ADVANCED PHARMACOLOGY QUIZZES
Question 1
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Which of the following statements is true about the prescribing practices of physicians?
Antibiotic
... [Show More] medications remain in the top five classifications of medications prescribed.
Older physicians tend to prescribe more appropriate medications than younger physicians.
Correct!
The dominant form of drug information used by primary care physicians continues to be that
provided by pharmaceutical companies.
Most physicians rely on a “therapeutic armamentarium” that consists of less than 100 drug
preparations per physician.
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.
Question 2
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A primary care NP recommends an over-the-counter medication for a patient who has acid
reflux. When teaching the patient about this drug, the NP should tell the patient:
not to worry about taking this drug with any other medications.
that over-the-counter acid reflux medications are generally safe to take with other medications.
Correct!
to take the dose recommended by the manufacturer.
to avoid taking other drugs that cause sedation while taking this drug.
Because patients often increase over-the-counter drug doses themselves, it is important to
reinforce the need to follow the manufacturer’s recommendations for dosing. As with any drug,
interactions may occur with other medications. Antacids do not cause sedation, so patients need
not be cautioned to avoid other sedating medications.
Question 3
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A woman who has been taking a COCP for 2 months tells the primary care NP that she has had
several headaches, breakthrough bleeding, and nausea. The NP should counsel the woman:
Correct!
that these effects will likely decrease in another month.
to change to a progestin-only pill.
to stop taking the COCP immediately.
to use a backup form of contraception.
Breakthrough bleeding, nausea, and headaches are common during the first 3 months of therapy
and should improve without intervention. Progestin-only pills are used for lactating women only.
Prolonged bleeding and severe headache would warrant discontinuation of the COCP. Backup
contraception is not indicated.
Question 4
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A patient asks a primary care nurse practitioner (NP) about using over-the-counter medications to
treat an upper respiratory infection with symptoms of cough, fever, and nasal congestion. The NP
should:
Correct!
suggest using single-ingredient products to treat each symptom separately.
tell the patient that over-the-counter medications are usually not effective in manufacturerrecommended doses.
recommend a cough preparation that also contains acetaminophen.
recommend a product containing antitussive, antipyretic, and decongestant ingredients.
A basic principle guiding over-the-counter use is to look at specific symptoms and treat each
separately because some products contain therapeutic doses of one ingredient and subtherapeutic
doses of others. Cough preparations containing acetaminophen often do not contain therapeutic
doses, and patients often overdose when they supplement with acetaminophen. Over-the-counter
medications are effective at recommended doses. Patients should follow dosing
recommendations on the package.
Question 5
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A patient has recurrent symptoms and tells the primary care NP that she can’t remember to take
her medication all the time. The NP should:
Correct!
ask her about her lifestyle, her schedule, and her understanding of her condition.
administer the medication in the clinic to ensure that she takes the drug.
give her shortened regimens of the drug to facilitate compliance.
provide written information about her condition and the medication.
If the attitude is that the patient has a problem for the health care provider to solve, then the
provider owns the problem and often hastens to solve it. When patients own their problems, they
are more likely to engage in their care and treatment. Giving shortened regimens, providing
written information, and administrating medication in the clinic are examples of the provider
solving the problem for the patient.
Question 6
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A postpartum woman will begin taking the minipill while she is nursing her infant. The primary
care NP should instruct the patient:
that irregular periods while taking the minipill may indicate she is pregnant.
Correct Answer
that this method does not increase her risk of thromboembolic events.
You Answered
to use backup contraception while taking the minipill.
to continue using the minipill for 6 months after she stops nursing.
Minipills are used primarily in breastfeeding women. There is no increased risk for
thromboembolic events for women taking these pills. It is not necessary to use a backup method
of contraception. Women should be advised to contact the provider when they stop nursing so
that a COCP can be prescribed. The more disrupted the bleeding pattern, the more likely it is that
ovulation is inhibited.
Question 7
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A patient who weighs 170 lb wishes to lose weight, with a target weight goal of 125 lb. To
initiate a program that will result in a loss of 1 lb per week, the primary care NP should
recommend a dietary intake of _____ kcal.
2000
1000
1700
Correct!
1200
To lose weight, a patient must decrease intake to below the level needed to maintain weight. The
patient must decrease daily calorie consumption by 500 kcal for each pound he or she wishes to
lose weekly. Because it takes approximately 10 kcal per pound to maintain weight, the NP can
assume that the patient currently takes in 1700 kcal/day and should recommend a diet of 1200
kcal/day for weight loss.
Question 8
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A patient who has hypothyroidism and is obese begins therapy with orlistat. The primary care NP
teaches the patient about this drug and then asks the patient to describe its use. Which statement
by the patient indicates understanding of the teaching?
Correct Answer
“I can expect the most benefit in the first few months.”
“I may eat a high-fat diet while taking orlistat.”
You Answered
“I should take an increased dose of levothyroxine while I am taking orlistat.”
“I should take fat-soluble vitamins each time I take orlistat.”
In long-term studies on the use of orlistat, most of the weight loss occurred during the first
months. Patients should not be counseled to eat a high-fat diet; the maximum amount of fat
excretion is around 25% to 30%. Patients should take fat-soluble vitamins, but the vitamins
should be taken at different times and not with orlistat. Orlistat interferes with levothyroxine
absorption, so the two drugs should be taken at different times, and thyroid levels should be
monitored with an increase in levothyroxine dose only when indicated by thyroid levels.
Question 9
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A patient with chronic back pain that is unrelieved by prescription analgesic medications asks a
primary care nurse practitioner (NP) about acupuncture treatments. The NP should tell this
patient:
there is no valid research documenting the efficacy of this treatment for pain.
biofield therapy has been shown to be more effective than acupuncture.
Correct!
most studies that show benefits of alternative therapies are based on observation.
creatine has been shown to be an effective herbal choice to treat back pain.
Current literature does not allow definitive conclusions to be drawn regarding the use of
complementary and alternative medicine (CAM) because much of what appears in the literature
continues to be based on observational reports and small studies. Biofield therapy has not been
shown to be more effective than acupuncture. Creatine is used to increase muscle mass.
Question 10
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The primary care nurse practitioner (NP) is using critical thinking skills when:
Correct!
analyzing current research and synthesizing new approaches to patient care.
using standardized protocols to guide patient care.
adhering to scientific principles to solve a patient problem.
following the practices of seasoned mentors when giving care.
Practitioners use critical thinking skills by reviewing and analyzing current knowledge and
synthesizing approaches to apply to unique patient situations. Using standardized protocols,
adhering to scientific principles, and following practices of seasoned mentors may be useful, but
these do not encompass the concept of critical thinking, which requires the practitioner to use
what is known in new situations.
Question 11
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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:
Correct Answer
order the closest formulary-approved approximation of the drug and monitor effectiveness.
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.
You Answered
write a letter of medical necessity to the insurer to explain the need for this particular medication.
The second step of medical decision making takes into account benefits versus costs along with
an understanding that it is impossible to do everything because of limited resources. The NP
should prescribe what is covered and evaluate its effectiveness; if it does not work, the thirdparty payer may be approached about the need for the other medication. Providing samples is not
always possible, and this practice is being discouraged, so it is not a viable solution. Asking
patients to pay out of pocket ultimately may be necessary but carries risks that the patient will
not obtain the medication. Writing a letter of medical necessity may be indicated if the available
drugs are not effective but is not the initial step.
Question 12
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A primary care NP prepares to teach a patient about the management of a chronic condition. The
patient says, “I don’t want to know all of that. Just tell me what to take and when.” The NP
should initially:
Correct Answer
give the patient basic written instructions about medications, follow up visits, and symptoms.
ask the patient to describe the disease process and the medications to evaluate understanding.
explain to the patient that without mutual cooperation, the treatment regimen will not be
effective.
You Answered
ask the patient to explore feelings and fears about having a chronic disease and taking
medications.
The patient has stated expectations about care and treatment for the condition. The NP should
begin by respecting that and providing the amount of information the patient wants. As the
therapeutic relationship grows, the NP may elicit more active participation and understanding.
Question 13
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In every state, prescriptive authority for NPs includes the ability to write prescriptions:
without physician-mandated involvement.
with full, independent prescriptive authority.
Correct!
for specified classifications of medications.
for controlled substances.
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.
Question 14
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A primary care NP has prescribed phentermine for a patient who is obese. The patient loses 10 lb
in the first month but reports that the drug does not seem to be suppressing appetite as much as
before. The NP should:
continue the phentermine at the same dose.
Correct Answer
discontinue the phentermine.
You Answered
increase the dose of phentermine.
change to a combination of phentermine and topiramate.
Tolerance to the effects of phentermine usually develops within a few weeks of starting therapy.
When this occurs, the drug should be discontinued, not increased. Phentermine use is not
recommended longer than a few weeks.
Question 15
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A patient asks the primary care NP which medication to use for mild to moderate pain. The NP
should recommend:
APAP.
You Answered
any over-the-counter pain product.
Tylenol.
Correct Answer
acetaminophen.
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.
Question 16
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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?
“This type of pill has fewer side effects than other types.”
Correct!
“I should expect to have only four periods each year.”
“I will need to use condoms for only 7 more days.”
“I have to take a pill only every 3 months.”
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.
Question 17
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A patient who has diabetes mellitus and congestive heart failure takes insulin and warfarin. The
patient will begin taking exogenous testosterone to treat secondary hypogonadism. The primary
care NP should recommend:
Correct!
more frequent blood glucose monitoring.
increasing insulin doses to prevent hypoglycemia.
increasing the dose of warfarin.
a higher than usual dose of testosterone.
Patients with diabetes may require a decrease in insulin dose because of the metabolic effects of
androgens. More frequent blood glucose monitoring should be performed. Warfarin doses may
need to be decreased because androgens increase sensitivity to anticoagulants.
Question 18
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A woman who has been taking a COCP tells the primary care NP that, because of frequent
changes in her work schedule, she has difficulty remembering to take her pills. The woman and
the NP decide to change to a vaginal ring. The NP will instruct her to insert the ring:
You Answered
and use a backup contraceptive for 7 days.
Correct Answer
within 7 days after her last active pill.
on the same day she stops taking her COCP.
and continue the COCP for one more cycle.
Patients should be switched from a COCP to a vaginal ring by insertion within 7 days after the
last active pill. No backup method is needed. Patients do not need to continue one more cycle of
COCPs. Women taking progestin-only pills insert the ring on the last day of the pill pack.
Question 19
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A primary care NP is developing a clinical practice guideline for management of a patient
population in a midsized suburban hospital. The NP should:
follow the guideline provided by a third-party payer to help ensure reimbursement.
write the guideline to adhere to long-standing practice protocols already in use.
Correct!
review expert opinion and experimental, anecdotal, correlational study data.
use an existing guideline from a leading research hospital.
Clinical guidelines should be written using all available evidence as well as expert opinion.
Existing guidelines from a different type of hospital may not be based on data generalizable to
this population. Third-party payer guidelines are usually weighted toward decreased costs. Longstanding protocols often do not take into account current knowledge and research.
Question 20
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To increase the likelihood of successful pharmacotherapy, when teaching a patient about using a
medication, the primary care nurse practitioner (NP) should:
You Answered
stress the importance of taking the medication exactly as it is prescribed.
give the patient copies of medication package inserts describing the drug use.
Correct Answer
encourage the patient to participate in the choice of the medication.
provide education about the medication actions and adverse effects.
It is important that the patient “owns the problem” and has a part in the solution. Providing
education about the medication, stressing the importance of following medication instructions,
and distributing package inserts may be useful, but it is essential that patients take an active role
in their care.
Question 21
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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:
selective serotonin reuptake inhibitor therapy until menopause begins.
Correct Answer
low-dose oral contraceptive therapy.
estrogen-progesterone HT.
You Answered
estrogen-only 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 22
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A man who has secondary hypogonadism associated with pituitary dysfunction will begin
exogenous testosterone therapy. The patient asks the primary care NP about future chances of
fathering children. The NP should tell him that:
Correct Answer
fertility may improve with testosterone therapy.
exogenous testosterone therapy will shut down sperm production.
You Answered
he should store sperm ahead of the initiation of testosterone therapy.
fertility can be restored when testosterone therapy is discontinued.
Men with secondary hypogonadism may become fertile with exogenous testosterone.
Question 23
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A 50-year-old woman who is postmenopausal is taking an aromatase inhibitor as part of a breast
cancer treatment regimen. She calls her primary care NP to report that she has had hot flashes
and increased vaginal discharge but no bleeding. The NP should:
recommend that she use a barrier method of contraception.
You Answered
tell her to stop taking the medication and call her oncologist.
Correct Answer
schedule her for a gynecologic examination.
reassure her that these are normal side effects of the medication.
Any abnormal vaginal discharge should be reported immediately and should be evaluated with a
gynecologic examination to rule out carcinoma. She is not showing signs of ovulation, so
contraception is not necessary. She should not stop taking the medication unless the gynecologic
examination is positive. These are common side effects but are not always normal.
UnansweredQuestion 24
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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:
provides dosing that is easier to regulate.
is absorbed less quickly.
has reduced bioavailability.
Correct Answer
has fewer systemic side effects.
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.
Question 25
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A patient who takes warfarin (Coumadin) experiences excessive bleeding, even though serum
drug levels are normal. The primary care NP should question this patient about the use of:
Correct!
ginkgo biloba.
green tea.
feverfew.
echinacea.
Ginkgo biloba decreases blood viscosity and can enhance the effects of warfarin. Feverfew,
echinacea, and green tea do not have this effect.
Question 1
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The primary care NP is prescribing a medication for an off-label use. To help prevent a
medication error, the NP should:
tell the patient to ignore the label directions and follow the verbal instructions given in the clinic.
You Answered
call the pharmacist to explain why the instructions deviate from common use.
Correct Answer
write “off-label use” on the prescription and provide a rationale.
write the alternative drug regimen on the prescription and send it to the pharmacy.
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 [Show Less]