TEST BANK FOR PHARMACOLOGY FOR PRIMARY PROVIDER 4TH EDITION EDMUNDS 2021 UPDATED ALL
CHAPTERS Chapter 01: Prescriptive Authority and Role Implementation:
... [Show More] Tradition vs. Change Test Bank ...... 2
Chapter 02: Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs) and Physician Assistants ................................ .......................... 4 Chapter 04: Special Populations: Geriatrics Test Bank ................................ ....... 11 Chapter 05: Special Populations: Pediatrics ................................ ............... 14 Chapter 06: Special Populations: Pregnant and Nursing Women Test Bank ..................... 19 Chapter 07: Over-the-Counter Medications Test Bank ................................ ....... 23 Chapter 08: Complementary and Alternative Therapies Test Bank ............................. 27 Chapter 09: Establishing the Therapeutic Relationship Test Bank ............................. 30 Chapter 11: Evidence-Based Decision Making and Treatment Guidelines Test Bank .............. 33 Chapter 12: Design and Implementation of Patient Education Test Bank ....................... 38 Chapter 13: Dermatologic Agents Test Bank ................................ ............... 42 Chapter 14: Eye, Ear, Throat, and Mouth Agents Test Bank ................................ ... 47 Chapter 15: Upper Respiratory Agents Test Bank ................................ ........... 50 Chapter 16: Asthma and Chronic Obstructive Pulmonary Disease Medications Test Bank ......... 53 Chapter 18: Coronary Artery Disease and Antianginal Medications Test Bank ................... 61 Chapter 19: Heart Failure and Digoxin Test Bank ................................ ........... 64 Chapter 20: Beta-Blockers Test Bank ................................ ..................... 67 Chapter 21: Calcium Channel Blockers Test Bank ................................ ........... 71 Chapter 22: ACE Inhibitors and Angiotensin Receptor Blockers ............................... 73 Chapter 23: Antiarrhythmic Agents Test Bank ................................ .............. 77 Chapter 24: Antihyperlipidemic Agents Test Bank ................................ .......... 80 Chapter 25: Agents that Act on Blood Test Bank ................................ ............ 84 Chapter 26: Antacids and the Management of GERD Test Bank ............................... 88 Chapter 28: Laxatives Test Bank ................................ ......................... 94 Chapter 28: Laxatives Test Bank ................................ ......................... 98 Chapter 29: Antidiarrheals Test Bank ................................ .................... 101 Chapter 30: Antiemetics Test Bank ................................ ...................... 104 Chapter 31: Medications for Irritable Bowel Syndrome and Other Gastrointestinal Problems ..... 107 Chapter 32: Diuretics Test Bank ................................ ........................ 110 Chapter 42: Medications for Dementia Test Bank ................................ .......... 117 Chapter 45: Antiepileptics Test Bank ................................ .................... 121 Chapter 46: Antiparkinson Agents Test Bank ................................ .............. 124
1 | P a g eChapter 47: Antidepressants Test Bank ................................ .................. 127
Chapter 47: Antidepressants Test Bank ................................ .................. 131
Chapter 48: Antianxiety and Insomnia Agents Test Bank ................................ .... 136
Chapter 49: Antipsychotics Test Bank ................................ ................... 138
Chapter 50: Substance Abuse Test Bank ................................ .................. 142
Chapter 72: Smoking Cessation Test Bank ................................ ................ 145
Chapter 17: Hypertension and Miscellaneous Antihypertensive Medications Test Bank .......... 148
Chapter 18: Coronary Artery Disease and Antianginal Medications Test Bank .................. 151
Chapter 21: Calcium Channel Blockers Test Bank ................................ .......... 154
Chapter 24: Antihyperlipidemic Agents Test Bank ................................ ......... 157
Chapter 52: Thyroid Medications Test Bank ................................ .............. 161
Chapter 53: Diabetes Mellitus Agents ................................ ................... 164
Chapter 35: Acetaminophen Test Bank ................................ ................... 168
Chapter 37: Disease-Modifying Antirheumatic Drugs and Immune Modulators Test Bank ........ 175
Chapter 38: Gout Medications Test Bank ................................ ................. 179
Chapter 39: Osteoporosis Treatment Test Bank ................................ ........... 182
Test Bank ................................ ................................ ........... 185
Chapter 43: Analgesia and Pain Management Test Bank ................................ .... 188
Chapter 44: Migraine Medications Test Bank ................................ ............. 191
Chapter 51: Glucocorticoids Test Bank ................................ ................... 196
Chapter 60: Cephalosporins Test Bank ................................ ................... 199
Chapter 62: Macrolides Test Bank ................................ ....................... 201
Chapter 63: Fluoroquinolones Test Bank ................................ ................. 204
Chapter 68: Antiretroviral Medications Test Bank ................................ ......... 206
Chapter 65: Sulfonamides Test Bank ................................ .................... 209
Chapter 08: Complementary and Alternative Therapies Test Bank ............................ 212
Chapter 70: The Immune System and Immunizations Test Bank ............................. 215
Chapter 73: Vitamins and Minerals Test Bank ................................ ............. 222
Chapter 01: Prescriptive Authority and Role Implementation: Tradition vs. Change
Test Bank
MULTIPLE 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
2 | P a g eb.
Competition from nonphysicians desiring
to meet primary care shortages
c.
d.
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.
c.
d.
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.
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:
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The need for monopolistic control in the
marketplace of primary outpatient care
The recognition that nonphysicians have
variable success providing primary carea.
attain the same level of expertise as
physicians who currently prescribe
medications.
b.
c.
d.
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.
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:
4 | P a g ea.
without physician supervision in private
practice.
b.
c.
d.
as CRNAs without physician supervision
in a hospital setting.
in any situation but will not be
reimbursed for this by government
insurers.
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)
2. CRNAs in most states:
a.
b.
c.
d.
REF: 9
must have a Drug Enforcement
Administration (DEA) number to practice.
must have prescriptive authority
to practice.
order and administer controlled
substances but do not have full prescriptive
authority.
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)
3. A CNM:
a.
b.
c.
d.
ANS: B
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REF: 9
may treat only women.
has prescriptive authority in all 50 states.
may administer only drugs used during
labor and delivery.
may practice only in birthing centers and
home birth settings.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.
c.
d.
for specified classifications of
medications.
without physician-mandated involvement.
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.
c.
d.
full prescriptive authority will be granted
to all NPs with doctoral degrees.
NPs will be better prepared to meet
emerging health care needs of patients.
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.
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are not required to follow drug treatmentprotocols.
c.
d.
may write for all drug categories with
physician co-signatures.
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.
b.
c.
d.
bioavailability.
pharmacokinetics.
pharmacodynamics.
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.
b.
c.
d.
APAP.
Tylenol.
acetaminophen.
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
7 | P a g esame 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.
c.
d.
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.
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.
b.
c.
d.
Rectal
Topical
Sublingual
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:
8 | P a g ea.
b.
c.
d.
is absorbed less quickly.
has reduced bioavailability.
has fewer systemic side effects.
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.
b.
c.
d.
alter drug absorption.
alter drug distribution.
lead to drug toxicity.
increase stomach upset.
ANS: A
Changing the pH of the gastric mucosa can alter the absorption of the drug. Drug
distribution is not affected. It may indirectly cause drug toxicity if a significant amount
more of the drug is absorbed. It would decrease stomach upset.
DIF: Cognitive Level: Applying (Application)
REF: 22
7. A patient will begin taking two drugs that are both protein-bound. The primary care NP
should:
a.
b.
c.
d.
prescribe increased doses of both drugs.
monitor drug levels, actions, and side
effects.
teach the patient to increase intake
of protein.
stagger the doses of drugs to be given 1
hour apart.
ANS: B
Protein-bound drugs bind to albumin, and serum albumin levels may affect how drugs are
distributed. The provider should monitor drug levels, actions, and side effects and change
dosing accordingly. Increasing the dose of both drugs is not recommended unless
monitoring indicates. Increasing dietary protein does not affect this. Staggering the drugs
will not affect this.
9 | P a g eDIF: Cognitive Level: Applying (Application)
REF: 25
8. A patient is taking drug A and drug B. The primary care NP notes increased effects of
drug B. The NP should suspect that in this case drug A is a cytochrome P450 (CYP450)
enzyme:
a.
inhibitor.
b.
c.
d.
substrate.
inducer.
metabolizer.
ANS: A
If drug A is a CYP450 enzyme inhibitor, it decreases the capacity of the enzyme to
metabolize drug B, causing more of drug B to be available. A substrate is a drug acted on
by the enzyme. If drug B is an enzyme inducer, it would cause increased metabolism of
drug A.
DIF: Cognitive Level: Applying (Application)
REF: 26 - 27
9. The primary care NP should understand that a drug is at a therapeutic level when it is:
a.
at peak plasma level.
b.
c.
d.
past 4 or 5 half-lives.
at its steady plasma state.
between minimal effective concentration
and toxic levels.
ANS: D
The therapeutic range of a drug is the area between the minimal effective concentration
and the toxic concentration. Peak plasma level is the highest level the drug reaches and
may be well into the toxic range. Steady state occurs when there is a stable concentration
of the drug and generally occurs after 4 or 5 half-lives.
DIF: Cognitive Level: Applying (Application)
REF: 31
10. A primary care NP is preparing to prescribe a drug and notes that the drug has
nonlinear kinetics. The NP should:
a.
b.
c.
monitor frequently for desired and
adverse effects.
administer a much higher initial dose as a
loading dose.
monitor creatinine clearance at baseline
and periodically.
10 | P a g ed.
administer the drug via a route that
avoids the first-pass effect.
ANS: A
Drugs with nonlinear kinetics are not eliminated based on dose or concentration of the
drug, and these drugs have a narrow therapeutic window and must be monitored
closely for desired effects and toxicity.
DIF: Cognitive Level: Applying (Application)
REF: 32
11. A primary care NP is prescribing a drug for a patient who does not take any other
medications. The NP should realize that:
a.
b.
c.
d.
CYP450 enzyme reactions will not
interfere with this drug’s metabolism.
substrates such as alcohol cannot
interfere with the drug when the patient is
abstaining.
food-drug interactions are limited to those
where food enhances or inhibits drug
absorption.
a thorough history of diet, alcohol use,
smoking, and over-the-counter and herbal
products is required.
ANS: D
Drugs are not the only substances that interfere with drug kinetics and dynamics. The
primary care NP should conduct a thorough history of food and alcohol intake, smoking,
and over-the-counter and herbal supplements to identify things that might interfere with a
drug. All of these may interfere with CYP enzymes. Alcohol intake can influence this even
when the patient is abstaining because of long-term effects on the liver.
DIF: Cognitive Level: Understanding (Comprehension)
Chapter 04: Special Populations: Geriatrics Test
Bank
MULTIPLE CHOICE
1. A nurse practitioner (NP) is considering a possible drug regimen for an 80-year-old
patient who reports being forgetful. To promote adherence to the regimen, the NP should:
a.
select drugs that can be given once or
twice daily.
b.
provide detailed written instructions
for each medication.
REF: 38-39
11 | P a g ec.
order medications that can be given on an
empty stomach.
d.
instruct the patient to take a lower dose
if side effects occur.
ANS: A
To promote adherence in elderly patients, selecting the smallest number of medications
with the simplest dose regimens is recommended, with once-daily dosing preferred.
Instructions should be simplified. Drug dosing should be timed with mealtimes to help
patients remember to take them. Lower dosing may be necessary with some drugs, but
patients should not do this without consulting their provider.
DIF: Cognitive Level: Applying (Application)
REF: 57 - 58
2. A 75-year-old patient who lives alone will begin taking a narcotic analgesic for pain. To
help ensure patient safety, the NP prescribing this medication should:
a.
b.
c.
d.
assess this patient’s usual sleeping
patterns.
ask the patient about problems
with constipation.
obtain a baseline creatinine clearance test
before the first dose.
perform a thorough evaluation of
cognitive and motor abilities.
ANS: D
The body system most significantly affected by increased receptor sensitivity in elderly
patients is the central nervous system, making this population sensitive to numerous
drugs. It is important to evaluate motor and cognitive function before beginning drugs
that affect the central nervous system to minimize the risk of falls. Assessment of
sleeping patterns is important, but not in relation to patient safety. It is not necessary to
evaluate stool patterns or renal function.
DIF: Cognitive Level: Applying (Application)
REF: 50| 55
3. A thin 90-year-old patient who will begin taking warfarin has experienced a recent weight
loss of 15 pounds. The NP caring for this patient should:
a.
b.
c.
obtain a baseline liver function test (LFT)
before starting the drug.
write the initial prescription at the
lowest possible dose.
encourage the patient to consume a
diet high in fat and protein.
12 | P a g ed.
counsel the patient to take the drug
with food to enhance absorption.
ANS: B
A common age change that affects the distribution of drugs in older adults is a decrease in
serum albumin. Significant changes that may affect drug therapy may be seen in
malnourished elderly patients. Warfarin has a high binding affinity with albumin.
Significant decreases in albumin may result in a greater free concentration of highly
protein-bound drugs. It is important to order the lowest possible dose and titrate
upward as needed. A baseline LFT is not indicated. A diet high in fat and protein is not
indicated.
DIF: Cognitive Level: Applying (Application)
REF: 50 - 51
4. An 86-year-old patient is seen in clinic for a scheduled follow-up after starting a new oral
medication 1 month prior. The patient reports no change in symptoms, and a laboratory
test reveals a subtherapeutic serum drug level. The NP caring for this patient should:
a.
b.
c.
d.
consider ordering more frequent dosing of
the drug.
titrate the patient’s dose upward
and recheck in 1 month.
ask the patient about any
increased frequency of bowel
movements.
determine the number of pills left in the
patient’s prescription bottle.
ANS: D
Because of cost concerns, poor understanding of a drug’s actions, or confusion about how
to take a medication, many elderly patients do not comply with drug regimens and may
not take drugs as prescribed. Before increasing the frequency or amount of a drug, it is
important to assess first whether or not the patient has been taking the drug as ordered.
Counting the number of pills in the bottle will help the provider assess whether the
patient is taking the drug as ordered. Changes in gastric motility do not generally have
major effects on the effectiveness or serum drug levels of medications.
DIF: Cognitive Level: Applying (Application)
REF: 57 - 58
5. An NP learns that a 90-year-old patient is chronically constipated and has frequent
problems with acid reflux. The NP notes a weight loss of 20 pounds in this patient in the
previous 6 months. Which of the following drugs that this patient is taking is cause for
concern?
a.
b.
c.
d.
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Quinidine
Naproxen
Calcium citrate
Calcium channel blockerANS: B
Naproxen has a high binding affinity for protein, and these drugs can become toxic in
patients who may have low serum albumin because of the amount of free drug in serum.
Constipation and acid reflux may cause problems with absorption for some drugs, but not
the drugs listed.
DIF: Cognitive Level: Analyzing (Analysis)
REF: 50 - 52
6. An NP is caring for a 70-year-old patient who reports having seasonal allergies with
severe rhinorrhea. Using the Beers criteria, which of the following medications should
the NP recommend for this patient?
a.
b.
c.
d.
Loratadine (Claritin)
Hydroxyzine (Vistaril)
Diphenhydramine (Benadryl)
Chlorpheniramine maleate (Chlorphen 12)
ANS: A
Loratadine is the only nonsedating antihistamine on this list. Older patients are especially
susceptible to sedation side effects and should not use these medications if possible.
DIF: Cognitive Level: Applying (Application)
REF: 57
7. An NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterol metered-dose
inhaler 2 puffs every 4 hours as needed for cough or wheezing for a 65-year-old patient
with recent onset of reactive airways disease who reports symptoms occurring every 1
or 2 weeks. At a follow-up appointment several months later, the patient reports no
change in frequency of symptoms. The NP’s initial action should be to:
a.
b.
c.
d.
order spirometry to evaluate
pulmonary function.
prescribe a systemic corticosteroid to help
with symptoms.
ask the patient to describe how
the medications are taken each day.
give the patient detailed information about
the use of metered-dose inhalers.
ANS: C
It is essential to explore with the older patient what he or she is actually doing with
regard to daily medication use and compare this against the “prescribed” medication
regimen before ordering further tests, prescribing any increase in medications, or
providing further education.
DIF: Cognitive Level: Applying (Application)
Chapter 05: Special Populations: Pediatrics
Test Bank
MULTIPLE CHOICE
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REF: 57 - 581. A nurse practitioner (NP) is preparing to prescribe a medication for a 5-year-old child. To
determine the correct dose for this child, the NP should:
a.
b.
c.
d.
ANS: D
The package insert provided by the manufacturer is the best source for pediatric dose
recommendations. Approximated reduction in the adult dose is not a safe or effective way
of calculating pediatric doses of medications, so using a third of the adult dose may not be
safe. Errors inherent in determining BSA make this method less reliable than dose based
on accurate weights. Dividing the adult dose by the child’s weight is incorrect.
DIF: Cognitive Level: Understanding (Comprehension)
REF: 64 - 65
2. An NP is prescribing a drug that is known to be safe in children but is unable to find
recommendations about drug dosing. The recommended adult dose is 100 mg per dose.
The child weighs 14 kg. Using Clark’s rule, the NP should order
mg per dose.
a.
b.
c.
d.
20
10
14
9.3
ANS: A
Clark’s rule suggests dividing the weight of the child in kg by the weight of an adult in kg and
multiplying the result by the adult dose to get an approximation of the child’s dose.
The average adult weighs 150 lb, or 70 kg. The equation is: 14 kg/70 kg = 0.2. 0.2 100 = 20
mg.
DIF: Cognitive Level: Understanding (Comprehension)
REF: 65
3. A child who weighs 22 lb, 2 oz needs a medication. The NP learns that the recommended
dosing for this drug is 25 to 30 mg per kg per day in three divided doses. The NP should
order:
calculate the dose at one third of the
recommended adult dose.
estimate the child’s body surface area
(BSA) to calculate the medication dose.
divide the recommended adult dose by the
child’s weight in kilograms (kg).
follow the drug manufacturer’s
recommendations for medication dosing.
15 | P a g ea. b. c. d.
100 mg daily. 100 mg tid.
300 mg daily. 300 mg tid.
ANS: B The NP should first convert the child’s weight to kg, which is about 10 kg. The dose is then calculated to be 250 to 300 mg per day in three divided doses, which is 83 to 100 mg per dose given tid.
DIF: Cognitive Level: Applying (Application) REF: 65
4. The mother of a 3-year-old child who weighs 15 kg tells the NP that she has liquid acetaminophen at home but does not know what dose to give her child. The NP should tell the mother:
a. b. c. d.
to give 1 teaspoon every 4 to 6 hours as needed.
to throw away the old medication and get a new bottle.
that she may give 5 to 7.5 mL per dose every 4 to 6 hours.
to find out whether she has a preparation made for infants or children.
ANS: D Acetaminophen drops for infants are three times as concentrated as the oral liquid for children. The drops have been pulled from the market, but many parents may still have old preparations on hand. The NP should first determine which preparation this mother has before giving dosage recommendations. If the mother has the oral liquid for children, answers A and C would both be acceptable because the concentration is 160 mg per 5 mL. The mother should not be counseled to throw away the medication until the NP has more information.
DIF: Cognitive Level: Applying (Application) REF: 65
5. The parent of a toddler asks the NP about using a topical antihistamine to treat the child’s atopic dermatitis symptoms. The NP should tell the parent that: a.
topical medications have fewer side effects in children.
b. c.
medications given by this route are not absorbed well in young children.
topical application of an antihistamine may result in drug toxicity in children.
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