Chapter 1: The Role of the Nurse Practitioner as Prescriber

Nurse practitioner prescriptive authority is regulated by:

A.The   National Council of State Boards of Nursing

B.The   U.S. Drug Enforcement Administration

C.The State Board of Nursing for each   state

D.The   State Board of Pharmacy

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

A.The   National Council of State Boards of Nursing

B.The   U.S. Drug Enforcement Administration

C.The   State Board of Nursing

D.The State Board of Medical Examiners

____ 3. Clinical judgment in prescribing includes:

A.Factoring in the cost to the patient   of the medication prescribed

B.Always   prescribing the newest medication available for the disease process

C.Handing   out drug samples to poor patients

D.Prescribing   all generic medications to cut costs

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

A.Asking   the patient what drug they think would work best for them

B.Consulting nationally recognized   guidelines for disease management

C.Prescribing   medications that are available as samples before writing a prescription

D.Following   U.S. Drug Enforcement Administration (DEA) guidelines for prescribing

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

A.The demonstrated ability of nurse   practitioners to control costs and improve patient outcomes

B.The fact   that nurse practitioners will be able to practice independently

C.The   fact that nurse practitioners will have full reimbursement under health-care   reform

D.The   ability to shift accountability for Medicaid to the state level

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.Antagonist

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 anemi

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