Mod 1-4

Question 1

1. When working with a patient to create a treatment plan, it is important to ask your patient questions regarding personal, financial, and health system factors that impact their overall health in order to:

A. Obtain past medical history

B. Determine predictors of adherence

C. Gather history on medication compliance

D. Screen for drug abuse

Answer 1

B. Determine predictors of adherence

Question 2

In regards to controlled substances, the following statements are all true except:

A. Registration for a DEA number is required for all who manufactures, distributes, prescribes, procures or dispenses any controlled substance.

B. All practitioners who regularly purchase, dispense/distribute and administer controlled substances must maintain and keep on file accurate records for 2 years.

C. A fax prescription for a Schedule II controlled substance is acceptable if the patient resides in a nursing home.

D. State laws are not allowed differences in the scheduling of controlled substances and must follow federal laws.

Answer 2

D. State laws are not allowed— because they are allowed to have differences, they can be more strict but not less

Question 3

Tommy, a 5 year old pediatric patient, was prescribed a therapeutic range dose of amoxicillin for strep throat. The mother of the patient denies any known drug allergies and states the patient was on amoxicillin for the first time 2 months ago for strep and tolerated it without any adverse drug reactions. After taking the first dose at home later that evening, Tommy developed hives, itching, and mild respiratory distress. He was transferred by ambulance to the emergency department for treatment. Which classification of adverse drug reaction would this be considered?

A First dose reaction

B. Type I

C. Type A

D. Early Reaction

Answer 3

B–Type I

is an immune mediated response often caused by re-exposure to a specific source, in this case amoxicillin. Type I reactions can range from mild (hives, allergic rhinitis) to severe (angioedema and anaphylaxis). Education to patient and caregiver about potential for allergic reaction should always be given at time of treatment counseling.

Question 4

When treating a patient with new onset seizures, which racial group is at risk for developing carbamazepine-induced Stevens Johnson syndrome and requires pharmacogenomic testing ?

A. Caucasian

B. African American

C. Hispanic

D. Asian

Answer 4

D –Asian - Asian ancestry is at risk of developing carbamazepine induced Stevens Johnson syndrome. They should undergo pharmacogenomic testing for the HLA-B*1502 allele as this increases the frequency 10 fold (Wood & Wright, p. 67, 2024).

Question 5

Which pediatric medication administration technique is not correct?

A. Administer liquid medications in the buccal pouch in 1mL increments in infants.

B. Assist parent/teen relationships in medication compliance and self- administration

C. Prescribe liquid medication for young school aged children to increase compliance.

D. Choose antibiotics with single or twice daily dosing for toddlers.

Answer 5

C- prescribing liquid medicaton for young shhcool aged children— you should ask their preference to mom or dad, some can start to swallow pills

Question 6

A patient is prescribed verapamil for hypertension control, which statement by the patient requires more education?

A. “I will need to increase fiber in my diet”

B. “I will talk to you about adverse drug reactions before stopping the medication”

C. “Even with my osteoporosis, I should stop taking my calcium and vitamin D supplement”

D. “I will buy orange juice instead of grapefruit”

Answer 6

C-

calcium can continue to be taken without impacting CCB

Question 7

Beta Blockers are contraindicated in patients with which disorder?

A. Myocardial Infarction

B. Atrial Fibrillation

C. Migraines

D. Asthma

Answer 7

D. asthma or COPD, no cardiac specific and can cause bronchial constriction

Question 8

PDE-5 Inhibitors like tildalafil should not be taken concurrently with:

A. Nitrates

B. Class III Antiarrhythmics

C. Grapefruit Juice

D. All of the Above

Answer 8

D–All of the above

Question 9

Collaboration is a key component to an effective health-care team. This collaboration could include all of the following professions, except:
A. Nurses
B Medical Doctors/DO
C Pharmacists
D All of the above

Answer 9

D. All of the above, No single member of the health-care team can provide high-quality care without collaborating with other team members and this includes a multitude of healthcare professionals as well as ancillary services involved in the patient’s care

Question 10

The Institute for Safe Medication Practice’s (ISMP’s) List of Error-Prone Abbreviations, Symbols, and Dose Designations suggest which of the following to provide a complete, safe prescription?
A Abbreviations are allowed as long as they are standardly used and easy to interpret
B. Do no need to indicate a general indication for the use
C. Indicate a safety cap is not required, as medications will be dispensed with them by default
D Do no need “Dispense as Written” because the pharmacist will determine if the generic is a better option for the patient

Answer 10

C–Indicate a safety cap is not required, as medications will be dispensed with them by default

The provider should indicate if a safety cap is not required only for patients that have dexteritiy concerns and can ensure that the medications could still be stored safely.

Question 11

An adverse drug reaction that occurs during or immediately after the administration of a medication or treatment is called?
A. First-dose reaction
B. Rapid reaction
C. Early reaction
D. Instant reaction

Answer 11

B–Rapid reaction

A rapid reaction is one that occurs during or immediately after the administration of a medication or treatment. The generally occurs when a medication is incorrectly administered, such as an IV push medication that is pushed too rapidly.

Distractors: A first-dose reaction occurs after the first dose of a medication is administered, as the name implies. An example would be orthostatic hypotension occuring after starting a new blood pressure medication. This generally does not occur with repeat doses.
An early reaction usually occurs early into treatment and generally resolves with continued treatments as tolerance develops. An example would be GI upset after starting Metformin that resolves after continuance of treatment.
Instant reaction is not listed as a type of ADR in the reading and is a distractor due to the similarity of the words instant and rapid only.

Question 12

The process of rational drug prescribing involves several steps in a systematic process that is used every time a prescription is written. Step 2 involves specifying the therapeutic objective which is defined as?
A. Determining if the goal of therapy is curative, symptom relieving, or preventative.
B. Formulating a diagnosis and differential care plan including early screening and effective drug therapy regimen.
C. Monitoring the drug therapy’s effectiveness through monitoring, detection, and evaluation.
D. Involving the patient in the treatment plan decisions and providing education as to why the medication should be chosen.

Answer 12

A–Specifying the therapeutic objective involves determining if the goal of therapy is to cure the disease, relieve the symptoms of disease, replace deficiencies, prevent long-term disease, or treat the combination of two conditions such as pain and inflammation.

Question 13

Which of the following is the first-line therapy for women with mild to moderate pain related to endometriosis?
A. Opioid pain relievers
B. NSAIDs and continuous hormonal contraceptives
C. Progestin therapy
D. SSRIs

Answer 13

B. NSAIDs and continuous hormonal contraceptives

NSAIDs and continuous hormonal contraceptives are listed as the first-line therapy for mild to moderate pain related to endometriosis. Continuous hormonal contraceptives such as Estrogen-progestin containing 20mcg of ethinyl estradiol help suppress ovarian function and may slow disease progression.

Question 14

Blood flow, body fat, body water composition, and plasma protein binding are the main factors of geriatric pharmacokinetics that effect which of the following?
A. Absorption
B. Drug Distribution
C. Metabolism
D. All of the above

Answer 14

D. all of the above

The factors listed affect all of the pharmacokinetics involved in the geriatric patient demographic.

Question 15

Which medication class is found to produce more coronary artery vasodilation and reduce vasospasms in Vasospastic Angina?
A. ACE Inhibitors
B. Calcium Channel Blockers
C. Angiotensin II Receptor Antagonists
D. Cardiac Glycosides

Answer 15

B–Calcium Channel Blockers (CCB) block the influx of calcium at the onset of excitation-contraction process to depolarize the membrane which results in coronary artery vasodilation and reduces vasospasms.

Question 16

Which of the following medications is used to treat atherosclerosis?
A. Antihypertensives
B. Antiemetics
C. Antilipidemics
D. Beta Blockers

Answer 16

C–Antilipidemics are used to treat atherosclerosis, the major cause of CVD.

Question 17

What are some patient barriers that may contribute to medication non-adherence?
A. Patient is a construction worker with poor health insurance coverage.
B. Patient has two children and is a single parent
C. Patient had to drop out of school in the 6th grade to take care of family
D. All of the above.

Answer 17

D– all of the above

Question 18

What control substance tier would Vyvanse fall under if you were told they could not have any refills, no telephone orders, unless there was a true emergency, and electronic prescriptions, are alright with proper software and scripts?
A. Teir 1
B. Teir 2
C. Teir 3
D. Teir 4
E. Teir 5

Answer 18

B. Teir 2

Question 19

A patient was just prescribed Penicillin and came back to the office with concerns of severe pruritus and urticaria. What of the following reactions would you suspect the patient is having?
A. Type 1 reaction
B. Type 2 Reaction
C. Type 3 reaction
D. Type 4 Reaction

Answer 19

A. Type 1 reaction

Question 20

What metabolic phase is responsible for 59% of adverse reactions?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV

Answer 20

A. Phase I

Phase I metabolism enzymes are responsible for approximately 59% of ADRs due to the creation of reactive metabolites through oxidation reaction catalyzed by Cytochrome P450 enzymes, which can potentially bind to the cellular endoplasmic reticulum and mitochondria and cause toxicity, especially in individuals with genetic variations affecting their enzyme activity (Page 61 and chart 6-1).

Question 21

A parent brings their child into the office and is prescribed Amoxicillin oral solution, before discharge, you are educating the parents about administration of this medication. Which of the following provided is FALSE:
A. You only want to administer small amounts at a time (1mL) into the inner buccal space.
B. Parents should report any hives, rashes, or wheezing to the office immediately.
C. If your baby is not taking the syringe, its ok to mix it with formula to ensure they get the right dose
D. Breastfed babies often sputter and choke the first time you administer medication using a syringe.

Answer 21

C. If your baby is not taking the syringe, its ok to mix it with formula to ensure they get the right dose

Question 22

Which medication is considered an Angiotensin II receptor Blocker?
A. Lisinopril
B. Hydrochlorothiazide
C. Losartan
D. Metoprolol

Answer 22

C. Losartan

Question 23

A 47-year-old African American female comes into the office with hypertension with a history of severe asthma, current smoking, hyperlipidemia, and hyperthyroidism. Which medication would you NOT consider prescribing?
A. Hydrochlorothiazide 12.5mg 1 tablet by mouth daily
B. Metoprolol 25mg 1 tablet by mouth daily
C. Losartan Potassium 50 mg 1 tablet by mouth daily
D. Amlodipine 5mg 1 tablet by mouth daily

Answer 23

B. Metoprolol 25mg 1 tablet by mouth daily

Metoprolol is a beta blocker which is contraindicated in those with severe asthma and COPD.

Question 24

The provider is assessing the patient during a routine primary care examination and is looking to determine the patient’s adherence to the prescribed drug regimen. What is the most reliable method for assessing adherence?
A. Ask the patient about any barriers to taking their medications and discuss options to alleviate them.
B. Patient’s report of taking medication as prescribed.
C. Administering a medication adherence scale.
D. Examine the patient’s lab work to determine compliance.

Answer 24

A. Ask the patient about any barriers to taking their medications and discuss options to alleviate them.

Question 25

When prescribing medications in the older population, a provider should always consider which of the following: A. Adherence B. Liver and Kidney function C. Polypharmacy D. Risk for falls E. All of the above

Answer 25

E. All of the above A provider must consider all of the above when prescribing to the older population. Adherence can be influenced by multiple factors such as financial status, multiple medications (being on “too many”), side effects, etc. Liver and Kidney function will dictate what dose the provider can prescribe and monitor, such as liver and kidney functions (liver panel & BMP). Polypharmacy should be considered due to certain medications interacting with each other or increasing side effects and ADRs. Fall risk should always be considered when prescribing to older adults, as medications can cause increased cognitive impairment, drops in blood pressure, dizziness, etc. (Page 1357).

Question 26

When a new drug is being developed, the FDA closely monitors the clinical tests using the drug. These tests are divided into three separate and distinct phases to evaluate the new drug’s efficacy and safety. Which of the following statements regarding the phases of the FDA clinical trials for a new drug is false? A. Phase III evaluates the efficacy and safety of the drug in a large, diverse population. B. Phase II examines the long-term side effects in a small group of healthy individuals. C. Phase II evaluates the safety of the new drug in patients and its effectiveness. D. Phase I examines the safety of the new drug in a small group of healthy individuals.

Answer 26

B. Phase II examines the long-term side effects in a small group of healthy individuals. Phase II trials are designed to focus on actual patients suffering from the illness the drug is being developed for, not healthy individuals. It also does not focus on the long-term side effects of the new drug but assesses the short-term side effects

Question 27

Adverse drug reactions (ADRs) can be medical emergencies, as more severe reactions can lead to hospitalization or even the patient’s death. The practitioner must be aware of two different types of ADRs, namely, pharmacological and idiosyncratic ADRs. Which of the following correctly distinguishes between the two different adverse drug reactions? A. Pharmacological ADRs only occur with toxic doses of medications, while idiosyncratic reactions happen with therapeutic medication doses. B. The immune system causes Pharmacological ADRs, while drug-drug interactions cause idiosyncratic reactions. C. Pharmacological ADRs are dose-dependent, with idiosyncratic ADRs being not dose-dependent and unpredictable. D. Pharmacological ADRs only affect a single body organ, while idiosyncratic ADRs affect the entire body’s organ systems.

Answer 27

C. Pharmacological ADRs are dose-dependent, with idiosyncratic ADRs being not dose-dependent and unpredictable. ADRs can range from mild to life-threatening, with upwards of 6% of all annual hospitalizations due to an ADR, with high costs nationwide due to these reactions (Woo & Wright, 2024, p. 48). As such, providers must always be vigilant regarding these reactions in their patients. Pharmacological reactions are the body’s exaggerated response to a drug and can be eliminated by reducing the dose or removing the drug entirely (Woo & Wright, 2024, pp. 48-49). On the other hand, Idiosyncratic ADRs are much more unpredictable, can be caused by various sources, such as the immune system or drug-drug interactions, and are often not dose-dependent.

Question 28

A patient comes in for a standard wellness check with their primary care provider. The patient has an established history of chronic kidney disease, and requires new medication to be prescribed. With this patient’s health history in mind, which of the following is the most important to consider when prescribing a new medication? A. The medication’s cost. B. The medication’s route of administration. C. The medication’s availability. D The medication’s elimination pathways.

Answer 28

D The medication’s elimination pathways.

Question 29

A parent brings their child, aged 3 years old and female, into the clinic for a well-child examination. The child shows signs and symptoms of a skin infection and will need topical medication. The provider remembers that they must be mindful of how drug absorption differs for the pediatric population compared to adults. Which of the following factors best explains this difference? A. Children absorb topical medications at a higher rate than adults. B. Children absorb topical medications at a lower rate than adults. C. Medications administered via a patch work better with children. D. There are no drug absorption differences between children and adults.

Answer 29

A. Children absorb topical medications at a higher rate than adults. Children have a larger body surface area than their size, which affects the topical absorption of various medicines (Woo & Wright, 2024, p. 1324). Due to this, children absorb topical medications at a higher rate than adults, and this factor can lead to systemic toxicity when topical medications are misapplied.

Question 30

As people age, many changes affect their bodies and systems. One example is that the geriatric population experiences changes in drug distribution when taking their medications. Which of the following statements regarding these changes in the geriatric population is true? A. Increased total body water can lead to higher water-soluble drug plasma concentrations. B. Lower serum albumin levels lead to less binding of drugs to protein molecules, producing higher levels of free drug and chance for toxicity. C. Increased lean body mass levels allow for better drug distribution. D A lower level of body fat can cause a prolonged half-life of lipophilic medications, leading to a more intense immediate effect.

Answer 30

B. Lower serum albumin levels lead to less binding of drugs to protein molecules, producing higher levels of free drug and chance for toxicity. In the geriatric population, plasma albumin levels typically decrease, which leads to higher free drug concentrations (Woo & Wright, 2024, p. 1355). Due to this, the drug’s effects are heightened and can lead to toxicity.

Question 31

Providers must be mindful of the systemic effects of heart failure that can negatively affect a patient’s health. When initiating drug therapy for a patient with chronic heart failure, which of the following statements is the most accurate? A. Start low and go slow, which can give therapeutic effects while minimizing side effects. B Start with a high dose initially, with a planned taper to follow. C Start with a standard dose for every patient. D Start with and keep the maximum drug dose due to the patient’s urgent medical needs.

Answer 31

A. Start low and go slow, which can give therapeutic effects while minimizing side effects. For chronic therapy, “start low and go slow” are the recommended steps when a provider is looking to start medication for the treatment of heart failure (Woo & Wright, 2024, p. 276). Typically, the doses are advanced over a week or two, leading to the desired therapeutic effect without significant side effects, such as orthostasis and headache.

Question 32

The provider meets with their patient during a scheduled primary care visit regarding increased edema in their lower extremities. The provider prepares to order a diuretic for the patient, but the provider remembers that diuretics can have different effects on different patient populations. Which of the following statements regarding using diuretics in specific patient populations is false? A. Glucose intolerance is an issue with all diuretics. B. Thiazide and loop diuretics are the drugs of choice for patients taking lithium. C. Patients suffering from gout may have exacerbations due to diuretic use, leading to heightened levels of uric acid. D. The geriatric population can experience an increased risk of electrolyte imbalances and hypotension.

Answer 32

B. Thiazide and loop diuretics are the drugs of choice for patients taking lithium. For patients who take lithium, taking thiazide and loop diuretics can lead to lithium toxicity, as these drugs lead to a reduction in renal lithium excretion (Woo & Wright, 2024, p. 292). These drugs can also affect other medications as well, such as insulin and warfarin.

Question 33

When prescribing a medication, the Nurse Practitioner should know which adverse drug reactions are most likely to result in patient nonadherence: A. Anaphylaxis B. Minor changes in appetite C. Side effects that interfere with daily activities D. Side effects that do not impact daily activities

Answer 33

C. Side effects that interfere with daily activities The correct answer is C because the side effects that interfere the most with daily activities are the most likely to produce nonadherence. These reactions include constipation, headache, dizziness, diarrhea, vomiting, anorexia, and nausea

Question 34

JP is a pt who has been experiencing chronic pain. He visits the NP and requests a refill of his hydromorphone prescription. The NP explains that the refill is not allowed for this medication due to its classification as a Schedule II drug. From the following examples, select which one is the most appropriate next step for the NP. A. Call the pharmacy and give a verbal order to refill this medication for the pt. B. Write a new prescription and let the pt know he will need to see a provider for each refill. C. Advise using Over-the-Counter medications to help with the pain D. Send 11 refills to the pharmacy to cover until next year.

Answer 34

B. Write a new prescription and let the pt know he will need to see a provider for each refill. The correct option is B because hydromorphone is a Schedule II medication and it cannot be refilled under federal law, so the provider should issue a new prescription and evaluate the pt before each refill.

Question 35

3- A patient has been prescribed Tacrolimus after undergoing a liver transplant. The Nurse Practitioner should know that close monitoring is required due to the drug’s: A. Wide therapeutic index B. Low risk of adverse effects C. Narrow therapeutic index D. High dose

Answer 35

C. Narrow therapeutic index The correct answer is C because Tacrolimus is a drug that has a narrow therapeutic index. This means that this medication has to be monitored closely because it can lead to significant toxicity or adverse effects.

Question 36

A pt is taken to the emergency department after calling 911 due to swelling of the tongue, and lips, and difficulty breathing right after taking Amoxicillin for the first time. The Nurse Practitioner knows this is an immune-mediated adverse reaction. Which hypersensitivity reaction type is most likely responsible for her symptoms? A. Type I: Immunoglobulin E (IgE)- mediated hypersensitivity B. Type II: Antibody-dependent cytotoxicity C. Type I: Immune complex hypersensitivity D. Type II: delayed-type hypersensitivity

Answer 36

A. Type I: Immunoglobulin E (IgE)- mediated hypersensitivity

Question 37

A 39-year-old female is diagnosed by her OB/GYN with chronic vulvodynia. After doing some studies, it is suggested that there might be a potential association between vulvovaginal fungal pathogens and vulvodynia symptoms. Which of the following is the most appropriate initial management if it is confirmed fungal involvement? A. Prescribe antibiotics and reassess symptoms in a week. B. Recommend topical antifungal therapy only. C. Start the patient on an oral antifungal therapy with itraconazole 400 mg daily for 5 weeks and monitor liver function every 3-4 weeks. D. Avoid antifungal therapy unless symptoms get worse.

Answer 37

C. Start the patient on an oral antifungal therapy with itraconazole 400 mg daily for 5 weeks and monitor liver function every 3-4 weeks. Option C is the right option because Itraconazole 400 mg for 5-8 weeks has been shown to decrease symptoms of vulvodynia caused by vulvovaginal fungal pathogens. However, this medication can cause some GI side effects, and it is also important to do some frequent interval fungal cultures as well as liver function studies every 3-4 weeks. Option A is incorrect because Antibiotics do not treat fungal pathogens, but antifungal therapy does. Option B is incorrect because topical medications can be prescribed, but the Itraconazole PO is more effective in decreasing symptoms by 69%. Option D is also incorrect because it is not a good idea to avoid antifungal therapy and wait until symptoms get worse. After all, this could hurt pt's health and quality of life (Woo & Robinson, 2024, p. 1300).

Question 38

A pediatric NP is reviewing the case of a 12-month-old baby who developed neurotoxicity after the treatment of scabies. Which topical medication is most likely responsible for this adverse reaction? A. Mupirocin B. Lindane C. Nystatin D. Penicillin

Answer 38

B because out of the medications provided, Lindane is the only medication used to treat scabies and lice and there have been reports that show it can cause neurotoxicity in young children and infants due to the increased systemic absorption of topical medications by this population

Question 39

An NP decided to switch a patient from an ACE inhibitor to an angiotensin receptor blocker (ARB) after reporting a persistent cough. The provider is thinking about prescribing a new medication with a short half-life and prolonged duration of action due to its active metabolite. Which medication is the NP likely prescribing? A. Captopril B. Losartan C. Aliskiren D. Enalapril

Answer 39

B. Losartan The correct answer Is Losartan because it has a short initial half-life of around 2 hours and its active metabolite extends the duration of action with a half-life of 6-9 hours which allows for once or twice daily dosing. Option 1 is incorrect because Captopril is an ACE inhibitor, not an ARB, and cough could be also caused by this drug. Option C is incorrect because Aliskeren has a 24-hour half-life and it can take up to two weeks to see a full therapeutic effect, so it does not suit as a quick replacement therapy. Option D is also incorrect because Enalapril is also an ACE inhibitor and has a longer half-life than Losartan (Woo & Robinson, 2024, p. 240)

Question 40

A 65-year-old African American male is diagnosed with Hypertension and is prescribed an angiotensin-converting enzyme inhibitor. What is the most important consideration when prescribing this medication to an African American patient? A. ACEIs are more effective in lowering blood pressure in Black patients if combined with a diuretic. B. ACEIs are contraindicated in Black patients and should be avoided C. ACEIs are the most effective therapy for all racial groups D. ACEI decreases the risk of angioedema in Black patients compared to White patients.

Answer 40

A. ACEIs are more effective in lowering blood pressure in Black patients if combined with a diuretic. Option A is the right option because ACE inhibitors tend to be less effective for Black patients in lowering blood pressure unless it is combined with a diuretic. Option B is incorrect because ACEIs are not contraindicated for Black patients but have to be used with caution. Option C is incorrect ACEIs are not necessarily the best option for all racial groups and option D is incorrect because it is the opposite way, Black patients have a higher risk of angioedema when using ACEIs

Question 41

Jeffery is a nurse practitioner who is seeing a patient who had recently been prescribed metoprolol for her hypertension. Which of the following patient statements does Jeffery recognize as a factor contributing to medication nonadherence? A. “My pharmacy is able to ship my medication refills to my house, so I don’t have to bother my daughter to pick it up.” B. “I am trying to remember to take my pill by regularly taking it when I brush my teeth in the morning and at night.” C. “I don’t remember what this pill is for, I just take whatever my daughter tells me to.” D. “I am forgetful, so my daughter puts my pills into my weekly pill organizer, so I can tell if I took it or not.”

Answer 41

C. Understanding the disease state and treatment regimen is essential for adherence. Providing education on the implications and importance of taking the prescribed medication can enhance adherence. (Woo & Wright, 2024, p. 6)

Question 41

Which of the following is not a critical feature of informed consent? A. Any patient can give informed consent B. The patient must be voluntary C. The patient must be given adequate information to make a decision D. Consent must be to the proposed interventions

Answer 41

A. Any patient can give informed consent A patient must be presumed legally and clinically competent to provide informed consent. The patient must be able to comprehend information, formulate a decision about the proposed intervention, and communicate the decision to the healthcare team.

Question 42

Sarah is a nurse practitioner who is treating a patient with consistent hypertension. In addition to the nonpharmacologic interventions, it has also been decided that this patient is going to require a prescribed anti-hypertensive medication. When determining which medication to prescribe, which action should not be taken when ensuring the appropriateness of drug selection? A. Assess the patient’s blood work to determine renal and liver function B. Review evidence of therapeutic impact of drug-using trials, reviews, and guidelines C. Assess the safety profile of the drug, including precautions and contraindications D. Perform a medication reconciliation to verify no drug-drug interactions with current and new drugs E. None of the above

Answer 42

E. Selecting appropriate drug treatment requires the consideration of multiple factors. Pharmacodynamics, pharmacokinetics, therapeutic factors, safety, patient factors, and cost must all be examined before prescribing a medication to ensure therapeutic results, avoid complications and adverse reactions and support adherence (Woo & Wright, 2024, pp. 31-33) aka they are all correct :)

Question 43

Which of the following types of immune-mediated adverse drug reaction is being described: A complication of heparin therapy that occurs when the body's immune system reacts to heparin by producing an immune response and creating antibodies that bind to platelets. The body then sees the platelets as foreign and destroys them, producing thrombocytopenia. A. Type one B. Type two C. Type three D. Type four

Answer 43

B. Type two --describes a hypersensitivity that is caused by antibodies uniting with a hapten and inducing destruction. Heparin induced thrombocytopenia is an antibody-dependent cytotoxic reaction that occurs after taking a drug (heparin), mediated antibodies binding to drug-coated cells. (Woo & Wright, 2024, p. 49) A is incorrect- Type one is an immediate hypersensitivity reaction that is systemic or local, occurring within an hour of taking a drug. It is mediated by IgE antibodies binding to mast cells and release histamine, leukotrienes, and prostaglandins, inducing inflammation (Woo & Wright, 2024, p. 49) C is incorrect- Type three is a hypersensitivity immune complex-mediated reaction that occurs when aggregates of antigens and IgG and IgM antibodies create insoluble complexes that are deposited in tissue. (Woo & Wright, 2024, p. 50) D is incorrect- Type four is a delayed hypersensitivity reaction that is mediated by T cells presenting drug molecules to other cells (Woo & Wright, 2024, p. 50)

Question 44

Paul is a nurse practitioner who is in his first day of clinical at a primary care office. His first female patient is here due to complaints of menopause symptoms, including incontinence, mood changes, and sleep disturbances. In addition to her pharmacologic treatments, Paul recommends which of the following will help with her symptoms non-pharmacologically. A. Decreasing intake of caffeine can reduce irritation of detrusor muscles and allow relation of the nervous system B. Performing Kegel exercises and participating in bladder training can reduce the incidence of stress incontinence C. Practice relaxation methods, including meditation or yoga, to calm the nervous system, enhance personal control, and promote calmness D. All of the above

Answer 44

D. All of the above The primary goal of menopausal treatment is to manage the vasomotor and other associated symptoms. Incontinence can be treated non-pharmacologically by decreasing caffeine beverages to lessen irritation and urgency, performing Kegel exercises and bladder training to strengthen muscles, and reducing constipation to relieve internal pressure. Mood changes can be treated non-pharmacologically by practicing meditation, yoga, or prayers to calm the nervous system and enhance personal control, obtaining adequate sleep to aid relaxation, and utilizing stress management techniques to improve relaxation. Sleep disturbances can be treated non-pharmacologically with exercise to stimulate serotonin production, decrease intake of stimulants to allow for relaxation of the nervous system, avoid alcohol and perform meditation or prayer to calm the nervous system (Woo & Wright, 2024, table 53-6)

Question 45

Lindsay is a pediatric nurse practitioner currently seeing a five-year-old patient with an ear infection and is here with her mom. When explaining the diagnosis and treatment plan, the child’s mom stated, “It is so hard to get her to take the medication. It turns into a battle every time.” Lindsay knows that it is essential that she implements techniques to ensure medication compliance. Which of the following would help with easing medication administration? A. Speaking directly to the mother about the purpose and importance of taking the medication as prescribed B. Asking the mother if she’d rather drink, chew, or swallow pills C. Choosing a medication that is in a more concentrated form to decrease the amount she has to take D. All of the above

Answer 45

C. If medication noncompliance is an issue, it is important to determine which methods are best apt to support medication compliance. Choosing to prescribe a medication that can be more concentrated will decrease the amount and amount of times a day the child will have to take the medication (Woo & Wright, 2024, p. 1333)

Question 46

Lena is a nurse practitioner, and she is meeting with a patient who has a history of Prinzmetal’s angina. Which medication would Lena expect to see on this patient's medication list? A. Calcium Channel blocker B. Beta Blocker C. Antiplatelet D. All of the above

Answer 46

A. Prinzmetal’s angina is vasospastic angina that can occur with or WITHOUT coronary artery disease. Calcium channel blockers are used for standard treatment because they produce more coronary artery dilation and reduced vasospasm

Question 47

Which of the following medical diseases contraindicates prescribing Lipitor? A. Myocardial infarction B. Alzheimer’s disease C. Hepatitis A D. Hypertriglyceridemia

Answer 47

C. Hepatitis A

Question 48

Mr. Smith is a patient of your practice that is visiting today to ask for pain medications due to his chronic back pain. After entering his information for a prescription, the Prescription Drug Monitoring Program (PDMP) flags that he has a similar prescription from another clinic the previous week. Which of the following would provide the most therapeutic outcome for the provider-patient relationship? A. Proceed with the prescription for Mr. Smith B. Confront him and deny any prescription C. Conduct an SBIRT screening immediately D. Ask Mr. Smith about his previous clinic visit

Answer 48

D. It is important to look for potential misuse of controlled substances when prescribing them, including seeking prescriptions from numerous providers. However, it’s important to first address the situation in a non-judgemental manner to strengthen communication between you and Mr. Smith (41)

Question 49

What would be an example of intentional nonadherence? A. A patient with dementia forgets where she put her pill caddy in the morning B. A mother of three missed her morning medication due to the kids being late for school C. A patient who stops taking his antibiotics cause they “aren’t working” D. A patient with depression who hasn’t left his room in two days to take his medication

Answer 49

C. Intentional nonadherence can occur when a patient stops taking their medication due to a lack of perception of effectiveness, such as stopping antibiotics when they don’t see immediate results

Question 50

While assessing a patient on digoxin, which statement would be the most significant? A. Carotid pulse of 66 bpm B. sensation of fullness in the abdomen C. Accidental concurrent antacid and digoxin consumption D. Taking their 6am dose at 10am

Answer 50

B--Educating patients on signs of digoxin toxicity is crucial for those that have it prescribed. Some signs of digoxin toxicity are similar to those of worsening heart failure, and should monitor and notify providers if any occur, which can include the sensation of fullness in the abdomen (Woo & Wright, 2024, p. 261), therefore the provider should assess digoxin levels.

Question 51

A patient that reports aching pain in their knees and ankles after starting allopurinol a week prior. Lab results show elevated levels of IgM and IgG, as well as immune complexes drawn from synovial fluid. What type of hypersensitivity reaction would you expect this patient is having? A. Type I B. Type II C. Type III D. Type IV

Answer 51

C. Elevated levels of IgM and IgG after starting a new medication, as well as immune complexes in the joints, are common signs of a type 3 allergic reaction, which is mediated by the immune system

Question 52

A patient on a low-dose antidepressant tests positive for a gene that studies have shown can worsen symptoms of patients with depression or anxiety. The patient states they have seen improvement in their symptoms from the medication after 10 months, and no adverse events have been reported. How would you respond? A. Keep the current prescription and educate the patient to notify you if any changes occur B. Increase the dosage of the medication to prevent development of further symptoms C. Add an anxiolytic prophylactically D. Switch to another class of antidepressant and discontinue the current medication immediately

Answer 52

A-- Although they may have a genetic disposition to the medication, patient response is the most important component to the prescription. If no harmful adverse reactions have occurred, it is acceptable to continue treatment and have them report any changes in condition

Question 53

When prescribing any medication to a female patient, which of these common correlations should the provider be cautious of? A. Women have a faster GFR compared to men, and require higher doses of medications that are excreted through the kidneys B. Due to a lower percentage of body fat, women have a lower volume of distribution for lipophilic medications C. Medications that are absorbed in the stomach should be adjusted due to gastric fluids being less acidic in females compared to males D. There are less adverse drug events in women, but still should have medication reconciliation at each appointment

Answer 53

C Women tend to have a less acidic stomach compared to men (2.59 pH compared to 1.92), so medications that are affected by gastric pH need to be adjusted (Woo & Wright, 2024, p. 1291

Question 54

While performing medication reconciliation for Mrs. Smith, a 68 year-old female with hypertension who was recently hospitalized for a fall, which medication would be the least suspected to be a contributing factor? A. Baby aspirin B. Furosemide/Lasix C. Digoxin D. Citalopram/Celexa

Answer 54

A-- Diuretics, Digoxin and SSRIs are more likely to affect a geriatric patient’s mental status and blood pressure, which can result in falls

Question 55

Mr. Dunn, a 45 year-old male, comes to your clinic for a follow-up appointment after starting atorvastatin for hyperlipidemia 4 weeks ago. He states that he has been taking it along with his blood pressure medication in the morning without issue, however states have muscle pain this morning and dark colored urine. Which of these would be the priority response to these symptoms? A. Perform a dietary recall for possible causes B. Educate Mr. Dunn to take his medications in the morning if possible C. Analyze his AFT/LFTs to see if the medications are effective D. Collect a urine sample immediately

Answer 55

D-- Mr. Dunn is exhibiting possible signs of rhabdomyolysis, a serious condition that, while rare, can be triggered by taking lipid reducing agents like atorvastatin (Woo & Wright, 2024, p. 284), and urine samples should be evaluated for myoglobin levels, as well as elevated CK levels in the blood

Question 56

Which of the following is not a factor that can help improve medication adherence? A. Short-acting drugs B. Explaining the science of prescribed medications C. Personalized drug schedules D. Simplifying the complexity of the regime

Answer 56

A. Short-acting drugs

Question 57

Nicolle, a nurse practitioner, is prescribing her patient oxycodone post-operatively. Nicolle knows oxycodone is in what Controlled Drug Schedule class? A. I B. II C. III D. IV

Answer 57

B-- schedule II Narcotics, including oxycodone, are a Schedule II drug, meaning no refills are permitted, no telephone orders unless emergent, and needs secure electronic software to prescribe. Other drugs in this class include stimulants, such an amphetime and depressants, such as pentobarbital. Schedule I are drugs with no accepted medical or legal use such as heroin and LSD. Schedule III drugs require an updated prescription every 6 months and allow telephone orders and include narcotic-nonnarcotic combination drugs, testosterone, steroids, depressants, and stimulants. Schedule IV have the same rules as Schedule III but have different penalties for illegal possession, including pentazocine, phentermine, benzodiazepines, and meprobamate.

Question 58

A nurse practitioner is caring for a 12 year old patient in the emergency room who is experiencing an anaphylactic reaction after taking amoxicillin for strep throat 20 minutes ago. The nurse practitioner knows that this patient is experiencing what type of immune reaction? A. Type 1 B. Type II C. Type III D. Type IV

Answer 58

A. Type 1 Type 1 immune-mediated reaction, also known as immunoglobulin [Ig] E–mediated, immediate-type hypersensitivity and may be local or systemic, including anaphylaxis. Type II reactions are reactions are antibody-dependent cytotoxic and affect a variety of organs and tissue. Type III reactions are immune complex hypersensitivity and occur when aggregates of antigens and IgG and IgM antibodies create insoluble immune complexes in vessels or the blood that are deposited in tissues. These reactions take a week or more to occur and may present as serum sickness, drug fever, or vasculitis. Type IV are cell-mediated or delayed-type hypersensitivity reactions are not an antibody-mediated reaction but rather a cell-mediated response that results in activation and proliferation of T cells, typically are the result of autoimmune and typically occur within 2-3 days and up to a week.

Question 59

Which of the following accurately describes the difference between passive and active monitoring of a prescription, per the World Health Organization’s Six Step Model of Rational Prescribing? A. Passive monitoring is for PRN/as needed prescriptions, while active monitoring is for daily or regular prescriptions. B. Passive monitoring involves follow-ups, testing and making adjustments as needed, while active monitoring involves educating the patient and instructing them to contact if needed. C. Passive monitoring involves educating the patient and instructing them to contact if needed, while active monitoring involves follow-ups, testing and making adjustments as needed. D. Passive monitoring and active monitoring are the same thing

Answer 59

C. Passive monitoring involves educating the patient and instructing them to contact if needed, while active monitoring involves follow-ups, testing and making adjustments as needed.

Question 60

Which of the following is a change physiological change during pregnancy that affects the drug process? A. Increased cardiac output B. Exacerbating preexisting conditions C. Increasing plasma volume D. All of the above

Answer 60

D. All of the above

Question 61

Which of the following is not true regarding polypharmacy? A. Often includes overlapping drugs for same therapeutic effects B. Contributes to decreased adherence C. Applies to only prescription drugs D. Can happen from underuse of nonpharmacological interventions

Answer 61

C. Applies to only prescription drugs

Question 62

A nurse practitioner is caring for a patient taking digoxin. The provider orders a serum digoxin test to check patient’s levels. The patient’s serum digoxin level is 3.0 ng/mL. The provider knows which of the following is true regarding this result? A. It is within normal accepted range, but on the high side B. It is within the normal accepted range, but on the low side C. It is outside of normal accepted range, dangerously low D. It is outside of normal accepted range, dangerously high

Answer 62

D. It is outside of normal accepted range, dangerously high A level above 2.0 ng/mL is considered digoxin toxicity. Toxicity is commonly caused by excessive administration of a CG, too much diuresis resulting in hypokalemia, concurrent development of renal insufficiency, or by administration of drugs that interfere with excretion of digoxin. Treatment of toxicity depends on the problem.

Question 63

A nurse practitioner is reviewing a medication list for a new patient. He sees the patient has a prescription for nitroglycerin sublingual tablets for treatment of acute angina attacks. Which of the following other medications on their list is a red flag for the nurse practitioner to note? A. Hydralazine B. Sildenafil C. Metformin D. Sertraline

Answer 63

B. Sildenafil

Question 64

The following are questions on the Morisky Simplified Self-Report Measure of Adherence to assess a patient's adherence to medication regimens except? A. Are you careless at times about taking your medicine? B. When you feel better do you sometimes stop taking your medicine? C. Do you ever have a hard time paying for your medications? D. Do you ever forget to take your medication?

Answer 64

C. Do you ever have a hard time paying for your medications? Rationale: The correct answer is “do you ever have a hard time paying for your medications?”. This is a good question to ask. It is part of factors influencing adherence but not part of the Morisky Simplified Self -Report Measure of Adherence.

Question 65

Some drugs can go through an expedited approval process for patient use by the FDA. The process for which the drug or therapy application is to be reviewed within 6 months. This is based on “significant improvement” in the safety or effectiveness above current options. What is this process? A. Breakthrough review B. Accelerated Approval C. Priority review D. Fast Track

Answer 65

C. Priority review The correct answer is Priority review. Breakthrough therapy is to expedite approval of drugs that treat serious conditions that current clinical evidence shows substantial improvement compared to current therapy. Accelerated approval is used to approve drugs based on surrogate or intermediate results like laboratory measures. Fast Track is used to approve drugs that fill unmet needs of serious conditions

Question 66

A patient is given heparin to treat a DVT. After starting the medication the patient has blood work done where it shows a critically low platelet level. This patient now has drug-induced immune thrombocytopenia. The clinician knows this is what type of immune mediated adverse drug reaction? A. Type I B. Type II C. Type III D. Type IV

Answer 66

B. Type II the correct answer is Type II or antibody-dependent cytotoxicity. Type II hypersensitivity reactions can occur throughout the body and blood stream, where the immune system destroys the body's tissues and cells depending on the reaction.

Question 67

Cetuximab is categorized as a Tier 1 drug by the CDC and FDA. In relation to pharmacogenetics, what is the recommendation prior to prescribing this drug? A PGx testing is recommended B. PGx testing is not recommended and will not be covered by Medicare/Medicaid C. PGx testing is required for correct prescribing D. PGx testing is not recommended but will be covered by Medicare/Medicaid

Answer 67

C. PGx testing is required for correct prescribing There are 3 tiers to the labeling of drugs regarding pharmacogenetic testing. Tier 1 requires PGx testing, Tier 2 recommends PGx testing and Tier 3 or “information only” are medications where reviews do not recommend testing and it will not be covered by

Question 68

The following are recommended treatments for pain related to primary dysmenorrhea except? A. Ibuprofen 400 mg Q6 B. Mefenamic acid 500 mg loading dose, 250mg Q6 C. Heat application D. Acetaminophen 650mg Q4

Answer 68

D. Acetaminophen 650mg Q4 Acetaminophen is not a recommended treatment for dysmenorrhea. The first line treatment is exercise and heat application, then it is preferred to use a phenylpropionic acid derivative (ibuprofen). If ineffective the next step is fenamate or mefenamic acid. Then it is recommended to look at hormonal contraceptives

Question 69

Hypogonadism is a condition where men have a failure of the testes to produce sperm, androgen or both. What is a cause of primary Hypogonadism? A. Pituitary disorders B. Obesity C. Klinefelter's syndrome D. Opioid use

Answer 69

C. Klinefelter's syndrome In Klinefelter syndrome there is an extra X chromosome causing abnormalities in testis formation. Primary Hypogonadism is in other terms testicular failure resulting in low testosterone and elevated gonadotropin. Secondary Hypogonadism is hypothalamic-pituitary failure including but not limited to pituitary disorders, obesity, opioid use and sarcoidosis

Question 70

What electrolyte abnormality can result in digoxin toxicity (Cardiac Glycoside)? A. Hypernatremia B. Hypokalemia C. Hyponatremia D. Hyperkalemia

Answer 70

B. Hypokalemia Cardiac glycosides work on the sodium-potassium-adenosine triphosphate system in the cardiac cells. Because of this electrolyte balance is important to the correct action of this medication. Increased potassium can reduce effects of toxicity. The treatment of toxicity sometimes calls for administration of potassium to counteract effects of the drug. Hypokalemia increases the enzyme-inhibiting action of cardiac glycosides causing toxicity

Question 71

All are absolute contraindications to the use of Angiotensin converting enzyme inhibitors (ACEIs) and Angiotensin II Receptor Blockers (ARBs) except. A. Bilateral renal artery stenosis B. Chronic Kidney Disease C. Pregnancy D. Angioedema

Answer 71

B. Chronic Kidney Disease CKD is not a contraindication for ACEI and ARB use however they should be used cautiously. Use of these meds in patients who have bilateral renal artery stenosis can cause renal failure due to the hypoperfusion of the kidneys caused by hypotension.

Question 72

Which of the following best describes the role of advanced practice registered nurses (APRNs) as prescribers? a. APRNs have a high level of responsibility in patient care and are solely responsible for making decisions when prescribing medications. b. APRNs' in-depth knowledge of pharmacokinetics and pharmacodynamics should prioritize pharmacological interventions first when managing patients' diseases and conditions. c. APRNs do not need to provide detailed explanations about new medications to patients who cannot understand, as long as the order indications are written in instructions. d. APRNs should be aware of the financial impact on drug adherence and maintain contact information for pharmaceutical companies that offer copay reductions and home delivery options.

Answer 72

d. APRNs should be aware of the financial impact on drug adherence and maintain contact information for pharmaceutical companies that offer copay reductions and home delivery options.

Question 73

Which of the following is the correct answer regarding prescribing controlled substance prescription as APRNs? a. All practitioners who regularly dispense and administer controlled substances must maintain and keep on file for a minimum of 2 years accurate records of controlled drugs they purchase, distribute, administer, and dispense. b. Both buprenorphine and methadone are illegal to prescribe for pain management. c. If patient show increased demand for prescription medications for somatic pain, it is practitioner’s responsibility to prescribe higher potency medication to treat the pain. d. If patient has chronic pain, practitioners do not need to include titration plan.

Answer 73

a. All practitioners who regularly dispense and administer controlled substances must maintain and keep on file for a minimum of 2 years accurate records of controlled drugs they purchase, distribute, administer, and dispense.

Question 74

Patient presents with an Arthus reaction, characterized by local vasculitis, severe pain, swelling, and edema, following a Td vaccination. Which of the following correctly explains the type of immune-mediated adverse drug reaction? a. Type 1 Immunoglobulin E-mediated, immediate-type hypersensitivity b. Type 2 Antibody-dependent cytotoxicity c. Type 3 Immune complex hypersensitivity d. Type 4 Cell-mediated or delayed hypersensitivity

Answer 74

c. Type 3 Immune complex hypersensitivity

Question 75

A patient is about to undergo pharmacogenetic testing and asks about its purpose. Which of the following responses is the most appropriate? A. “The medication carbamazepine that you will be taking requires testing for the HLA-B*1502 allele. If the test is positive, which is common in patients of Asian ancestry, you may be at high risk of developing carbamazepine-induced Stevens-Johnson syndrome or toxic epidermal necrolysis.” B. “Pharmacogenetic testing is required for all patients before initiating any new medication.” C. “Since you’ve reported no prior adverse reactions to medications and are not currently taking any medications, pharmacogenetic testing is not necessary.” D“Medicare will not cover the cost of the test, and you will need to pay out of pocket.”

Answer 75

A. “The medication carbamazepine that you will be taking requires testing for the HLA-B*1502 allele. If the test is positive, which is common in patients of Asian ancestry, you may be at high risk of developing carbamazepine-induced Stevens-Johnson syndrome or toxic epidermal necrolysis.”

Question 76

Which of the following is an appropriate consideration when prescribing medications to older patients? A Geriatric patients need to be regularly monitored for therapeutic and adverse effects, serum drug concentrations, and dosages should be adjusted as needed due to a reduction in liver function, which impacts drug metabolism. B. Cerebral blood flow and neurotransmitter concentrations remain unchanged with age, preventing drug penetration into the central nervous system. C. If older adults are exercising regularly and eating healthy, they do not need to have their vaccinations updated annually. D. Oxidative metabolism (phase 1 reactions), first-pass metabolism, and acetylation and conjugation (phase 2 pathways) decrease with age.

Answer 76

A Geriatric patients need to be regularly monitored for therapeutic and adverse effects, serum drug concentrations, and dosages should be adjusted as needed due to a reduction in liver function, which impacts drug metabolism.

Question 77

Which of the following is the correct consideration for pediatric populations? A. If a pediatric patient's body weight is similar to an adult's, the dose should be adjusted based on body weight. B. The proton pump inhibitor pantoprazole should be dosed based on actual body weight. C. Clindamycin should be dosed based on total body weight in both obese and non-obese children. D. Rash around the diaper area should be treated with increased dose of corticosteroids.

Answer 77

C. Clindamycin should be dosed based on total body weight in both obese and non-obese children.

Question 78

A 55-year-old patient with chronic kidney disease (CKD) and a renal output of 45 mL/min, diabetes with proteinuria, and recently diagnosed hypertension. Which of the following is the most appropriate choice of pharmacologic treatment? a. Nifedipine b. Aliskiren c. Metoprolol d. Lisinopril

Answer 78

d. Lisinopril Aliskiren is a direct renin inhibitor (DRI) and are not to be used in diabetic patients with renal output of less than 60ml/hr (p.240). c. Metoprolol is a beta blockers. Beta blockers are used with caution for patients with diabetes who have major blood glucose variation ranges because they decrease insulin secretion and may mask many of the signs of hypoglycemia. BBs are the gold standard to help reduce the second cardiac event post-MI (p.266).

Question 79

A 53 years old women present with severe constipation, found to have a fasting triglyceride level of 850 mg/dL. Which of the following is the appropriate treatment for this patient? a. Niacin b. No treatment and re-assess in 3 months c. Fibrate therapy d. Cholestyramine

Answer 79

c. Fibrate therapy Elevated triglycerides are recognized as an independent risk factor for CVD, especially in women, and fibric acid derivatives are the drugs of choice for patients with very high triglyceride levels (greater than 800 mg/dL) who are at risk for pancreatitis because of this high level (p.288).