Pharmacotherapeutics for Advanced Practice Nurse Prescribers 4th Edition by Teri Moser Woo – Test Bank
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Sample Test
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 child because:
|
1. |
Drugs given in liquid form
are less irritating to the stomach. |
|
2. |
A 6-year-old child may have
problems swallowing a pill. |
|
3. |
Liquid forms of medication
eliminate the concern for first-pass effect. |
|
4. |
Liquid ibuprofen does not
have to be dosed as often as the tablet form. |
____ 2. In deciding which of
multiple drugs used to use to treat a condition, the NP chooses Drug A because
it:
|
1. |
Has serious side effects
and it is not being used for a life-threatening condition |
|
2. |
Will be taken twice daily
and will be taken at home |
|
3. |
Is expensive, but covered
by health insurance |
|
4. |
None of these are important
in choosing a drug |
____ 3. A client asks the NP about
the differences in drug effects between men and women. What is known about the
differences between the pharmacokinetics of men and women?
|
1. |
Body temperature varies
between men and women. |
|
2. |
Muscle mass is greater in
women. |
|
3. |
Percentage of fat differs
between genders. |
|
4. |
Proven subjective factors
exist between the genders. |
____ 4. The first step in the
prescribing process according to the World Health Organization is:
|
1. |
Choosing the treatment |
|
2. |
Educating the patient about
the medication |
|
3. |
Diagnosing the patient’s
problem |
|
4. |
Starting the treatment |
____ 5. Treatment goals in
prescribing should:
|
1. |
Always be curative |
|
2. |
Be patient-centered |
|
3. |
Be convenient for the
provider |
|
4. |
Focus on the cost of
therapy |
____ 6. The therapeutic goals when
prescribing include(s):
|
1. |
Curative |
|
2. |
Palliative |
|
3. |
Preventive |
|
4. |
All of the above |
____ 7. When determining drug
treatment the NP prescriber should:
|
1. |
Always use evidence-based
guidelines |
|
2. |
Individualize the drug
choice for the specific patient |
|
3. |
Rely on his or her
experience when prescribing for complex patients |
|
4. |
Use the newest drug on the
market for the condition being treated |
____ 8. Patient education
regarding prescribed medication includes:
|
1. |
Instructions written at the
high school reading level |
|
2. |
Discussion of expected
adverse drug reactions |
|
3. |
How to store leftover
medication such as antibiotics |
|
4. |
Verbal instructions always
in English |
____ 9. Passive monitoring of drug
effectiveness includes:
|
1. |
Therapeutic drug levels |
|
2. |
Adding or subtracting
medications from the treatment regimen |
|
3. |
Ongoing provider visits |
|
4. |
Instructing the patient to
report if the drug is not effective |
____ 10. Pharmacokinetic factors that affect
prescribing include:
|
1. |
Therapeutic index |
|
2. |
Minimum effective
concentration |
|
3. |
Bioavailability |
|
4. |
Ease of titration |
____ 11. Pharmaceutical promotion may affect
prescribing. To address the impact of pharmaceutical promotion, the following
recommendations have been made by the Institute of Medicine:
|
1. |
Conflicts of interest and
financial relationships should be disclosed by those providing education. |
|
2. |
Providers should ban all
pharmaceutical representatives from their office setting. |
|
3. |
Drug samples should be used
for patients who have the insurance to pay for them, to ensure the patient
can afford the medication. |
|
4. |
Providers should only
accept low-value gifts, such as pens and pads of paper, from the
pharmaceutical representative. |
____ 12. Under new U.S. Food and Drug
Administration labeling, Pregnancy Categories will be:
|
1. |
Strengthened with a new
coding such as C+ or C- to discern when a drug is more or less toxic to the
fetus |
|
2. |
Changed to incorporate a
pregnancy risk summary and clinical considerations on the drug label |
|
3. |
Eliminated, and replaced
with a link to the National Library of Medicine TOXNET Web site for in-depth
information regarding pregnancy concerns |
|
4. |
Clarified to include
information such as safe dosages in each trimester of pregnancy |
Chapter 3. Rational Drug Selection
Answer Section
MULTIPLE CHOICE
1. ANS:
2
PTS: 1
2. ANS:
2
PTS: 1
3. ANS:
3
PTS: 1
4. ANS:
3
PTS: 1
5. ANS:
2
PTS: 1
6. ANS:
4
PTS: 1
7. ANS:
2
PTS: 1
8. ANS:
2
PTS: 1
9. ANS:
4
PTS: 1
10. ANS:
3
PTS: 1
11. ANS:
1
PTS: 1
12. ANS:
2
PTS: 1
Chapter 4. Legal and Professional Issues in Prescribing
Multiple Choice
Identify the choice that best completes the statement or answers
the question.
____ 1. The U.S. Food and Drug
Administration regulates:
|
1. |
Prescribing of drugs by MDs
and NPs |
|
2. |
The official labeling for
all prescription and over-the-counter drugs |
|
3. |
Off-label recommendations
for prescribing |
|
4. |
Pharmaceutical educational
offerings |
____ 2. The U.S. Food and Drug
Administration approval is required for:
|
1. |
Medical devices, including
artificial joints |
|
2. |
Over-the-counter vitamins |
|
3. |
Herbal products, such as St
John’s wort |
|
4. |
Dietary supplements, such
as Ensure |
____ 3. An Investigational New
Drug is filed with the U.S. Food and Drug Administration:
|
1. |
When the manufacturer has
completed phase III trials |
|
2. |
When a new drug is
discovered |
|
3. |
Prior to animal testing of
any new drug entity |
|
4. |
Prior to human testing of
any new drug entity |
____ 4. Phase IV clinical trials
in the United States are also known as:
|
1. |
Human bioavailability
trials |
|
2. |
Postmarketing research |
|
3. |
Human safety and efficacy
studies |
|
4. |
The last stage of animal
trials before the human trials begin |
____ 5. Off-label prescribing is:
|
1. |
Regulated by the U.S. Food
and Drug Administration |
|
2. |
Illegal by NPs in all
states (provinces) |
|
3. |
Legal if there is
scientific evidence for the use |
|
4. |
Regulated by the Drug
Enforcement Administration |
____ 6. The U.S. Drug Enforcement
Administration:
|
1. |
Registers manufacturers and
prescribers of controlled substances |
|
2. |
Regulates NP prescribing at
the state level |
|
3. |
Sanctions providers who
prescribe drugs off-label |
|
4. |
Provides prescribers with a
number they can use for insurance billing |
____ 7. Drugs that are designated
Schedule II by the U.S. Drug Enforcement Administration:
|
1. |
Are known teratogens during
pregnancy |
|
2. |
May not be refilled; a new
prescription must be written |
|
3. |
Have a low abuse potential |
|
4. |
May be dispensed without a
prescription unless regulated by the state |
____ 8. Precautions that should be
taken when prescribing controlled substances include:
|
1. |
Faxing the prescription for
a Schedule II drug directly to the pharmacy |
|
2. |
Using tamper-proof paper
for all prescriptions written for controlled drugs |
|
3. |
Keeping any pre-signed
prescription pads in a locked drawer in the clinic |
|
4. |
Using only numbers to
indicate the amount of drug to be prescribed |
____ 9. Strategies prescribers can
use to prevent misuse of controlled prescription drugs include:
|
1. |
Use of chemical dependency
screening tools |
|
2. |
Firm limit-setting
regarding prescribing controlled substances |
|
3. |
Practicing “just say no” to
deal with patients who are pushing the provider to prescribe controlled
substances |
|
4. |
All of the above |
____ 10. Behaviors predictive of addiction to
controlled substances include:
|
1. |
Stealing or borrowing
another patient’s drugs |
|
2. |
Requiring increasing doses
of opiates for pain associated with malignancy |
|
3. |
Receiving refills of a
Schedule II prescription on a regular basis |
|
4. |
Requesting that only their
own primary care provider prescribe for them |
____ 11. Medication agreements or “Pain
Medication Contracts” are recommended to be used:
|
1. |
Universally for all
prescribing for chronic pain |
|
2. |
For patients who have
repeated requests for pain medication |
|
3. |
When you suspect a patient
is exhibiting drug-seeking behavior |
|
4. |
For patients with pain
associated with malignancy |
____ 12. A prescription needs to be written
for:
|
1. |
Legend drugs |
|
2. |
Most controlled drugs |
|
3. |
Medical devices |
|
4. |
All of the above |
Chapter 4. Legal and Professional Issues in Prescribing
Answer Section
MULTIPLE CHOICE
1. ANS:
2
PTS: 1
2. ANS:
1
PTS: 1
3. ANS:
4
PTS: 1
4. ANS:
2
PTS: 1
5. ANS:
3
PTS: 1
6. ANS:
1
PTS: 1
7. ANS:
2
PTS: 1
8. ANS:
2
PTS: 1
9. ANS:
4
PTS: 1
10. ANS:
1
PTS: 1
11. ANS:
1
PTS: 1
12. ANS:
4
PTS: 1
Chapter 35. Headaches
Multiple Choice
Identify the choice that best completes the statement or answers
the question.
____ 1. Paige has a history of
chronic migraines and would benefit from preventative medication. Education
regarding migraine preventive medication includes:
|
1. |
Medication is taken at the
beginning of the headache to prevent it from getting worse. |
|
2. |
Medication alone is the
best preventative against migraines occurring. |
|
3. |
Medication should not be
used more than four times a month. |
|
4. |
The goal of treatment is to
reduce migraine occurrence by 50%. |
____ 2. A first-line drug for
abortive therapy in simple migraine is:
|
1. |
Sumatriptan (Imitrex) |
|
2. |
Naproxen (Aleve) |
|
3. |
Butorphanol nasal spray
(Stadol NS) |
|
4. |
Butalbital and acetaminophen
(Fioricet) |
____ 3. Vicky, age 56 years, comes
to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that
she takes for migraines. She has been taking this medication for over 2 years
for migraines and states one dose usually works to abort her migraine. What is
the best care for her?
|
1. |
Switch her to sumatriptan
(Imitrex) to treat her migraines. |
|
2. |
Assess how often she is
using Fiorinal and refill her medication. |
|
3. |
Switch her to a beta
blocker such as propranolol to prevent her migraine. |
|
4. |
Request she return to the
original prescriber of Fiorinal as you do not prescribe butalbital for
migraines. |
____ 4. When prescribing
ergotamine suppositories (Wigraine) to treat acute migraine, patient education
would include:
|
1. |
Ergotamine will briefly
make the migraine worse before the migraine resolves. |
|
2. |
The patient may experience
bradycardia and dizziness. |
|
3. |
They may need premedication
with an antinausea medication. |
|
4. |
Ergotamine works best if the
patient starts off with a full suppository to get the full effect. |
____ 5. Migraines in pregnancy may
be safely treated with:
|
1. |
Acetaminophen with codeine
(Tylenol #3) |
|
2. |
Sumatriptan (Imitrex) |
|
3. |
Ergotamine tablets
(Ergostat) |
|
4. |
Dihydroergotamine (DHE) |
____ 6. Xi, a 54-year-old female,
has a history of migraines that do not respond well to OTC migraine medication.
She is asking to try Maxalt (rizatriptan) because it works well for her friend.
Appropriate decision making would be:
|
1. |
Prescribe the Maxalt, but
only give her four tablets with no refills to monitor the use. |
|
2. |
Prescribe Maxalt and
arrange to have her observed in the clinic or urgent care with the first
dose. |
|
3. |
Explain that rizatriptan is
not used for postmenopausal migraines and recommend Fiorinal (aspirin and
butalbital). |
|
4. |
Prescribe sumatriptan
(Imitrex) with the explanation that it is the most effective triptan. |
____ 7. Kelly is a 14-year-old
patient who presents to the clinic with a classic migraine. She says she is
having a headache two to three times a month. The initial plan would be:
|
1. |
Prescribe NSAIDs as
abortive therapy and have her keep a headache diary to identify her triggers. |
|
2. |
Prescribe zolmitriptan
(Zomig) as abortive therapy and recommend relaxation therapy to reduce her
stress. |
|
3. |
Prescribe acetaminophen
with codeine (Tylenol #3) for her to take at the first onset of her migraine. |
|
4. |
Prescribe sumatriptan
(Imitrex) nasal spray and arrange for her to receive the first dose in the
clinic. |
____ 8. Jayla is a 9-year-old
patient who has been diagnosed with migraines for almost 2 years. She is
missing up to a week of school each month. Her headache diary confirms she
averages four or five migraines per month. Which of the following would be
appropriate?
|
1. |
Prescribe amitriptyline
(Elavil) daily, start at a low dose and increase dosage slowly every 2 weeks
until it’s effective in eliminating migraines. |
|
2. |
Encourage her mother to
give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the
first sign of a headache to abort the headache. |
|
3. |
Prescribe propranolol
(Inderal) to be taken daily for at least 3 months. |
|
4. |
Explain that it is rare for
a 9-year-old child to get migraines and she needs an MRI to rule out a brain
tumor. |
____ 9. Amber is a 24-year-old
patient who has had migraines for 10 years. She reports a migraine on average
of once a month. The migraines are effectively aborted with naratriptan
(Amerge). When refilling Amber’s naratriptan, education would include:
|
1. |
Naratriptan will interact
with antidepressants, including selective serotonin reuptake inhibitors
(SSRIs) and St John’s wort, and she should inform any providers she sees that
she has migraines. |
|
2. |
Continue to monitor her
headaches, if the migraine is consistently happening around her menses there
is preventive therapy available. |
|
3. |
Pregnancy is
contraindicated when taking a triptan. |
|
4. |
All of the above |
____ 10. When prescribing for migraines,
patient education includes:
|
1. |
Triptans are safe to be
used as often as needed as long as the patient is healthy. |
|
2. |
Use triptan before trying
OTC meds such as acetaminophen or naproxen. |
|
3. |
Stress reduction and
regular sleep are integral to migraine treatment. |
|
4. |
If migraines worsen they
are to increase their medication. |
____ 11. Juanita presents to the clinic with a
complaint of headaches off and on for months. She reports they feel like
someone is “squeezing” her head. She occasionally takes Tylenol for the pain,
but usually just “toughs it out.” Initial treatment for tension headache
includes asking her to keep a headache diary and a prescription for:
|
1. |
Sumatriptan (Imitrex) |
|
2. |
Naproxen (Aleve) |
|
3. |
Ergotamine (Ergostat) |
|
4. |
Tylenol with codeine
(Tylenol #3) |
____ 12. Nonpharmacologic therapy for tension
headaches includes:
|
1. |
Biofeedback |
|
2. |
Stress management |
|
3. |
Massage therapy |
|
4. |
All of the above |
____ 13. James has been diagnosed with cluster
headaches. Appropriate acute therapy would be:
|
1. |
Butalbital and aspirin
(Fiorinal) |
|
2. |
Meperidine IM (Demerol) |
|
3. |
Oxygen 100% for 15 to 30
minutes |
|
4. |
Indomethacin (Indocin) |
____ 14. Preventative therapy for cluster
headaches includes:
|
1. |
Massage or relaxation
therapy |
|
2. |
Ergotamine nightly before
bed |
|
3. |
Intranasal lidocaine four
times a day during “clusters” of headaches |
|
4. |
Propranolol (Inderal) daily |
____ 15. When prescribing any headache
therapy, appropriate use of medications needs to be discussed to prevent
medication-overuse headaches. A clinical characteristic of medication-overuse
headaches is that they:
|
1. |
Are increasing in frequency |
|
2. |
Are increasing in intensity |
|
3. |
Recur when medication wears
off |
|
4. |
Begin to “cluster” into a
pattern |
Chapter 35. Headaches
Answer Section
MULTIPLE CHOICE
1. ANS:
4
PTS: 1
2. ANS:
2
PTS: 1
3. ANS:
2
PTS: 1
4. ANS:
3
PTS: 1
5. ANS:
1
PTS: 1
6. ANS:
2
PTS: 1
7. ANS:
1
PTS: 1
8. ANS:
3
PTS: 1
9. ANS:
4
PTS: 1
10. ANS:
3
PTS: 1
11. ANS:
2
PTS: 1
12. ANS:
4
PTS: 1
13. ANS:
3
PTS: 1
14. ANS:
2
PTS: 1
15. ANS:
3
PTS: 1
Chapter 52. Pain Management: Acute and Chronic Pain
Multiple Choice
Identify the choice that best completes the statement or answers
the question.
____ 1. Different areas of the
brain are involved in specific aspects of pain. The reticular and limbic
systems in the brain influence the:
|
1. |
Sensory aspects of pain |
|
2. |
Discriminative aspects of
pain |
|
3. |
Motivational aspects of
pain |
|
4. |
Cognitive aspects of pain |
____ 2. Patients need to be
questioned about all pain sites because:
|
1. |
Patients tend to report the
most severe or important in their perception. |
|
2. |
Pain tolerance generally
decreases with repeated exposure. |
|
3. |
The reported pain site is
usually the most important to treat. |
|
4. |
Pain may be referred from a
different site to the one reported. |
____ 3. The chemicals that promote
the spread of pain locally include:
|
1. |
Serotonin |
|
2. |
Norepinephrine |
|
3. |
Enkephalin |
|
4. |
Neurokinin A |
____ 4. Narcotics are exogenous
opiates. They act by:
|
1. |
Inhibiting pain
transmission in the spinal cord |
|
2. |
Attaching to receptors in
the afferent neuron to inhibit the release of substance P |
|
3. |
Blocking neurotransmitters
in the midbrain |
|
4. |
Increasing beta-lipoprotein
excretion from the pituitary gland |
____ 5. Age is a factor in
different responses to pain. Which of the following age-related statements
about pain is NOT true?
|
1. |
Preterm and newborn infants
do not yet have functional pain pathways. |
|
2. |
Painful experiences and
prolonged exposure to analgesic drugs during pregnancy may permanently alter
neuronal organization in the child. |
|
3. |
Increases in the pain
threshold in older adults may be related to peripheral neuropathies and
changes in skin thickness. |
|
4. |
Decreases in pain tolerance
are evident in older adults. |
____ 6. Which of the following
statements is true about acute pain?
|
1. |
Somatic pain comes from
body surfaces and is only sharp and well-localized. |
|
2. |
Visceral pain comes from
the internal organs and is most responsive to acetaminophen and opiates. |
|
3. |
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. |
|
4. |
Acute neuropathic pain is
caused by lack of blood supply to the nerves in a given area. |
____ 7. One of the main drug
classes used to treat acute pain is NSAIDs. They are used because:
|
1. |
They have less risk for
liver damage than acetaminophen. |
|
2. |
Inflammation is a common
cause of acute pain. |
|
3. |
They have minimal GI
irritation. |
|
4. |
Regulation of blood flow to
the kidney is not affected by these drugs. |
____ 8. Opiates are used mainly to
treat moderate to severe pain. Which of the following is NOT true about these
drugs?
|
1. |
All opiates are scheduled
drugs which require a DEA license to prescribe. |
|
2. |
Opiates stimulate only mu
receptors for the control of pain. |
|
3. |
Most of the adverse effects
of opiates are related to mu receptor stimulation. |
|
4. |
Naloxone is an antagonist
to opiates. |
____ 9. If interventions to
resolve the cause of pain (e.g., rest, ice, compression, and elevation) are
insufficient, pain medications are given based on the severity of pain. Drugs
are given in which order of use?
|
1. |
NSAIDs, opiates,
corticosteroids |
|
2. |
Low-dose opiates, salicylates,
increased dose of opiates |
|
3. |
Opiates, non-opiates,
increased dose of non-opiate |
|
4. |
Non-opiate, increased dose
of non-opiate, opiate |
____ 10. The goal of treatment of acute pain
is:
|
1. |
Pain at a tolerable level
where the patient may return to activities of daily living |
|
2. |
Reduction of pain with a
minimum of drug adverse effects |
|
3. |
Reduction or elimination of
pain with minimum adverse reactions |
|
4. |
Adequate pain relief
without constipation or nausea from the drugs |
____ 11. Which of the following statements is
true about age and pain?
|
1. |
Use of drugs that depend
heavily on the renal system for excretion may require dosage adjustments in
very young children. |
|
2. |
Among the NSAIDs,
indomethacin is the preferred drug because of lower adverse effects profiles
than other NSAIDs. |
|
3. |
Older adults who have
dementia probably do not experience much pain due to loss of pain receptors
in the brain. |
|
4. |
Acetaminophen is especially
useful in both children and adults because it has no effect on platelets and
has fewer adverse effects than NSAIDs. |
____ 12. Pain assessment to determine adequacy
of pain management is important for all patients. This assessment is done to:
|
1. |
Determine if the diagnosis
of source of pain is correct |
|
2. |
Determine if the current
regimen is adequate or different combinations of drugs and non-drug therapy
are required |
|
3. |
Determine if the patient is
willing and able to be an active participant in his or her pain management |
|
4. |
All of the above |
____ 13. Pathological similarities and
differences between acute pain and chronic pain include:
|
1. |
Both have decreased levels
of endorphins. |
|
2. |
Chronic pain has a
predominance of C-neuron stimulation. |
|
3. |
Acute pain is most commonly
associated with irritation of peripheral nerves. |
|
4. |
Acute pain is diffuse and
hard to localize. |
____ 14. A treatment plan for management of
chronic pain should include:
|
1. |
Negotiation with the
patient to set personal goals for pain management |
|
2. |
Discussion of ways to
improve sleep and stress |
|
3. |
An exercise program to
improve function and fitness |
|
4. |
All of the above |
____ 15. Chronic pain is a complex problem.
Some specific strategies to deal with it include:
|
1. |
Telling the patient to “let
pain be your guide” to using treatment therapies |
|
2. |
Prescribing pain medication
on a “PRN” basis to keep down the amount used |
|
3. |
Scheduling return visits on
a regular basis rather than waiting for poor pain control to drive the need
for an appointment |
|
4. |
All of the above |
____ 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?
|
1. |
Use of more than one drug
to treat the pain |
|
2. |
Multiple times when
prescriptions are lost with requests to refill |
|
3. |
Preferences for treatments
that include alternative medicines |
|
4. |
Presence of a family member
who has abused drugs |
____ 17. The Pain Management Contract is appropriate
for:
|
1. |
Patients with cancer who
are taking morphine |
|
2. |
Patients with chronic pain
who will require long-term use of opiates |
|
3. |
Patients who have a complex
drug regimen |
|
4. |
Patients who see multiple
providers for pain control |
Chapter 52. Pain Management: Acute and Chronic Pain
Answer Section
MULTIPLE CHOICE
1. ANS:
3
PTS: 1
2. ANS:
1
PTS: 1
3. ANS:
4
PTS: 1
4. ANS:
2
PTS: 1
5. ANS:
1
PTS: 1
6. ANS:
3
PTS: 1
7. ANS:
2
PTS: 1
8. ANS:
2
PTS: 1
9. ANS:
4
PTS: 1
10. ANS:
3
PTS: 1
11. ANS:
4
PTS: 1
12. ANS:
4
PTS: 1
13. ANS:
2
PTS: 1
14. ANS:
4
PTS: 1
15. ANS:
3
PTS: 1
16. ANS:
2
PTS: 1
17. ANS:
2
PTS: 1
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