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NR 508-PHARMACOLOGY BUNDLE
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NR 508-Pharmacology Mid-term EXAM GRADED A 2023
NR 508-Pharmacology Mid-term EXAM GRADED A 2023 Question 1 2 / 2 pts A patient has three consecutive blood pressure readings of 140/95 mm Hg. The... [Show More] patient’s body mass index is 24. A fasting plasma glucose is 100 mg/dL. Creatinine clearance and cholesterol tests are normal. The primary care NP should order: a β-blocker. an angiotensin-converting enzyme inhibitor. Correct! a thiazide diuretic. dietary and lifestyle changes. The patient has stage I hypertension. Because there are no compelling indications for other treatment, a thiazide diuretic should be used initially to treat the hypertension. Dietary and lifestyle changes should also be recommended but are not sufficient for patients with stage I hypertension. Other drugs may be added later if thiazide diuretic therapy fails. Question 2 2 / 2 pts An African-American patient is taking captopril (Capoten) 25 mg twice daily. When performing a physical examination, the primary care nurse practitioner (NP) learns that the patient continues to have blood pressure readings of 135/90 mm Hg. The NP should: increase the captopril dose to 50 mg twice daily. Correct! add a thiazide diuretic to this patient’s regimen. change the drug to losartan (Cozaar) 50 mg once daily. recommend a low-sodium diet in addition to the medication. Some African-American patients do not appear to respond as well as whites in terms of blood pressure reduction. The addition of a low-dose thiazide diuretic often allows for efficacy in blood pressure lowering that is comparable with that seen in white patients. Increasing the captopril dose is not indicated. Losartan is an angiotensin receptor blocker (ARB) and is not indicated in this case. Question 3 2 / 2 pts A 50-year-old woman reports severe, frequent hot flashes and vaginal dryness. She is having irregular periods. She has no family history of CHD or breast cancer and has no personal risk factors. The primary care NP should recommend: estrogen-only HT. Correct! low-dose oral contraceptive therapy. selective serotonin reuptake inhibitor therapy until menopause begins. estrogen-progesterone HT. Oral contraceptive pills are not approved by the U.S. Food and Drug Administration for management of perimenopausal symptoms except to treat irregular menstrual bleeding. This patient has a low risk for CHD and breast cancer, so oral contraceptive pills are relatively safe. She is also at risk for pregnancy, so oral contraceptive pills can help to prevent that. Question 4 2 / 2 pts The primary care NP is prescribing a medication for an off-label use. To help prevent a medication error, the NP should: Correct! write “off-label use” on the prescription and provide a rationale. call the pharmacist to explain why the instructions deviate from common use. write the alternative drug regimen on the prescription and send it to the pharmacy. tell the patient to ignore the label directions and follow the verbal instructions given in the clinic. When prescribing a drug for an off-label use, the provider should specify this on the written prescription and should provide a rationale so that the pharmacist understands why the prescription is different from the normal use. Calling the pharmacist would not provide written documentation. Merely writing the different instructions can lead to errors if the pharmacist changes the label to conform to usual standards. The patient may forget verbal instructions and follow the usual regimen instead. Question 5 2 / 2 pts The primary care nurse practitioner (NP) sees a patient in the clinic who has a blood pressure of 130/85 mm Hg. The patient’s laboratory tests reveal high-density lipoprotein, 35 mg/dL; triglycerides, 120 mg/dL; and fasting plasma glucose, 100 mg/dL. The NP calculates a body mass index of 29. The patient has a positive family history for cardiovascular disease. The NP should: prescribe a thiazide diuretic. [Show Less]
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NR 508 Week 4 Mid-Term EXAM QUESTIONS AND ANSWERS 2023
NR 508 Week 4 Mid-Term EXAM QUESTIONS AND ANSWERS 2023 Question 12 pts Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15... [Show More] months. She has a positive family history of breast cancer. The primary care NP should recommend: testosterone therapy. estrogenonly therapy. nonhormonal drugs for osteoporosis. estrogenprogesterone therapy for 1 to 2 years. Flag this Question Question 22 pts A woman is in her first trimester of pregnancy. She tells the primary care nurse practitioner (NP) that she continues to have severe morning sickness on a daily basis. The NP notes a weight loss of 1 pound from her previous visit 2 weeks prior. The NP should consult an obstetrician and prescribe: aprepitant (Emend). ondansetron (Zofran). scopolamine transdermal. prochlorperazine (Compazine). Flag this Question Question 32 pts A 75-year-old patient who has cardiovascular disease reports insomnia and vomiting for several weeks. The primary care NP orders thyroid function tests. The tests show TSH is decreased and T4 is increased. The NP should consult with an endocrinologist and order: thyrotropin. methimazole. levothyroxine. propylthiouracil. Flag this Question Question 42 pts A 55-year-old patient with no prior history of hypertension has a blood pressure greater than 140/90 on three separate occasions. The patient does not smoke, has a body mass index of 24, and exercises regularly. The patient has no known risk factors for cardiovascular disease. The primary care NP should: prescribe a thiazide diuretic and an angiotensinconverting enzyme inhibitor. perform a careful cardiovascular physical assessment. counsel the patient about dietary and lifestyle changes. order a urinalysis and creatinine clearance and begin therapy with a βblocker. Flag this Question Question 52 pts A patient reports fatigue, weight loss, and dry skin. The primary care nurse practitioner (NP) orders thyroid function tests. The patient’s thyroid stimulating hormone (TSH) is 40 microunits/mL, and T4 is 0.1 ng/mL. The NP should refer the patient to an endocrinologist and prescribe: methimazole. liothyronine. levothyroxine. propylthiouracil. Flag this Question Question 62 pts When prescribing a medication for a chronic condition, the primary care NP should tell the patient: to contact the pharmacy whenever refills are needed. that it is necessary to return to the clinic for each monthly refill of the medication. about the frequency of clinic visits necessary for the number of refills authorized. to ask the pharmacist to supply several months’ worth of the medication at a time. Flag this Question Question 72 pts A child who has congenital hypothyroidism takes levothyroxine 75 mcg/day. The child weighs 15 kg. The primary care NP sees the child for a 3-year-old check-up. The NP should consult with a pediatric endocrinologist to discuss: increasing the dose to 90 mcg/day. decreasing the dose to 30 mcg/day. . discussing the need for lifetime replacement therapy with the child’s parents. Flag this Question Question 82 pts A patient who has IBS experiences diarrhea, bloating, and pain but does not want to take medication. The primary care NP should recommend: 25 g of fiber each day. avoiding gluten and lactose in the diet. increasing water intake to eight to ten glasses per day. beginning aerobic exercise, such as running, every day. Flag this Question Question 92 pts A woman who uses a transdermal contraceptive calls the primary care NP to report that while dressing that morning she discovered that the patch had come off and she was unable to find the patch. The NP should tell her to apply a new patch and: take one cycle of COCPs. take a home pregnancy test. use condoms for the next 7 days. contact the clinic if she misses a period. Flag this Question Question 102 pts A patient has been diagnosed with IBS and tells the primary care NP that symptoms of diarrhea and cramping are worsening. The patient asks about possible drug therapy to treat the symptoms. The NP should prescribe: mesalamine (Asacol). dicyclomine (Bentyl). simethicone (Phazyme). metoclopramide (Reglan). Flag this Question Question 112 pts A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes, “Dispense as Written.” The NP should explain that a different brand of this drug: may cause different adverse effects. does not necessarily have the same therapeutic effect. is likely to be less safe than the brand specified in the prescription. may vary in the amount of drug that reaches the site of action in the body. Flag this Question Question 122 pts A patient comes to the clinic with a history of syncope and weakness for 2 to 3 days. The primary care NP notes thready, rapid pulses and 3-second capillary refill. An ECG reveals a heart rate of 198 beats per minute with a regular rhythm. The NP should: (PSVT) administer intravenous fluids and obtain serum electrolytes. [Show Less]
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NR 508 Final Exam QUESTIONS AND ANSWERS GRADED A2023
NR 508 Final Exam QUESTIONS AND ANSWERS GRADED A2023 A patient who has diabetes reports intense discomfort when needing to void. A urinalysis is normal.... [Show More] To treat this, the primary care NP should consider prescribing: flavoxate (Urispas). bethanechol (Urecholine). phenazopyridine (Pyridium). oxybutynin chloride (Ditropan XL). This patient is describing urge incontinence, or overactive bladder, which occurs when the detrusor muscle is hyperactive, causing an intense urge to void before the bladder is full. Urge incontinence is associated with many conditions, including diabetes. Oxybutynin chloride, which is an anticholinergic, acts to decrease detrusor overactivity and is indicated for treatment of urge incontinence. Flavoxate is used to treat dysuria associated with UTI. Bethanechol is indicated for urinary retention. Phenazopyridine is used to treat dysuria. A patient reports difficulty returning to sleep after getting up to go to the bathroom every night. A physical examination and a sleep hygiene history are noncontributory. The primary care NP should prescribe: zaleplon. ZolpiMist. ramelteon. chloral hydrate. ZolpiMist oral spray is useful for patients who have trouble returning to sleep in the middle of the night. Zaleplon and ramelteon are used for insomnia caused by difficulty with sleep onset. Chloral hydrate is not typically used as outpatient therapy. A 5-year-old child who has no previous history of otitis media is seen in clinic with a temperature of 100° F. The primary care NP visualizes bilateral erythematous, nonbulging, intact tympanic membranes. The child is taking fluids well and is playing with toys in the examination room. The NP should: prescribe azithromycin once daily for 5 days. prescribe amoxicillin twice daily for 10 days. prescribe amoxicillin-clavulanate twice daily for 10 days. initiate antibiotic therapy if the child’s condition worsens. Signs and symptoms of otitis media that indicate a need for antibiotic treatment include otalgia, fever, otorrhea, or a bulging yellow or red tympanic membrane. This child has a low-grade fever, no history of otitis media, a nonbulging tympanic membrane, and no otorrhea, so watchful waiting is appropriate. When an antibiotic is started, amoxicillin is the drug of choice. An 80-year-old patient with congestive heart failure has a viral upper respiratory infection. The patient asks the primary care NP about treating the fever, which is 38.5° C. The NP should: recommend acetaminophen. recommend high-dose acetaminophen. tell the patient that antibiotics are needed with a fever that high. tell the patient a fever less than 40° C does not need to be treated. Patients with congestive heart failure may have tachycardia from fever that aggravates their symptoms, so fever should be treated. High doses should be given with caution in elderly patients because of possible decreased hepatic function. Antibiotics should not be given without evidence of bacterial infection. A patient who takes levodopa and carbidopa for Parkinson’s disease reports experiencing freezing episodes between doses. The primary care NP should consider using: selegiline. amantadine. apomorphine. modified-release levodopa. Apomorphine injection is used for acute treatment of immobility known as “freezing.” A patient is being tapered from long-term therapy with prednisolone and reports weight loss and fatigue. The primary care NP should counsel this patient to: consume foods high in vitamin D and calcium. begin taking dexamethasone because it has longer effects. expect these side effects to occur as the medication is tapered. increase the dose of prednisolone to the most recent amount taken. Sudden discontinuation or rapid tapering of glucocorticoids in patients who have developed adrenal suppression can precipitate symptoms of adrenal insufficiency, including nausea, weakness, depression, anorexia, myalgia, hypotension, and hypoglycemia. When patients experience these symptoms during a drug taper, the dose should be increased to the last dose. Vitamin D deficiency is common while taking glucocorticoids, but these are not symptoms of vitamin D deficiency. Changing to another glucocorticoid is not recommended. Patients should be taught to report the side effects so that action can be taken and should not be told that they are to be expected. The primary care nurse practitioner (NP) sees a 50-year-old woman who reports frequent leakage of urine. The NP learns that this occurs when she laughs or sneezes. She also reports having an increased urge to void even when her bladder is not full. She is not taking any medications. The NP should: perform a dipstick urinalysis. prescribe desmopressin (DDAVP). prescribe oxybutynin chloride (Ditropan XL). teach exercises to strengthen the pelvic muscles. A focused history with a careful physical examination is essential for determining the cause of incontinence. Urinalysis can rule out urinary tract infection (UTI), which can cause incontinence. Medications are prescribed after determining the cause, if any, and treating underlying conditions. Exercises to strengthen the pelvic muscles are part of treatment. A 7-year-old patient who has severe asthma takes oral prednisone daily. At a well-child examination, the primary care NP notes a decrease in the child’s linear growth rate. The NP should consult the child’s asthma specialist about: gradually tapering the child off the prednisone. [Show Less]
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NR 508 Week 4 Midterm Exam, Chamberlain college of Nursing
NR 508 Week 4 Midterm Exam, Chamberlain college of Nursing 1. A patient asks a primary care NP whether over-the-counter drugs are safer than prescrip... [Show More] tion drugs. The NP should explain that over-the-counter drugs are: (Points : 2) generally safe when label information is understood and followed. safer because over-the-counter doses are lower than prescription doses of the same drug. less safe because they are not well regulated by the Food and Drug Administration (FDA). not extensively tested, so claims made by manufacturers cannot be substantiated. Question 2.2. A woman who is being treated with radiotherapy for breast cancer asks her primary care nurse practitioner (NP) about using dietary supplements to improve her chance of recovery. The NP should tell her that: (Points : 2) vitamin E is not harmful but has not been shown to change outcomes. no supplements have been shown to alter outcomes or response to therapy. folic acid and other B vitamins may improve ability to tolerate chemotherapy. vitamin C, taken at least 6 days per week, may lower her risk of cancer recurrence. Question 3.3. A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and hemoglobin A1c is 7.3%. The NP should: (Points : 2) begin insulin therapy. change to therapy with colesevelam (Welchol). add a third oral antidiabetic agent to this patient’s drug regimen. enroll the patient in a weight loss program to achieve better glycemic control. Question 4.4. A patient comes to the clinic to discuss weight loss. The primary care NP notes a BMI of 32 and performs a health risk assessment that reveals no obesity-related risk factors. The NP should recommend: (Points : 2) orlistat (Xenical). surgical intervention. changes in diet and exercise. changes in diet and exercise along with short-term phentermine. Question 5.5. Which of the following statements is true about the prescribing practices of physicians? (Points : 2) Older physicians tend to prescribe more appropriate medications than younger physicians. Antibiotic medications remain in the top five classifications of medications prescribed. Most physicians rely on a “therapeutic armamentarium” that consists of less than 100 drug preparations per physician. The dominant form of drug information used by primary care physicians continues to be that provided by pharmaceutical companies. Question 6.6. A primary care NP is aware that many patients in the community use herbal remedies to treat various conditions. The NP understands the importance of: (Points : 2) learning about the actions, uses, doses, and toxicities of these agents. prescribing these agents when possible to ensure safe dosing. counseling patients to stop using herbal products to avoid toxic side effects. teaching patients that these products are unregulated and unsafe to use. Question 7.7. A patient who is at risk for DVT tells the primary care NP she has just learned she is pregnant. The NP should expect that this patient will use which of the following anticoagulant medications? (Points : 2) Aspirin Heparin Dabigatran Warfarin Question 8.8. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of medications, it will be important to: (Points : 2) attain the same level of expertise as physicians who currently prescribe medications. learn from the experiences of physicians and develop expertise based on evidence-based practice. maintain collaborative and supervisorial relationships with physicians who will oversee prescribing practices. develop relationships with pharmaceutical representatives to learn about new medications as they are developed. Question 9.9. A patient with a previous history of myocardial infarction (MI) who takes nitroglycerin for angina develops hypertension. The primary care NP is considering ordering an ACE inhibitor. Preliminary laboratory tests reveal decreased renal function. The NP should: (Points : 2) begin therapy with a low-dose ACE inhibitor. choose an ARB instead. add a low-dose thiazide diuretic to the drug regimen. order a renal perfusion study before starting treatment. NR 508 Week 4 Midterm Exam, Chamberlain college of Nursing 1. A patient asks a primary care NP whether over-the-counter drugs are safer than prescription drugs. The NP should explain that over-the-counter drugs are: (Points : 2) generally safe when label information is understood and followed. safer because over-the-counter doses are lower than prescription doses of the same drug. less safe because they are not well regulated by the Food and Drug Administration (FDA). not extensively tested, so claims made by manufacturers cannot be substantiated. Question 2.2. A woman who is being treated with radiotherapy for breast cancer asks her primary care nurse practitioner (NP) about using dietary supplements to improve her chance of recovery. The NP should tell her that: (Points : 2) vitamin E is not harmful but has not been shown to change outcomes. no supplements have been shown to alter outcomes or response to therapy. folic acid and other B vitamins may improve ability to tolerate chemotherapy. vitamin C, taken at least 6 days per week, may lower her risk of cancer recurrence. Question 3.3. A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and hemoglobin A1c is 7.3%. The NP should: (Points : 2) begin insulin therapy. change to therapy with colesevelam (Welchol). add a third oral antidiabetic agent to this patient’s drug regimen. enroll the patient in a weight loss program to achieve better glycemic control. Question 4.4. A patient comes to the clinic to discuss weight loss. The primary care NP notes a BMI of 32 and performs a health risk assessment that reveals no obesity-related risk factors. The NP should recommend: (Points : 2) orlistat (Xenical). surgical intervention. changes in diet and exercise. changes in diet and exercise along with short-term phentermine. Question 5.5. Which of the following statements is true about the prescribing practices of physicians? (Points : 2) Older physicians tend to prescribe more appropriate medications than younger physicians. Antibiotic medications remain in the top five classifications of medications prescribed. Most physicians rely on a “therapeutic armamentarium” that consists of less than 100 drug preparations per physician. The dominant form of drug information used by primary care physicians continues to be that provided by pharmaceutical companies. Question 6.6. A primary care NP is aware that many patients in the community use herbal remedies to treat various conditions. The NP understands the importance of: (Points : 2) learning about the actions, uses, doses, and toxicities of these agents. prescribing these agents when possible to ensure safe dosing. counseling patients to stop using herbal products to avoid toxic side effects. teaching patients that these products are unregulated and unsafe to use. Question 7.7. A patient who is at risk for DVT tells the primary care NP she has just learned she is pregnant. The NP should expect that this patient will use which of the following anticoagulant medications? (Points : 2) Aspirin Heparin Dabigatran Warfarin Question 8.8. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of medications, it will be important to: (Points : 2) attain the same level of expertise as physicians who currently prescribe medications. learn from the experiences of physicians and develop expertise based on evidence-based practice. maintain collaborative and supervisorial relationships with physicians who will oversee prescribing practices. develop relationships with pharmaceutical representatives to learn about new medications as they are developed. Question 9.9. A patient with a previous history of myocardial infarction (MI) who takes nitroglycerin for angina develops hypertension. The primary care NP is considering ordering an ACE inhibitor. Preliminary laboratory tests reveal decreased renal function. The NP should: (Points : 2) begin therapy with a low-dose ACE inhibitor. choose an ARB instead. add a low-dose thiazide diuretic to the drug regimen. order a renal perfusion study before starting treatment. NR 508 Week 4 Midterm Exam, Chamberlain college of Nursing 1. A patient asks a primary care NP whether over-the-counter drugs are safer than prescription drugs. The NP should explain that over-the-counter drugs are: (Points : 2) generally safe when label information is understood and followed. safer because over-the-counter doses are lower than prescription doses of the same drug. less safe because they are not well regulated by the Food and Drug Administration (FDA). not extensively tested, so claims made by manufacturers cannot be substantiated. Question 2.2. A woman who is being treated with radiotherapy for breast cancer asks her primary care nurse practitioner (NP) about using dietary supplements to improve her chance of recovery. The NP should tell her that: (Points : 2) vitamin E is not harmful but has not been shown to change outcomes. no supplements have been shown to alter outcomes or response to therapy. folic acid and other B vitamins may improve ability to tolerate chemotherapy. vitamin C, taken at least 6 days per week, may lower her risk of cancer recurrence. Question 3.3. A patient with type 2 diabetes mellitus takes metformin (Glucophage) 1000 mg twice daily and glyburide (Micronase) 12 mg daily. At an annual physical examination, the BMI is 29 and hemoglobin A1c is 7.3%. The NP should: (Points : 2) begin insulin therapy. change to therapy with colesevelam (Welchol). add a third oral antidiabetic agent to this patient’s drug regimen. enroll the patient in a weight loss program to achieve better glycemic control. Question 4.4. A patient comes to the clinic to discuss weight loss. The primary care NP notes a BMI of 32 and performs a health risk assessment that reveals no obesity-related risk factors. The NP should recommend: (Points : 2) orlistat (Xenical). surgical intervention. changes in diet and exercise. changes in diet and exercise along with short-term phentermine. Question 5.5. Which of the following statements is true about the prescribing practices of physicians? (Points : 2) Older physicians tend to prescribe more appropriate medications than younger physicians. Antibiotic medications remain in the top five classifications of medications prescribed. Most physicians rely on a “therapeutic armamentarium” that consists of less than 100 drug preparations per physician. The dominant form of drug information used by primary care physicians continues to be that provided by pharmaceutical companies. Question 6.6. A primary care NP is aware that many patients in the community use herbal remedies to treat various conditions. The NP understands the importance of: (Points : 2) learning about the actions, uses, doses, and toxicities of these agents. prescribing these agents when possible to ensure safe dosing. counseling patients to stop using herbal products to avoid toxic side effects. teaching patients that these products are unregulated and unsafe to use. Question 7.7. A patient who is at risk for DVT tells the primary care NP she has just learned she is pregnant. The NP should expect that this patient will use which of the following anticoagulant medications? (Points : 2) Aspirin Heparin Dabigatran Warfarin Question 8.8. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of medications, it will be important to: (Points : 2) attain the same level of expertise as physicians who currently prescribe medications. learn from the experiences of physicians and develop expertise based on evidence-based practice. maintain collaborative and supervisorial relationships with physicians who will oversee prescribing practices. develop relationships with pharmaceutical representatives to learn about new medications as they are developed. Question 9.9. A patient with a previous history of myocardial infarction (MI) who takes nitroglycerin for angina develops hypertension. The primary care NP is considering ordering an ACE inhibitor. Preliminary laboratory tests reveal decreased renal function. The NP should: (Points : 2) begin therapy with a low-dose ACE inhibitor. choose an ARB instead. add a low-dose thiazide diuretic to the drug regimen. order a renal perfusion study before starting treatment. [Show Less]
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NR 508-Pharmacology Mid-term Question 1 2 / 2 pts A patient has three consecutive blood pr
NR 508-Pharmacology Mid-term Question 1 2 / 2 pts A patient has three consecutive blood pressure readings of 140/95 mm Hg. The patient’s body mass in... [Show More] dex is 24. A fasting plasma glucose is 100 mg/dL. Creatinine clearance and cholesterol tests are normal. The primary care NP should order: a β-blocker. an angiotensin-converting enzyme inhibitor. Correct! a thiazide diuretic. dietary and lifestyle changes. The patient has stage I hypertension. Because there are no compelling indications for other treatment, a thiazide diuretic should be used initially to treat the hypertension. Dietary and lifestyle changes should also be recommended but are not sufficient for patients with stage I hypertension. Other drugs may be added later if thiazide diuretic therapy fails. Question 2 2 / 2 pts An African-American patient is taking captopril (Capoten) 25 mg twice daily. When performing a physical examination, the primary care nurse practitioner (NP) learns that the patient continues to have blood pressure readings of 135/90 mm Hg. The NP should: increase the captopril dose to 50 mg twice daily. Correct! add a thiazide diuretic to this patient’s regimen. change the drug to losartan (Cozaar) 50 mg once daily. recommend a low-sodium diet in addition to the medication. Some African-American patients do not appear to respond as well as whites in terms of blood pressure reduction. The addition of a low-dose thiazide diuretic often allows for efficacy in blood pressure lowering that is comparable with that seen in white patients. Increasing the captopril dose is not indicated. Losartan is an angiotensin receptor blocker (ARB) and is not indicated in this case. Question 3 2 / 2 pts A 50-year-old [Show Less]
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NR 508 test bank pharmacology 2022 Chapter 01: Prescriptive Authority and Role
NR 508 test bank pharmacology 2022 Chapter 01: Prescriptive Authority and Role Implementation: Tradition vs. Change Test Bank MULTIPLE CHOICE ... [Show More] 1. Which of the following has influenced an emphasis on primary care education in medical schools? a. Changes in Medicare reimbursement methods recommended in 1992 b. Competition from nonphysicians desiring to meet primary care shortages c. The need for monopolistic control in the marketplace of primary outpatient care d. The recognition that nonphysicians have variable success providing primary care ANS: A The Physician Payment Review Commission in 1992 directly increased financial reimbursement to clinicians who provide primary care. Coupled with a shortage of primary care providers, this incentive led medical schools to place greater emphasis on preparing primary care physicians. Competition from nonphysicians increased coincidentally as professionals from other disciplines stepped up to meet the needs. Nonphysicians have had increasing success at providing primary care and have been shown to be safe and effective. DIF: Cognitive Level: Remembering (Knowledge) REF: 2 2. Which of the following statements is true about the prescribing practices of physicians? a. Older physicians tend to prescribe more appropriate medications than younger physicians. b. Antibiotic medications remain in the top five classifications of medications prescribed. c. Most physicians rely on a “therapeutic armamentarium” that consists of less than 100 drug preparations per physician. d. The dominant form of drug information used by primary care physicians continues to be that provided by pharmaceutical companies. ANS: D Even though most physicians claim to place little weight on drug advertisements, pharmaceutical representatives, and patient preference and state that they rely on academic sources for drug information, a study showed that commercial rather than scientific sources of drug information dominated their drug information materials. Younger physicians tend to prescribe fewer and more appropriate drugs. Antibiotics have dropped out of the top five classifications of drugs prescribed. Most physicians have a therapeutic armamentarium of about 144 drugs. DIF: Cognitive Level: Remembering (Knowledge) REF: 3 3. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of medications, it will be important to: a. attain the same level of expertise as physicians who currently prescribe medications. b. learn from the experiences of physicians and develop expertise based on evidence- based practice. c. maintain collaborative and supervisorial relationships with physicians who will oversee prescribing practices. d. develop relationships with pharmaceutical representatives to learn about new medications as they are developed. ANS: B As nonphysicians develop the roles associated with prescriptive authority, it will be important to learn from the past experiences of physicians and to develop prescribing practices based on evidence-based medicine. It is hoped that all prescribers, including physicians and nurse practitioners, will strive to do better than in the past. NPs should work toward prescriptive authority and for practice that is not supervised by another professional. Pharmaceutical representatives provide information that carries some bias. Academic sources are better. DIF: Cognitive Level: Applying (Application) REF: 4 Chapter 02: Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs) and Physician Assistants Test Bank MULTIPLE CHOICE 1. A primary care NP will begin practicing in a state in which the governor has opted out of the federal facility reimbursement requirement. The NP should be aware that this defines how NPs may write prescriptions: a. without physician supervision in private practice. b. as CRNAs without physician supervision in a hospital setting. c. in any situation but will not be reimbursed for this by government insurers. d. only with physician supervision in both private practice and a hospital setting. ANS: B In 2001, the Centers for Medicare and Medicaid Services changed the federal physician supervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write prescriptions and dispense drugs without physician supervision. DIF: Cognitive Level: Understanding (Comprehension) REF: 9 2. CRNAs in most states: a. must have a Drug Enforcement Administration (DEA) number to practice. b. must have prescriptive authority to practice. c. order and administer controlled substances but do not have full prescriptive authority. d. administer medications, including controlled substances, under direct physician supervision. ANS: C Only five states grant independent prescriptive authority to CRNAs. CRNAs do not require prescriptive authority because they dispense a drug immediately to a patient and [Show Less]
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NR 508 NR508 ADVANCED PHARM
NR 508 NR508 ADVANCED PHARM MIDTERM QUESTIONS AND ANSWERS EXAM 3 GRADED A 2022/2023 A patient who has primary hyperlipidemia and who takes at... [Show More] orvastatin (Lipitor) continues to have LDL cholesterol of 140 mg/dL after 3 months of therapy. The primary care NP increases the dose from 10 mg daily to 20 mg daily. The patient reports headache and dizziness a few weeks after the dose increase. The NP should: change the atorvastatin dose to 15 mg twice daily. change the patient’s medication to cholestyramine (Questran). add ezetimibe (Zetia) and lower the atorvastatin to 10 mg daily. recommend supplements of omega-3 along with the atorvastatin. When used in combination with a low-dose statin, ezetimibe has been noted to produce an additional 18% reduction in LDL. Because this patient continues to have elevated LDL along with side effects of the statin, the NP should resume the lower dose of the statin and add ezetimibe. Atorvastatin is given once daily. Cholestyramine and omega- 3 supplements are not indicated. A patient who has hyperlipidemia has been taking atorvastatin (Lipitor) 60 mg daily for 6 months. The patient’s initial lipid profile showed LDL of 180 mg/dL, HDL of 45 mg/dL, and triglycerides of 160 mg/dL. The primary care NP orders a lipid profile today that shows LDL of 105 mg/dL, HDL of 50 mg/dL, and triglycerides of 120 mg/dL. The patient reports muscle pain and weakness. The NP should: order liver function tests (LFTs). order a creatine kinase-MM (CK-MM) level. change atorvastatin to twice-daily dosing. add gemfibrozil (Lopid) to the patient’s medication regimen. Hepatotoxicity and muscle toxicity are the two primary adverse effects of greatest concern with statin use. Patients who report muscle discomfort or weakness should have a CK-MM level drawn. LFTs are indicated with signs of hepatotoxicity. It is not correct to change the dosing schedule. Gemfibrozil is not indicated. A patient comes to the clinic with a 4-day history of 10 to 12 liquid stools each day. The patient reports seeing blood and mucus in the stools. The patient has had nausea but no vomiting. The primary care NP notes a temperature of 37.9° C, a heart rate of 96 beats per minute, and a blood pressure of 90/60 mm Hg. A physical examination reveals dry oral mucous membranes and capillary refill of 4 seconds. The NP’s priority should be to: obtain stool cultures. begin rehydration therapy. consider prescribing metronidazole. administer opioid antidiarrheal medications. Acute diarrhea is usually mild and self-limited. Nonpharmacologic measures, especially bowel rest and adequate hydration, are helpful and should be a priority. Stool cultures may be ordered after hydration therapy is begun. Metronidazole is indicated if C. difficile is present. Opioid antidiarrheals may prolong symptoms. A perimenopausal woman tells the primary care NP that she is having hot flashes and increasingly severe mood swings. The woman has had a hysterectomy. The NP should prescribe: estrogen-only HT. low-dose oral contraceptive therapy. selective serotonin reuptake inhibitor therapy until menopause begins. estrogen-progesterone HT. Estrogen-only regimens are used in women without a uterus and may be initiated to treat perimenopause symptoms if needed. Low-dose oral contraceptive pills are used to treat irregular menstrual bleeding in perimenopausal women. A primary care NP prescribes a nitroglycerin transdermal patch, 0.4 mg/hour release, for a patient with chronic stable angina. The NP should teach the patient to: change the patch four times daily. use the patch as needed for angina pain. use two patches daily and change them every 12 hours. apply one patch daily in the morning and remove in 12 hours. To avoid tolerance, the patient should remove the patch after 12 hours. The transdermal patch is not changed four times daily or used on a prn basis. The patch is applied once daily. A parent calls a clinic for advice about giving an over-the-counter cough medicine to a 6-year-old child. The parent tells the NP that the medication label does not give instructions about how much to give a child. The NP should: order a prescription antitussive medication for the child. ask the parent to identify all of the ingredients listed on the medication label. calculate the dose for the active ingredient in the over-the-counter preparation. tell the parent to approximate the dose at about one third to one half the adult dose. Over-the-counter cough medications often contain dextromethorphan, which can be toxic to young children. It is important to identify ingredients of an over-the-counter medication before deciding if it is safe for children. A prescription antitussive is probably not warranted until the cough is evaluated to determine the cause. Until the ingredients are known, it is not safe to approximate the child’s dose based on only the active ingredient. A patient who has disabling intermittent claudication is not a candidate for surgery. Which of the following medications should the primary care NP prescribe to treat this patient? Cilostazol (Pletal) Warfarin (Coumadin) Pentoxifylline (Trental) Low-dose, short-term aspirin Patients with disabling intermittent claudication who are not candidates for surgery or catheter-based intervention should be treated with cilostazol rather than pentoxifylline. Warfarin is not indicated. Patients with chronic limb ischemia are treated with lifelong aspirin therapy. The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners. Which statement by the patient indicates she understands the regimen? “I have to take a pill only every 3 months.” “I should expect to have only four periods each year.” “I will need to use condoms for only 7 more days.” “This type of pill has fewer side effects than other types.” The extended-cycle pills have fewer pill-free intervals, so women have only four periods a year. Patients take pills every day. Because this patient has multiple partners, she should continue to use condoms. This type of pill has the same side effects as other types. The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma. The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes. The NP should: provide pharmaceutical company samples of the medication for the patient. inform the patient that the drug must be paid for out of pocket because it is not covered. [Show Less]
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nr 508 test bank pharmacology COMPLETE TESTBANK GRADED A
nr 508 test bank pharmacology COMPLETE TESTBANK GRADED A Chapter 01: Prescriptive Authority and Role Implementation: Tradition vs. Change Test Bank MUL... [Show More] TIPLE CHOICE 1. Which of the following has influenced an emphasis on primary care education in medical schools? a. Changes in Medicare reimbursement methods recommended in 1992 b. Competition from nonphysicians desiring to meet primary care shortages c. The need for monopolistic control in the marketplace of primary outpatient care d. The recognition that nonphysicians have variable success providing primary care ANS: A The Physician Payment Review Commission in 1992 directly increased financial reimbursement to clinicians who provide primary care. Coupled with a shortage of primary care providers, this incentive led medical schools to place greater emphasis on preparing primary care physicians. Competition from nonphysicians increased coincidentally as professionals from other disciplines stepped up to meet the needs. Nonphysicians have had increasing success at providing primary care and have been shown to be safe and effective. DIF: Cognitive Level: Remembering (Knowledge) REF: 2 2. Which of the following statements is true about the prescribing practices of physicians? a. Older physicians tend to prescribe more appropriate medications than younger physicians. b. Antibiotic medications remain in the top five classifications of medications prescribed. c. Most physicians rely on a “therapeutic armamentarium” that consists of less than 100 drug preparations per physician. d. The dominant form of drug information used by primary care physicians continues to be that provided by pharmaceutical companies. ANS: D Even though most physicians claim to place little weight on drug advertisements, pharmaceutical representatives, and patient preference and state that they rely on academic sources for drug information, a study showed that commercial rather than scientific sources of drug information dominated their drug information materials. Younger physicians tend to prescribe fewer and more appropriate drugs. Antibiotics have dropped out of the top five classifications of drugs prescribed. Most physicians have a therapeutic armamentarium of about 144 drugs. DIF: Cognitive Level: Remembering (Knowledge) REF: 3 3. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of medications, it will be important to: a. attain the same level of expertise as physicians who currently prescribe medications. b. learn from the experiences of physicians and develop expertise based on evidence- based practice. c. maintain collaborative and supervisorial relationships with physicians who will oversee prescribing practices. d. develop relationships with pharmaceutical representatives to learn about new medications as they are developed. ANS: B As nonphysicians develop the roles associated with prescriptive authority, it will be important to learn from the past experiences of physicians and to develop prescribing practices based on evidence-based medicine. It is hoped that all prescribers, including physicians and nurse practitioners, will strive to do better than in the past. NPs should work toward prescriptive authority and for practice that is not supervised by another professional. Pharmaceutical representatives provide information that carries some bias. Academic sources are better. DIF: Cognitive Level: Applying (Application) REF: 4 Chapter 02: Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs) and Physician Assistants Test Bank MULTIPLE CHOICE 1. A primary care NP will begin practicing in a state in which the governor has opted out of the federal facility reimbursement requirement. The NP should be aware that this defines how NPs may write prescriptions: a. without physician supervision in private practice. b. as CRNAs without physician supervision in a hospital setting. c. in any situation but will not be reimbursed for this by government insurers. d. only with physician supervision in both private practice and a hospital setting. ANS: B In 2001, the Centers for Medicare and Medicaid Services changed the federal physician supervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write prescriptions and dispense drugs without physician supervision. DIF: Cognitive Level: Understanding (Comprehension) REF: 9 2. CRNAs in most states: a. must have a Drug Enforcement Administration (DEA) number to practice. b. must have prescriptive authority to practice. c. order and administer controlled substances but do not have full prescriptive authority. d. administer medications, including controlled substances, under direct physician supervision. ANS: C Only five states grant independent prescriptive authority to CRNAs. CRNAs do not require prescriptive authority because they dispense a drug immediately to a patient and do not prescribe. Without prescriptive authority, they do not need a DEA number. DIF: Cognitive Level: Understanding (Comprehension) REF: 9 3. A CNM: a. may treat only women. b. has prescriptive authority in all 50 states. c. may administer only drugs used during labor and delivery. d. may practice only in birthing centers and home birth settings. ANS: B CNMs have prescriptive authority in all 50 states. They may treat partners of women for sexually transmitted diseases. They have full prescriptive authority and are not limited to drugs used during childbirth. They practice in many other types of settings. DIF: Cognitive Level: Remembering (Knowledge) REF: 9 4. In every state, prescriptive authority for NPs includes the ability to write prescriptions: a. for controlled substances. b. for specified classifications of medications. c. without physician-mandated involvement. d. with full, independent prescriptive authority. ANS: B All states now have some degree of prescriptive authority granted to NPs, but not all states allow authority to prescribe controlled substances. Many states still require some degree of physician involvement with certain types of drugs. DIF: Cognitive Level: Understanding (Comprehension) REF: 12 5. The current trend toward transitioning NP programs to the doctoral level will mean that: a. NPs licensed in one state may practice in other states. b. full prescriptive authority will be granted to all NPs with doctoral degrees. c. NPs will be better prepared to meet emerging health care needs of patients. d. requirements for physician supervision of NPs will be removed in all states. ANS: C The American Association of Colleges of Nursing has recommended transitioning graduate level NP programs to the doctoral level as a response to changes in health care delivery and emerging health care needs. NPs with doctoral degrees will not necessarily have full prescriptive authority or be freed from requirements about physician supervision because those are subject to individual state laws. NPs will still be required to meet licensure requirements of each state. DIF: Cognitive Level: Understanding (Comprehension) REF: 12 6. An important difference between physician assistants (PAs) and NPs is PAs: a. always work under physician supervision. b. are not required to follow drug treatment protocols. c. may write for all drug categories with physician co-signatures. d. have both inpatient and outpatient independent prescriptive authority. ANS: A PAs commonly have co-signature requirements and work under physician supervision. DIF: Cognitive Level: Understanding (Comprehension) REF: 17 Chapter 03: General Pharmacokinetic and Pharmacodynamic Principles Test Bank MULTIPLE CHOICE 1. A primary care nurse practitioner (NP) prescribes a drug to an 80-year-old African- American woman. When selecting a drug and determining the correct dose, the NP should understand that the knowledge of how age, race, and gender may affect drug excretion is based on an understanding of: a. bioavailability. b. pharmacokinetics. c. pharmacodynamics. d. anatomy and physiology. ANS: B Pharmacokinetics is the study of the action of drugs in the body and may be thought of as what the body does to the drug. Factors such as age, race, and gender may change the way the body acts to metabolize and excrete a drug. Bioavailability refers to the amount of drug available at the site of action. Pharmacodynamics is the study of the effects of drugs on the body. Anatomy and physiology is a basic understanding of how the body functions. DIF: Cognitive Level: Understanding (Comprehension) REF: 21 2. A patient asks the primary care NP which medication to use for mild to moderate pain. The NP should recommend: a. APAP. b. Tylenol. c. acetaminophen. d. any over-the-counter pain product. ANS: C Providers should use generic drug names when prescribing drugs or recommending them to patients, unless a particular brand is essential for some reason. Because acetaminophen can have many trade names, it is important for patients to understand that the drug is the same for all to avoid overdosing on acetaminophen. APAP is a commonly used abbreviation but should not be used when recommending the drug to patients. DIF: Cognitive Level: Applying (Application) REF: 21 3. A patient wants to know why a cheaper version of a drug cannot be used when the primary care NP writes a prescription for a specific brand name of the drug and writes, “Dispense as Written.” The NP should explain that a different brand of this drug: a. may cause different adverse effects. b. does not necessarily have the same therapeutic effect. c. is likely to be less safe than the brand specified in the prescription. d. may vary in the amount of drug that reaches the site of action in the body. ANS: D Different formulations of the same drug may have varying degrees of bioavailability, and it may be important to stick to a particular brand for drugs with narrow therapeutic ranges. All drugs with similar active ingredients should have the same therapeutic actions and side effects and should be equally safe. DIF: Cognitive Level: Applying (Application) REF: 22 4. A primary care NP wishes to order a drug that will be effective immediately after administration of the drug. Which route should the NP choose? a. Rectal b. Topical c. Sublingual d. Intramuscular ANS: C The sublingual route is preferred for quick action because the drug is directly absorbed into the bloodstream and avoids the pass through of the liver, where much of an oral drug is metabolized. Rectal routes have unpredictable absorption rates. Topical routes are the slowest. Intramuscular routes are slow. DIF: Cognitive Level: Remembering (Knowledge) REF: 22 5. A patient receives an inhaled corticosteroid to treat asthma. The patient asks the primary care NP why the drug is given by this route instead of orally. The NP should explain that the inhaled form: a. is absorbed less quickly. b. has reduced bioavailability. c. has fewer systemic side effects. d. provides dosing that is easier to regulate. ANS: C An inhaled corticosteroid goes directly to the site of action and does not have to pass through gastrointestinal tract absorption or the liver to get to the lungs. It is generally well absorbed at this site, although dosing is not necessarily easier to regulate because it is not always clear how much of an inhaled drug gets into the lungs. DIF: Cognitive Level: Applying (Application) REF: 21 6. A patient takes an oral medication that causes gastrointestinal upset. The patient asks the primary care NP why the drug information insert cautions against using antacids while taking the drug. The NP should explain that the antacid may: a. alter drug absorption. b. alter drug distribution. c. lead to drug toxicity. [Show Less]
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