Pharmacotherapeutics for Advanced Practice 3rd Edition by Virginia Poole Arcangelo, Andrew M. Peterson – Test Bank  

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Pharmacotherapeutics for Advanced Practice 3rd Edition by Virginia Poole Arcangelo, Andrew M. Peterson – Test Bank

 

Sample  Questions

 

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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. The chemicals that promote the spread of pain locally include:
A. Serotonin
B. Norepinephrine
C. Enkephalin
D. Neurokinin A

 

 

ANS:  D                    PTS:   1

 

  1. 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 neurotransmitters in the midbrain
D. Increasing beta-lipoprotein excretion from the pituitary

 

 

ANS:  B                    PTS:   1

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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

 

  1. 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 medicines
D. Presence of a family member who has abused drugs

 

 

ANS:  B                    PTS:   1

 

  1. 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 11.  Contact Dermatitis

 

MULTIPLE CHOICE

 

  1. When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication would be:
A. Intermediate potency corticosteroid ointment (Kenalog)
B. A combination of a corticosteroid and an antifungal (Lotrisone)
C. A low potency corticosteroid cream applied sparingly (hydrocortisone 1%)
D. A high potency corticosteroid cream (Diprolene AF)

 

 

ANS:  C                    PTS:   1

 

  1. Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used for:
A. Short-term or intermittent treatment of atopic dermatitis
B. Topical treatment of fungal infections (Candida)
C. Chronic, inflammatory seborrheic dermatitis
D. Recalcitrant nodular acne

 

 

ANS:  A                    PTS:   1

 

  1. Long-term treatment of moderate atopic dermatitis includes:
A. Topical corticosteroids and emollients
B. Topical corticosteroids alone
C. Topical antipruritics
D. Oral corticosteroids for exacerbations of atopic dermatitis

 

 

ANS:  A                    PTS:   1

 

  1. Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with:
A. Topical antipruritics
B. Oral corticosteroids for 2 to 3 weeks
C. Thickly applied topical intermediate-dose corticosteroids
D. Isolation of the patient to prevent spread of the dermatitis

 

 

ANS:  B                    PTS:   1

 

  1. When a patient has contact dermatitis, wet dressings with Domeboro solution are used for:
A. Cleaning the weeping area of dermatitis
B. Bathing the patient to prevent infection
C. Relief of inflammation
D. Providing a barrier layer to protect the surrounding skin

 

 

ANS:  C                    PTS:   1

 

  1. Topical corticosteroids are used to treat several disorders. Topical corticosteroids are contraindicated for treatment of which of the following conditions?
a. Psoriasis c. Eczema
b. Contact dermatitis d. Rosacea

 

 

ANS:  D                    PTS:   1

 

  1. A topical corticosteroid may be used to treat facial eczema. What instruction must be given to a patient for whom a topical corticosteroid is prescribed for treatment of facial eczema?
a. “Be careful not to get any of the medication in your eyes.”
b. “Stay out of strong sunlight while using the medication.”
c. “Put a thin layer of medication on once a day just before you go to bed for the night.”
d. “Check before you use it that the medication is labeled fluorinated.”

 

 

ANS:  A                    PTS:   1

 

  1. Group I topical corticosteroids may cause adverse reactions. A patient who is being treated with a group I topical corticosteroid must be closely monitored for
a. increased hepatic enzymes. c. epithelial keratopathy.
b. HPA suppression. d. bone marrow depression.

 

 

ANS:  B                    PTS:   1

 

  1. Treatment with gentamicin (Garamycin) may present disadvantages for the patient. A renal patient’s use of the drug may lead to
a. deterioration of the immune system.
b. risk of liver damage secondary to systemic absorption.
c. occurrence of secondary retroviral infection.
d. ototoxicity.

 

 

ANS:  D                    PTS:   1

 

  1. The topical antiviral drug acyclovir (Zovirax) is used to treat several different conditions. Which of the following conditions is an unlabeled use for acyclovir (Zovirax)?
a. Herpes genitalis c. Herpes labialis
b. Herpes simplex virus types I and II d. Epstein-Barr virus

 

 

ANS:  C                    PTS:   1

 

  1. Lindane (Kwell, Scabene) is used to treat several different disorders. For which disorder is the use of lindane (Kwell, Scabene) contraindicated?
a. Pediculosis pubis c. Scabies
b. Sarcoptes scabiei d. Seizures

 

 

ANS:  D                    PTS:   1

 

 

 

 

 

 

  1. Scabies treatment for a 4-year-old child includes a prescription for:
A. Permethrin 5% cream applied from the neck down
B. Pyrethrin lotion
C. Lindane 1% shampoo
D. All of the above

 

 

ANS:  A                    PTS:   1

 

  1. Vanessa has been diagnosed with scabies. Her education would include:
A. She should apply the scabies treatment cream for an hour and wash it off
B. Scabies may need to be retreated in a week after initial treatment
C. All members of the household and close personal contacts should be treated
D. Malathion is flammable and she should take care until the solution dries

 

 

ANS:  C                    PTS:   1

 

  1. Catherine has head lice and her mother is asking about what products are available that are not neurotoxic. The only non-neurotoxin head lice treatment is:
A. Permethrin 1% (Nix)
B. Lindane shampoo
C. Malathion (Ovide)
D. Benzoyl alcohol (Ulesfia)

 

 

ANS:  D                    PTS:   1

Chapter 15. Psoriasis

 

MULTIPLE CHOICE

 

  1. Appropriate initial treatment for psoriasis would be:
A. An immunomodulator (Protopic or Elidel)
B. Wet soaks with Burrow’s or Domeboro solution
C. Intermittent therapy with intermediate potency topical corticosteroids
D. Anthralin (Drithocreme)

 

 

ANS:  C                    PTS:   1

 

  1. Patient education when prescribing the Vitamin D3 derivative calcipotriene for psoriasis includes:
A. Apply thickly to affected psoriatic areas two to three times a day
B. A maximum of 100 grams per week may be applied
C. Do not use calcipotriene in combination with their topical corticosteroids
D. Calcipotriene may be augmented with the use of coal tar products

 

 

ANS:  B                    PTS:   1

 

  1. Whart is the peak onset age of Psoriasis
A. 16-22 C. 57-60
B. 30-34 D. Both A and C

 

 

ANS:  D                    PTS:   1

 

 

  1. A patient with psoriasis needs to apply a lubricating lotion to a psoriatic plaque. The health provider recommends which of the following types of substances?

 

A. Alcohol C. Emollient
B. Astringent D. Antiseptic

 

 

ANS:  C                    PTS:   1

 

 

 

  1. Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:
A. High vitamin D levels
B. Hyperkalemia
C. Hypercalcemia
D. Hyperuricemia

 

 

ANS:   C                     PTS:    1

 

 

  1. Jesse is prescribed tazarotene for his psoriasis. Patient education regarding topical tazarotene includes:
A. Tazarotene is applied in a thin film to the psoriasis plaque lesions
B. Apply liberally to all psoriatic lesions
C. Apply tazarotene to non-affected areas to prevent breakout
D. Tazarotene may cause hypercalcemia if overused

 

 

ANS:   A                     PTS:    1

 

 

 

Chapter 21.  Angina

 

MULTIPLE CHOICE

 

  1. Angina is produced by an imbalance between oxygen supply (MOS) and demand (MOD) in the myocardium. Which of the following drugs help to correct this imbalance by increasing MOS?
A. Calcium channel blockers
B. Beta blockers
C. ACE inhibitors
D. Aspirin

 

 

ANS:  C                    PTS:   1

 

  1. Not all chest pain is caused by myocardial ischemia. Non-cardiac causes of chest pain include:
A. Pulmonary embolism
B. Pneumonia
C. Gastroesophageal reflux
D. All of the above

 

 

ANS:  D                    PTS:   1

 

  1. The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is:
A. Class I
B. Class II
C. Class III
D. Class IV

 

 

ANS:  B                    PTS:   1

 

  1. Patients at high risk for developing significant coronary heart disease are those with:
A. LDL values between 100 and 130
B. Systolic blood pressure between 120 and 130
C. Class III angina
D. Obesity

 

 

ANS:  C                    PTS:   1

 

  1. To reduce mortality, all patients with angina, regardless of Class, should be on:
A. Aspirin 81 to 325 mg/d
B. Nitroglycerin sublingually for chest pain
C. ACE inhibitors or ARBs
D. Digoxin

 

 

ANS:  A                    PTS:   1

 

  1. Patients who have angina, regardless of Class, who are also diabetic, should be on:
A. Nitrates
B. Beta blockers
C. ACE inhibitors
D. Calcium channel blockers

 

 

ANS:  C                    PTS:   1

 

  1. Management of all types and grades of angina includes the use of lifestyle modification to reduce risk factors. Which of these modifications are appropriate for which reason? Both the modification and the reason for it must be true for the answer to be correct.
A. Lose at least 10 pounds of body weight. Excessive weight increases cardiac workload.
B. Reduce sodium intake to no more than 2,400 mg of sodium. Sodium increases blood volume and cardiac workload.
C. Increase potassium intake to at least 100 mEq/d. The heart needs higher levels of potassium to improve contractility and oxygen supply.
D. Intake a moderate amount of alcohol. Moderate intake has been shown by research to improve cardiac function.

 

 

ANS:  B                    PTS:   1

 

  1. Nitrates are especially helpful for patients with angina who also have:
A. Heart failure
B. Hypertension
C. Both A and B
D. Neither A nor B

 

 

ANS:  C                    PTS:   1

 

  1. Beta blockers are especially helpful for patients with exertional angina who also have:
A. Arrhythmias
B. Hypothyroidism
C. Hyperlipidemia
D. Atherosclerosis

 

 

ANS:  A                    PTS:   1

 

  1. Rapid-acting nitrates are important for all angina patients. Which of the following are true statements about their use?
A. These drugs are useful for immediate symptom relief when the patient is certain it is angina.
B. The dose is one sublingual tablet or spray every 5 minutes until the chest pain goes away.
C. Take one nitroglycerine tablet or spray at the first sign of angina; repeat every 5 minutes for no more than three doses. If chest pain is still not relieved, go to the hospital.
D. All of the above

 

 

ANS:  C                    PTS:   1

 

  1. Isosorbide dinitrate is a long-acting nitrate given BID. The schedule for administration is 7 AM and 2 PM because:
A. Long-acting forms have a higher risk for toxicity
B. Orthostatic hypotension is a common adverse effect
C. It must be taken with milk or food
D. Nitrate tolerance can develop

 

 

ANS:  D                    PTS:   1

 

  1. Combinations of a long-acting nitrate and a beta blocker are especially effective in treating angina because:
A. Nitrates increase MOS and beta blockers increase MOD
B. Their additive affects permit lower doses of both drugs and their adverse reactions cancel each other out.
C. They address the pathology of patients with exertional angina who have fixed atherosclerotic coronary heart disease
D. All of the above

 

 

ANS:  B                    PTS:   1

 

  1. Although they are often described as helpful in the lay media, which of the following therapies have not been shown to be helpful based on clinical evidence?
A. Vitamins C and E
B. Co-enzyme Q10
C. Folic acid
D. All of the above

 

 

ANS:  D                    PTS:   1

 

  1. Drug choices to treat angina in older adults differ from those of younger adults only in:
A. Consideration of risk factors for diseases associated with and increased in aging
B. The placement of drug therapy as a treatment choice before lifestyle changes are tried
C. The need for at least three drugs in the treatment regimen because of the complexity of angina in the older adult
D. Those with higher risk for silent myocardial infarction (MI)

 

 

ANS:  A                    PTS:   1

 

  1. Which of the following drugs has been associated with increased risk for myocardial infarction (MI) in women?
A. Aspirin
B. Beta blockers
C. Estrogen replacement
D. Lipid-lowering agents

 

 

ANS:  C                    PTS:   1

 

  1. Cost of antianginal drug therapy should be considered in drug selection because of all of the following EXCEPT:
A. Patients often require multiple drugs
B. A large number of angina patients are older adults on fixed incomes
C. Generic formulations may be cheaper but are rarely bioequivalent
D. Lack of drug selectivity may result in increased adverse reactions

 

 

ANS:  C                    PTS:   1

 

  1. Five questions should be asked during the follow up of any angina patient. They include:
A. Have there been any changes in lab data since the last visit?
B. Has the level of physical activity associated with the angina changed since the last visit?
C. Have new risk factors come to light in producing the angina?
D. Is the patient filling prescriptions and taking the drugs as prescribed?

 

 

ANS:  B                    PTS:   1

 

  1. Situations that suggest referral to a specialist is appropriate include:
A. When chronic stable angina becomes unpredictable in its characteristics and precipitating factors
B. When a post-MI patient develops new-onset angina
C. When standard therapy is not successful in improving exercise tolerance or reducing the incidence of angina
D. All of the above

 

 

ANS:  D                    PTS:   1