Pharmacotherapeutics for Nurse Practitioner Prescribers 3rd Edition by Teri Moser Woo – Test Bank





Pharmacotherapeutics for Nurse Practitioner Prescribers 3rd Edition by Teri Moser Woo – Test Bank


Sample  Questions


Chapter 3: Rational Drug Selection


Multiple Choice

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 because:

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



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

A. Has serious side effects and it is not being used for a life-threatening condition
B. Will be taken twice daily and will be taken at home
C. Is expensive, and is not covered by health insurance
D. 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?

A. Body temperature varies between men and women
B. Muscle mass is greater in women
C. Percentage of fat differs between genders
D. Proven subjective factors exist between the genders



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

A. Choosing the treatment
B. Educating the patient about the medication
C. Diagnosing the patient’s problem
D. Starting the treatment



____    5.   Treatment goals in prescribing should:

A. Always be curative
B. Be patient-centered
C. Be convenient for the provider
D. Focus on the cost of therapy



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

A. Curative
B. Palliative
C. Preventive
D. All of the above



____    7.   When determining drug treatment the NP prescriber should:

A. Always use evidence-based guidelines
B. Individualize the drug choice for the specific patient
C. Rely on his or her experience when prescribing for complex patients
D. Use the newest drug on the market for the condition being treated



____    8.   Patient education regarding prescribed medication includes:

A. Instructions written at the high school reading level
B. Discussion of expected adverse drug reactions
C. How to store leftover medication such as antibiotics
D. Verbal instructions always in English



____    9.   Passive monitoring of drug effectiveness includes:

A. Therapeutic drug levels
B. Adding or subtracting medications from the treatment regimen
C. Ongoing provider visits
D. Instructing the patient to report if the drug is not effective



____  10.   Pharmacokinetic factors that affect prescribing include:

A. Therapeutic index
B. Minimum effective concentration
C. Bioavailability
D. 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:

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

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):

A. A 32-year-old male
B. A 22-year-old female
C. A 3-month-old female
D. A 48-year-old male



____    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



____    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



____    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



____    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



____    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



____    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



____    8.   Sarah developed a rash after using a topical medication. This is a Type __ allergic drug reaction.

A. I



____    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



____  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



____  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



____  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



____  13.   The ACE inhibitor lisinopril is a known teratogen. Teratogens cause Type ____ adverse drug reaction.

A. A
B. B
C. C
D. D



____  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



____  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



____  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



____  17.   Drugs that may cause a Type E adverse drug reaction include:

A. Beta blockers
B. Immunomodulators
C. Antibiotics
D. Oral contraceptives



____  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



____  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

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):

A. Who is the decision maker in the family regarding health-care decisions
B. The patient’s view of health and illness
C. Attitudes regarding the use of drugs to treat illness
D. All of the above



____    2.   Ethnic differences have been found in drug:

A. Absorption
B. Hepatic metabolism
C. Filtration at the glomerulus
D. Passive tubular reabsorption



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

A. Hospitals
B. Clinics that serve the poor
C. Organizations that receive federal funds
D. Clinics that serve ethnic minorities



____    4.   According to the National Standards of Culturally and Linguistically Appropriate Services (CLAS), interpreters for health care:

A. May be a bilingual family member
B. May be a bilingual nurse or other health-care provider
C. Must be a professionally trained medical interpreter
D. 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:

A. The belief among African Americans that prayer is more powerful than drugs
B. Poor compliance on the part of the African-American patient
C. The genetic predisposition for illness found among African Americans
D. 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:

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



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

A. True
B. False



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

A. Slower metabolism of antidepressants, requiring lower doses
B. Faster metabolism of neuroleptics, requiring higher doses
C. Altered metabolism of omeprazole, requiring higher doses
D. Slower metabolism of alcohol, requiring higher doses



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

A. Require acetylization in order to metabolize drugs
B. Are unable to tolerate higher doses of some drugs that require acetylization
C. May have a toxic reaction to drugs that require acetylization
D. Require higher doses of drugs metabolized by acetylization to achieve efficacy



____  10.   Hispanic native healers (curanderas):

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

Chapter 9: Nutritional Supplements 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:

A. Food causing increased therapeutic drug levels
B. Food affecting the metabolism of the drug
C. Food altering the volume of distribution of drugs
D. Food affecting the gastrointestinal absorption of drugs



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

A. Altering the pH of the colon, which decreases absorption
B. Competing with the drug for plasma proteins
C. Altering gastric emptying time
D. Altering the pH of urine



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

A. Enhanced drug metabolism
B. Altered vitamin K absorption
C. Increased vitamin D absorption
D. Altered drug bioavailability



____    4.   Fasting for an extended period can:

A. Increase drug absorption due to lack of competition between food and the drug
B. Alter the pH of the gastrointestinal tract, affecting absorption
C. Cause vasoconstriction, leading to decreased drug absorption
D. Shrink the stomach, causing decreased surface area for drug absorption



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

A. Calcium
B. Magnesium
C. Iron
D. All of the above



____    6.   A low-carbohydrate, high-protein diet may:

A. Increase drug-metabolizing enzymes
B. Decrease drug absorption from the GI tract
C. Alter drug binding to plasma proteins
D. Enhance drug elimination



____    7.   Grapefruit juice contains furanocoumarins that have been found to:

A. Alter absorption of drugs through competition for binding sites
B. Inhibit CYP 3A4, leading to decreased first pass metabolism of drugs
C. Alter vitamin K metabolism, leading to prolonged bleeding
D. Enhance absorption of calcium and vitamin D



____    8.   Cruciferous vegetables may alter drug pharmacokinetics by:

A. Enhancing absorption of weakly acidic drugs
B. Altering CYP 3A4 activity, leading to elevated levels of drugs, such as the statins
C. Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by CYP 1A2
D. Decreasing first pass metabolism of drugs



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

A. Result in basic drugs being reabsorbed in the renal tubule
B. Increase the elimination of basic drugs in the urine
C. Decrease the elimination of acidic drugs
D. 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?

A. Protein
B. Calcium
C. Iron
D. Vitamin K



____  11.   Phenytoin decreases folic acid absorption by:

A. Altering the pH of the stomach
B. Increasing gastric emptying time
C. Inhibiting intestinal enzymes required for folic acid absorption
D. 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:

A. Spinach
B. Milk
C. Romaine lettuce
D. Cauliflower



____  13.   The American Dietetic Association (ADA) has recommended the use of specific nutritional supplements in the following population(s):

A. 400 IU per day of vitamin D in all infants and children
B. 1000 IU per day of vitamin D for all pregnant women
C. 60 mg per day of iron for all adults over age 50 years
D. All of the above



____  14.   The American Dietetic Association (ADA) recommends pregnant women take a supplement including:

A. 1000 IU daily of vitamin D
B. 2.4 mcg/day of vitamin B12
C. 600 mcg/day of folic acid
D. 8 mg/day of iron



____  15.   The American Heart Association (AHA) and the ADA recommend a minimum daily fiber intake of ____ for cardiovascular health:

A. 10 mg/day
B. 15 mg/day
C. 20 mg/day
D. 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?

A. Iron
B. Vitamin A
C. Vitamin B6
D. Vitamin C



____  17.   Vitamin B2 (riboflavin) may be prescribed to:

A. Decrease the incidence of beriberi
B. Reduce headaches and migraines
C. Prevent pernicious anemia
D. Treat hyperlipidemia



____  18.   Isoniazid (INH) may induce a deficiency of which vitamin?

A. Vitamin B6
B. Vitamin C
C. Vitamin D
D. Vitamin E



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

A. Beriberi
B. Peripheral neuropathy
C. Rickets
D. Megaloblastic anemia



____  20.   Vitamin B12 deficiency may lead to:

A. Hair loss
B. Insomnia
C. Dry scales on the scalp
D. Numbness and tingling of the hands



____  21.   Smokers are at risk for vitamin C deficiency. It is recommended that smokers take ____ vitamin C supplement.

A. 100 mg/day
B. 500 mg/day
C. 1000 mg/day
D. 35 mg/day more than nonsmokers



____  22.   There is strong evidence to support that adequate vitamin C intake prevents:

A. The common cold
B. Breast cancer
C. Scurvy
D. All of the above



____  23.   Adequate vitamin D is needed for:

A. Absorption of calcium from the gastrointestinal tract
B. Regulation of serum calcium levels
C. Regulation of serum phosphate levels
D. 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:

A. IM vitamin K (phytonadione) within 24 hours of birth
B. Oral vitamin K supplementation in the first 3 weeks of life
C. Formula containing vitamin K or breast milk
D. Oral vitamin K in the first 24 hours after birth



____  25.   Symptoms of folate deficiency include:

A. Thinning of the hair
B. Bruising easily
C. Glossitis
D. 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?

A. Vitamin B12
B. Vitamin C
C. Folate
D. Niacin



____  27.   According to the 2003–2006 NHANES study of dietary intake, the group at highest risk for inadequate calcium intake was:

A. Elderly (over age 60 years)
B. Teenage females
C. Teenage males
D. Preschoolers



____  28.   Patients with iron deficiency will develop:

A. Hemolytic anemia
B. Megaloblastic anemia
C. Macrocytic-hypochromic anemia
D. Microcytic-hypochromic anemia



____  29.   There is evidence that dietary supplementation or adequate intake of fish oils and omega-3 fatty acids have well documented:

A. Concern for developing cardiac dysrhythmias
B. Anti-inflammatory effects
C. Total cholesterol-lowering effects
D. Effects on fasting blood sugar



____  30.   There is enough preliminary evidence to recommend that children with autism receive which supplemental nutrient?

A. Vitamin B1 (thiamine)
B. Vitamin B2 (riboflavin)
C. Calcium
D. Omega-3 fatty acids



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

A. Asthma
B. Autism
C. Arthritis
D. All of the above



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

A. Omega-3 fatty acids
B. Probiotics
C. Plant sterols
D. Calcium



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

A. Antacids
B. Antihypertensives
C. Antidiarrheals
D. Antibiotics



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

A. Probiotics
B. Omega-3 fatty acids
C. Plant sterols
D. Fiber

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. Nurse practitioner competence includes the ability to:

A. Search for information using the most common search engines
B. Serve as content experts in developing, implementing, and evaluating information systems
C. Write programs to assure the integrity of health information
D. Utilize IT to prescribe drugs



____    2.   You are going to prescribe a drug that has been on the market for less than 2 months. Your best source of drug information at this time (besides calling the pharmacist) is:

A. The Physician’s Desk Reference
B. Any nurse’s drug handbook
C. Micromedix Online
D. Pharmacist’s Drug Reference



____    3.   Which of the following is a primary benefit of the use of computerized physician order entry (CPOE) for patient medications?

A. Reduces time that prescribing drugs takes
B. Eliminates the need to chart drugs prescribed
C. Decreases prescribing and transcription errors
D. 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 IT system can be realized. Which of the following is NOT a barrier to adoption and use of IT in prescribing drugs?

A. Cost of initial set up
B. Access to highly skilled experts
C. Compatibility between systems
D. Patient confidentiality risks



____    5.   Electronic Health Records (EHRs):

A. Are bring discouraged by the Centers for Medicare and Medicaid Services due to cost issues
B. Allow for all patient data to be centralized in one location for access by multiple providers
C. Use macros and templates to individualize care
D. Use standardized software to facilitate interoperability between systems



____    6.   Factors that facilitate keeping patient information confidential in an EHR system include:

A. Designing software so that only those who need the information can gain access
B. Requiring providers to log-off at the end of the clinical day
C. Keeping a file of the login and password information for each provider in a secure place
D. 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:

A. Patient history data with a summary of their diagnoses
B. The usual dosage for the drug being prescribed
C. The patient’s latest lab values, such as potassium levels
D. 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:

A. The history showed that the patient had tolerated the medication in the past
B. The benefit outweighed the risk
C. The medication was therapeutically appropriate and needed
D. All of the above



____    9.   One barrier to use of the Web for both prescribing and for patient teaching is:

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



____  10.   IT 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:

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



____  11.   Data in the EHR that the provider reviews prior to a patient encounter varies with the clinic setting. In an urgent care clinic, the provider should review:

A. The patient’s current diagnosis and history
B. Drugs the patient is currently taking
C. Any recent previous encounter for the same problem as this visit and what was done
D. All of the above



____  12.   IT can also be used to interact with a patient between encounters. Which of the following statements about such interactions is true?

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



____  13.   Discharge summaries using IT have several advantages. They can:

A. Replace the need for oral instruction since the patient has printed material to read at home
B. Be filed with the patient’s chart to document patient teaching
C. Both A and B
D. Neither A nor B



____  14.   IT 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:

A. Warning them about the questionable quality of health information online
B. Telling them to contact the office about any web sites they have questions about
C. Teaching them how to identify high quality web sites and “red flags” to inaccurate content
D. All of the above



____  15.   Incorporating 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:

A. Turning the screen around so the patient can see material being recorded
B. Not placing the computer screen between the provider and the patient
C. Both A and B
D. Neither A nor B

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:

A. Be safe and labeled for appropriate use
B. Have a low potential for abuse or misuse
C. Be taken for a condition the patient can reliably self-diagnose
D. All of the above



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

A. No one, there is no oversight for over-the-counter medications
B. The U.S. Food and Drug Administration Center for Drug Evaluation and Research
C. The Drug Enforcement Administration
D. MedWatch



____    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:

A. Get a new patent for the over-the-counter form of the drug
B. Lower the costs, since most prescription benefit plans do not cover generics
C. Market the drug to a whole new population, as they are able to market to patients instead of just providers
D. 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.

A. True
B. False



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

A. Constipation
B. Cough and colds
C. Heartburn
D. Acute and chronic pain



____    6.   Common over-the-counter pain relievers such as acetaminophen or ibuprofen:

A. Are always safer for the patient than prescription pain medication
B. Are harmful if taken in higher than recommended amounts
C. Have minimal interaction with prescription medications
D. 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:

A. His appropriately only telling you about his regularly prescribed medications
B. His hiding information regarding his inappropriate use of aspirin from you
C. A common misconception that intermittently taken over-the counter medications are not an important part of his drug history
D. A common misuse of over-the-counter aspirin



____    8.   The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:

A. Requires all providers screen their patients for methamphetamine use
B. Restricts the prescribing of amphetamines to U.S. citizens
C. Requires a prescription be written for all methamphetamine precursors in all states
D. 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:

A. Not to take their regularly prescribed medications while on these antibiotics
B. Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption
C. Not to take antacids while on these medications, as the antacid decreases absorption
D. That there are no drug interactions with these antibiotics



____  10.   The OTC antidiarrheal bismuth subsalicylate (Pepto Bismol) is recommended:

A. As traveler’s diarrhea prophylaxis
B. For all children with diarrhea
C. To be combined with aspirin to be the most effective
D. To be stopped immediately if blackened stool occurs



____  11.   Sadie’s adult daughter reports that when Sadie (age 84 years) takes Tylenol PM (acetaminophen and diphenhydramine) to help her sleep she has “strange dreams” including wandering and thinking she is at her childhood home. You understand:

A. This is a sign of early dementia and she should undergo cognitive testing
B. Sadie is not taking an effective dose to help her stay asleep
C. Sadie is exhibiting signs of an allergic reaction to the diphenhydramine in the Tylenol PM
D. Delirium is a common adverse reaction seen when elderly patients take diphenhydramine



____  12.   Vanessa is a 19-year-old female who calls the advice nurse worried that a condom broke yesterday when she was having intercourse. She reports a normal menses 10 days ago. One recommendation for care is:

A. She should come into the clinic immediately for a pregnancy test
B. She may purchase emergency contraception OTC at a local drugstore
C. She should call the clinic back if she does not have a normal menses when it is due
D. She should come into the clinic within the next couple days for a “same day start” prescription for birth control

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:

A. Understanding that obesity is a contraindication to prescribing phentermine
B. Anorexiants may cause tolerance and should only be prescribed for 6 months
C. Patients should be monitored for postural hypotension
D. 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 SSRIs and St John’s Wort due to:

A. Additive respiratory depression risk
B. Additive effects affecting liver function
C. The risk of serotonin syndrome
D. The risk of altered cognitive functioning



____    3.   Antonia is a 3 year old 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.

A. IV phenobarbital
B. Rectal diazepam (Diastat)
C. IV phenytoin (Dilantin)
D. Oral carbamazepine (Tegretol)



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

A. Assessing for phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment
B. Assessing for pedal edema throughout therapy
C. Assessing heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm
D. Assessing 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:

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



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

A. Renal toxicity, leading to renal failure
B. Hepatotoxicity, leading to liver failure
C. Dermatologic reaction, including Steven’s Johnson and toxic epidermal necrolysis
D. Cardiac effects, including supraventricular tachycardia



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

A. Routine troponin levels to assess for cardiac damage
B. Annual eye examinations to assess for cataract development
C. Monthly pregnancy tests for all women of childbearing age
D. 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:

A. Increased seizure activity, as this drug may auto-induce seizures
B. Altered renal function, including renal failure
C. Blood dyscrasias, which are uncommon but possible
D. 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:

A. Increase her dose
B. Assess for suicidal ideation
C. Discontinue the medication immediately
D. 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:

A. Tell her to increase her caloric intake to counter the effects of the topiramate
B. Consult with a neurologist, as this is not a common adverse effect of topiramate
C. Decrease her dose of topiramate
D. 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:

A. Routine therapeutic drug levels every 3 to 4 months
B. Assessing for dermatologic reactions, including Steven’s Johnson
C. Routine serum electrolytes, especially in hot weather
D. 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:

A. He should not play sports due to the risk of increased seizures
B. He should monitor his temperature and ability to sweat in the heat while playing
C. Reminding him that he may need higher dosages of topiramate when exercising
D. 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:

A. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures
B. To wear sunscreen due to photosensitivity from levetiracetam
C. To get an annual eye exam while on levetiracetam
D. To  report weight loss if it occurs



____  14.   Levetiracetam has known drug interactions with:

A. Oral contraceptives
B. Carbamazepine
C. Warfarin
D. Few, if any, drugs



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

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



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

A. Contraceptive failure
B. Excessive weight gain
C. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine
D. Induction of estrogen metabolism, requiring higher estrogen content OCs be prescribed



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

A. Eczema
B. Asthma
C. Diabetes
D. 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 MAOIs:

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



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

A. Fluoxetine
B. Fluvoxamine
C. Sertraline
D. Escitalopram



____  20.   Suzanne is started on paroxetine (Paxil), an SSRI, for depression. Education regarding her antidepressant includes:

A. SSRIs may take 2 to 6 weeks before she will have maximum drug effects
B. Red-green color blindness may occur and should be reported
C. If she experiences dry mouth or heart rates greater than 80, stop taking the drug immediately
D. 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:

A. Fluoxetine (Prozac)
B. Paroxetine (Paxil)
C. Amitriptyline (Elavil)
D. 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:

A. For excessive weight loss
B. With the Abnormal Involuntary Movement Scale (AIMS) for EPS symptoms
C. Monthly for tolerance to the haloperidol
D. 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:

A. Reduce the chance of tardive dyskinesia
B. Potentiate the effects of the drug
C. Reduce the tolerance which tends to occur
D. Increase CNS depression



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

A. Insomnia
B. Weight gain
C. Hypertension
D. Galactorrhea



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

A. Bradykinesia, akathisia, and agitation
B. Excessive weight gain
C. Hypertension
D. 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:

A. Chlordiazepoxide (Librium)
B. Clonazepam (Klonopin)
C. Alprazolam (Xanax)
D. Oxazepam (Serax)



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

A. Duloxetine (Cymbalta)
B. Fluoxetine (Prozac)
C. Oxazepam (Serax)
D. Buspirone (Buspar) and a SSRI combined



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

A. Take temazepam nightly approximately 15 minutes before bedtime
B. Temazepam should not be used more than three times a week for less than 3 months
C. Drinking 1 ounce of alcohol will cause additive effects and the patient will sleep better
D. 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:

A. Zolpidem should be taken just before going to bed
B. Zolpidem may cause dry mouth and constipation
C. Patients may need to double the dose for effectiveness
D. 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:

A. Orthostatic hypotension
B. Agitation and irritability
C. Drowsiness and nausea
D. Painful urination and abdominal distention



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

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



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

A. Valproate is safe during all trimesters of pregnancy.
B. She can get pregnant while taking valproate, but she should take adequate folic acid.
C. Valproate is not safe at any time during pregnancy.
D. 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:

A. The medication may cause sedation and they should not drive
B. Constipation is a common side effect and they should increase fluids and fiber
C. Patients should not take any other acetaminophen-containing medications at the same time
D. 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:

A. Ibuprofen (Advil)
B. Acetaminophen with hydrocodone (Vicodin)
C. Oxycodone (Oxycontin)
D. Oral morphine (Roxanol)



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

A. Ibuprofen (Advil)
B. Acetaminophen with hydrocodone (Vicodin)
C. Oxycodone (Oxycontin)
D. 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:

A. Slurred speech and insomnia
B. Bradycardia and confusion
C. Dizziness and orthostatic hypotension
D. Insomnia and decreased appetite



____  37.   Monitoring for a child on methylphenidate for ADHD includes:

A. ADHD symptoms
B. Routine height and weight checks
C. Amount of methylphenidate being used
D. All of the above



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

A. Blood pressure
B. Blood glucose levels
C. Urine ketone levels
D. 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:

A. Loratadine
B. Diphenhydramine
C. Ipratropium
D. Albuterol



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

A. Expectorants
B. Beta-2-agonists
C. Antitussives
D. Antihistamines



____    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?

A. Betamethasone, an inhaled corticosteroid
B. Salmeterol, an inhaled long-acting beta-agonist
C. Albuterol, a short-acting beta-agonist
D. 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:

A. Risk of life-threatening dermatological reactions
B. Increased incidence of cardiac events when LTBAs are used
C. Increased risk of asthma-related deaths when LTBAs are used
D. Risk for life-threatening alterations in electrolytes



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

A. Albuterol
B. Pirbuterol
C. Formoterol
D. Ipratropium



____    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:

A. Congratulate him on making a positive change in his life
B. Recommend he try stopping smoking instead of the Atkin’s diet
C. Schedule him for regular serum theophylline levels during his diet due to increased excretion of theophylline
D. 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:

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



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

A. Used for the treatment of COPD
B. Used in the treatment of asthma
C. Combined with albuterol for treatment of asthma exacerbations
D. Combined with fluticasone for the treatment of persistent asthma



____    9.   Christy has exercise 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:

A. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day
B. Beclomethasone needs to be used every day to treat her asthma
C. Report any systemic side effects she is experiencing, such as weight gain
D. Use the albuterol MDI immediately after her corticosteroid MDI to facilitate bronchodilation



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

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



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

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



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

A. Albuterol
B. MMR vaccine
C. Insulin
D. None of the above



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

A. They need to get any live vaccines before starting the medication.
B. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective.
C. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.
D. 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:

A. Fluticasone (Flonase)
B. Cetirizine (Zyrtec)
C. OTC cromolyn nasal spray (Nasalcrom)
D. 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:

A. Urinary retention
B. Cardiac output
C. Peripheral edema
D. Skin for rash



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

A. More effective than first generation antihistamines
B. Less sedating than the first generation antihistamines
C. Prescription products, therefore are covered by insurance
D. Able to be taken with CNS sedatives, such as alcohol



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

A. Take the dimenhydrinate after they get nauseated
B. Drink lots of water while taking the dimenhydrinate
C. Take the dimenhydrinate 15 minutes before it is needed
D. Double the dose if one tablet is not effective



____  18.   Decongestants such as pseudoephedrine (Sudafed):

A. Are Schedule III drugs in all states
B. Should not be prescribed or recommended for children under 4 years of age
C. Are effective in treating the congestion children experience with the common cold
D. 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:

A. Older adults
B. Hypertensive patients
C. Infants
D. All of the above



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

A. Oral pseudoephedrine
B. Oral phenylephrine
C. Nasal oxymetazoline
D. Nasal azelastine



____  21.   The first-line treatment for cough related to a URI in a 5 year old is:

A. Fluids and symptomatic care
B. Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids)
C. Guaifenesin and codeine syrup (Tussin AC)
D. Chlorpheniramine and dextromethorphan syrup (Nyquil for Kids)

Chapter 19: Drugs Affecting the Immune System


Multiple Choice

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


____    1.   Attenuated vaccines are also known as:

A. Killed vaccines
B. Booster vaccines
C. Inactivated vaccines
D. Live vaccines



____    2.   Live attenuated influenza vaccine (FluMist) may be administered to:

A. All patients over 6 months of age
B. Patients between age 2 years and 49 years with no risk factors
C. Patients with a URI or asthma
D. Pregnant women



____    3.   The reason that two MMR vaccines at least a month apart are recommended is:

A. The second dose of MMR “boosts” the immunity built from the first dose
B. Two vaccines 1 month apart is the standard dosing for all live virus vaccines
C. If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine
D. Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR



____    4.   MMR vaccine is not recommended for pregnant women because:

A. Pregnant women do not build adequate immunity to the vaccine
B. There is a risk of the pregnant women developing measles encephalopathy
C. There is a risk of the fetus developing congenital rubella syndrome
D. Pregnant women can receive the MMR vaccine



____    5.   If the MMRV (measles, mumps, rubella, and varicella) combined vaccine is ordered to be given as the first MMR and varicella dose to a child the CDC recommends:

A. Parents be informed of the increased risk of fever and febrile seizures over the MMR plus varicella 2 shot regimen
B. Patients must also receive MMRV as the second dose of MMR and varicella in order to build adequate immunity
C. Patients be premedicated with acetaminophen 15 minutes before the vaccine is given
D. Patients should not be around pregnant women for the first 48 hours after the vaccine is given



____    6.   The rotavirus vaccine (RotaTeq, Rotarix):

A. Is a live vaccine that replicates in the small intestine, providing active immunity against rotavirus
B. Should not be administered to infants who are or may be potentially immunocompromised
C. Is not given to an infant who has a febrile illness (temperature greater than 100.5°F)
D. All of the above



____    7.   Varicella vaccine is recommended to be given to patients who are:

A. HIV positive with a CD4+ T-lymphocyte percentage less than 15 percent
B. Taking corticosteroids (up to 2 mg/kg/day or less than 20 mg/day)
C. Pregnant
D. Immunocompromised



____    8.   Zoster vaccine (Zostavax) is:

A. A live varicella zoster vaccine from the same strain used to develop the varicella vaccine
B. Effective in preventing varicella zoster in patients of all ages
C. Recommended for patients age 40 to 80 who have had chickenpox
D. Administered at the same time as other live vaccines, as long as they are given the same day



____    9.   True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include:

A. Fever up to 104°F (40.5°C) after previous DTaP vaccine
B. Family history of seizures after DTaP vaccine
C. Adolescent pregnancy
D. Anaphylactic reaction with a previous dose



____  10.   Hepatitis B vaccine (HBV) is contraindicated in patients who:

A. Were born less than 32 weeks gestation (give first dose at age 6 months)
B. Are pregnant
C. Are on hemodialysis
D. Are allergic to yeast



____  11.   Human papillomavirus (HPV) vaccine (Gardasil, Cervarix):

A. Is a live virus vaccine that provides immunity to six strains of HPV virus
B. Has a common adverse effect of syncope within 15 minutes of giving the vaccine
C. Should not be given to males younger than age 12 years
D. May be given to pregnant women



____  12.   Influenza vaccine may be administered annually to:

A. Patients with egg allergy
B. Pregnant patients
C. Patients age 6 weeks or older
D. Patients with acute febrile illness



____  13.   Immune globulin serums (IGs):

A. Provide active immunity against infectious diseases
B. Are contraindicated during pregnancy
C. Are heated to above body temperature to kill most hepatitis, HIV, and other viruses such as parvovirus
D. Are derived from pooled plasma of adults and contain specific antibodies in proportion to the donor population



____  14.   Hepatitis B immune globulin (HBIG) is administered to provide passive immunity to:

A. Infants born to HBsAg-positive mothers
B. Household contacts of hepatitis-B virus infected people
C. Persons exposed to blood containing hepatitis B virus
D. All of the above



____  15.   Rho(D) immune globulin (RhoGAM) is given to:

A. Infants born to women who are Rh positive
B. Sexual partners of Rh positive women
C. Rh negative women after a birth, miscarriage, or abortion
D. Rh negative women at 36 weeks gestation



____  16.   Tuberculin purified protein derivative (PPD):

A. Is administered to patients who are known tuberculin-positive reactors
B. May be administered to patients who are on immunosuppressives
C. May be administered 2 to 3 weeks after an MMR or varicella vaccine
D. May be administered the same day as the MMR and/or varicella vaccine



____  17.   Diane may benefit from cyclosporine (Sandimmune). Cyclosporin may be prescribed to:

A. Treat rheumatoid arthritis
B. Treat patients with corn allergy
C. Pregnant patients
D. Treat patients with liver dysfunction



____  18.   Azathioprine has significant adverse drug effects, including:

A. Hypertension
B. Hirsutism
C. Risk of cancer
D. Gingival hyperplasia

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:

A. Cortical bone
B. Femoral neck
C. Cervical vertebrae
D. Pelvic bones



____    2.   Bisphosphonates treat or prevent osteoporosis by:

A. Inhibiting osteoclastic activity
B. Fostering bone resorption
C. Enhancing calcium uptake in bone
D. 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?

A. Selective estrogen receptor modulators
B. Aspirin
C. Glucocorticoids
D. 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:

A. Lipase
B. Protease
C. Amylase
D. Pancreatin



____    5.   Brands of pancreatic enzyme replacement drugs are:

A. Bioequivalent
B. About the same in cost per unit of lipase across brands
C. Able to be interchanged between generic and brand-name products to reduce cost
D. None of the above



____    6.   When given subcutaneously, NPH insulin begins to take effect (onset of action):

A. 15 to 30 minutes after administration
B. 60 to 90 minutes after administration
C. 3 to 4 hours after administration
D. 6 to 8 hours after administration



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

A. “Fruity” breath odor and rapid respiration
B. Diarrhea, abdominal pain, weight loss, and hypertension
C. Dizziness, confusion, diaphoresis, and tachycardia
D. Easy bruising, palpitations, cardiac dysrhythmias, and coma



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

A. Increase blood glucose levels
B. Produce unexplained diaphoresis
C. Interfere with the ability of the body to metabolize glucose
D. Mask the signs and symptoms of altered glucose levels



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

A. Optimal time of preprandial injection is 15 minutes.
B. Duration of action is increased when the dose is increased.
C. It is compatible with NPH insulin.
D. It has no pronounced peak.



____  10.   The decision may be made to switch from BID NPH insulin to insulin glargine to improve glycemia control throughout the day. If this is done:

A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia
B. The initial dose of glargine is 2 to 10 Units per day
C. Patients who have been on high doses of NPH will need tests for insulin antibodies
D. 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 complications risks. Which of the following statements are accurate based on research?

A. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.
B. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.
C. Newer premixed insulins are better at lowering HbA1C and post-prandial glucose levels than are long-acting insulins.
D. Patients who are not controlled on oral agents and have post-prandial hyperglycemia can have NPH insulin added at bedtime.



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

A. Substitutes for insulin usually secreted by the pancreas
B. Decreases glycogenolysis by the liver
C. Increases the release of insulin from beta cells
D. Decreases peripheral glucose utilization



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

A. Draw a serum creatinine to assess renal function
B. Try the patient on insulin
C. Tell the patient to increase iodine intake
D. 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:

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



____  15.   Sitagliptin has been approved for:

A. Monotherapy in once daily doses
B. Combination therapy with metformin
C. Both A and B
D. Neither A nor B



____  16.   GLP-1 agonists:

A. Directly bind to a receptor in the pancreatic beta cell
B. Have been approved for monotherapy
C. Speed gastric emptying to decrease appetite
D. Can be given orally once daily



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

A. Digoxin
B. Warfarin
C. Lovastatin
D. All of the above



____  18.   Administration of exenatide is by subcutaneous injection:

A. 30 minutes prior to the morning meal
B. 60 minutes prior to the morning and evening meal
C. 15 minutes after the evening meal
D. 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:

A. Tinnitus and decreased salivation
B. Fever and sore throat
C. Hypocalcemia and osteoporosis
D. Laryngeal edema and difficulty swallowing



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

A. Excessive sedation
B. Tachycardia and angina
C. Weight gain
D. Cold intolerance