Approach 4th Edition Test Bank

Pharmacotherapeutics For Advanced Practice A Practical Approach 4th Edition Test Bank Chapter 1 Issues for the Practitioner in Drug Therapy

MULTIPLE CHOICE

1. Nurse practitioner prescriptive authority is regulated by:

• The National Council of State Boards of Nursing
• The U.S. Drug Enforcement Administration
• The State Board of Nursing for each state
• The State Board of Pharmacy

ANS: C PTS: 1

2. Physician Assistant (PA) prescriptive authority is regulated by:

• The National Council of State Boards of Nursing
• The U.S. Drug Enforcement Administration
• The State Board of Nursing
• The State Board of Medical Examiners

ANS: D PTS: 1

3. Clinical judgment in prescribing includes:

• Factoring in the cost to the patient of the medication prescribed
• Always prescribing the newest medication available for the disease process
• Handing out drug samples to poor patients
• Prescribing all generic medications to cut costs

ANS: A PTS: 1

4. Criteria for choosing an effective drug for a disorder include:

• Asking the patient what drug they think would work best for them
• Consulting nationally recognized guidelines for disease management
• Prescribing medications that are available as samples before writing a prescription
• Following U.S. Drug Enforcement Administration (DEA) guidelines for

prescribing

ANS: B PTS: 1

5. Nurse practitioner practice may thrive under health-care reform due to:

• The demonstrated ability of nurse practitioners to control costs and improve patient

outcomes

• The fact that nurse practitioners will be able to practice independently
• The fact that nurse practitioners will have full reimbursement under health-care

reform

• The ability to shift accountability for Medicaid to the state level

ANS: A PTS: 1 1 / 4

Chapter 2.Pharmacokinetic Basis of Therapeutics and Pharmacodynamic

MULTIPLE CHOICE

• A patient’s nutritional intake and lab work reflects hypoalbuminemia. This is critical to

prescribing because:

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

ANS: A PTS: 1

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

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

ANS: C PTS: 1

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

• The kidneys
• The lungs
• The bile and feces
• The skin

ANS: B PTS: 1

• Medroxyprogesterone (Depo Provera) is prescribed IM to create a storage reservoir of the

drug. Storage reservoirs:

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

ANS: C PTS: 1

• The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:
• Propensity to go to the target receptor
• Biological half-life
• Pharmacodynamics
• Safety and side effects

ANS: B PTS: 1

• 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:

• Rapidly achieves drug levels in the therapeutic range
• Requires four to five half-lives to attain
• Is influenced by renal function 2 / 4

• Is directly related to the drug circulating to the target tissues

ANS: A PTS: 1

• The point in time on the drug concentration curve that indicates the first sign of a therapeutic

effect is the:

• Minimum adverse effect level
• Peak of action
• Onset of action
• Therapeutic range

ANS: C PTS: 1

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

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

ANS: D PTS: 1

• A laboratory result indicates the peak level for a drug is above the minimum toxic

concentration. This means that the:

• Concentration will produce therapeutic effects
• Concentration will produce an adverse response
• Time between doses must be shortened
• Duration of action of the drug is too long

ANS: B PTS: 1

• Drugs that are receptor agonists may demonstrate what property?
• Irreversible binding to the drug receptor site
• Up-regulation with chronic use
• Desensitization or down-regulation with continuous use
• Inverse relationship between drug concentration and drug action

ANS: C PTS: 1

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

• Down-regulation of the drug receptor
• An exaggerated response if abruptly discontinued
• Partial blockade of the effects of agonist drugs
• An exaggerated response to competitive drug agonists

ANS: B PTS: 1

12. Factors that affect gastric drug absorption include:

• Liver enzyme activity
• Protein-binding properties of the drug molecule
• Lipid solubility of the drug
• Ability to chew and swallow

ANS: C PTS: 1 3 / 4

13. Drugs administered via intravenous (IV) route:

• Need to be lipid soluble in order to be easily absorbed
• Begin distribution into the body immediately
• Are easily absorbed if they are nonionized
• May use pinocytosis to be absorbed

ANS: B PTS: 1

• When a medication is added to a regimen for a synergistic effect, the combined effect of the

drugs is:

• The sum of the effects of each drug individually
• Greater than the sum of the effects of each drug individually
• Less than the effect of each drug individually
• Not predictable, as it varies with each individual

ANS: B PTS: 1

• Which of the following statements about bioavailability is true?
• Bioavailability issues are especially important for drugs with narrow therapeutic

ranges or sustained release mechanisms.

• All brands of a drug have the same bioavailability.
• Drugs that are administered more than once a day have greater bioavailability than

drugs given once daily.

• Combining an active drug with an inert substance does not affect bioavailability.

ANS: A PTS: 1

• Which of the following statements about the major distribution barriers (blood-brain or fetal-

placental) is true?

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

ANS: B PTS: 1

• 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:

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

ANS: C PTS: 1

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

• More active than the parent drug
• Less active than the parent drug
• Totally “deactivated” so that they are excreted without any effect
• All of the above

ANS: D PTS: 1

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