(Test Bank) Pharmacotherapeutics For Advanced Practice A Practical Approach

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4th Edition

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Pharmacotherapeutics For Advanced Practice A Practical Approach 4th Edition Test Bank Chapter 1 Issues for the Practitioner in Drug Therapy MULTIPLE CHOICE 1. Nurse practitioner prescriptive authority is regulated by: A. The National Council of State Boards of Nursing B. The U.S. Drug Enforcement Administration C. The State Board of Nursing for each state D. The State Board of Pharmacy ANS: C PTS: 1 2. Physician Assistant (PA) prescriptive authority is regulated by: A. The National Council of State Boards of Nursing B. The U.S. Drug Enforcement Administration C. The State Board of Nursing D. The State Board of Medical Examiners ANS: D PTS: 1 3. Clinical judgment in prescribing includes: A. Factoring in the cost to the patient of the medication prescribed B. Always prescribing the newest medication available for the disease process C. Handing out drug samples to poor patients D. Prescribing all generic medications to cut costs ANS: A PTS: 1 4. Criteria for choosing an effective drug for a disorder include: A. Asking the patient what drug they think would work best for them B. Consulting nationally recognized guidelines for disease management C. Prescribing medications that are available as samples before writing a prescription D. Following U.S. Drug Enforcement Administration (DEA) guidelines for prescribing ANS: B PTS: 1 5. Nurse practitioner practice may thrive under health -care reform due to: A. The demonstrated ability of nurse practitioners to control costs and improve patient outcomes B. The fact that nurse practitioners will be able to practice independently C. The fact that nurse practitioners will have full reimbursement under health -care reform D. The ability to shift accountability for Medicaid to the state level ANS: A PTS: 1 Chapter 2.Pharmacokinetic Basis of Therapeutics and Pharmacodynamic MULTIPLE CHOICE 1. A patient’s nutritional intake and lab work reflects hypoalbuminemia. This is critical to prescribing because: A. Distribution of drugs to target tissue may be affected B. The solubility of the drug will not match the site of absorption C. There will be less free drug available to generate an effect D. Drugs bound to albumin are readily excreted by the kidney ANS: A PTS: 1 2. Drugs that have a significant first-pass effect: A. Must be given by the enteral (oral) route only B. Bypass the hepatic circulation C. Are rapidly metabolized by the liver and may have little if any desired action D. Are converted by the liver to more active and fat-soluble forms ANS: C PTS: 1 3. The route of excretion of a volatile drug will likely be: A. The kidneys B. The lungs C. The bile and feces D. The skin ANS: B PTS: 1 4. Medroxyprogesterone (Depo Provera) is prescribed IM to create a storage reservoir of the drug. Storage reservoirs: A. Assure that the drug will reach its intended target tissue B. Are the reason for giving loading doses C. Increase the length of time a drug is available and active D. Are most common in collagen tissues ANS: C PTS: 1 5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s: A. Propensity to go to the target receptor B. Biological half-life C. Pharmacodynamics D. Safety and side effects ANS: B PTS: 1 6. Azithromycin dosing requires the first day’s dose be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose: A. Rapidly achieves drug levels in the therapeutic range B. Requires four to five half-lives to attain C. Is influenced by renal function D. Is directly related to the drug circulating to the target tissues ANS: A PTS: 1 7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: A. Minimum adverse effect level B. Peak of action C. Onset of action D. Therapeutic range ANS: C PTS: 1 8. Phenytoin requires a trough level be drawn. Peak and trough levels are done: A. When the drug has a wide therapeutic range B. When the drug will be administered for a short time only C. When there is a high correlation between the dose and saturation of receptor sites D. To determine if a drug is in the therapeutic range ANS: D PTS: 1 9. A laboratory result indicates the peak level for a drug is above the minimum toxic concentration. This means that the: A. Concentration will produce therapeutic effects B. Concentration will produce an adverse response C. Time between doses must be shortened D. Duration of action of the drug is too long ANS: B PTS: 1 10. Drugs that are receptor agonists may demonstrate what property? A. Irreversible binding to the drug receptor site B. Up-regulation with chronic use C. Desensitization or down -regulation with continuous use D. Inverse relationship between drug concentration and drug action ANS: C PTS: 1 11. Drugs that are receptor antagonists, such as beta blockers, may cause: A. Down -regulation of the drug receptor B. An exaggerated response if abruptly discontinued C. Partial blockade of the effects of agonist drugs D. An exaggerated response to competitive drug agonists ANS: B PTS: 1 12. Factors that affect gastric drug absorption include: A. Liver enzyme activity B. Protein -binding properties of the drug molecule C. Lipid solubility of the drug D. Ability to chew and swallow ANS: C PTS: 1 13. Drugs administered via intravenous (IV) route: A. Need to be lipid soluble in order to be easily absorbed B. Begin distribution into the body immediately C. Are easily absorbed if they are nonionized D. May use pinocytosis to be absorbed ANS: B PTS: 1 14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: A. The sum of the effects of each drug individually B. Greater than the sum of the effects of each drug individually C. Less than the effect of each drug individually D. Not predictable, as it varies with each individual ANS: B PTS: 1 15. Which of the following statements about bioavailability is true? A. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained release mechanisms. B. All brands of a drug have the same bioavailability. C. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily. D. Combining an active drug with an inert substance does not affect bioavailability. ANS: A PTS: 1 16. Which of the following statements about the major distribution barriers (blood -brain or fetal- placental) is true? A. Water soluble and ionized drugs cross these barriers rapidly. B. The blood -brain barrier slows the entry of many drugs into and from brain cells. C. The fetal-placental barrier protects the fetus from drugs taken by the mother. D. Lipid soluble drugs do not pass these barriers and are safe for pregnant women. ANS: B PTS: 1 17. Drugs are metabolized mainly by the liver via Phase I or Phase II reactions. The purpose of both of these types of reactions is to: A. Inactivate prodrugs before they can be activated by target tissues B. Change the drugs so they can cross plasma membranes C. Change drug molecules to a form that an excretory organ can excrete D. Make these drugs more ionized and polar to facilitate excretion ANS: C PTS: 1 18. Once they have been metabolized by the liver, the metabolites may be: A. More active than the parent drug B. Less active than the parent drug C. Totally “deactivated” so that they are excreted without any effect D. All of the above ANS: D PTS: 1 19. All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: A. Reduced circulation and perfusion of the kidney B. Chronic renal disease C. Competition for a transport site by another drug D. Unbinding a nonvolatile drug from plasma proteins ANS: D PTS: 1 20. Steady state is: A. The point on the drug concentration curve when absorption exceeds excretion B. When the amount of drug in the body remains constant C. When the amount of drug in the body stays below the MTC D. All of the above ANS: B PTS: 1 21. Two different pain meds are given together for pain relief. The drug-drug interaction is: A. Synergistic B. Antagonistic C. Potentiative D. Additive ANS: D PTS: 1 22. Actions taken to reduce drug-drug interaction problems include all of the following    EXCEPT: A. Reducing the dose of one of the drugs B. Scheduling their administration at different times C. Prescribing a third drug to counteract the adverse reaction of the combination D. Reducing the dosage of both drugs ANS: C PTS: 1 23. Phase I oxidative -reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process? A. Protein malnutrition B. Iron deficiency anemia C. Both A and B D. Neither A nor B ANS: D PTS: 1 24. The time required for the amount of drug in the body to decrease by 50% is called: A. Steady state B. Half-life C. Phase II metabolism D. Reduced bioavailability time ANS: B PTS: 1 25. An agonist activates a receptor and stimulates a response. When given frequently over time the body may: A. Up-regulate the total number of receptors B. Block the receptor with a partial agonist C. Alter the drug’s metabolism D. Down -regulate the numbers of that specific receptor ANS: D PTS: 1 26. Drug antagonism is best defined as an effect of a drug that: A. Leads to major physiologic psychological dependence B. Is modified by the concurrent administration of another drug C. Cannot be metabolized before another dose is administered D. Leads to a decreased physiologic response when combined with another drug ANS: B PTS: 1 27. Instructions to a client regarding self-administration of oral enteric -coated tablets should include which of the following statements? A. “Avoid any other oral medicines while taking this drug.” B. “If swallowing this tablet is difficult, dissolve it in 3 ounce s of orange juice.” C. “The tablet may be crushed if you have any difficultly taking it.” D. “To achieve best effect, take the tablet with at least 8 ounces of fluid.” ANS: D PTS: 1 28. The major reason for not crushing a sustained release capsule is that, if crushed, the coated beads of the drugs could possibly result in: A. Disintegration B. Toxicity C. Malabsorption D. Deterioration ANS: B PTS: 1 29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? A. Sodium bicarbonate B. Ascorbic acid C. Salicylic acid D. Glucose ANS: A PTS: 1 30. Which of the following variables is a factor in drug absorption? A. The smaller the surface area for absorption, the more rapidly the drug is absorbed. B. A rich blood supply to the area of absorption leads to better absorption. C. The less soluble the drug, the more easily it is absorbed. D. Ionized drugs are easily absorbed across the cell membrane. ANS: B PTS: 1 31. An advantage of prescribing a sublingual medication is that the medication is: A. Absorbed rapidly B. Excreted rapidly C. Metabolized minimally D. Distributed equally ANS: A PTS: 1 32. Drugs that use CYP 3A4 isoenzymes for metabolism may: A. Induce the metabolism of another drug B. Inhibit the metabolism of another drug C. Both A and B D. Neither A nor B ANS: C PTS: 1 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: A. After the second dose B. After four to five half -lives C. When the patient feels the full effect of the drug D. One hour after IV administration ANS: B PTS: 1 34. Up-regulation or hypersensitization may lead to: A. Increased response to a drug B. Decreased response to a drug C. An exaggerated response if the drug is withdrawn D. Refractoriness or complete lack of response ANS: C PTS: 1 Chapter 3. Impact of Drug Interactions and Adverse Events on Therapeutics MULTIPLE CHOICE 1. Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs): A. A 32-year-old male B. A 22-year-old female C. A 3-month -old female D. A 48-year-old male ANS: C PTS: 1 2. Infants and young children are at higher risk of ADRs due to: A. Immature renal function in school -age children B. Lack of safety and efficacy studies in the pediatric population C. Children’s skin being thicker than adults, requiring higher dosages of topical medication D. Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution ANS: B PTS: 1 3. The elderly are at high risk of ADRs due to: A. Having greater muscle mass than younger adults, leading to higher volume of distribution B. The extensive studies that have been conducted on drug safety in this age group C. The blood -brain barrier being less permeable, requiring higher doses to achieve therapeutic effect D. Age-related decrease in renal function ANS: D PTS: 1 4. The type of adverse drug reaction that is the result of an unwanted but otherwise normal pharmacological action of a drug given in the usual therapeutic doses is A. Type A B. Type B C. Type C D. Type D ANS: A PTS: 1 5. Digoxin may cause a Type A adverse drug reaction due to: A. Idiosyncratic effects B. Its narrow therapeutic index C. Being a teratogen D. Being a carcinogen ANS: B PTS: 1 6. Changes in the individual pharmacokinetic parameters of adsorption, distribution, or elimination may result in high concentrations of the drug in the body, leading to which type of adverse drug reaction? A. Type A B. Type C C. Type D D. Type E ANS: A PTS: 1 7. According to the World Health Organization Classification, Type B adverse reactions are: A. When a drug is a teratogen B. When a drug is carcinogenic C. A delayed ADR, such as renal failure D. An allergic or idiosyncratic response ANS: D PTS: 1 8. Sarah developed a rash after using a topical medication. This is a Type allergic drug reaction. A. I B. II C. III D. IV ANS: D PTS: 1 9. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n): A. Cytotoxic hypersensitivity reaction B. Immune complex hypersensitivity C. Immediate hypersensitivity reaction D. Delayed hypersensitivity reaction ANS: A PTS: 1 10. Anaphylactic shock is a: A. Type I reaction, called immediate hypersensitivity reaction B. Type II reaction, called cytotoxic hypersensitivity reaction C. Type III allergic reaction, called immune complex hypersensitivity D. Type IV allergic reaction, called delayed hypersensitivity reaction ANS: A PTS: 1 11. James has hypothalamic -pituitary -adrenal axis suppression from chronic prednisone (a corticosteroid) use. He is at risk for what type of adverse drug reaction? A. Type B B. Type C C. Type E D. Type F ANS: B PTS: 1 12. The treatment for a patient who experiences hypothalamic -pituitary -adrenal axis suppression while taking the corticosteroid prednisone, a Type C adverse drug reaction, is to: A. Immediately discontinue the prednisone B. Administer epinephrine C. Slowly taper the patient off of the prednisone D. Monitor for long-term effects, such as cancer ANS: C PTS: 1 13. The ACE inhibitor lisinopril is a known teratogen. Teratogens cause Type adverse drug reaction. A. A B. B C. C D. D ANS: D PTS: 1 14. Cardiac defects are a known Type D adverse drug reaction to lithium. Lithium causes a Type D adverse drug reaction because it is: A. An immunosuppressant B. A carcinogen C. A teratogen D. An antiseizure medication ANS: C PTS: 1 15. Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a Type D reaction because they are known: A. Teratogens B. Carcinogens C. To cause hypersensitivity reactions D. Hypothalamus -pituitary -adrenal (HPA) axis suppressants ANS: B PTS: 1 16. 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 Type adverse drug reaction when he no longer requires the opioids. A. A B. C C. E D. G ANS: C PTS: 1 17. Drugs that may cause a Type E adverse drug reaction include: A. Beta blockers B. Immunomodulators C. Antibiotics D. Oral contraceptives ANS: A PTS: 1 18. Unexpected failure of drug therapy is a Type adverse drug reaction, commonly caused by . A. B; cytotoxic hypersensitivity B. B; idiosyncratic response C. C; cumulative effects of drug D. F; drug-drug interaction ANS: D PTS: 1 19. Clopidogrel treatment failure may occur when it is co -administered with omeprazole, known as a Type adverse drug reaction. A. A B. C C. E D. F ANS: D PTS: 1 Chapter 4. Principles of Pharmacotherapy in Children MULTIPLE CHOICE 1. The Pediatric Research Equity Acts requires: A. All children be provided equal access to drug research trials B. Children to be included in the planning phase of new drug development C. That pediatric drug trials guarantee children of multiple ethnic groups are included D. All applications for new active ingredients, new indications, new dosage forms, or new routes of administration require pediatric studies ANS: D PTS: 1 2. The Best Pharmaceuticals for Children Act: A. Includes a pediatric exclusivity rule which extends the patent on drugs studied in children B. Establishes a committee that writes guidelines for pediatric prescribing C. Provides funding for new drug development aimed at childr en D. Encourages manufacturers specifically to develop pediatric formulations ANS: B PTS: 1 3. The developmental variation in Phase I enzymes has what impact on pediatric prescribing? A. None, Phase I enzymes are stable throughout childhood. B. Children should always be prescribed lower than adult doses per weight due to low enzyme activity until puberty. C. Children should always be prescribed higher than adult doses per weight due to high enzyme activity. D. Prescribing dosages will vary based on the developmental activity of each enzyme, at times requiring lower than adult doses and other times higher than adult doses based on the age of the child. ANS: D PTS: 1 4. Developmental variation in renal function has what impact on prescribing for infants and children? A. Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months. B. Higher doses of water soluble drugs may need to be prescribed due to increased renal excretion. C. Renal excretion rates have no impact on prescribing. D. Parents need to be instructed on whether drugs are renally excreted or not. ANS: A PTS: 1 5. Topical corticosteroids are prescribed cautiously in young children due to: A. They may cause an intense hypersensitivity reaction B. Hypothalamic -pituitary -adrenal (HPA) axis suppression C. Corticosteroids are less effective in young children D. Young children may accumulate corticosteroids leading to toxic levels ANS: B PTS: 1 6. Liza is breastfeeding her 2 -month -old son and has an infection that requires an antibiotic. What drug factors influence the effect of the drug on the infant? A. Maternal drug levels B. Half-life C. Lipid -solubility D. All of the above ANS: D PTS: 1 7. Drugs that are absolutely contraindicated in lactating women include: A. Selective serotonin reuptake inhibitors B. Antiepileptic drugs such as carbamazepine C. Antineoplastic drugs such as methotrexate D. All of the above ANS: C PTS: 1 8. Zia is a 4 month old with otitis media. Education of his parents regarding administering oral antibiotics to an infant includes: A. How to administer an oral drug using a medication syringe B. Mixing the medication with a couple ounces of formula and putting it in a bottle C. Discontinuing the antibiotic if diarrhea occurs D. Calling for an antibiotic change if the infant chokes and sputters during administration ANS: A PTS: 1 9. To increase adherence in pediatric patients a prescription medication should: A. Have a short half-life B. Be the best tasting of the effective drugs C. Be the least concentrated form of the medication D. Be administered 3 or 4 times a day ANS: B PTS: 1 10. Janie is a 5-month -old breastfed infant with a fever. Treatment for her fever may include: A. “Baby” aspirin B. Acetaminophen suppository C. Ibuprofen suppository D. Alternating acetaminophen and ibuprofen ANS: B PTS: 1 Chapter 5. Principles of Pharmacotherapy in Pregnancy and Lactation MULTIPLE CHOICE 1. The client has been prescribed Doxylamine (Unisom) for treatment of nausea and vomiting during pregnancy. What aspect of the client’s history will cause the nurse to contact the primary health care provider? a. Arthritis b. Depression c. Asthma d. Hyperglycemia ANS: C PTS: 1 2. The nurse is teaching a group of pregnant women the importance of adequate nutr ition for the fetus. The nurse instructs the clients that folic acid deficiency during preconception and early in pregnancy can result in: a. skeletal defects. b. neural tube defects. c. intrauterine growth retardation. d. small -for-gestational -age infants. ANS: B PTS: 1 3. A client is ordered to receive iron and antacids. The nurse teaches the client that iron and antacids should be administered: a. at the same time. b. 2 hours apart. c. with the antacid first. d. with the iron first. ANS: B PTS: 1 4. A client, 10 weeks pregnant, complains of severe nausea of pregnancy. Meclizine (Bonine) is prescribed. The client reports to the nurse that she has begun to experience dizziness. What is the highest priority nursing intervention? a. Contact the pharmacist; this indicates an overdosage of the medication. b. Contact the physician; this is an expected side effect of the medication. c. Contact the pharmacist; this indicates incorrect preparation of the medication. d. Contact the physician; this is an adverse reaction to the medication. ANS: B PTS: 1 5. A client complains of severe pregnancy -related nausea and is placed on Meclizine (Bonine). The nurse notes in the client history that the client is undergoing treatment for glaucoma. What is the highest priority nursing intervention? a. Recognize that one of the off -label uses for the drug is treatment of glaucoma. b. Contact the pharmacist; the dosage of the drug should be decreased when glaucoma is present. c. Recognize that use of the drug when glaucoma is present may result in a fatal reaction. d. Contact the physician; the drug should be used with caution when glaucoma is present. ANS: D PTS: 1 6. Betamethasone (Celestone) is ordered for a client in preterm labor. The client asks the nurse what the medication will do to help her. The nurse explains to the client that the medication will: a. help her to breathe more effectively during the labor process. b. prevent her infant from developing respiratory distress syndrome. c. help her infant to breathe more effectively during the labor process. d. prevent her from developing congestive heart failure during labor. ANS: B PTS: 1 7. A client is admitted to the labor and delivery unit and is being treated with terbutaline (Brethine). The nurse plans the client’s care with the knowledge that this medication is used to: a. induce labor. b. decrease uterine contractions. c. stimulate fetal heart rate. d. enhance placental blood flow. ANS: B PTS: 1 8. The client is being treated with hydralazine hydrochloride (Apresoline). What would be a positive outcome for the client as a result of treatment with this medication? a. Diastolic BP is maintained between 90 and 110 mm Hg. b. Diastolic BP is maintained between 70 and 90 mm Hg. c. Systolic BP is maintained between 100 and 120 mm Hg. d. Systolic BP is maintained between 90 and 110 mm Hg. ANS: A PTS: 1 9. A client diagnosed with pregnancy -induced hypertension (PIH) is treated with magnesium sulfate. The nurse tells the client that the purpose of this treatment is to: a. prolong labor. b. prevent seizures. c. increase blood pressure. d. stimulate urination. ANS: B PTS: 1 10. A prenatal client discloses that she takes high doses of vitamins. Which is the most accurate instruction that the nurse can provide in response to the client’s statement? a. “High levels of vitamins may cause harm to the fetus.” b. “Only water -soluble vitamins may be harmful during pregnancy.” c. “Megadoses of vitamins are associated with positive birth outcomes.” d. “Vitamin supplementation is not needed during pregnancy.” ANS: A PTS: 1 11. A pregnant woman experiences constipation. The nurse anticipates that which laxative may be used first after activity and dietary methods are unsuccessful? a. Mineral oil b. Psyllium (Metamucil) c. Lactulose d. Milk of magnesia ANS: B PTS: 1 12. The client is scheduled for treatment with betamethasone (Celestone). The nurse anticipates that this medication will be administered via the route. a. oral b. intravenous c. intramuscular d. subcutaneous ANS: C PTS: 1 13. The client is scheduled for treatment with betamethasone (Celestone). The nurse anticipates that the medication will be administered to the client during which week or before of her pregnancy. a. 38 b. 36 c. 35 d. 33 ANS: D PTS: 1 14. The healthcare provider orders hydroxyzine (Vistaril) for a client in labor. To achieve a positive outcome, the nurse plans to administer the drug via which route? a. Intradermally b. Intravenously c. Intramuscularly via Z-track technique d. Subcutaneously via Z-track technique ANS: C PTS: 1 15. An epidural block is ordered for a primipara client in labor. The nurse anticipates that this epidural block will be given when the cervix is dilated at centimeters. a. 2 to 3 b. 3 to 4 c. 4 to 5 d. 5 to 6 ANS: D PTS: 1 16. A client is being treated with an ergot alkaloid medication. Which observation wou ld cause the nurse to contact the primary healthcare provider? a. Hypertension b. Itching c. Jugular vein distention d. Seizure activity ANS: D PTS: 1 17. The client is scheduled for an epidural anesthetic as she delivers. What will be the highest priority nursing intervention? a. Administer 1 L of an isotonic IV solution and encourage use of a bedpan after spinal anesthesia. b. Administer 500 mL of a hypotonic IV solution and assess the level of consciousness because the patient is sedated. c. Administer 500 mL of a hypertonic IV solution and assess fetal heart rate and progress of labor as per pregnancy protocol. d. Administer 1 L of hypotonic IV solution and allow the client to ambulate during the spinal anesthesia. ANS: A PTS: 1 18. The best candidate for treatment with dinoprostone (Cervidil) is the woman who needs her: a. labor stopped. b. cervix ripened. c. labor stimulated. d. labor prolonged. ANS: B PTS: 1 19. Which will most likely be part of the nursing care of a woman postcaesarean section with spinal anesthesia? a. Early ambulation to avoid constipation b. Fluid restrictions to decrease blood volume c. Lying flat 6 to 8 hours to avoid spinal headache d. IV antibiotics to avoid postpartum infection ANS: C PTS: 1 20. The client is scheduled to be treated with Oxytocin by nasal spray. The nurse plans to administer the drug: a. 2 to 3 minutes after the client nurses her baby. b. 2 to 3 minutes before the client nurses her baby. c. after delivery of the placenta. d. as delivery of the placenta is imminent. ANS: B PTS: 1 MULTIPLE RESPONSE 1. A young women in labor, G1P0, is diagnosed with pregnancy -induced hypertension (PIH). She is ordered to receive magnesium sulfate. What are the other components of her nursing care? (Select all that apply.) a. Maintaining a quiet environmen t b. Assessing vital signs and fetal heart tones frequently c. Providing large amounts of PO and IV fluids to maintain fluid volume d. Allowing the woman to ambulate ad lib e. Assessing for clonus and deep tendon reflexes f. Monitoring urine hourly for protein ANS: A, B, E, F PTS: 1 Chapter 6. Principles of Pharmacotherapy in Elderly Patients MULTIPLE CHOICE 1. Principles of prescribing for older adults include: A. Avoiding prescribing any newer high-cost medications B. Starting at a low dose and increasing the dose slowly C. Keeping total dose at lower therapeutic range D. All of the above ANS: B PTS: 1 2. Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie? A. Increased volume of distribution B. Decreased lipid solubility C. Decreased plasma proteins D. Increased muscle to fat ratio ANS: C PTS: 1 3. Glen is an 82 year old who needs to be prescribed a new drug. What changes in elimination should be taken into consideration when prescribing for Glen? A. Increased GFR will require higher doses of some renally excreted drugs B. Decreased tubular secretion of medication will require dosage adjustments C. Thin skin will cause increased elimination via sweat D. Decreased lung capacity will lead to measurable decreases in lung excretion of drugs ANS: B PTS: 1 4. A medication review of an elderly person’s medications involves: A. Asking the patient to bring a list of current prescription medications to the visit B. Having the patient bring all of their prescription, over-the-counter, and herbal medication to the visit C. Asking what other providers are writing prescriptions for them D. All of the above ANS: D PTS: 1 5. Steps to avoid polypharmacy include: A. Prescribing two or fewer drugs from each drug class B. Reviewing a complete drug history every 12 to 18 months C. Encouraging the elderly patient to coordinate their care with all of their providers D. Evaluating for duplications in drug therapy and discontinuing any duplications ANS: D PTS: 1 6. Robert is a 72 year old who has hypertension and angina. He is at risk for common medication practices seen in the elderly including: A. Use of another person’s medications B. Hoarding medications C. Changing his medication regimen without telling his provider D. All of the above ANS: D PTS: 1 7. To improve positive outcomes when prescribing for the elderly the nurse practitioner should: A. Assess cognitive functioning in the elder B. Encourage the patient to take a weekly “drug holiday” to keep drug costs down C. Encourage the patient to cut drugs in half with a knife to lower costs D. All of the above ANS: A PTS: 1 8. When an elderly diabetic patient is constipated the best treatment options include: A. Mineral oil B. Bulk -forming laxatives such as psyllium C. Stimulant laxatives such as senna D. Stool softeners such as docusate ANS: D PTS: 1 9. Delta is an 88 year old who has mild low back pain. What guidelines should be followed when prescribing pain management for Delta? A. Keep the dose of oxycodone low to prevent development of tolerance B. Acetaminophen is the first-line drug of choice C. Avoid prescribing NSAIDs D. Add in a short -acting benzodiazepine for a synergistic effect on pain ANS: B PTS: 1 10. Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the elderly include: A. Diuretics B. Trazodone C. Clonazepam D. Levodopa ANS: A PTS: 1 Chapter 7 Principles of Pharmacotherapy in Pain Management MULTIPLE CHOICE 1. Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence: A. The sensory aspects of pain B. The discriminative aspects of pain C. The motivational aspects of pain D. The cognitive aspects of pain ANS: C PTS: 1 2. Patients need to be questioned about all pain sites because: A. Patients tend to report the most severe or important in their perception B. Pain tolerance generally decreases with repeated exposure C. The reported pain site is usually the most important to treat D. Pain may be referred from a different site to the one reported ANS: A PTS: 1 3. The chemicals that promote the spread of pain locally include: A. Serotonin B. Norepinephrine C. Enkephalin D. Neurokinin A ANS: D PTS: 1 4. Narcotics are exogenous opiates. They act by: A. Inhibiting pain transmission in the spinal cord B. Attaching to receptors in the afferent neuron to inhibit the release of substance P C. Blocking neurotransmitte rs in the midbrain D. Increasing beta-lipoprotein excretion from the pituitary ANS: B PTS: 1 5. Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true? A. Preterm and newborn infants do not yet have functional pain pathways. B. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child. C. Increases in pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness D. Decreases in pain tolerance are evident in older adults ANS: A PTS: 1 6. Which of the following statements is true about acute pain? A. Somatic pain comes from body surfaces and is only sharp and well-localized. B. Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates. C. Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site. D. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area. ANS: C PTS: 1 7. One of the main drug classes used to treat acute pain is NSAIDs. They are used because: A. They have less risk for liver damage than acetaminophen B. Inflammation is a common cause of acute pain C. They have minimal GI irritation D. Regulation of blood flow to the kidney is not affected by these drugs ANS: B PTS: 1 8. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? A. All opiates are scheduled drugs which require a DEA license to prescribe. B. Opiates stimulate only mu receptors for the control of pain. C. Most of the adverse effects of opiates are related to mu receptor stimulation. D. Naloxone is an antagonist to opiates. ANS: B PTS: 1 9. If interventions to resolve the cause of pain (RICE) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use? A. NSAIDs, opiates, corticosteroids B. Low-dose opiates, salicylates, increased dose of opiates C. Opiates, non-opiates, increased dose of non-opiate D. Non-opiate, increased dose of non-opiate, opiate ANS: D PTS: 1 10. The goal of treatment of acute pain is: A. Pain at a tolerable level where patient may return to activities of daily living B. Reduction of pain with a minimum of drug adverse effects C. Reduction or elimination of pain with minimum adverse reactions D. Adequate pain relief without constipation or nausea from the drugs ANS: C PTS: 1 11. Which of the following statements is true about age and pain? A. Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children. B. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs. C. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain. D. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs. ANS: D PTS: 1 12. Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to: A. Determine if the diagnosis of source of pain is correct B. Determine if the current regimen is adequate or different combinations of drugs and non-drug therapy are required C. Determine if the patient is willing and able to be an active participant in his or her pain management D. All of the above ANS: D PTS: 1 13. Pathological similarities and differences between acute pain and chronic pain include: A. Both have decreased levels of endorphins B. Chronic pain has a predominance of C-neuron stimulation C. Acute pain is most commonly associated with irritation of peripheral nerves D. Acute pain is diffuse and hard to localize ANS: B PTS: 1 14. A treatment plan for management of chronic pain should include: A. Negotiation with the patient to set personal goals for pain management B. Discussion of ways to improve sleep and stress C. An exercise program to improve function and fitness D. All of the above ANS: D PTS: 1 15. Chronic pain is a complex problem. Some specific strategies to deal with it include: A. Telling the patient to “let pain be your guide” to using treatment therapies B. Prescribing pain medication on a “PRN” basis to keep down the amount used C. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment D. All of the above ANS: C PTS: 1 16. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency? A. Use of more than one drug to treat the pain B. Multiple times when prescriptions are lost with requests to refill C. Preferences for treatments that include alternative medicin es D. Presence of a family member who has abused drugs ANS: B PTS: 1 17. The Pain Management Contract is appropriate for: A. Patients with a history of chemical dependency or possible inappropriate use of pain medications B. All patients with chronic pain who will require long-term use of opiates C. Patients who have a complex drug regimen D. Patients who see multiple providers for pain control ANS: A PTS: 1 Chapter 8. Principles of Antimicrobial Therapy MULTIPLE CHOICE 1. A nurse is ordered to draw blood levels for a person receiving an antibiotic. The nurse is aware that peaks and troughs of serum antibiotic levels are monitored for drugs with a: a. narrow therapeutic index. b. large therapeutic index. c. long half-life. d. short half-life. ANS: A PTS: 1 2. A client’s medication warrants peak and trough levels to be drawn. The nurse is aware that if the peak level of the drug is too high, what could occur? a. Mild side effects b. Inadequate drug action c. Slow onset of drug action d. Drug toxicity ANS: D PTS: 1 3. Drug concentration is important for the eradication of bacterial infection. It is desired to keep the drug dose: a. below minimum effective concentration. b. above minimum effective concentration. c. below minimum toxic level. d. above minimum toxic level. ANS: B PTS: 1 4. With continuous use of antibiotics, antibiotic resistance result because: a. bacteria are producing fewer mutations. b. the immune system has enhanced ability to fight infection. c. mutant bacteria are surviving antibiotic use. d. fewer new antibiotics have been produced. ANS: C PTS: 1 5. A client with otitis media is ordered to receive amoxicillin (Amoxil). The client discloses to the nurse that she is allergic to penicillin. What is the highest priority action on the part of the nurse? a. Notify the healthcare provider that the client is allergic to penicillin. b. Encourage the client to take the dose under close monitoring. c. Administer half of the amoxicillin dose under supervision. d. Report the amoxicillin order to the supervisor. ANS: A PTS: 1