NR 508 NR508 Final Exam Test Bank completed by chapters
NR508 Final Questons
Chapter 1
1.Nurse practitioner prescriptive authority is regulated
... [Show More] by:
1.
The National Council of State Boards of Nursing
2.
The U.S. Drug Enforcement Administration
3.
The State Board of Nursing for each state
4.
The State Board of Pharmacy
2.The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include:
1. Nurses know more about Pharmacology than other prescribers because they take it
both in their basic nursing program and in their APRN program.
2. Nurses care for the patient from a holistic approach and include the patient in
decision making regarding their care.
3. APRNs are less likely to prescribe narcotics and other controlled substances.
4. APRNs are able to prescribe independently in all states, whereas a physician’s
assistant needs to have a physician supervising their practice.
3.Clinical judgment in prescribing includes:
1. Factoring in the cost to the patient of the medication prescribed
2. Always prescribing the newest medication available for the disease process
3. Handing out drug samples to poor patients
4. Prescribing all generic medications to cut costs
4.Criteria for choosing an effective drug for a disorder include:
1. Asking the patient what drug they think would work best for them
2. Consulting nationally recognized guidelines for disease management
3. Prescribing medications that are available as samples before writing a prescription
4. Following U.S. Drug Enforcement Administration guidelines for prescribing
5.Nurse practitioner practice may thrive under health-care reform because of:
1. The demonstrated ability of nurse practitioners to control costs and improve
patient outcomes
2. The fact that nurse practitioners will be able to practice independently
3. The fact that nurse practitioners will have full reimbursement under health-care
reform
4. The ability to shift accountability for Medicaid to the state level
Chapter 2. Review of Basic Principles of Pharmacology
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:
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 effects2. 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 absorbed
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 fetal-placental) is
true?
1. Water soluble and ionized drugs cross these barriers rapidly.
2. The blood-brain barrier slows the entry of many drugs into and from brain
cells.
3. The fetal-placental barrier protects the fetus from drugs taken by the mother.
4. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women.17.Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these
types of reactions is to:
1. Inactivate prodrugs before they can be activated by target tissues
2. Change the drugs so they can cross plasma membranes
3. Change drug molecules to a form that an excretory organ can excrete
4. Make these drugs more ionized and polar to facilitate excretion
18.Once they have been metabolized by the liver, the metabolites may be:
1. More active than the parent drug
2. Less active than the parent drug
3. Totally “deactivated” so they are excreted without any effect
4. All of the above
19.All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete
drugs via the renal system would be increased by:
1. Reduced circulation and perfusion of the kidney
2. Chronic renal disease
3. Competition for a transport site by another drug
4. Unbinding a nonvolatile drug from plasma proteins
20.Steady state is:
1. The point on the drug concentration curve when absorption exceeds excretion
2. When the amount of drug in the body remains constant
3. When the amount of drug in the body stays below the minimum toxic
concentration
4. All of the above
21.Two different pain medications are given together for pain relief. The drug—drug interaction is:
1. Synergistic
2. Antagonistic
3. Potentiative
4. Additive
22.Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:
1. Reducing the dosage of one of the drugs
2. Scheduling their administration at different times
3. Prescribing a third drug to counteract the adverse reaction of the combination
4. Reducing the dosage of both drugs
23.Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of
the following would reduce or inhibit this process?
1. Protein malnutrition
2. Iron-deficiency anemia
3. Both 1 and 2
4. Neither 1 nor 2
24.The time required for the amount of drug in the body to decrease by 50% is called:
1. Steady state2. Half-life
3. Phase II metabolism
4. Reduced bioavailability time
25.An agonist activates a receptor and stimulates a response. When given frequently over time, the body
may:
1. Upregulate the total number of receptors
2. Block the receptor with a partial agonist
3. Alter the drug’s metabolism
4. Downregulate the numbers of that specific receptor
26.Drug antagonism is best defined as an effect of a drug that:
1. Leads to major physiological and psychological dependence
2. Is modified by the concurrent administration of another drug
3. Cannot be metabolized before another dose is administered
4. Leads to a decreased physiological response when combined with another drug
27.Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of
the following statements?
1. “Avoid any other oral medicines while taking this drug.”
2. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”
3. “The tablet may be crushed if you have any difficulty taking it.”
4. “To achieve best effect, take the tablet with at least 8 ounces of fluid.”
28.The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the
drugs could possibly result in:
1. Disintegration
2. Toxicity
3. Malabsorption
4. Deterioration
29.Which of the following substances is the most likely to be absorbed in the intestines rather than in the
stomach?
1. Sodium bicarbonate
2. Ascorbic acid
3. Salicylic acid
4. Glucose
30.Which of the following variables is a factor in drug absorption?
1. The smaller the surface area for absorption, the more rapidly the drug is absorbed.
2. A rich blood supply to the area of absorption leads to better absorption.
3. The less soluble the drug, the more easily it is absorbed.
4. Ionized drugs are easily absorbed across the cell membrane.
31.An advantage of prescribing a sublingual medication is that the medication is:
1. Absorbed rapidly
2. Excreted rapidly
3. Metabolized minimally
4. Distributed equally32.Drugs that use CYP 3A4 isoenzymes for metabolism may:
1. Induce the metabolism of another drug
2. Inhibit the metabolism of another drug
3. Both 1 and 2
4. Neither 1 nor 2
33.Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
1. After the second dose
2. After four to five half-lives
3. When the patient feels the full effect of the drug
4. One hour after IV administration
34.Upregulation or hypersensitization may lead to:
1. Increased response to a drug
2. Decreased response to a drug
3. An exaggerated response if the drug is withdrawn
4. Refractoriness or complete lack of response
Chapter 3. Rational Drug Selection
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 curative2. 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 patients
4. Use the newest drug on the market for the condition being treated
8.Patient education regarding prescribed medication includes:
1. Instructions written at the high school reading level
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 label3. Eliminated, and replaced with a link to the National Library of Medicine TOXNET
Web site for in-depth information regarding pregnancy concerns
4. Clarified to include information such as safe dosages in each trimester of
pregnancy
Chapter 4. Legal and Professional Issues in Prescribing
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 state
8.Precautions that should be taken when prescribing controlled substances include:1. Faxing the prescription for a Schedule II drug directly to the pharmacy
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 above
Chapter 5. Adverse Drug Reactions
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 group3. The blood-brain barrier being less permeable, requiring higher doses to achieve
therapeutic effect
4. Age-related decrease in renal function
4.The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic doses is
type:
1. A
2. B
3. C
4. D
5.Digoxin may cause a type A adverse drug reaction due to:
1. Idiosyncratic effects
2. Its narrow therapeutic index
3. Being a teratogen
4. Being a carcinogen
6.Sarah developed a rash after using a topical medication. This is a type __ allergic drug reaction.
1. I
2. II
3. III
4. IV
7.A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n):
1. Cytotoxic hypersensitivity reaction
2. Immune complex hypersensitivity
3. Immediate hypersensitivity reaction
4. Delayed hypersensitivity reaction
8.Anaphylactic shock is a:
1. Type I reaction, called immediate hypersensitivity reaction
2. Type II reaction, called cytotoxic hypersensitivity reaction
3. Type III allergic reaction, called immune complex hypersensitivity
4. Type IV allergic reaction, called delayed hypersensitivity reaction
9.James has hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a corticosteroid) use.
He is at risk for what type of adverse drug reaction?
1. Type B
2. Type C
3. Type E
4. Type F
10.Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D
reaction because they are known:
1. Teratogens
2. Carcinogens
3. To cause hypersensitivity reactions
4. Hypothalamus-pituitary-adrenal axis suppressants11.A 24-year-old male received multiple fractures in a motor vehicle accident that required significant
amounts of opioid medication to treat his pain. He is at risk for a _____ adverse drug reaction
when he no longer requires the opioids.
1. Rapid
2. First-dose
3. Late
4. Delayed
12.An example of a first-dose reaction that may occur includes:
1. Orthostatic hypotension that does not occur with repeated doses
2. Purple glove syndrome with phenytoin use
3. Hemolytic anemia from ceftriaxone use
4. Contact dermatitis from neomycin use
13.Drugs that are prone to cause adverse drug effects include:
1. Diuretics
2. Inhaled anticholinergics
3. Insulins
4. Stimulants
14.The U.S. Food and Drug Administration MedWatch system is activated when:
1. There is an adverse event to a vaccine.
2. The patient has a severe reaction that is noted in the “Severe Reaction” section in
the medication label.
3. A lactating woman takes a medication that is potentially toxic to the breastfeeding
infant.
4. An adverse event or serious problem occurs with a medication that is not
already identified on the label.
15.The Vaccine Adverse Events Reporting System is:
1. A mandatory reporting system for all health-care providers when they encounter an
adverse vaccine event
2. A voluntary reporting system that health-care providers or consumers may
use to report vaccine adverse events
3. Utilized to send out safety alerts regarding emerging vaccine safety issues
4. Activated when a vaccine has been proven to cause significant adverse effects
Chapter 6. Factors That Foster Positive Outcomes
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.
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 above9.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:
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. Social2. Financial
3. Health system
4. All of the above
Chapter 9. Nutrition and Nutraceuticals
1.The most frequent type of drug-food interaction is food:
1. Causing increased therapeutic drug levels
2. Affecting the metabolism of the drug
3. Altering the volume of distribution of drugs
4. Affecting the gastrointestinal absorption of drugs
2.Food in the gastrointestinal tract affects drug absorption by:
1. Altering the pH of the colon, which decreases absorption
2. Competing with the drug for plasma proteins
3. Altering gastric emptying time
4. Altering the pH of urine
3.Food can alter the pH of the stomach, leading to:
1. Enhanced drug metabolism
2. Altered vitamin K absorption
3. Increased vitamin D absorption
4. Altered drug bioavailability
4.Fasting for an extended period can:
1. Increase drug absorption due to lack of competition between food and the drug
2. Alter the pH of the gastrointestinal tract, affecting absorption
3. Cause vasoconstriction, leading to decreased drug absorption
4. Shrink the stomach, causing decreased surface area for drug absorption
5.Tetracycline needs to be given on an empty stomach because it chelates with:
1. Calcium
2. Magnesium
3. Iron
4. All of the above
6.A low-carbohydrate, high-protein diet may:
1. Increase drug-metabolizing enzymes
2. Decrease drug absorption from the GI tract
3. Alter drug binding to plasma proteins
4. Enhance drug elimination
7.Grapefruit juice contains furanocoumarins that have been found to:
1. Alter absorption of drugs through competition for binding sites
2. Inhibit CYP 3A4, leading to decreased first-pass metabolism of drugs
3. Alter vitamin K metabolism, leading to prolonged bleeding
4. Enhance absorption of calcium and vitamin D
8.Cruciferous vegetables may alter drug pharmacokinetics by:
1. Enhancing absorption of weakly acidic drugs
2. Altering CYP 3A4 activity, leading to elevated levels of drugs, such as the statins3. 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 iron
15.The American Heart Association and the American Dietetic Association recommend a minimum daily
fiber intake of ______ for cardiovascular health:
1. 10 mg/day
2. 15 mg/day
3. 20 mg/day4. 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 cold
2. Breast cancer
3. Scurvy
4. All of the above
23.Adequate vitamin D is needed for:
1. Absorption of calcium from the gastrointestinal tract2. 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 effects
4. Effects on fasting blood sugar
30.There is enough preliminary evidence to recommend that children with autism receive which
supplemental nutrient?
1. Vitamin B1 (thiamine)
2. Vitamin B2 (riboflavin)
3. Calcium4. Omega-3 fatty acids
31.There is sufficient evidence to support the use of omega-3 fatty acids to treat the following disease(s):
1. Asthma
2. Autism
3. Arthritis
4. All of the above
32.It is reasonable to recommend supplementation with _________ in the treatment of hyperlipidemia.
1. Omega-3 fatty acids
2. Probiotics
3. Plant sterols
4. Calcium
33.Probiotics are recommended to be co-administered when ____________ are prescribed:
1. Antacids
2. Antihypertensives
3. Antidiarrheals
4. Antibiotics
34.It is reasonable to add ___________ to a Helicobacter pylori treatment regimen to improve eradication
rates of H. pylori.
1. Probiotics
2. Omega-3 fatty acids
3. Plant sterols
4. Fiber
Chapter 13. Over-the-Counter Medications
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 overthe-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 providers4. 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 medications
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 antibiotics
chapter 14. Drugs Affecting the Autonomic Nervous System
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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 contractility3. 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?
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
resistance3. 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:
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 inhibitors4. All of the ab [Show Less]