
13. ANS: 3 PTS: 1
14. ANS: 4 PTS: 1
15. ANS: 4 PTS: 1
16. ANS: 1 PTS: 1
17. ANS: 3 PTS: 1
18. ANS: 3 PTS: 1
19. ANS: 3 PTS: 1TestBankWorld.org
Chapter 40. Hypertension
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____ 1. Because primary hypertension has no identifiable cause, treatment is based on interfering with the
physiological mechanisms that regulate blood pressure. Thiazide diuretics treat hypertension because
they:
1. Increase renin secretion
2. Decrease the production of aldosterone
3. Deplete body sodium and reduce fluid volume
4. Decrease blood viscosity
____ 2. Because of its action on various body systems, the patient taking a thiazide or loop diuretic may also
need to receive the following supplement:
1. Potassium
2. Calcium
3. Magnesium
4. Phosphates
____ 3. All patients with hypertension benefit from diuretic therapy, but those who benefit the most are:
1. Those with orthostatic hypertension
2. African Americans
3. Those with stable angina
4. Diabetics
____ 4. Beta blockers treat hypertension because they:
1. Reduce peripheral resistance
2. Vasoconstrict coronary arteries
3. Reduce norepinephrine
4. Reduce angiotensin II production
____ 5. Which of the following disease processes could be made worse by taking a nonselective beta
blocker?
1. Asthma
2. Diabetes
3. Both might worsen
4. Beta blockade does not affect these disorders
____ 6. Disease states in addition to hypertension in which beta blockade is a compelling indication for the
use of beta blockers include:
1. Heart failure
2. Angina
3. Myocardial infarction
4. Dyslipidemia
____ 7. Angiotensin-converting enzyme (ACE) inhibitors treat hypertension because they:TestBankWorld.org
1. Reduce sodium and water retention
2. Decrease vasoconstriction
3. Increase vasodilation
4. All of the above
____ 8. Compelling indications for an ACE inhibitor as treatment for hypertension based on clinical trials
includes:
1. Pregnancy
2. Renal parenchymal disease
3. Stable angina
4. Dyslipidemia
____ 9. An ACE inhibitor and what other class of drug may reduce proteinuria in patients with diabetes
better than either drug alone?
1. Beta blockers
2. Diuretics
3. Nondihydropyridine calcium channel blockers
4. Angiotensin II receptor blockers
____ 10. If not chosen as the first drug in hypertension treatment, which drug class should be added as a
second step because it will enhance the effects of most other agents?
1. ACE inhibitors
2. Beta blockers
3. Calcium channel blockers
4. Diuretics
____ 11. Treatment costs are important for patients with hypertension. Which of the following statements
about cost is NOT true?
1. Hypertension is a chronic disease where patients may be taking drugs for a long
time.
2. Most patients will require more than one drug to treat the hypertension.
3. The cost includes the price of any routine or special laboratory tests that a specific
drug may require.
4. Few antihypertensive drugs come in generic formulations.
____ 12. Caffeine, exercise, and smoking should be avoided for at least how many minutes before blood
pressure measurement?
1. 15
2. 30
3. 60
4. 90
____ 13. Blood pressure checks in children:
1. Should occur with their annual physical examinations after 6 years of age
2. Require a blood pressure cuff that is one-third the diameter of the child’s arm
3. Should be done during every health-care visit after 3 years of age
4. Require additional laboratory tests such as serum creatinineTestBankWorld.org
____ 14. Lack of adherence to blood pressure management is very common. Reasons for this lack of
adherence include:
1. Lifestyle changes are difficult to achieve and maintain.
2. Adverse drug reactions are common and often fall into the categories more
associated with nonadherence.
3. Costs of drugs and monitoring with laboratory tests can be expensive.
4. All of the above
____ 15. Lifestyle modifications for patients with prehypertension or hypertension include:
1. Diet and increase exercise to achieve a BMI greater than 25.
2. Drink 4 ounces of red wine at least once per week.
3. Adopt the dietary approaches to stop hypertension (DASH) diet.
4. Increase potassium intake.
____ 16. Which diuretic agents typically do not need potassium supplementation?
1. The loop diuretics
2. The thiazide diuretics
3. The aldosterone inhibitors
4. They all need supplementation
____ 17. Aldactone family medications are frequently used when the hypertensive patient also has:
1. Hyperkalemia
2. Advancing liver dysfunction
3. The need for birth control
4. Rheumatoid arthritis
____ 18. Hypertensive African Americans are typically listed as not being as responsive to which drug
groups?
1. ACE inhibitors
2. Calcium channel blockers
3. Diuretics
4. Bidil (hydralazine family of medications)
____ 19. What educational points concerning fluid intake must be covered with diuretic prescriptions?
1. Fluid should be restricted when on them.
2. Fluids should contain at least one salty item daily.
3. Fluid intake should remain near normal for optimal performance.
4. Avoidance of potassium-rich fluids is encouraged.
____ 20. What is a common side effect concern with hypertensive medications and all individuals, but
especially the elderly?
1. Risk of falls
2. Triggering of a hypertensive crisis
3. Erectile priapism
4. Risk for bladder cancer developmentTestBankWorld.org
Chapter 40. Hypertension
Answer Section
MULTIPLE CHOICE
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