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

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

Chapter 2: Review of Basic Principles of Pharmacology

 

Multiple Choice

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

 

____    1.   A patient’s nutritional intake and lab work reflects hypoalbuminemia. This is critical to prescribing because:

A. Distribution of drugs to target tissue may be affected
B. The solubility of the drug will not match the site of absorption
C. There will be less free drug available to generate an effect
D. Drugs bound to albumin are readily excreted by the kidney

 

 

____    2.   Drugs that have a significant first-pass effect:

A. Must be given by the enteral (oral) route only
B. Bypass the hepatic circulation
C. Are rapidly metabolized by the liver and may have little if any desired action
D. Are converted by the liver to more active and fat-soluble forms

 

 

____    3.   The route of excretion of a volatile drug will likely be:

A. The kidneys
B. The lungs
C. The bile and feces
D. The skin

 

 

____    4.   Medroxyprogesterone (Depo Provera) is prescribed IM to create a storage reservoir of the drug. Storage reservoirs:

A. Assure that the drug will reach its intended target tissue
B. Are the reason for giving loading doses
C. Increase the length of time a drug is available and active
D. Are most common in collagen tissues

 

 

____    5.   The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:

A. Propensity to go to the target receptor
B. Biological half-life
C. Pharmacodynamics
D. Safety and side effects

 

 

____    6.   Azithromycin dosing requires the first day’s dose be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:

A. Rapidly achieves drug levels in the therapeutic range
B. Requires four to five half-lives to attain
C. Is influenced by renal function
D. Is directly related to the drug circulating to the target tissues

 

 

____    7.   The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:

A. Minimum adverse effect level
B. Peak of action
C. Onset of action
D. Therapeutic range

 

 

____    8.   Phenytoin requires a trough level be drawn. Peak and trough levels are done:

A. When the drug has a wide therapeutic range
B. When the drug will be administered for a short time only
C. When there is a high correlation between the dose and saturation of receptor sites
D. To determine if a drug is in the therapeutic range

 

 

____    9.   A laboratory result indicates the peak level for a drug is above the minimum toxic concentration. This means that the:

A. Concentration will produce therapeutic effects
B. Concentration will produce an adverse response
C. Time between doses must be shortened
D. Duration of action of the drug is too long

 

 

____  10.   Drugs that are receptor agonists may demonstrate what property?

A. Irreversible binding to the drug receptor site
B. Up-regulation with chronic use
C. Desensitization or down-regulation with continuous use
D. Inverse relationship between drug concentration and drug action

 

 

____  11.   Drugs that are receptor antagonists, such as beta blockers, may cause:

A. Down-regulation of the drug receptor
B. An exaggerated response if abruptly discontinued
C. Partial blockade of the effects of agonist drugs
D. An exaggerated response to competitive drug agonists

 

 

____  12.   Factors that affect gastric drug absorption include:

A. Liver enzyme activity
B. Protein-binding properties of the drug molecule
C. Lipid solubility of the drug
D. Ability to chew and swallow

 

 

____  13.   Drugs administered via intravenous (IV) route:

A. Need to be lipid soluble in order to be easily absorbed
B. Begin distribution into the body immediately
C. Are easily absorbed if they are nonionized
D. May use pinocytosis to be absorbed

 

 

____  14.   When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:

A. The sum of the effects of each drug individually
B. Greater than the sum of the effects of each drug individually
C. Less than the effect of each drug individually
D. Not predictable, as it varies with each individual

 

 

____  15.   Which of the following statements about bioavailability is true?

A. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained release mechanisms.
B. All brands of a drug have the same bioavailability.
C. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily.
D. Combining an active drug with an inert substance does not affect bioavailability.

 

 

____  16.   Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true?

A. Water soluble and ionized drugs cross these barriers rapidly.
B. The blood-brain barrier slows the entry of many drugs into and from brain cells.
C. The fetal-placental barrier protects the fetus from drugs taken by the mother.
D. Lipid soluble drugs do not pass these barriers and are safe for pregnant women.

 

 

____  17.   Drugs are metabolized mainly by the liver via Phase I or Phase II reactions. The purpose of both of these types of reactions is to:

A. Inactivate prodrugs before they can be activated by target tissues
B. Change the drugs so they can cross plasma membranes
C. Change drug molecules to a form that an excretory organ can excrete
D. Make these drugs more ionized and polar to facilitate excretion

 

 

____  18.   Once they have been metabolized by the liver, the metabolites may be:

A. More active than the parent drug
B. Less active than the parent drug
C. Totally “deactivated” so that they are excreted without any effect
D. All of the above

 

 

____  19.   All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by:

A. Reduced circulation and perfusion of the kidney
B. Chronic renal disease
C. Competition for a transport site by another drug
D. Unbinding a nonvolatile drug from plasma proteins

 

 

____  20.   Steady state is:

A. The point on the drug concentration curve when absorption exceeds excretion
B. When the amount of drug in the body remains constant
C. When the amount of drug in the body stays below the MTC
D. All of the above

 

 

____  21.   Two different pain meds are given together for pain relief. The drug-drug interaction is:

A. Synergistic
B. Antagonistic
C. Potentiative
D. Additive

 

 

____  22.   Actions taken to reduce drug-drug interaction problems include all of the following  EXCEPT:

A. Reducing the dose of one of the drugs
B. Scheduling their administration at different times
C. Prescribing a third drug to counteract the adverse reaction of the combination
D. Reducing the dosage of both drugs

 

 

____  23.   Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?

A. Protein malnutrition
B. Iron deficiency anemia
C. Both A and B
D. Neither A nor B

 

 

____  24.   The time required for the amount of drug in the body to decrease by 50% is called:

A. Steady state
B. Half-life
C. Phase II metabolism
D. Reduced bioavailability time

 

 

____  25.   An agonist activates a receptor and stimulates a response. When given frequently over time the body may:

A. Up-regulate the total number of receptors
B. Block the receptor with a partial agonist
C. Alter the drug’s metabolism
D. Down-regulate the numbers of that specific receptor

 

 

____  26.   Drug antagonism is best defined as an effect of a drug that:

A. Leads to major physiologic psychological dependence
B. Is modified by the concurrent administration of another drug
C. Cannot be metabolized before another dose is administered
D. Leads to a decreased physiologic response when combined with another drug

 

 

____  27.   Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements?

A. “Avoid any other oral medicines while taking this drug.”
B. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”
C. “The tablet may be crushed if you have any difficultly taking it.”
D. “To achieve best effect, take the tablet with at least 8 ounces of fluid.”

 

 

____  28.   The major reason for not crushing a sustained release capsule is that, if crushed, the coated beads of the drugs could possibly result in:

A. Disintegration
B. Toxicity
C. Malabsorption
D. Deterioration

 

 

____  29.   Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach?

A. Sodium bicarbonate
B. Ascorbic acid
C. Salicylic acid
D. Glucose

 

 

____  30.   Which of the following variables is a factor in drug absorption?

A. The smaller the surface area for absorption, the more rapidly the drug is absorbed.
B. A rich blood supply to the area of absorption leads to better absorption.
C. The less soluble the drug, the more easily it is absorbed.
D. Ionized drugs are easily absorbed across the cell membrane.

 

 

____  31.   An advantage of prescribing a sublingual medication is that the medication is:

A. Absorbed rapidly
B. Excreted rapidly
C. Metabolized minimally
D. Distributed equally

 

 

____  32.   Drugs that use CYP 3A4 isoenzymes for metabolism may:

A. Induce the metabolism of another drug
B. Inhibit the metabolism of another drug
C. Both A and B
D. Neither A nor B

 

 

____  33.   Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:

A. After the second dose
B. After four to five half-lives
C. When the patient feels the full effect of the drug
D. One hour after IV administration

 

 

____  34.   Up-regulation or hypersensitization may lead to:

A. Increased response to a drug
B. Decreased response to a drug
C. An exaggerated response if the drug is withdrawn
D. Refractoriness or complete lack of response

 

Chapter 2: Review of Basic Principles of Pharmacology

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

Chapter 12: Pharmacoeconomics

 

Multiple Choice

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

 

____    1.   Pharmacoeconomics is:

A. The study of the part of the U.S. economy devoted to drug use
B. The study of the impact of prescription drug costs on the overall economy
C. The analysis of the costs and consequences of any health care-related treatment or service
D. The analysis of the clinical efficacy of the drug

 

 

____    2.   The direct costs of drug therapy include:

A. The actual cost of acquiring the medication
B. The loss of income due to illness
C. Pain and suffering due to inadequate drug therapy
D. The cost of a funeral associated with premature death

 

 

____    3.   Indirect costs associated with drug therapy include:

A. The cost of diagnostic tests to monitor therapeutic levels
B. Health-care provider time to prescribe and educate the patient
C. Child-care expenses incurred while receiving therapy
D. Loss of wages while undergoing drug therapy

 

 

____    4.   The intangible costs of drug therapy include:

A. Loss of wages while undergoing therapy
B. Inconvenience, pain, and suffering incurred with therapy
C. Cost of medical equipment in the lab used to monitor therapeutic drug levels
D. Cost of prescription drug coverage, such as Medicare Part D

 

 

____    5.   When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as:

A. Cost-minimization analysis
B. Cost-of-illness analysis
C. Cost-effectiveness analysis
D. Cost-benefit analysis

 

 

____    6.   Cost-effectiveness analysis compares two or more treatments or programs that are:

A. Not necessarily therapeutically equivalent
B. Considered equal in efficacy
C. Compared with the dollar value of the benefit received
D. Expressed in terms of patient preference or quality-adjusted life years

 

 

____    7.   When the costs of a specific treatment or intervention are calculated and then compared with the dollar value of the benefit received it is referred to as:

A. Cost-minimization analysis
B. Cost-of-illness analysis
C. Cost-effectiveness analysis
D. Cost-benefit analysis

 

 

____    8.   Mary has a two-tiered prescription benefit plan, which means:

A. She can receive differing levels of care based on whether she chooses an “in-plan” provider or not
B. She is eligible for the new Medicare Part D “donut hole” reduction of costs program
C. She pays a higher copay for brand-name drugs than for generic drugs
D. She must always choose to be treated with generic drugs first

 

 

____    9.   Prescribing less expensive generic drugs or drugs off the $4 retail pharmacy lists:

A. Increases the complexity of the pharmacoeconomics of prescribing for the individual patient
B. Increases compliance by reducing the financial burden of drug costs to the patient
C. Is not sound prescribing practice due to the inferiority of the generic products
D. Will increase the overall cost of drugs to the system due to the ease of overprescribing less expensive drugs

 

 

____  10.   James tells you that he is confused by his Medicare Part D coverage plan. An appropriate intervention would be:

A. Order cognitive testing to determine the source of his confusion
B. Sit down with him and explain the whole Medicare Part D process
C. Refer him to the Medicare specialist in his insurance plan to explain the benefit to him
D. Request his son come to the next appointment so you can explain the benefit to him

 

 

____  11.   The “donut hole” in Medicare Part D:

A. Will be totally eliminated with the federal health-care reform enacted in 2010
B. Refers to the period of time when annual individual drug costs are between $250 and $2250 per year and drugs costs are covered 75%
C. Refers to the period between when the annual individual drug costs are $2250 and $5100 and the patient pays 50% of the costs of brand name drugs (2011)
D. Has no effect on whether patients continue to fill their prescriptions during the coverage gap

 

 

____  12.   Research has shown that when patients who are covered by Medicare Part D reach the “donut hole” in coverage they:

A. Ask for extra refills of medication to get them through the months of no coverage
B. Fill their prescriptions less, including critical medications such as warfarin or a statin
C. Fill their critical medications, but hold off on filling less critical medications
D. Demonstrate no change in their prescription filling pattern

 

Chapter 12: Pharmacoeconomics

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

 

Chapter 24: Drugs Used in Treating Infectious Diseases

 

Multiple Choice

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

 

____    1.   Factors that place a patient at risk of developing an antimicrobial resistant organism include:

A. Age over 50 years
B. School attendance
C. Travel within the United States
D. Inappropriate use of antimicrobials

 

 

____    2.   Infants and young children are at higher risk of developing antibiotic-resistant infections due to:

A. Developmental differences in pharmacokinetics of the antibiotics in children
B. Children this age are more likely to be in daycare and exposed to pathogens from other children
C. Parents of young children insist on preventive antibiotics so they don’t miss work when their child is sick
D. Immunosuppression from the multiple vaccines they receive in the first 2 years of life

 

 

____    3.   Providers should use an antibiogram when prescribing. An antibiogram is:

A. The other name for the Centers for Disease Control guidelines for prescribing antibiotics
B. An algorithm used for prescribing antibiotics for certain infections
C. The reference also known as the Pink Book, published by the Centers for Disease Control
D. A chart of the local resistance patterns to antibiotics developed by laboratories

 

 

____    4.   There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins due to:

A. Similar renal excretion of both classes of drugs
B. When these drug classes are metabolized in the liver they both produce resistant enzymes
C. Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase producing organisms
D. There is not an issue with cross-resistance between the penicillins and cephalosporins

 

 

____    5.   Jonathan has been diagnosed with strep throat and needs a prescription for an antibiotic. He says the last time he had penicillin he developed a red, blotchy rash. The appropriate antibiotic to prescribe would be:

A. Penicillin VK, since his rash does not sound like a serious rash
B. Amoxicillin
C. Cefadroxil (Duricef)
D. Erythromycin

 

 

____    6.   Sarah is a 25-year-old female who is 8 weeks pregnant and has a urinary tract infection. What would be the appropriate antibiotic to prescribe for her?

A. Ciprofloxacin (Cipro)
B. Amoxicillin (Trimox)
C. Doxycycline
D. Trimethoprim-sulfamethoxazole (Septra)

 

 

____    7.   Pong-tai is a 12 month old who is being treated with amoxicillin for acute otitis media. His parents call the clinic and say he has developed diarrhea. The appropriate action would be to:

A. Advise the parents that some diarrhea is normal with amoxicillin and try feeding him yogurt daily
B. Change the antibiotic to one that is less of a gastrointestinal irritant
C. Order stool cultures for suspected viral pathogens not treated by the amoxicillin
D. Recommend increased fluids and fiber in his diet

 

 

____    8.   Lauren is a 13 year old who comes to clinic with a 4-day history of cough, low grade fever, and rhinorrhea. When she blows her nose or coughs the mucous is greenish-yellow. The appropriate antibiotic to prescribe would be:

A. Amoxicillin
B. Amoxicillin/clavulanate
C. TMP/SMZ (Septra)
D. None

 

 

____    9.   Joanna had a small ventricle septal defect (VSD) repaired when she was 3 years old and has no residual cardiac problems. She is now 28 and is requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American College of Cardiology and the American Heart Association guidelines is:

A. No antibiotic required for dental procedures
B. Amoxicillin 2 grams 1 hour before the procedure
C. Ampicillin 2 grams IM or IV 30 minutes before the procedure
D. Azithromycin 1 gram 1 hour before the procedure

 

 

____  10.   To prevent further development of antibacterial resistance it is recommended fluoroquinolones be reserved for treatment of:

A. Urinary tract infections in young women
B. Upper respiratory infections in adults
C. Skin and soft tissue infections in adults
D. Community-acquired pneumonia in patients with comorbidities

 

 

____  11.   Fluoroquinolones have a Black Box warning regarding ____ even months after treatment.

A. Renal dysfunction
B. Hepatic toxicity
C. Tendon rupture
D. Development of glaucoma

 

 

____  12.   Janet was recently treated with clindamycin for an infection. She calls the advice nurse because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?

A. Encourage increased fluids and fiber
B. Assess for pseudomembranous colitis
C. Advise her to eat yogurt daily to help restore her gut bacteria
D. Start her on an antidiarrheal medication

 

 

____  13.   Keng has chronic hepatitis that has led to mildly impaired liver function. He has an infection that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction?

A. Azithromycin (Zithromax)
B. Clarithromycin (Biaxin)
C. Erythromycin (E-mycin)
D. None of the above

 

 

____  14.   Jamie has glucose-6-phosphate dehydrogenase deficiency (G6PD) and requires an antibiotic. Which class of antibiotics should be avoided in this patient?

A. Penicillins
B. Macrolides
C. Cephalosporins
D. Sulfonamides

 

 

____  15.   If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-sensitivity to:

A. Loop diuretics
B. Sulfonylureas
C. Thiazide diuretics
D. All of the above

 

 

____  16.   Tetracyclines such as minocycline are safe to use in:

A. Pregnant women
B. Adolescents
C. Patients with renal dysfunction
D. Patients with hepatic dysfunction

 

 

____  17.   Tetracyclines should not be prescribed to children younger than 8 years due to:

A. Risk of developing cartilage problems
B. Development of significant diarrhea
C. Risk of kernicterus
D. Adverse effects on bone growth

 

 

____  18.   Nicole is a 16 year old who is taking minocycline for acne. She comes to the clinic complaining of a headache. What would be the plan of care?

A. Advise acetaminophen or ibuprofen as needed for headaches
B. Prescribe sumatriptan (Imitrex) to be taken at the onset of the headache
C. Evaluate for pseudotremor cerebri
D. Assess her caffeine intake and sleep patterns

 

 

____  19.   Patricia has been prescribed doxycycline for a Chlamydia infection. She is healthy and her only medication is an oral combined contraceptive. Patricia’s education would include:

A. Use a back-up method of birth control (condom) until her next menses
B. Doxycycline may cause tendonitis and she should report any joint pain
C. Her partner will need treatment if her infection doesn’t clear with the doxycycline
D. Doxycycline is used for one dose treatment of STIs; take the whole prescription at once

 

 

____  20.   To prevent the development of peripheral neuropathy in patients taking isoniazid for tuberculosis the patient is also prescribed:

A. Niacin (Vitamin B3)
B. Pyridoxine (Vitamin B6)
C. Riboflavin (Vitamin B2)
D. Thiamine (Vitamin B1)

 

 

____  21.   Sadie is an 82-year-old patient who has herpes zoster (shingles) and would benefit from an antiviral such as valacyclovir. Prior to prescribing valacyclovir she will need assessment of:

A. Complete blood count to rule out anemia
B. Liver function
C. Renal function
D. Immunocompetence

 

 

____  22.   When prescribing acyclovir, patients should be educated regarding:

A. High risk of developing diarrhea
B. Need to drink lots of fluids during treatment
C. Risk for life-threatening rash such as Stevens-Johnson
D. Eccentric dosing schedule

 

 

____  23.   Nicholas has been diagnosed with Type A influenza. Appropriate prescribing of oseltamivir (Tamiflu) would include:

A. Starting oseltamivir within the first 48 hours of influenza symptoms
B. Advising the patient he can stop the oseltamivir when his symptoms resolve
C. Educating the patient that oseltamivir will cure influenza
D. Prophylactic treatment of all family members

 

 

____  24.   Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes:

A. Platelet count
B. BUN and creatinine
C. White blood cell count
D. AST, ALT, alkaline phosphatase, and bilirubin

 

 

____  25.   When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would include:

A. Metronidazole is safe in the first trimester of pregnancy
B. Consuming alcohol in any form may cause a severe reaction
C. Sexual partners need concurrent therapy
D. Headaches are a sign of a serious adverse reaction and need immediate evaluation

 

 

True/False

Indicate whether the statement is true or false.

 

____    1.   As of 2011 every antibiotic drug class has resistant organisms which influence prescribing decisions.

 

 

Chapter 24: Drugs Used in Treating Infectious Diseases

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

TRUE/FALSE

 

  1. ANS:  T                    PTS:   1

 

 

Chapter 36: Heart Failure

 

Multiple Choice

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

 

____       1.   ACE inhibitors are a central part of the treatment of heart failure because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes in heart failure is NOT addressed by ACE inhibitors?

A. Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently.
B. Reduced formation of cross-bridges so that contractile force decreases.
C. Activation of the sympathetic nervous system that increases heart rate and preload.
D. Decreased renal blood flow that decreases oxygen supply to the kidneys.

 

 

____       2.   One of the three types of heart failure involves systolic dysfunction. Potential causes of this most common form of heart failure include:

A. Myocardial ischemia and injury secondary to myocardial infarction
B. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction
C. Increased demands of the heart beyond its ability to adapt secondary to anemia
D. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension

 

 

____       3.   The American Heart Association and the American College of Cardiology have devised a classification system for heart failure that can be used to direct treatment. Patients with symptoms and underlying disease are classified as:

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

 

 

____       4.   Diagnosis of heart failure cannot be made by symptoms alone since many disorders share the same symptoms. The most specific and sensitive diagnostic test for heart failure is:

A. Chest x-rays that show cephalization and measure heart size
B. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction
C. Complete blood count, BUN, and serum electrolytes that facilitate staging for end-organ damage
D. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction

 

 

____       5.   Treatments for heart failure, including drug therapy, are based on the stages developed by the ACC/AHA. Stage A patients are treated with:

A. Drugs for hypertension and hyperlipidemia, if they exist
B. Lifestyle management including diet, exercise, and smoking cessation only
C. ACE inhibitors to directly affect the heart failure only
D. No drugs are used in this early stage

 

 

____       6.   Class I recommendations for Stage A heart failure include:

A. Aerobic exercise within tolerance levels to prevent the development of heart failure
B. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention
C. Beta blockers for all patients regardless of cardiac history
D. Treatment of thyroid disorders, especially if they are associated with tachyarrhythmias

 

 

____       7.   Stage B patients should have beta blockers added to their heart failure treatment regimen when:

A. They have an ejection fraction less than 40%
B. They have had a recent MI
C. Both A and B
D. Neither A nor B

 

 

____       8.   Increased life expectancy for patients with heart failure has been associated with the use of:

A. ACE inhibitors, especially when started early in the disease process
B. All beta blockers regardless of selectivity
C. Thiazide and Loop diuretics
D. Cardiac glycosides

 

 

____       9.   Stage C patients usually require a combination of three to four drugs to manage their heart failure. In addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true?

A. Diuretics reduce preload associated with fluid retention.
B. Diuretics can be used earlier than Stage C when the goal is control of hypertension.
C. Diuretics may produce problems with electrolyte imbalances and abnormal glucose and lipid metabolism.
D. Diuretics from the potassium-sparing class should be used when using an ARB.

 

 

____     10.   Digoxin has a very limited role in treatment of heart failure. It is used mainly for patients with:

A. Ejection fractions above 40%
B. An audible S3
C. Mitral stenosis as a primary cause for heart failure
D. Renal insufficiency

 

 

____     11.   Which of the following classes of drugs is contraindicated in heart failure?

A. Nitrates
B. Long-acting dihydropyridines
C. Calcium channel blockers
D. Alpha-beta blockers

 

 

____     12.   Heart failure is a leading cause of death and hospitalization in older adults (greater than 65 years old). The drug of choice for this population is:

A. Aldosterone antagonists
B. Eplerenone
C. ACE inhibitors
D. ARBs

 

 

____     13.   ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes are considered to be safe, at least in the later parts of pregnancy?

A. Diuretics
B. ARBs
C. Beta blockers
D. Nitrates

 

 

____     14.   Heart failure is a chronic condition that can be adequately managed in primary care. However, consultation with or referral to a cardiologist is appropriate when:

A. Symptoms markedly worsen or the patient becomes hypotensive and has syncope
B. There is evidence of progressive renal insufficiency or failure
C. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic
D. Any of the above

 

Chapter 36: Heart Failure

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:   C                     PTS:    1

 

  1. ANS:   A                     PTS:    1

 

  1. ANS:   C                     PTS:    1

 

  1. ANS:   B                     PTS:    1

 

  1. ANS:   A                     PTS:    1

 

  1. ANS:   D                     PTS:    1

 

  1. ANS:   C                     PTS:    1

 

  1. ANS:   A                     PTS:    1

 

  1. ANS:   D                     PTS:    1

 

  1. ANS:   B                     PTS:    1

 

  1. ANS:   C                     PTS:    1

 

  1. ANS:   C                     PTS:    1

 

  1. ANS:   C                     PTS:    1

 

  1. ANS:   D                     PTS:    1

 

 

Chapter 50: Pediatric Patients

 

Multiple Choice

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

 

____    1.   The Pediatric Research Equity Acts requires:

A. All children be provided equal access to drug research trials
B. Children to be included in the planning phase of new drug development
C. That pediatric drug trials guarantee children of multiple ethnic groups are included
D. All applications for new active ingredients, new indications, new dosage forms, or new routes of administration require pediatric studies

 

 

____    2.   The Best Pharmaceuticals for Children Act:

A. Includes a pediatric exclusivity rule which extends the patent on drugs studied in children
B. Establishes a committee that writes guidelines for pediatric prescribing
C. Provides funding for new drug development aimed at children
D. Encourages manufacturers specifically to develop pediatric formulations

 

 

____    3.   The developmental variation in Phase I enzymes has what impact on pediatric prescribing?

A. None, Phase I enzymes are stable throughout childhood.
B. Children should always be prescribed lower than adult doses per weight due to low enzyme activity until puberty.
C. Children should always be prescribed higher than adult doses per weight due to high enzyme activity.
D. Prescribing dosages will vary based on the developmental activity of each enzyme, at times requiring lower than adult doses and other times higher than adult doses based on the age of the child.

 

 

____    4.   Developmental variation in renal function has what impact on prescribing for infants and children?

A. Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months.
B. Higher doses of water soluble drugs may need to be prescribed due to increased renal excretion.
C. Renal excretion rates have no impact on prescribing.
D. Parents need to be instructed on whether drugs are renally excreted or not.

 

 

____    5.   Topical corticosteroids are prescribed cautiously in young children due to:

A. They may cause an intense hypersensitivity reaction
B. Hypothalamic-pituitary-adrenal (HPA) axis suppression
C. Corticosteroids are less effective in young children
D. Young children may accumulate corticosteroids leading to toxic levels

 

 

____    6.   Liza is breastfeeding her 2-month-old son and has an infection that requires an antibiotic. What drug factors influence the effect of the drug on the infant?

A. Maternal drug levels
B. Half-life
C. Lipid-solubility
D. All of the above

 

 

____    7.   Drugs that are absolutely contraindicated in lactating women include:

A. Selective serotonin reuptake inhibitors
B. Antiepileptic drugs such as carbamazepine
C. Antineoplastic drugs such as methotrexate
D. All of the above

 

 

____    8.   Zia is a 4 month old with otitis media. Education of his parents regarding administering oral antibiotics to an infant includes:

A. How to administer an oral drug using a medication syringe
B. Mixing the medication with a couple ounces of formula and putting it in a bottle
C. Discontinuing the antibiotic if diarrhea occurs
D. Calling for an antibiotic change if the infant chokes and sputters during administration

 

 

____    9.   To increase adherence in pediatric patients a prescription medication should:

A. Have a short half-life
B. Be the best tasting of the effective drugs
C. Be the least concentrated form of the medication
D. Be administered 3 or 4 times a day

 

 

____  10.   Janie is a 5-month-old breastfed infant with a fever. Treatment for her fever may include:

A. “Baby” aspirin
B. Acetaminophen suppository
C. Ibuprofen suppository
D. Alternating acetaminophen and ibuprofen

 

Chapter 50: Pediatric Patients

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  D                    PTS:   1

 

  1. ANS:  C                    PTS:   1

 

  1. ANS:  A                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

  1. ANS:  B                    PTS:   1

 

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