lOMoARcPSD|32744169
lOMoARcPSD|32744169
Chapter 1 Issues for the Practitioner in Drug Therapy
MULTIPLE CHOICE
1. 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
Pharmacotherapeutics for advanced practice a practical
ANS: C PTS: 1
2. Physician Assistant (PA) prescriptive authority is regulated by:
approach 5th edition test bank A. The National Council of State Boards of Nursing
B. The U.S. Drug Enforcement Administration
C. The State Board of Nursing
Pharmacology for Nurses (Mercy College) D. The State Board of Medical Examiners
ANS: D PTS: 1
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
ANS: A PTS: 1
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
ANS: B PTS: 1
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
ANS: A PTS: 1
, lOMoARcPSD|32744169 lOMoARcPSD|32744169
Chapter 2.Pharmacokinetic Basis of Therapeutics and Pharmacodynamic D. Is directly related to the drug circulating to the target tissues
ANS: A PTS: 1
MULTIPLE CHOICE
7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic
1. A patient’s nutritional intake and lab work reflects hypoalbuminemia. This is critical to
effect is the:
A. Minimum adverse effect level
prescribing because:
B. Peak of action
A. Distribution of drugs to target tissue may be affected
C. Onset of action
B. The solubility of the drug will not match the site of absorption
D. Therapeutic range
C. There will be less free drug available to generate an effect
D. Drugs bound to albumin are readily excreted by the kidney ANS: C PTS: 1
ANS: A PTS: 1
8. Phenytoin requires a trough level be drawn. Peak and trough levels are done:
A. When the drug has a wide therapeutic range
2. Drugs that have a significant first-pass effect:
B. When the drug will be administered for a short time only
A. Must be given by the enteral (oral) route only
C. When there is a high correlation between the dose and saturation of receptor sites
B. Bypass the hepatic circulation
D. To determine if a drug is in the therapeutic range
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 ANS: D PTS: 1
ANS: C PTS: 1
9. A laboratory result indicates the peak level for a drug is above the minimum toxic
3. The route of excretion of a volatile drug will likely be:
concentration. This means that the:
A. Concentration will produce therapeutic effects
A. The kidneys
B. Concentration will produce an adverse response
B. The lungs
C. Time between doses must be shortened
C. The bile and feces
D. Duration of action of the drug is too long
D. The skin
ANS: B PTS: 1
ANS: B PTS: 1
10. Drugs that are receptor agonists may demonstrate what property?
4. Medroxyprogesterone (Depo Provera) is prescribed IM to create a storage reservoir of the
A. Irreversible binding to the drug receptor site
drug. Storage reservoirs:
B. Up-regulation with chronic use
A. Assure that the drug will reach its intended target tissue
C. Desensitization or down-regulation with continuous use
B. Are the reason for giving loading doses
D. Inverse relationship between drug concentration and drug action
C. Increase the length of time a drug is available and active
D. Are most common in collagen tissues ANS: C PTS: 1
ANS: C PTS: 1
11. Drugs that are receptor antagonists, such as beta blockers, may cause:
A. Down-regulation of the drug receptor
5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:
B. An exaggerated response if abruptly discontinued
A. Propensity to go to the target receptor
C. Partial blockade of the effects of agonist drugs
B. Biological half-life
D. An exaggerated response to competitive drug agonists
C. Pharmacodynamics
D. Safety and side effects ANS: B PTS: 1
ANS: B PTS: 1
12. Factors that affect gastric drug absorption include:
A. Liver enzyme activity
6. Azithromycin dosing requires the first day’s dose be twice those of the other 4 days of the
B. Protein-binding properties of the drug molecule
prescription. This is considered a loading dose. A loading dose:
C. Lipid solubility of the drug
A. Rapidly achieves drug levels in the therapeutic range
D. Ability to chew and swallow
B. Requires four to five half-lives to attain
C. Is influenced by renal function ANS: C PTS: 1
, lOMoARcPSD|32744169 lOMoARcPSD|32744169
13. Drugs administered via intravenous (IV) route: 19. All drugs continue to act in the body until they are changed or excreted. The ability of the
A. Need to be lipid soluble in order to be easily absorbed body to excrete drugs via the renal system would be increased by:
B. Begin distribution into the body immediately A. Reduced circulation and perfusion of the kidney
C. Are easily absorbed if they are nonionized B. Chronic renal disease
D. May use pinocytosis to be absorbed C. Competition for a transport site by another drug
D. Unbinding a nonvolatile drug from plasma proteins
ANS: B PTS: 1
ANS: D PTS: 1
14. When a medication is added to a regimen for a synergistic effect, the combined effect of the
drugs is: 20. Steady state is:
A. The sum of the effects of each drug individually A. The point on the drug concentration curve when absorption exceeds excretion
B. Greater than the sum of the effects of each drug individually B. When the amount of drug in the body remains constant
C. Less than the effect of each drug individually C. When the amount of drug in the body stays below the MTC
D. Not predictable, as it varies with each individual D. All of the above
ANS: B PTS: 1 ANS: B PTS: 1
15. Which of the following statements about bioavailability is true? 21. Two different pain meds are given together for pain relief. The drug-drug interaction is:
A. Bioavailability issues are especially important for drugs with narrow therapeutic A. Synergistic
ranges or sustained release mechanisms. B. Antagonistic
B. All brands of a drug have the same bioavailability. C. Potentiative
C. Drugs that are administered more than once a day have greater bioavailability than D. Additive
drugs given once daily.
ANS: D PTS: 1
D. Combining an active drug with an inert substance does not affect bioavailability.
ANS: A PTS: 1 22. Actions taken to reduce drug-drug interaction problems include all of the following
EXCEPT:
16. Which of the following statements about the major distribution barriers (blood-brain or A. Reducing the dose of one of the drugs
fetal-placental) is true? B. Scheduling their administration at different times
A. Water soluble and ionized drugs cross these barriers rapidly. C. Prescribing a third drug to counteract the adverse reaction of the combination
B. The blood-brain barrier slows the entry of many drugs into and from brain cells. D. Reducing the dosage of both drugs
C. The fetal-placental barrier protects the fetus from drugs taken by the mother.
ANS: C PTS: 1
D. Lipid soluble drugs do not pass these barriers and are safe for pregnant women.
ANS: B PTS: 1 23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements.
Which of the following would reduce or inhibit this process?
17. Drugs are metabolized mainly by the liver via Phase I or Phase II reactions. The purpose of A. Protein malnutrition
both of these types of reactions is to: B. Iron deficiency anemia
A. Inactivate prodrugs before they can be activated by target tissues C. Both A and B
B. Change the drugs so they can cross plasma membranes D. Neither A nor B
C. Change drug molecules to a form that an excretory organ can excrete
ANS: D PTS: 1
D. Make these drugs more ionized and polar to facilitate excretion
ANS: C PTS: 1 24. The time required for the amount of drug in the body to decrease by 50% is called:
A. Steady state
18. Once they have been metabolized by the liver, the metabolites may be: B. Half-life
A. More active than the parent drug C. Phase II metabolism
B. Less active than the parent drug D. Reduced bioavailability time
C. Totally “deactivated” so that they are excreted without any effect
ANS: B PTS: 1
D. All of the above
ANS: D PTS: 1
, lOMoARcPSD|32744169 lOMoARcPSD|32744169
25. An agonist activates a receptor and stimulates a response. When given frequently over time A. Absorbed rapidly
the body may: B. Excreted rapidly
A. Up-regulate the total number of receptors C. Metabolized minimally
B. Block the receptor with a partial agonist D. Distributed equally
C. Alter the drug’s metabolism
ANS: A PTS: 1
D. Down-regulate the numbers of that specific receptor
ANS: D PTS: 1 32. Drugs that use CYP 3A4 isoenzymes for metabolism may:
A. Induce the metabolism of another drug
26. Drug antagonism is best defined as an effect of a drug that: B. Inhibit the metabolism of another drug
A. Leads to major physiologic psychological dependence C. Both A and B
B. Is modified by the concurrent administration of another drug D. Neither A nor B
C. Cannot be metabolized before another dose is administered
ANS: C PTS: 1
D. Leads to a decreased physiologic response when combined with another drug
ANS: B PTS: 1 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
A. After the second dose
27. Instructions to a client regarding self-administration of oral enteric-coated tablets should B. After four to five half-lives
include which of the following statements? C. When the patient feels the full effect of the drug
A. “Avoid any other oral medicines while taking this drug.” D. One hour after IV administration
B. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”
ANS: B PTS: 1
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.”
34. Up-regulation or hypersensitization may lead to:
ANS: D PTS: 1 A. Increased response to a drug
B. Decreased response to a drug
28. The major reason for not crushing a sustained release capsule is that, if crushed, the coated C. An exaggerated response if the drug is withdrawn
beads of the drugs could possibly result in: D. Refractoriness or complete lack of response
A. Disintegration
ANS: C PTS: 1
B. Toxicity
C. Malabsorption
D. Deterioration
ANS: B PTS: 1
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
ANS: A PTS: 1
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.
ANS: B PTS: 1
31. An advantage of prescribing a sublingual medication is that the medication is:
lOMoARcPSD|32744169
Chapter 1 Issues for the Practitioner in Drug Therapy
MULTIPLE CHOICE
1. 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
Pharmacotherapeutics for advanced practice a practical
ANS: C PTS: 1
2. Physician Assistant (PA) prescriptive authority is regulated by:
approach 5th edition test bank A. The National Council of State Boards of Nursing
B. The U.S. Drug Enforcement Administration
C. The State Board of Nursing
Pharmacology for Nurses (Mercy College) D. The State Board of Medical Examiners
ANS: D PTS: 1
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
ANS: A PTS: 1
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
ANS: B PTS: 1
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
ANS: A PTS: 1
, lOMoARcPSD|32744169 lOMoARcPSD|32744169
Chapter 2.Pharmacokinetic Basis of Therapeutics and Pharmacodynamic D. Is directly related to the drug circulating to the target tissues
ANS: A PTS: 1
MULTIPLE CHOICE
7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic
1. A patient’s nutritional intake and lab work reflects hypoalbuminemia. This is critical to
effect is the:
A. Minimum adverse effect level
prescribing because:
B. Peak of action
A. Distribution of drugs to target tissue may be affected
C. Onset of action
B. The solubility of the drug will not match the site of absorption
D. Therapeutic range
C. There will be less free drug available to generate an effect
D. Drugs bound to albumin are readily excreted by the kidney ANS: C PTS: 1
ANS: A PTS: 1
8. Phenytoin requires a trough level be drawn. Peak and trough levels are done:
A. When the drug has a wide therapeutic range
2. Drugs that have a significant first-pass effect:
B. When the drug will be administered for a short time only
A. Must be given by the enteral (oral) route only
C. When there is a high correlation between the dose and saturation of receptor sites
B. Bypass the hepatic circulation
D. To determine if a drug is in the therapeutic range
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 ANS: D PTS: 1
ANS: C PTS: 1
9. A laboratory result indicates the peak level for a drug is above the minimum toxic
3. The route of excretion of a volatile drug will likely be:
concentration. This means that the:
A. Concentration will produce therapeutic effects
A. The kidneys
B. Concentration will produce an adverse response
B. The lungs
C. Time between doses must be shortened
C. The bile and feces
D. Duration of action of the drug is too long
D. The skin
ANS: B PTS: 1
ANS: B PTS: 1
10. Drugs that are receptor agonists may demonstrate what property?
4. Medroxyprogesterone (Depo Provera) is prescribed IM to create a storage reservoir of the
A. Irreversible binding to the drug receptor site
drug. Storage reservoirs:
B. Up-regulation with chronic use
A. Assure that the drug will reach its intended target tissue
C. Desensitization or down-regulation with continuous use
B. Are the reason for giving loading doses
D. Inverse relationship between drug concentration and drug action
C. Increase the length of time a drug is available and active
D. Are most common in collagen tissues ANS: C PTS: 1
ANS: C PTS: 1
11. Drugs that are receptor antagonists, such as beta blockers, may cause:
A. Down-regulation of the drug receptor
5. The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:
B. An exaggerated response if abruptly discontinued
A. Propensity to go to the target receptor
C. Partial blockade of the effects of agonist drugs
B. Biological half-life
D. An exaggerated response to competitive drug agonists
C. Pharmacodynamics
D. Safety and side effects ANS: B PTS: 1
ANS: B PTS: 1
12. Factors that affect gastric drug absorption include:
A. Liver enzyme activity
6. Azithromycin dosing requires the first day’s dose be twice those of the other 4 days of the
B. Protein-binding properties of the drug molecule
prescription. This is considered a loading dose. A loading dose:
C. Lipid solubility of the drug
A. Rapidly achieves drug levels in the therapeutic range
D. Ability to chew and swallow
B. Requires four to five half-lives to attain
C. Is influenced by renal function ANS: C PTS: 1
, lOMoARcPSD|32744169 lOMoARcPSD|32744169
13. Drugs administered via intravenous (IV) route: 19. All drugs continue to act in the body until they are changed or excreted. The ability of the
A. Need to be lipid soluble in order to be easily absorbed body to excrete drugs via the renal system would be increased by:
B. Begin distribution into the body immediately A. Reduced circulation and perfusion of the kidney
C. Are easily absorbed if they are nonionized B. Chronic renal disease
D. May use pinocytosis to be absorbed C. Competition for a transport site by another drug
D. Unbinding a nonvolatile drug from plasma proteins
ANS: B PTS: 1
ANS: D PTS: 1
14. When a medication is added to a regimen for a synergistic effect, the combined effect of the
drugs is: 20. Steady state is:
A. The sum of the effects of each drug individually A. The point on the drug concentration curve when absorption exceeds excretion
B. Greater than the sum of the effects of each drug individually B. When the amount of drug in the body remains constant
C. Less than the effect of each drug individually C. When the amount of drug in the body stays below the MTC
D. Not predictable, as it varies with each individual D. All of the above
ANS: B PTS: 1 ANS: B PTS: 1
15. Which of the following statements about bioavailability is true? 21. Two different pain meds are given together for pain relief. The drug-drug interaction is:
A. Bioavailability issues are especially important for drugs with narrow therapeutic A. Synergistic
ranges or sustained release mechanisms. B. Antagonistic
B. All brands of a drug have the same bioavailability. C. Potentiative
C. Drugs that are administered more than once a day have greater bioavailability than D. Additive
drugs given once daily.
ANS: D PTS: 1
D. Combining an active drug with an inert substance does not affect bioavailability.
ANS: A PTS: 1 22. Actions taken to reduce drug-drug interaction problems include all of the following
EXCEPT:
16. Which of the following statements about the major distribution barriers (blood-brain or A. Reducing the dose of one of the drugs
fetal-placental) is true? B. Scheduling their administration at different times
A. Water soluble and ionized drugs cross these barriers rapidly. C. Prescribing a third drug to counteract the adverse reaction of the combination
B. The blood-brain barrier slows the entry of many drugs into and from brain cells. D. Reducing the dosage of both drugs
C. The fetal-placental barrier protects the fetus from drugs taken by the mother.
ANS: C PTS: 1
D. Lipid soluble drugs do not pass these barriers and are safe for pregnant women.
ANS: B PTS: 1 23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements.
Which of the following would reduce or inhibit this process?
17. Drugs are metabolized mainly by the liver via Phase I or Phase II reactions. The purpose of A. Protein malnutrition
both of these types of reactions is to: B. Iron deficiency anemia
A. Inactivate prodrugs before they can be activated by target tissues C. Both A and B
B. Change the drugs so they can cross plasma membranes D. Neither A nor B
C. Change drug molecules to a form that an excretory organ can excrete
ANS: D PTS: 1
D. Make these drugs more ionized and polar to facilitate excretion
ANS: C PTS: 1 24. The time required for the amount of drug in the body to decrease by 50% is called:
A. Steady state
18. Once they have been metabolized by the liver, the metabolites may be: B. Half-life
A. More active than the parent drug C. Phase II metabolism
B. Less active than the parent drug D. Reduced bioavailability time
C. Totally “deactivated” so that they are excreted without any effect
ANS: B PTS: 1
D. All of the above
ANS: D PTS: 1
, lOMoARcPSD|32744169 lOMoARcPSD|32744169
25. An agonist activates a receptor and stimulates a response. When given frequently over time A. Absorbed rapidly
the body may: B. Excreted rapidly
A. Up-regulate the total number of receptors C. Metabolized minimally
B. Block the receptor with a partial agonist D. Distributed equally
C. Alter the drug’s metabolism
ANS: A PTS: 1
D. Down-regulate the numbers of that specific receptor
ANS: D PTS: 1 32. Drugs that use CYP 3A4 isoenzymes for metabolism may:
A. Induce the metabolism of another drug
26. Drug antagonism is best defined as an effect of a drug that: B. Inhibit the metabolism of another drug
A. Leads to major physiologic psychological dependence C. Both A and B
B. Is modified by the concurrent administration of another drug D. Neither A nor B
C. Cannot be metabolized before another dose is administered
ANS: C PTS: 1
D. Leads to a decreased physiologic response when combined with another drug
ANS: B PTS: 1 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
A. After the second dose
27. Instructions to a client regarding self-administration of oral enteric-coated tablets should B. After four to five half-lives
include which of the following statements? C. When the patient feels the full effect of the drug
A. “Avoid any other oral medicines while taking this drug.” D. One hour after IV administration
B. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”
ANS: B PTS: 1
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.”
34. Up-regulation or hypersensitization may lead to:
ANS: D PTS: 1 A. Increased response to a drug
B. Decreased response to a drug
28. The major reason for not crushing a sustained release capsule is that, if crushed, the coated C. An exaggerated response if the drug is withdrawn
beads of the drugs could possibly result in: D. Refractoriness or complete lack of response
A. Disintegration
ANS: C PTS: 1
B. Toxicity
C. Malabsorption
D. Deterioration
ANS: B PTS: 1
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
ANS: A PTS: 1
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.
ANS: B PTS: 1
31. An advantage of prescribing a sublingual medication is that the medication is:
