Pharmacotherapeutics for Advanced Practice Nurse Prescribers 4th Edition by Teri Moser Woo – Test Bank +A

Pharmacotherapeutics for Advanced Practice Nurse Prescribers 4th Edition by Teri Moser Woo  – Test Bank +A

Pharmacotherapeutics for Advanced Practice Nurse Prescribers 4th Edition by Teri Moser Woo – Test Bank +A

Pharmacotherapeutics for Advanced Practice Nurse Prescribers 4th Edition by Teri Moser Woo – Test Bank +A

Identify the choice that best completes the statement or answers the question.

____ 1. An NP would prescribe the liquid form of ibuprofen for a 6-year-old child because:

1.Drugs given in liquid form are less irritating to the stomach.
2.A 6-year-old child may have problems swallowing a pill.
3.Liquid forms of medication eliminate the concern for first-pass effect.
4.Liquid ibuprofen does not have to be dosed as often as the tablet form.

____ 2. In deciding which of multiple drugs used to use to treat a condition, the NP chooses Drug A because it:

1.Has serious side effects and it is not being used for a life-threatening condition
2.Will be taken twice daily and will be taken at home
3.Is expensive, but covered by health insurance
4.None of these are important in choosing a drug

____ 3. A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women?

1.Body temperature varies between men and women.
2.Muscle mass is greater in women.
3.Percentage of fat differs between genders.
4.Proven subjective factors exist between the genders.

____ 4. The first step in the prescribing process according to the World Health Organization is:

1.Choosing the treatment
2.Educating the patient about the medication
3.Diagnosing the patient’s problem
4.Starting the treatment

____ 5. Treatment goals in prescribing should:

1.Always be curative
2.Be patient-centered
3.Be convenient for the provider
4.Focus on the cost of therapy

____ 6. The therapeutic goals when prescribing include(s):

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
4.Ease of titration

____ 11. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical promotion, the following recommendations have been made by the Institute of Medicine:

1.Conflicts of interest and financial relationships should be disclosed by those providing education.
2.Providers should ban all pharmaceutical representatives from their office setting.
3.Drug samples should be used for patients who have the insurance to pay for them, to ensure the patient can afford the medication.
4.Providers should only accept low-value gifts, such as pens and pads of paper, from the pharmaceutical representative.

____ 12. Under new U.S. Food and Drug Administration labeling, Pregnancy Categories will be:

1.Strengthened with a new coding such as C+ or C- to discern when a drug is more or less toxic to the fetus
2.Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label
3.Eliminated, and replaced with a link to the National Library of Medicine TOXNET Web site for in-depth information regarding pregnancy concerns
4.Clarified to include information such as safe dosages in each trimester of pregnancy

Chapter 5. Adverse Drug Reactions

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs):

1.A 32-year-old male
2.A 22-year-old female
3.A 3-month-old female
4.A 48-year-old male

____ 2. Infants and young children are at higher risk of ADRs due to:

1.Immature renal function in school-age children
2.Lack of safety and efficacy studies in the pediatric population
3.Children’s skin being thicker than adults, requiring higher dosages of topical medication
4.Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution

____ 3. The elderly are at high risk of ADRs due to:

1.Having greater muscle mass than younger adults, leading to higher volume of distribution
2.The extensive studies that have been conducted on drug safety in this age group
3.The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect
4.Age-related decrease in renal function

____ 4. The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic doses is type:


____ 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.


____ 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:

3.To cause hypersensitivity reactions
4.Hypothalamus-pituitary-adrenal axis suppressants

____ 11. A 24-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for a _____ adverse drug reaction when he no longer requires the opioids.


____ 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:

2.Inhaled anticholinergics

____ 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 7. Cultural and Ethnic Influences in Pharmacotherapeutics

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Cultural factors that must be taken into account when prescribing include(s):

1.Who the decision maker is in the family regarding health-care decisions
2.The patient’s view of health and illness
3.Attitudes regarding the use of drugs to treat illness
4.All of the above

____ 2. Ethnic differences have been found in drug:

2.Hepatic metabolism
3.Filtration at the glomerulus
4.Passive tubular reabsorption

____ 3. The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all:

2.Clinics that serve the poor
3.Organizations that receive federal funds
4.Clinics that serve ethnic minorities

____ 4. According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care:

1.May be a bilingual family member
2.May be a bilingual nurse or other health-care provider
3.Must be a professionally trained medical interpreter
4.Must be an employee of the organization

____ 5. According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:

1.The belief among African Americans that prayer is more powerful than drugs
2.Poor compliance on the part of the African American patient
3.The genetic predisposition for illness found among African Americans
4.Discrimination, cultural barriers, and lack of access to health care

____ 6. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:

1.Increased CYP 2D6 activity, leading to rapid metabolism of some drugs
2.Largely unknown due to lack of studies of this population
3.Rapid metabolism of alcohol, leading to increased tolerance
4.Decreased elimination of opioids, leading to increased risk for addiction

____ 7. Pharmacokinetics among Asians are universal to all the Asian ethnic groups.


____ 8. Alterations in drug metabolism among Asians may lead to:

1.Slower metabolism of antidepressants, requiring lower doses
2.Faster metabolism of neuroleptics, requiring higher doses
3.Altered metabolism of omeprazole, requiring higher doses
4.Slower metabolism of alcohol, requiring higher doses

____ 9. Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:

1.Require acetylization in order to metabolize drugs
2.Are unable to tolerate higher doses of some drugs that require acetylization
3.May have a toxic reaction to drugs that require acetylization
4.Require higher doses of drugs metabolized by acetylization to achieve efficacy

____ 10. Hispanic native healers (curanderas):

1.Are not heavily utilized by Hispanics who immigrate to the United States
2.Use herbs and teas in their treatment of illness
3.Provide unsafe advice to Hispanics and should not be trusted
4.Need to be licensed in their home country in order to practice in the United States

Chapter 9. Nutrition and Nutraceuticals

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. The most frequent type of drug-food interaction is food:

1.Causing increased therapeutic drug levels
2.Affecting the metabolism of the drug
3.Altering the volume of distribution of drugs
4.Affecting the gastrointestinal absorption of drugs

____ 2. Food in the gastrointestinal tract affects drug absorption by:

1.Altering the pH of the colon, which decreases absorption
2.Competing with the drug for plasma proteins
3.Altering gastric emptying time
4.Altering the pH of urine

____ 3. Food can alter the pH of the stomach, leading to:

1.Enhanced drug metabolism
2.Altered vitamin K absorption
3.Increased vitamin D absorption
4.Altered drug bioavailability

____ 4. Fasting for an extended period can:

1.Increase drug absorption due to lack of competition between food and the drug
2.Alter the pH of the gastrointestinal tract, affecting absorption
3.Cause vasoconstriction, leading to decreased drug absorption
4.Shrink the stomach, causing decreased surface area for drug absorption

____ 5. Tetracycline needs to be given on an empty stomach because it chelates with:

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 statins
3.Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by CYP 1A2
4.Decreasing first-pass metabolism of drugs

____ 9. Milk and other foods that alkalinize the urine may:

1.Result in basic drugs being reabsorbed in the renal tubule
2.Increase the elimination of basic drugs in the urine
3.Decrease the elimination of acidic drugs
4.Not alter drug elimination due to the minimal change in urine pH

____ 10. Antacids such as calcium carbonate (Tums) can reduce the absorption of which of the following nutrients?

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:

3.Romaine lettuce

____ 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/day
4.25 mg/day

____ 16. Which of the following vitamin or mineral supplements may by teratogenic if a pregnant woman takes more than the recommended amount?

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?


____ 19. Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B6 (pyridoxine) to prevent:

2.Peripheral neuropathy
4.Megaloblastic anemia

____ 20. Vitamin B12 deficiency may lead to:

1.Hair loss
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
4.All of the above

____ 23. Adequate vitamin D is needed for:

1.Absorption of calcium from the gastrointestinal tract
2.Regulation of serum calcium levels
3.Regulation of serum phosphate levels
4.All of the above

____ 24. Newborns are at risk for early vitamin K deficiency bleeding and the American Academy of Pediatrics recommends that all newborns receive:

1.IM vitamin K (phytonadione) within 24 hours of birth
2.Oral vitamin K supplementation in the first 3 weeks of life
3.Formula containing vitamin K or breast milk
4.Oral vitamin K in the first 24 hours after birth

____ 25. Symptoms of folate deficiency include:

1.Thinning of the hair
2.Bruising easily
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

____ 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

____ 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)
4.Omega-3 fatty acids

____ 31. There is sufficient evidence to support the use of omega-3 fatty acids to treat the following disease(s):

4.All of the above

____ 32. It is reasonable to recommend supplementation with _________ in the treatment of hyperlipidemia.

1.Omega-3 fatty acids
3.Plant sterols

____ 33. Probiotics are recommended to be co-administered when ____________ are prescribed:


____ 34. It is reasonable to add ___________ to a Helicobacter pylori treatment regimen to improve eradication rates of H. pylori.

2.Omega-3 fatty acids
3.Plant sterols

Chapter 11. Information Technology and Pharmacotherapeutics

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to:

1.Search for information using the most common search engines
2.Serve as content experts in developing, implementing, and evaluating information systems
3.Write programs to assure the integrity of health information
4.Use information technology to prescribe drugs

____ 2. You are going to prescribe a drug and the electronic health record (EHR) alerts you that there is a potential drug–drug interaction. The alert is generated by:

1.The Food and Drug Administration MedWatch system
2.TOXNET, the National Institutes of Health alert system
3.The EHR clinical decision support system
4.Lexicomp, a commercial medication alert system

____ 3. Which of the following is a primary benefit of the use of computerized provider order entry for patient medications?

1.Reduces time that prescribing drugs takes
2.Eliminates the need to chart drugs prescribed
3.Decreases prescribing and transcription errors
4.Helps keep the number of drugs prescribed to a minimum

____ 4. A number of barriers and concerns exist before the goals of a safe and efficient information technology (IT) system can be realized. Which of the following is NOT a barrier to adoption and use of IT in prescribing drugs?

1.Cost of initial setup
2.Access to highly skilled experts
3.Compatibility between systems
4.Patient confidentiality risks

____ 5. EHRs:

1.Are being discouraged by the Centers for Medicare and Medicaid Services due to cost issues
2.Allow for all patient data to be centralized in one location for access by multiple providers
3.Use macros and templates to individualize care
4.Use standardized software to facilitate interoperability between systems

____ 6. Factors that facilitate keeping patient information confidential in an electronic health record (EHR) system include:

1.Designing software so that only those who need the information can gain access
2.Requiring providers to log off at the end of the clinical day
3.Keeping a file of the login and password information for each provider in a secure place
4.Having patients sign informed consent documents to have their data on an EHR

____ 7. Decision support systems often provide medication alerts that tell the prescriber:

1.Patient history data with a summary of their diagnoses
2.The usual dosage for the drug being prescribed
3.The patient’s latest laboratory values, such as potassium levels
4.Potential drug-to-drug interactions with other medications the patient is taking

____ 8. Prescribers have been shown to override a medication alert about a patient’s allergies when:

1.The history showed that the patient had tolerated the medication in the past
2.The benefit outweighed the risk
3.The medication was therapeutically appropriate and needed
4.All of the above

____ 9. The use of information technology for quality improvement in pharmacotherapeutics includes:

1.Incorporating the use of “apps” into all patient encounters
2.Tracking data trends within the practice via the electronic health record database
3.Informing patients that they have access to their medication list via the Internet
4.Using macros for individualizing patient care management

____ 10. The advantage of using information technology for patient education includes:

1.The ability to track the number of times you have given the patient the same instructions regarding their medication
2.Standardized and individualized patient education that is simultaneously recorded into the patient record
3.Easy access to private patient information specific to populations with a similar diagnosis
4.The ability to download and interpret patient information in multiple languages, easily and accurately

____ 11. One barrier to use of the Internet for both prescribing and for patient teaching is:

1.Lack of free public access to the Internet
2.Age, with older adults rarely understanding how to use a computer
3.Web pages and hyperlinks may change, be deleted, or be replaced
4.Few Web sites with information about drugs are free

____ 12. Information technology can be a time-saving device in a busy practice if it is used wisely. One way to make it a help rather than a hindrance is to:

1.Prioritize what is needed information and avoid spending time reading “interesting” information not central to the problem at hand
2.Integrate professional and personal searching so that the same browser does not need to be accessed repeatedly
3.Check e-mail frequently so that patient questions can be addressed promptly
4.Check for viruses, spyware, and malware

____ 13. Data in the electronic health record that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review:

1.The patient’s current diagnosis and history
2.Drugs the patient is currently taking
3.Any recent previous encounter for the same problem as this visit and what was done
4.All of the above

____ 14. Information technology (IT) can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true?

1.Patients feel the provider does not care about them if they are not seen in a face-to-face encounter.
2.Data collected from patients between encounters via IT is less accurate and complete.
3.Collecting data between encounters via IT may mean a more efficient face-to-face encounter.
4.Between encounters is a good time to collect screening data.

____ 15. Discharge summaries using information technology have several advantages. They can:

1.Replace the need for oral instruction because the patient has printed material to read at home
2.Be filed with the patient’s chart to document patient teaching
3.Both 1 and 2
4.Neither 1 nor 2

____ 16. Information technology can also be used for patient teaching during the encounter and after it. The provider can help patients and their families become savvy consumers of health-care information by:

1.Warning them about the questionable quality of health information online
2.Identifying easily used “apps” that patients can use to manage their medications
3.Teaching them how to identify high-quality Web sites and “red flags” signaling inaccurate content
4.All of the above

____ 17. Incorporating information technology (IT) into a patient encounter takes skill and tact. During the encounter, the provider can make the patient more comfortable with the IT the provider is using by:

1.Turning the screen around so the patient can see material being recorded
2.Not placing the computer screen between the provider and the patient
3.Both 1 and 2
4.Neither 1 nor 2

Chapter 13. Over-the-Counter Medications

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must:

1.Be safe and labeled for appropriate use
2.Have a low potential for abuse or misuse
3.Be taken for a condition the patient can reliably self-diagnose
4.All of the above

____ 2. In the United States, over-the-counter drugs are regulated by:

1.No one. There is no oversight for over-the-counter medications.
2.The U.S. Food and Drug Administration Center for Drug Evaluation and Research
3.The U.S. Drug Enforcement Administration

____ 3. As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to:

1.Get a new patent for the over-the-counter form of the drug
2.Lower the costs because most prescription benefit plans do not cover generics
3.Market the drug to a whole new population, as they are able to market to patients instead of just providers
4.Continue to make large profits from their blockbuster brand-name drug

____ 4. New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do.


____ 5. The ailment that generates the greatest over-the-counter annual drug sales is:

2.Cough and colds
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 15. Drugs Affecting the Central Nervous System

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:

1.Understanding that obesity is a contraindication to prescribing phentermine
2.Anorexiants may cause tolerance and should only be prescribed for 6 months
3.Patients should be monitored for postural hypotension
4.Renal function should be monitored closely while on anorexiants

____ 2. Before prescribing phentermine to Sarah, a thorough drug history should be taken including assessing for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St John’s wort due to:

1.Additive respiratory depression risk
2.Additive effects affecting liver function
3.The risk of serotonin syndrome
4.The risk of altered cognitive functioning

____ 3. Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for_________ to be used for an episode of status epilepticus.

1.IV phenobarbital
2.Rectal diazepam (Diastat)
3.IV phenytoin (Dilantin)
4.Oral carbamazepine (Tegretol)

____ 4. Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:

1.For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
2.For pedal edema throughout therapy
3.Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
4.For vision changes, such as red-green blindness, at least annually

____ 5. Dwayne has recently started on carbamazepine to treat seizures. He comes to see you and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels include:

1.Dwayne hasn’t been taking his carbamazepine because it causes insomnia.
2.Carbamazepine auto-induces metabolism, leading to lower levels in spite of good compliance.
3.Dwayne was not originally prescribed the correct amount of carbamazepine.
4.Carbamazepine is probably not the right antiseizure medication for Dwayne.

____ 6. Carbamazepine has a Black Box Warning due to life-threatening:

1.Renal toxicity, leading to renal failure
2.Hepatotoxicity, leading to liver failure
3.Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis
4.Cardiac effects, including supraventricular tachycardia

____ 7. Long-term monitoring of patients who are taking carbamazepine includes:

1.Routine troponin levels to assess for cardiac damage
2.Annual eye examinations to assess for cataract development
3.Monthly pregnancy tests for all women of childbearing age
4.Complete blood count every 3 to 4 months

____ 8. Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for:

1.Increased seizure activity, as this drug may auto-induce seizures
2.Altered renal function, including renal failure
3.Blood dyscrasias, which are uncommon but possible
4.Central nervous system excitement, leading to insomnia

____ 9. Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be:

1.Increase her dose
2.Assess for suicidal ideation
3.Discontinue the medication immediately
4.Decrease her dose to half then slowly titrate up the dose

____ 10. Selma, who is overweight, recently started taking topiramate for seizures and at her follow-up visit you note she has lost 3 kg. The appropriate action would be:

1.Tell her to increase her caloric intake to counter the effects of the topiramate.
2.Consult with a neurologist, as this is not a common adverse effect of topiramate.
3.Decrease her dose of topiramate.
4.Reassure her that this is a normal side effect of topiramate and continue to monitor her weight.

____ 11. Monitoring of a patient on gabapentin to treat seizures includes:

1.Routine therapeutic drug levels every 3 to 4 months
2.Assessing for dermatologic reactions, including Steven’s Johnson
3.Routine serum electrolytes, especially in hot weather
4.Recording seizure frequency, duration, and severity

____ 12. Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:

1.He should not play sports due to the risk of increased seizures
2.He should monitor his temperature and ability to sweat in the heat while playing
3.Reminding him that he may need higher dosages of topiramate when exercising
4.Encouraging him to use sunscreen due to photosensitivity from topiramate

____ 13. Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam includes reminding her:

1.To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
2.To wear sunscreen due to photosensitivity from levetiracetam
3.To get an annual eye exam while on levetiracetam
4.To report weight loss if it occurs

____ 14. Levetiracetam has known drug interactions with:

1.Combined oral contraceptives
4.Few, if any, drugs

____ 15. Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:

1.Reassuring her she has a viral infection and to call if she isn’t better in 4 or 5 days
2.Ruling out a hypersensitivity reaction that may lead to multi-organ failure
3.Rapid strep test and symptomatic care if strep test is negative
4.Observation only, with further assessment if she worsens

____ 16. Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause:

1.Contraceptive failure
2.Excessive weight gain
3.Reduced lamotrigine levels, requiring doubling the dose of lamotrigine
4.Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed

____ 17. The tricyclic antidepressants should be prescribed cautiously in patients with:

4.Heart disease

____ 18. A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):

1.He should not be prescribed any serotonergic drug such as sumatriptan (Imitrex)
2.MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce
3.Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment
4.All of the above

____ 19. Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:


____ 20. Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes:

1.SSRIs may take 2 to 6 weeks before she will have maximum drug effects.
2.Red-green color blindness may occur and should be reported.
3.If she experiences dry mouth or heart rates greater than 80, she should stop taking the drug immediately.
4.She should eat lots of food high in fiber to prevent constipation.

____ 21. Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:

1.Fluoxetine (Prozac)
2.Paroxetine (Paxil)
3.Amitriptyline (Elavil)
4.Duloxetine (Cymbalta)

____ 22. Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider:

1.For excessive weight loss
2.With the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS)
3.Monthly for tolerance to the haloperidol
4.Only by the mental health provider, as most NPs in primary care do not care for mentally ill patients

____ 23. Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:

1.Reduce the chance of tardive dyskinesia
2.Potentiate the effects of the drug
3.Reduce the tolerance that tends to occur
4.Increase central nervous system (CNS) depression

____ 24. Patients who are prescribed olanzapine (Zyprexa) should be monitored for:

2.Weight gain

____ 25. A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:

1.Bradykinesia, akathisia, and agitation
2.Excessive weight gain
4.Potentially fatal agranulocytosis

____ 26. In choosing a benzodiazepam to treat anxiety the prescriber needs to be aware of the possibility of dependence. The benzodiazepam with the greatest likelihood of rapidly developing dependence is:

1.Chlordiazepoxide (Librium)
2.Clonazepam (Klonopin)
3.Alprazolam (Xanax)
4.Oxazepam (Serax)

____ 27. A patient with anxiety and depression may respond to:

1.Duloxetine (Cymbalta)
2.Fluoxetine (Prozac)
3.Oxazepam (Serax)
4.Buspirone (Buspar) and an SSRI combined

____ 28. When prescribing temazepam (Restoril) for insomnia, patient education includes:

1.Take temazepam nightly approximately 15 minutes before bedtime.
2.Temazepam should not be used more than three times a week for less than 3 months.
3.Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep better.
4.Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of temazepam.

____ 29. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because:

1.Zolpidem should be taken just before going to bed.
2.Zolpidem may cause dry mouth and constipation.
3.Patients may need to double the dose for effectiveness.
4.They should stop drinking alcohol at least 30 minutes before taking zolpidem.

____ 30. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow therapeutic range, it is important to recognize symptoms of toxicity, such as:

1.Orthostatic hypotension
2.Agitation and irritability
3.Drowsiness and nausea
4.Painful urination and abdominal distention

____ 31. Tom is taking lithium for bipolar disorder. He should be taught to:

1.Take his lithium with food
2.Eat a diet with consistent levels of salt (sodium)
3.Drink at least 2 quarts of water if he is in a hot environment
4.Monitor blood glucose levels

____ 32. Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?

1.Valproate is safe during all trimesters of pregnancy.
2.She can get pregnant while taking valproate, but she should take adequate folic acid.
3.Valproate is not safe at any time during pregnancy.
4.Valproate is a known teratogen, but may be taken after the first trimester if necessary.

____ 33. When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3), instructions to the patient should include:

1.The medication may cause sedation and they should not drive.
2.Constipation is a common side effect and they should increase fluids and fiber.
3.Patients should not take any other acetaminophen-containing medications at the same time.
4.All of the above

____ 34. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:

1.Ibuprofen (Advil)
2.Acetaminophen with hydrocodone (Vicodin)
3.Oxycodone (Oxycontin)
4.Oral morphine (Roxanol)

____ 35. Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:

1.Ibuprofen (Advil)
2.Acetaminophen with hydrocodone (Vicodin)
3.Oxycodone (Oxycontin)
4.Oral morphine (Roxanol)

____ 36. Jack, age 8, has attention deficit disorder (ADD) and is prescribed methylphenidate (Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are:

1.Slurred speech and insomnia
2.Bradycardia and confusion
3.Dizziness and orthostatic hypotension
4.Insomnia and decreased appetite

____ 37. Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes:

1.ADHD symptoms
2.Routine height and weight checks
3.Amount of methylphenidate being used
4.All of the above

____ 38. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor:

1.Blood pressure
2.Blood glucose levels
3.Urine ketone levels
4.Liver function

Chapter 17. Drugs Affecting the Respiratory System

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Digoxin levels need to be monitored closely when the following medication is started:


____ 2. Patients with pheochromocytoma should avoid which of the following classes of drugs because of the possibility of developing hypertensive crisis?


____ 3. Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all?

1.Betamethasone, an inhaled corticosteroid
2.Salmeterol, an inhaled long-acting beta-agonist
3.Albuterol, a short-acting beta-agonist
4.Montelukast, a leukotriene modifier

____ 4. Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug Administration due to the:

1.Risk of life-threatening dermatological reactions
2.Increased incidence of cardiac events when LTBAs are used
3.Increased risk of asthma-related deaths when LTBAs are used
4.Risk for life-threatening alterations in electrolytes

____ 5. The bronchodilator of choice for patients taking propranolol is:


____ 6. James is a 52-year-old overweight smoker taking theophylline for his persistent asthma. He tells his provider he is going to start the Atkin’s diet for weight loss. The appropriate response would be:

1.Congratulate him on making a positive change in his life.
2.Recommend he try stopping smoking instead of the Atkin’s diet.
3.Schedule him for regular testing of serum theophylline levels during his diet due to increased excretion of theophylline.
4.Decrease his theophylline dose because a high-protein diet may lead to elevated theophylline levels.

____ 7. Li takes theophylline for his persistent asthma and calls the office with a complaint of nausea, vomiting, and headache. The best advice for him would be to:

1.Reassure him this is probably a viral infection and should be better soon
2.Have him seen the same day for an assessment and theophylline level
3.Schedule him for an appointment in 2 to 3 days, which he can cancel if he is better
4.Order a theophylline level at the laboratory for him

____ 8. Tiotropium bromide (Spiriva) is an inhaled anticholinergic:

1.Used for the treatment of chronic obstructive pulmonary disease (COPD)
2.Used in the treatment of asthma
3.Combined with albuterol for treatment of asthma exacerbations
4.Combined with fluticasone for the treatment of persistent asthma

____ 9. Christy has exercise-induced and mild persistent asthma and is prescribed two puffs of albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (QVAR) is also prescribed. Teaching regarding her inhalers includes:

1.Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day
2.Beclomethasone needs to be used every day to treat her asthma
3.Report any systemic side effects she is experiencing, such as weight gain
4.Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation

____ 10. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be instructed:

1.Montelukast twice a day is started when there is an asthma exacerbation.
2.Patients may experience weight gain on montelukast.
3.Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.
4.Lethargy and hypersomnia may occur when taking montelukast.

____ 11. Montelukast (Singulair) may be prescribed for:

1.A 6-year-old child with exercise-induced asthma
2.A 2-year-old child with moderate persistent asthma
3.An 18-month-old child with seasonal allergic rhinitis
4.None of the above; montelukast is not approved for use in children

____ 12. The known drug interactions with the inhaled corticosteroid beclomethasone (QVAR) include:

2.MMR vaccine
4.None of the above

____ 13. When educating patients who are starting on inhaled corticosteroids, the provider should tell them that:

1.They need to get any live vaccines before starting the medication.
2.Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective.
3.Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.
4.They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids.

____ 14. Patients with allergic rhinitis may benefit from a prescription of:

1.Fluticasone (Flonase)
2.Cetirizine (Zyrtec)
3.OTC cromolyn nasal spray (Nasalcrom)
4.Any of the above

____ 15. Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for:

1.Urinary retention
2.Cardiac output
3.Peripheral edema
4.Skin rash

____ 16. First-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal allergies because they are:

1.More effective than first-generation antihistamines
2.Less sedating than the first-generation antihistamines
3.Prescription products, therefore are covered by insurance
4.Able to be taken with central nervous system (CNS) sedatives, such as alcohol

____ 17. When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should be instructed to:

1.Take the dimenhydrinate after they get nauseated
2.Drink lots of water while taking the dimenhydrinate
3.Take the dimenhydrinate 15 minutes before it is needed
4.Double the dose if one tablet is not effective

____ 18. Decongestants such as pseudoephedrine (Sudafed):

1.Are Schedule III drugs in all states
2.Should not be prescribed or recommended for children under 4 years of age
3.Are effective in treating the congestion children experience with the common cold
4.May cause drowsiness in patients of all ages

____ 19. Cough and cold medications that contain a sympathomimetic decongestant such as phenylephrine should be used cautiously in what population:

1.Older adults
2.Hypertensive patients
4.All of the above

____ 20. Martin is a 60-year-old patient with hypertension. The first-line decongestant to prescribe would be:

1.Oral pseudoephedrine
2.Oral phenylephrine
3.Nasal oxymetazoline
4.Nasal azelastine

____ 21. The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-year-old child is:

1.Fluids and symptomatic care
2.Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids)
3.Guaifenesin and codeine syrup (Tussin AC)
4.Chlorpheniramine and dextromethorphan syrup (Nyquil for Kids)

Chapter 21. Drugs Affecting the Endocrine System

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Both men and women experience bone loss with aging. The bones most likely to demonstrate significant loss are:

1.Cortical bones
2.Femoral neck bones
3.Cervical vertebrae
4.Pelvic bones

____ 2. Bisphosphonates treat or prevent osteoporosis by:

1.Inhibiting osteoclastic activity
2.Fostering bone resorption
3.Enhancing calcium uptake in the bone
4.Strengthening the osteoclastic proton pump

____ 3. Prophylactic use of bisphosphonates is recommended for patients with early osteopenia related to long-term use of which of the following drugs?

1.Selective estrogen receptor modulators
4.Calcium supplements

____ 4. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic secretions. Each replacement drug has lipase, protease, and amylase components, but the drug is prescribed in units of:


____ 5. Brands of pancreatic enzyme replacement drugs are:

2.About the same in cost per unit of lipase across brands
3.Able to be interchanged between generic and brand-name products to reduce cost
4.None of the above

____ 6. When given subcutaneously, how long until neutral protamine Hagedorn insulin begins to take effect (onset of action) after administration?

1.15 to 30 minutes
2.60 to 90 minutes
3.3 to 4 hours
4.6 to 8 hours

____ 7. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and symptoms of hypoglycemia include:

1.“Fruity” breath odor and rapid respiration
2.Diarrhea, abdominal pain, weight loss, and hypertension
3.Dizziness, confusion, diaphoresis, and tachycardia
4.Easy bruising, palpitations, cardiac dysrhythmias, and coma

____ 8. Nonselective beta blockers and alcohol create serious drug interactions with insulin because they:

1.Increase blood glucose levels
2.Produce unexplained diaphoresis
3.Interfere with the ability of the body to metabolize glucose
4.Mask the signs and symptoms of altered glucose levels

____ 9. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the following statements about this form of insulin is NOT true?

1.Optimal time of preprandial injection is 15 minutes.
2.Duration of action is increased when the dose is increased.
3.It is compatible with neutral protamine Hagedorn insulin.
4.It has no pronounced peak.

____ 10. The decision may be made to switch from twice daily neutral protamine Hagedorn (NPH) insulin to insulin glargine to improve glycemia control throughout the day. If this is done:

1.The initial dose of glargine is reduced by 20% to avoid hypoglycemia.
2.The initial dose of glargine is 2 to 10 units per day.
3.Patients who have been on high doses of NPH will need tests for insulin antibodies.
4.Obese patients may require more than 100 units per day.

____ 11. When blood glucose levels are difficult to control in type 2 diabetes some form of insulin may be added to the treatment regimen to control blood glucose and limit complication risks. Which of the following statements is accurate based on research?

1.Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.
2.Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.
3.Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.
4.Patients who are not controlled on oral agents and have postprandial hyperglycemia can have neutral protamine Hagedorn insulin added at bedtime.

____ 12. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it:

1.Substitutes for insulin usually secreted by the pancreas
2.Decreases glycogenolysis by the liver
3.Increases the release of insulin from beta cells
4.Decreases peripheral glucose utilization

____ 13. Prior to prescribing metformin, the provider should:

1.Draw a serum creatinine to assess renal function
2.Try the patient on insulin
3.Tell the patient to increase iodine intake
4.Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions

____ 14. The action of “gliptins” is different from other antidiabetic agents because they:

1.Have a low risk for hypoglycemia
2.Are not associated with weight gain
3.Close ATP-dependent potassium channels in the beta cell
4.Act on the incretin system to indirectly increase insulin production

____ 15. Sitagliptin has been approved for:

1.Monotherapy in once-daily doses
2.Combination therapy with metformin
3.Both 1 and 2
4.Neither 1 nor 2

____ 16. GLP-1 agonists:

1.Directly bind to a receptor in the pancreatic beta cell
2.Have been approved for monotherapy
3.Speed gastric emptying to decrease appetite
4.Can be given orally once daily

____ 17. Avoid concurrent administration of exenatide with which of the following drugs?

4.All of the above

____ 18. Administration of exenatide is by subcutaneous injection:

1.30 minutes prior to the morning meal
2.60 minutes prior to the morning and evening meal
3.15 minutes after the evening meal
4.60 minutes before each meal daily

____ 19. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with propylthiouracil. Patients should be taught to report:

1.Tinnitus and decreased salivation
2.Fever and sore throat
3.Hypocalcemia and osteoporosis
4.Laryngeal edema and difficulty swallowing

____ 20. Elderly patients who are started on levothyroxine for thyroid replacement should be monitored for:

1.Excessive sedation
2.Tachycardia and angina
3.Weight gain
4.Cold intolerance

____ 21. Which of the following is not an indication that growth hormone supplements should be discontinued?

1.Imaging indication of epiphyseal closure
2.Growth curve increases have plateaued
3.Complaints of mild bone pain
4.Achievement of anticipated height goals

____ 22. Besides osteoporosis, IV bisphosphonates are also indicated for:

1.Paget’s Disease
2.Early osteopenia
3.Renal cancer
4.Early closure of cranial sutures

____ 23. What is the role of calcium supplements when patients take bisphosphonates?

1.They must be restricted to allow the medication to work.
2.They must be taken in sufficient amounts to provide foundational elements for bone growth.
3.They must be taken at the same time as the bisphosphonates.
4.They only work with bisphosphonates if daily intake is restricted.

____ 24. Which of the following statements about pancreatic enzymes is true?

1.Dosing may be titrated according to the decrease of steatorrhea.
2.The amount of carbohydrates in the meal drives the amount of enzyme used.
3.The amount of medication used is increased with a cystic fibrosis pulmonary flare.
4.The FDA and Internet-available formulations are bioequivalent.

____ 25. Besides cystic fibrosis, which other medical state may trigger the need for pancreatic enzymes?

1.Paget’s disease
2.Pulmonary cancers
3.Gallbladder surgery
4.Some bariatric surgeries

Chapter 23. Drugs Affecting the Integumentary System

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Erik presents with one golden-crusted lesion at the site of an insect bite consistent with impetigo. His parents have limited finances and request the least expensive-treatment. Which medication would be the best choice for treatment?

1.Mupirocin (Bactroban)
2.Bacitracin and polymixin B (generic double antibiotic ointment)
3.Retapamulin (Altabax)
4.Oral cephalexin (Keflex)

____ 2. Juakeem is a nasal methicillin resistant staphylococcus aureus (MRSA) carrier. Treatment to eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes:

1.Take the oral medication exactly as prescribed.
2.Insert one-half of the dose in each nostril twice a day.
3.Alternate treating one nare in the morning and the other in the evening.
4.Nasal MRSA eradication requires at least 4 weeks of therapy, with up to 8 weeks needed in some patients.

____ 3. Instructions for applying a topical antibiotic or antiviral ointment include:

1.Apply thickly to the infected area, spreading the medication well past the borders of the infection.
2.If the rash worsens, apply a thicker layer of medication to settle down the infection.
3.Wash hands before and after application of topical antimicrobials.
4.None of the above

____ 4. When Sam used clotrimazole (Lotrimin AF) for athlete’s foot he developed a red, itchy rash consistent with a hypersensitivity reaction. He now has athlete’s foot again. What would be a good choice of antifungal for Sam?

1.Miconazole (Micatin) powder
2.Ketoconazole (Nizoral) cream
3.Terbinafine (Lamisil) cream
4.Griseofulvin (Grifulvin V) suspension

____ 5. When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the patient or parent to:

1.Mix the griseofulvin with ice cream before administering
2.Take the griseofulvin until the tinea clears, in approximately 4 to 5 weeks
3.Shampoo with baby shampoo daily while taking the griseofulvin
4.Griseofulvin is best absorbed if ingested with a high-fat food.

____ 6. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:

1.OTC topical azole (clotrimazole, miconazole)
2.Oral terbinafine
3.Oral griseofulvin microsize
4.Nystatin cream or ointment

____ 7. When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold sores) patient education would include:

1.Spread penciclovir liberally all over lips and area surrounding lips.
2.Penciclovir therapy is started at the first sign of a cold sore outbreak.
3.Skin irritation is normal with penciclovir and it should resolve.
4.The penciclovir should be used a minimum of 2 weeks to prevent recurrence.

____ 8. Erika has been prescribed isotretinoin (Accutane) by her dermatologist and is presenting to her primary care provider with symptoms of sadness and depression. A Beck’s Depression Scale indicates she has mild to moderate depression. What would be the best care for her at this point?

1.Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant
2.Refer her to a mental health therapist
3.Contact her dermatologist about discontinuing the isotretinoin
4.Reassure her that mood swings are normal and schedule follow up in a week

____ 9. Drew is a 17-year-old competitive runner who presents with complaint of pain in his hip that occurred after he fell while running. His only medical problem is severe acne for which he takes isotretinoin (Accutane). With this history what would you be concerned for?

1.He may have pulled a muscle and needs to rest to recover.
2.He is at risk for bone injuries and needs to be evaluated for fracture.
3.Isotretinoin interacts with ibuprofen which is the pain medication of choice.
4.Teen athletes are at risk for repetitive stress injuries.

____ 10. Catherine calls the clinic with concerns that her acne is worse 1 week after starting topical tretinoin. What would be the appropriate care for her?

1.Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin.
2.Switch her to an oral antibiotic to treat her acne.
3.Advise her to apply an oil-based lotion to her face to soothe the redness.
4.Reassure her that the worsening of acne is normal and it should improve with continued use.

____ 11. Li is a 6-month-old infant with severe eczema. She would benefit from topical corticosteroid therapy. Instructions for using topical corticosteroids in children include:

1.Apply liberally to all areas with eczema.
2.Double the frequency of application when the eczema is severe.
3.Apply sparingly to eczema areas.
4.Cover the eczema area with an occlusive dressing after applying a corticosteroid.

____ 12. Jose has had eczema for many years and reports that he thinks his corticosteroid cream is not working as well as it was previously. He may be experiencing tolerance to the corticosteroid. Treatment options include:

1.Increase the potency of the corticosteroid cream.
2.Recommend an interrupted or cyclic schedule of application.
3.Increase the frequency of dosing of the corticosteroid.
4.Discontinue the corticosteroid because it isn’t working any longer .

____ 13. When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed that:

1.Tacrolimus is the most effective if it is used continuously for 4 to 6 months.
2.Tacrolimus should be spread generously over the affected area.
3.The FDA has issued a Black Box warning about the use of tacrolimus and the development of cancer in animals and humans.
4.The FDA recommends patients be screened for cancer before prescribing tacrolimus.

____ 14. Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:

1.High vitamin D levels

____ 15. Jesse is prescribed tazarotene for his psoriasis. Patient education regarding topical tazarotene includes instructing them:

1.That tazarotene is applied in a thin film to the psoriasis plaque lesions
2.To apply it liberally to all psoriatic lesions
3.To apply tazarotene to nonaffected areas to prevent breakout
4.That tazarotene may cause hypercalcemia if it is overused

____ 16. Instructions for the use of selenium sulfide shampoo (Selsun) to treat scalp seborrhea include:

1.Shampoo daily and rinse well.
2.Worsening of seborrhea for the first week is normal.
3.Seborrhea usually clears up after a few weeks of treatment.
4.Shampoo twice a week for 2 weeks, then weekly.

____ 17. Topical diphenhydramine (Benadryl) is available OTC to treat itching. Patients or parents should be instructed regarding the use of topical diphenhydramine that:

1.For maximum effectiveness in treating itching, combine topical with oral diphenhydramine.
2.Topical diphenhydramine is the treatment of choice in treating poison ivy or poison oak.
3.Topical diphenhydramine should not be used in children younger than age 2 years.
4.When applying topical diphenhydramine, apply the cream liberally to all areas that itch.

____ 18. A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his leg. Normal adverse effects of silver sulfadiazine cream include:

1.Transient leukopenia on days 2 to 4 that should resolve
2.Worsening of burn symptoms briefly before resolution
3.A red, scaly rash that will resolve with continued use

____ 19. Instructions for the use of malathion (Ovide) for head lice include:

1.Use a blow dryer to dry the hair after applying.
2.Malathion (Ovide) is used daily for a week until all lice are dead.
3.Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours.
4.Use gloves to apply the malathion (Ovide).

____ 20. When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education would include:

1.All members of the household and personal contacts should also be treated.
2.Infants should have permethrin applied from the neck down.
3.The permethrin is washed off after 10 to 20 minutes.
4.Permethrin is flammable and to avoid open flame while the medication is applied.

Chapter 27. Anemia

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Pernicious anemia is treated with:

1.Folic acid supplements
2.Thiamine supplements
3.Vitamin B12

____ 2. Premature infants require iron supplementation with:

1.10 mg/day of iron
2.2 mg/kg per day until age 12 months
3.7 mg/day in their diet
4.1 mg/kg per day until they are receiving adequate intake of iron from foods

____ 3. Breastfed infants should receive iron supplementation of:

1.3 mg/kg per day
2.6 mg/kg per day
3.1 mg/kg per day
4.Breastfed babies do not need iron supplementation

____ 4. Valerie presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her ferritin is 15 ng/mL. Initial treatment for her anemia would be:

1.18 mg/day of iron supplementation
2.6 mg/kg per day of iron supplementation
3.325 mg ferrous sulfate per day
4.325 mg ferrous sulfate tid

____ 5. Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be:

1.18 mg/day of iron supplementation
2.6 mg/kg per day of elemental iron
3.325 mg ferrous sulfate per day
4.325 mg ferrous sulfate tid

____ 6. Monitoring for a patient taking iron to treat iron deficiency anemia is:

1.Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started
2.Complete blood count every 4 weeks throughout treatment
3.Annual complete blood count
4.Reticulocyte count in 4 weeks

____ 7. Valerie has been prescribed iron to treat her anemia. Education of patients prescribed iron would include:

1.Take the iron with milk if it upsets her stomach.
2.Antacids may help with the nausea and GI upset caused by iron.
3.Increase fluids and fiber to treat constipation.
4.Iron is best tolerated if it is taken at the same time as her other medications.

____ 8. Allie has just had her pregnancy confirmed and is asking about how to ensure a healthy baby. What is the folic acid requirement during pregnancy?

1.40 mcg/day
2.200 mcg/day
3.800 mcg/day
4.2 gm/day

____ 9. Kyle has Crohn’s disease and has a documented folate deficiency. Drug therapy for folate deficiency anemia is:

1.Oral folic acid 1 to 2 mg per day
2.Oral folic acid 1 gram per day
3.IM folate weekly for at least 6 months
4.Oral folic acid 400 mcg daily

____ 10. Patients who are being treated for folate deficiency require monitoring of:

1.Complete blood count every 4 weeks
2.Hematocrit and hemoglobin at 1 week and then at 8 weeks
3.Reticulocyte count at 1 week
4.Folate levels every 4 weeks until hemoglobin stabilizes

____ 11. The treatment of vitamin B12 deficiency is:

1.1,000 mcg daily of oral cobalamin
2.2 gm per day of oral cobalamin
3.Vitamin B12 100 mcg/day IM
4.500 mcg/dose nasal cyanocobalamin 2 sprays once a week

____ 12. The dosage of Vitamin B12 to initially treat pernicious anemia is:

1.Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month
2.Vitamin B12 IM monthly
3.Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month
4.Oral cobalamin 1,000 mcg daily

____ 13. Before beginning IM vitamin B12 therapy, which laboratory values should be obtained?

1.Reticulocyte count, hemoglobin, and hematocrit
3.Vitamin B12
4.All of the above

____ 14. ________ should be monitored when vitamin B12 therapy is started.

1.Serum calcium
2.Serum potassium
4.C-reactive protein

____ 15. Anemia due to chronic renal failure is treated with:

1.Epoetin alfa (Epogen)
2.Ferrous sulfate
3.Vitamin B12

Chapter 31. Contraception

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Women who are taking an oral contraceptive containing the progesterone drospirenone may require monitoring of:

2.Serum calcium
3.White blood count
4.Serum potassium

____ 2. The mechanism of action of oral combined contraceptives that prevents pregnancy is:

1.Estrogen prevents the luteinizing hormone surge necessary for ovulation.
2.Progestins thicken cervical mucus and slow tubal motility.
3.Estrogen thins the endometrium making implantation difficult.
4.Progestin suppresses follicle stimulating hormone release.

____ 3. To improve actual effectiveness of oral contraceptives women should be educated regarding:

1.Use of a back-up method if they have vomiting or diarrhea during a pill packet
2.Doubling pills if they have diarrhea during the middle of a pill pack
3.The fact that they will have a normal menstrual cycle if they miss two pills
4.The fact that mid-cycle spotting is not normal and the provider should be contacted immediately

____ 4. A contraindication to the use of combined contraceptives is:

1.Adolescence (not approved for this age)
2.A history of clotting disorder
3.Recent pregnancy
4.Being overweight

____ 5. Obese women may have increased risk of failure with which contraceptive method?

1.Combined oral contraceptives
2.Progestin-only oral contraceptive pill
3.Injectable progestin
4.Combined topical patch

____ 6. Ashley comes to the clinic with a request for oral contraceptives. She has successfully used oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be:

1.Recommend she return to the clinic at the start of her next menses to get a Depo Provera shot.
2.Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first 7 days.
3.Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first 7 days.
4.Discuss the advantages of using the topical birth control patch and recommend she consider using the patch.

____ 7. When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is:

1.Immediate protection against pregnancy the first week of using the pill
2.No back-up method is needed when starting
3.Menses occur during the week
4.They can start the pill on the Sunday after the office visit

____ 8. The topical patch combined contraceptive (Ortho Evra) is:

1.Started on the first day of the menstrual cycle
2.Recommended for women over 200 pounds
3.Not as effective as oral combined contraceptives
4.Known to have more adverse effects, such as nausea, than the oral combined contraceptives

____ 9. Progesterone-only pills are recommended for women who:

1.Are breastfeeding
2.Have a history of migraine
3.Have a medical history that contradicts the use of estrogen
4.All of the above

____ 10. Women who are prescribed progestin-only contraception need education regarding which common adverse drug effects?

1.Increased migraine headaches
2.Increased risk of developing blood clots
3.Irregular vaginal bleeding for the first few months
4.Increased risk for hypercalcemia

____ 11. An advantage of using the NuvaRing vaginal ring for contraception is:

1.It does not require fitting and is easy to insert.
2.It is inserted once a week, eliminating the need to remember to take a daily pill.
3.Patients get a level of estrogen and progestin equal to combined oral contraceptives.
4.It also provides protection against vaginal infections.

____ 12. Oral emergency contraception (Plan B) is contraindicated in women who:

1.Had intercourse within the past 72 hours
2.May be pregnant
3.Are taking combined oral contraceptives
4.Are using a diaphragm

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