Test Bank For Lehnes Pharmacotherapeutics for Advanced
Practice Nurses and Physician Assistants 2nd Edition
Rosenthal | Chapter 1-92 | 9780323554954 | All Chapters
with Answers and Rationals
3. A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would
be most concerning to the provider?
a. The patient had a recent yeast infection.
b. There is a family history of cervical cancer.
c. The patient drinks two glasses of wine every night.
d. The patient is unemployed. - ANSWER: ANS: C. The patient drinks two glasses of wine every night.
Patients taking metronidazole should be educated not to drink alcohol to prevent a disulfiram-like
reaction. It would be concerning that the patient drinks wine daily. History of a yeast infection may
indicate increased risk for recurrence with administration of an antimicrobial. A family history of
cervical cancer is not related to administration of metronidazole. Unemployment can indicate lack of
insurance coverage, which may limit the patient's ability to purchase medications; however, generic
metronidazole is one of the less expensive medications.
5. A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber confirms
that the dosing is correct. Which possible cause of this situation will the provide explore?
a. Whether a loading dose was administered
b. If the drug was completely dissolved in the IV solution
c. Whether patient is taking a medication that binds to serum albumin
d. If the ordered dose frequency is longer than the gentamicin half-life - ANSWER: ANS: C
c. Whether patient is taking a medication that binds to serum albumin
Gentamicin binds to albumin, but only weakly, & in the presence of another drug that binds to
albumin, it can rise to toxic levels in blood serum. A loading dose increases the initial amount of a
drug & is used to bring drug levels to the desired plateau more quickly. A drug that is not completely
dissolved carries a risk of causing embolism but this addresses a different concern. A drug given at a
frequency longer than the drug half-life will likely be at subtherapeutic levels & not at toxic levels.
10. A patient who has been taking sertraline for depression was prescribed azithromycin to treat an
infection by a provider at an after-hours clinic. What action will the primary care provider take to
address the risk this combination of medication has posed for the patient?
a. Discontinue the azithromycin and write an order for an alternative antibiotic.
b. Discontinue the sertraline and write an order for a different antidepressant
medication.
c. Reduce the sertraline dosage while taking azithromycin.
d. Withhold the sertraline until the azithromycin therapy is completed. - ANSWER: ANS: A
Both sertraline and azithromycin prolong the QT interval, and when taken together, they
increase the risk of fatal dysrhythmias. Because the antibiotic is used for a short time and because the
patient was already taking sertraline, it is correct to consider using a different antibiotic. Reducing the
dose of sertraline does not alter the combined effects of two drugs that lengthen the QT interval.
Sertraline should not be stopped abruptly, so withholding it during antibiotic therapy is not indicated.
Additionally, it is important to reinforce the need to tell all providers that sertraline is being taken.
15. A provider considers prescribing tamoxifen for a woman with breast cancer. Upon reviewing
results of genetic testing, the prescriber notes that the patient has variations in the CYP2Dy allele
,resulting in a deficiency of the CYP2D6 isoenzymes. What action will this deficiency warrant in the
prescribing of tamoxifen, a CYP2D6 substrate?
a. The tamoxifen will not be prescribed.
b. The individual doses of tamoxifen will be increased.
c. The tamoxifen will be ordered but in lower than normal dosage.
d. The patient's serum tamoxifen level will be routinely monitored. - ANSWER: ANS: A
a. The tamoxifen will not be prescribed.
Women with a deficiency of CYP2D6 isoenzymes lack the ability to convert tamoxifen to its active
form, endoxifen, & will not benefit from this drug. Another drug should be used to treat this patient's
breast cancer. Increasing the dose, reducing the dose, or monitoring serum drug levels will not make
this drug more effective in these women.
17. Which patient ethnic ancestry creates a risk factor that may result in minimal beneficial response
to tamoxifen therapy?
a. African
b. French
c. Native American
d. Japanese - ANSWER: ANS: B
b. French
Between 8% & 10% of women of European ancestry have a gene variant that prevents the effective
metabolism of tamoxifen that negatively affects the medication's therapeutic effect. None of the
other options present with a similar risk factor.
18. Before initiating cetuximab therapy, the provider will order epidermal growth factor receptor
(EGFR) testing for the patient having which condition?
a. Breast cancer
b. Colorectal cancer
c. Bone cancer
d. Brain cancer - ANSWER: ANS: B
b. Colorectal cancer
Cetuximab is used mainly for metastatic colorectal cancer. The medication works only against tumors
that express EGRF; all other tumors are unresponsive. This makes testing in advance of treatment
required. Cetuximab is not appropriate for any of the other conditions listed.
6. An infant developed a pruritic rash following exposure to an allergen. The infant's parents ask the
provider about using a topical antihistamine. What information should the provider use to address
the parents' question?
a. Antihistamines given by this route are not absorbed as well in children.
b. Applying an antihistamine to the skin can cause toxicity in this age group.
c. The child will also need oral medication to achieve effective results.
d. Topical medications have fewer side effects than those given by other routes. - ANSWER: ANS: B
b. Applying an antihistamine to the skin can cause toxicity in this age group.
Drug absorption through the skin is more rapid in infants, because their skin is thinner & has greater
blood flow; therefore, infants are at increased risk of toxicity from topical drugs. Because of increased
drug absorption through the skin, infants should not be given additional drugs via other routes. If a
drug is more likely to be absorbed rapidly, it will have more side effects.
,11. A child attending daycare is prescribed 750 mg of an antibiotic for 10 days. The drug may be dosed
in several ways and is available in two concentrations. Which dosing regimen will the provider
consider to best assure drug adherence?
a. 375 mg of a 250 mg/5 mL solution PO twice daily
b. 250 mg of a 250 mg/5 mL solution PO three times daily
c. 250 mg of a 500 mg/5 mL solution PO three times daily
d. 375 mg of a 500 mg/5 mL solution PO twice daily - ANSWER: ANS: D
d. 375 mg of a 500 mg/5 mL solution PO twice daily
To promote adherence to a drug regimen in children, it is important to consider the size & timing of
the dose. In this case the preparation containing 500 mg/5 mL means that a smaller volume can be
given, which is more palatable to a child. Twice daily dosing is more convenient for parents, especially
when a child is in daycare or school; it also helps prevent the problem of the medication being left
either at home or at school.
12. A 5-year-old has gray teeth. When taking a medication history, the provider will ask about
previous use of which group of medications?
a. Glucocorticoids
b. Salicylates
c. Sulfonamides
d. Tetracyclines - ANSWER: ANS: D
d. Tetracyclines
Tetracyclines cause discoloration in developing teeth in children. Glucocorticoids are associated with
growth suppression. Salicylates are associated with Reye syndrome. Sulfonamides are associated with
kernicterus in newborns.
4. A provider orders thioridazine for a patient with diabetes mellitus who is diagnosed with
schizophrenia. The patient requests olanzapine, which the patient has seen advertised on television.
Which response will the provider give to address the primary reason the patient is not being
prescribed olanzapine?
a. "Olanzapine is more expensive than thioridazine."
b. "Olanzapine causes more metabolic side effects than thioridazine."
c. "Thioridazine has fewer side effects than olanzapine."
d. "Thioridazine has a faster onset of action than olanzapine." - ANSWER: ANS: B
b. "Olanzapine causes more metabolic side effects than thioridazine."
Olanzapine is an SGA & although it has fewer extrapyramidal side effects than the FGA the provider
has ordered, it has an increased risk of metabolic side effects, which is contraindicated in patients
with diabetes. It is more expensive, but this is not the most important reason for not prescribing it.
Thioridazine has more side effects than olanzapine, but the side effects caused by olanzapine are
more critical for this patient. Thioridazine does not have a faster onset of action.
12. A college track star with a history of seasonal allergies is diagnosed with bipolar disorder. After the
prescriber teaches the patient about newly ordered lithium, which statement by the patient indicates
the need for further teaching?
a. "I can continue to use ibuprofen as needed for muscle pain."
b. "I need to drink extra fluids before & during exercise."
c. "I should stop taking antihistamines while taking lithium."
d. "I should report muscle weakness & tremors to my provider." - ANSWER: ANS: A
Because ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can increase lithium levels as
much as 60%, it should not be used by patients taking lithium. Aspirin does not have this effect.
, Lithium induces polyuria in 50% to 70% of patients, so patients should be advised to drink extra fluids,
especially during exercise. Antihistamines have anticholinergic effects, which cause urinary hesitancy;
this can be uncomfortable when patients experience the polyuria associated with lithium use. Muscle
weakness & tremors can occur with lithium; tremors can be treated with β blockers or by altering the
lithium regimen.
13. A patient with bipolar disorder who has been taking lithium for several years has developed a
goiter. When the serum tests reveal hypothyroidism what will the provider prescribe for this patient?
a. Levothyroxine therapy
b. Increasing the lithium dose
c. Iodine supplements daily
d. Propylthiouracil - ANSWER: ANS: A
Patients taking lithium may experience reduced incorporation of iodine into the thyroid hormone,
resulting in goiter and hypothyroidism. Administration of levothyroxine or withdrawing the lithium
will reverse both. Increasing the lithium dose or prescribing propylthiouracil will make this worse.
Iodine supplements are not indicated.
16. Azithromycin is prescribed for a patient who develops an infection. The patient's only other
medication is simvastatin. Which patient symptom will create the greatest concern for the provider?
a. Nausea
b. Tiredness
c. Muscle pain
d. Headache - ANSWER: ANS: C
Statins can injure muscle tissue, causing muscle aches and pain known as myopathy/rhabdomyolysis.
Azithromycin also can cause myopathy and therefore should be used with caution in patients
concurrently taking simvastatin. Nausea, tiredness, and headache would not cause the provider as
much concern as the likelihood of myopathy.
Unit 10: Drugs for Endocrine Disorders Rosenthal: Lehne's Pharmacotherapeutics for Advanced
Practice Nurses and Physician Assistants, 2nd Edition - ANSWER:
1. The provider working on a high-acuity medical-surgical unit is prioritizing care for four patients who
were just admitted. Which patient presents with needs that the provider should address first?
a. A patient with diabetes who is NPO and has a blood glucose level of 80 mg/dl needs a change in
diet status after receiving 20 units of 70/30 Novolin insulin.
b. A patient needs a temporary hold placed on digoxin because the heart rate was 58 beats/minute
when digoxin was scheduled to be administered.
c. A patient with hypertension requests an analgesic for a headache. Current blood pressure is 136/92
mm Hg.
d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin is concerned
about the possibility of an allergic reaction. - ANSWER: ANS: A
The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because
this patient needs to consume a good source of glucose immediately or perhaps the NPO status will
be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58
beats/minute, but this is not a priority action. The patient with a headache needs to be followed up, &
prescription for pain medication but because the blood pressure is 136/92 mm Hg, the headache is
probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction
to the vancomycin.
2. The provider is assessing a newly diagnosed patient for short-term complications of diabetes. What
evaluation does this assessment include?
Practice Nurses and Physician Assistants 2nd Edition
Rosenthal | Chapter 1-92 | 9780323554954 | All Chapters
with Answers and Rationals
3. A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would
be most concerning to the provider?
a. The patient had a recent yeast infection.
b. There is a family history of cervical cancer.
c. The patient drinks two glasses of wine every night.
d. The patient is unemployed. - ANSWER: ANS: C. The patient drinks two glasses of wine every night.
Patients taking metronidazole should be educated not to drink alcohol to prevent a disulfiram-like
reaction. It would be concerning that the patient drinks wine daily. History of a yeast infection may
indicate increased risk for recurrence with administration of an antimicrobial. A family history of
cervical cancer is not related to administration of metronidazole. Unemployment can indicate lack of
insurance coverage, which may limit the patient's ability to purchase medications; however, generic
metronidazole is one of the less expensive medications.
5. A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber confirms
that the dosing is correct. Which possible cause of this situation will the provide explore?
a. Whether a loading dose was administered
b. If the drug was completely dissolved in the IV solution
c. Whether patient is taking a medication that binds to serum albumin
d. If the ordered dose frequency is longer than the gentamicin half-life - ANSWER: ANS: C
c. Whether patient is taking a medication that binds to serum albumin
Gentamicin binds to albumin, but only weakly, & in the presence of another drug that binds to
albumin, it can rise to toxic levels in blood serum. A loading dose increases the initial amount of a
drug & is used to bring drug levels to the desired plateau more quickly. A drug that is not completely
dissolved carries a risk of causing embolism but this addresses a different concern. A drug given at a
frequency longer than the drug half-life will likely be at subtherapeutic levels & not at toxic levels.
10. A patient who has been taking sertraline for depression was prescribed azithromycin to treat an
infection by a provider at an after-hours clinic. What action will the primary care provider take to
address the risk this combination of medication has posed for the patient?
a. Discontinue the azithromycin and write an order for an alternative antibiotic.
b. Discontinue the sertraline and write an order for a different antidepressant
medication.
c. Reduce the sertraline dosage while taking azithromycin.
d. Withhold the sertraline until the azithromycin therapy is completed. - ANSWER: ANS: A
Both sertraline and azithromycin prolong the QT interval, and when taken together, they
increase the risk of fatal dysrhythmias. Because the antibiotic is used for a short time and because the
patient was already taking sertraline, it is correct to consider using a different antibiotic. Reducing the
dose of sertraline does not alter the combined effects of two drugs that lengthen the QT interval.
Sertraline should not be stopped abruptly, so withholding it during antibiotic therapy is not indicated.
Additionally, it is important to reinforce the need to tell all providers that sertraline is being taken.
15. A provider considers prescribing tamoxifen for a woman with breast cancer. Upon reviewing
results of genetic testing, the prescriber notes that the patient has variations in the CYP2Dy allele
,resulting in a deficiency of the CYP2D6 isoenzymes. What action will this deficiency warrant in the
prescribing of tamoxifen, a CYP2D6 substrate?
a. The tamoxifen will not be prescribed.
b. The individual doses of tamoxifen will be increased.
c. The tamoxifen will be ordered but in lower than normal dosage.
d. The patient's serum tamoxifen level will be routinely monitored. - ANSWER: ANS: A
a. The tamoxifen will not be prescribed.
Women with a deficiency of CYP2D6 isoenzymes lack the ability to convert tamoxifen to its active
form, endoxifen, & will not benefit from this drug. Another drug should be used to treat this patient's
breast cancer. Increasing the dose, reducing the dose, or monitoring serum drug levels will not make
this drug more effective in these women.
17. Which patient ethnic ancestry creates a risk factor that may result in minimal beneficial response
to tamoxifen therapy?
a. African
b. French
c. Native American
d. Japanese - ANSWER: ANS: B
b. French
Between 8% & 10% of women of European ancestry have a gene variant that prevents the effective
metabolism of tamoxifen that negatively affects the medication's therapeutic effect. None of the
other options present with a similar risk factor.
18. Before initiating cetuximab therapy, the provider will order epidermal growth factor receptor
(EGFR) testing for the patient having which condition?
a. Breast cancer
b. Colorectal cancer
c. Bone cancer
d. Brain cancer - ANSWER: ANS: B
b. Colorectal cancer
Cetuximab is used mainly for metastatic colorectal cancer. The medication works only against tumors
that express EGRF; all other tumors are unresponsive. This makes testing in advance of treatment
required. Cetuximab is not appropriate for any of the other conditions listed.
6. An infant developed a pruritic rash following exposure to an allergen. The infant's parents ask the
provider about using a topical antihistamine. What information should the provider use to address
the parents' question?
a. Antihistamines given by this route are not absorbed as well in children.
b. Applying an antihistamine to the skin can cause toxicity in this age group.
c. The child will also need oral medication to achieve effective results.
d. Topical medications have fewer side effects than those given by other routes. - ANSWER: ANS: B
b. Applying an antihistamine to the skin can cause toxicity in this age group.
Drug absorption through the skin is more rapid in infants, because their skin is thinner & has greater
blood flow; therefore, infants are at increased risk of toxicity from topical drugs. Because of increased
drug absorption through the skin, infants should not be given additional drugs via other routes. If a
drug is more likely to be absorbed rapidly, it will have more side effects.
,11. A child attending daycare is prescribed 750 mg of an antibiotic for 10 days. The drug may be dosed
in several ways and is available in two concentrations. Which dosing regimen will the provider
consider to best assure drug adherence?
a. 375 mg of a 250 mg/5 mL solution PO twice daily
b. 250 mg of a 250 mg/5 mL solution PO three times daily
c. 250 mg of a 500 mg/5 mL solution PO three times daily
d. 375 mg of a 500 mg/5 mL solution PO twice daily - ANSWER: ANS: D
d. 375 mg of a 500 mg/5 mL solution PO twice daily
To promote adherence to a drug regimen in children, it is important to consider the size & timing of
the dose. In this case the preparation containing 500 mg/5 mL means that a smaller volume can be
given, which is more palatable to a child. Twice daily dosing is more convenient for parents, especially
when a child is in daycare or school; it also helps prevent the problem of the medication being left
either at home or at school.
12. A 5-year-old has gray teeth. When taking a medication history, the provider will ask about
previous use of which group of medications?
a. Glucocorticoids
b. Salicylates
c. Sulfonamides
d. Tetracyclines - ANSWER: ANS: D
d. Tetracyclines
Tetracyclines cause discoloration in developing teeth in children. Glucocorticoids are associated with
growth suppression. Salicylates are associated with Reye syndrome. Sulfonamides are associated with
kernicterus in newborns.
4. A provider orders thioridazine for a patient with diabetes mellitus who is diagnosed with
schizophrenia. The patient requests olanzapine, which the patient has seen advertised on television.
Which response will the provider give to address the primary reason the patient is not being
prescribed olanzapine?
a. "Olanzapine is more expensive than thioridazine."
b. "Olanzapine causes more metabolic side effects than thioridazine."
c. "Thioridazine has fewer side effects than olanzapine."
d. "Thioridazine has a faster onset of action than olanzapine." - ANSWER: ANS: B
b. "Olanzapine causes more metabolic side effects than thioridazine."
Olanzapine is an SGA & although it has fewer extrapyramidal side effects than the FGA the provider
has ordered, it has an increased risk of metabolic side effects, which is contraindicated in patients
with diabetes. It is more expensive, but this is not the most important reason for not prescribing it.
Thioridazine has more side effects than olanzapine, but the side effects caused by olanzapine are
more critical for this patient. Thioridazine does not have a faster onset of action.
12. A college track star with a history of seasonal allergies is diagnosed with bipolar disorder. After the
prescriber teaches the patient about newly ordered lithium, which statement by the patient indicates
the need for further teaching?
a. "I can continue to use ibuprofen as needed for muscle pain."
b. "I need to drink extra fluids before & during exercise."
c. "I should stop taking antihistamines while taking lithium."
d. "I should report muscle weakness & tremors to my provider." - ANSWER: ANS: A
Because ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), can increase lithium levels as
much as 60%, it should not be used by patients taking lithium. Aspirin does not have this effect.
, Lithium induces polyuria in 50% to 70% of patients, so patients should be advised to drink extra fluids,
especially during exercise. Antihistamines have anticholinergic effects, which cause urinary hesitancy;
this can be uncomfortable when patients experience the polyuria associated with lithium use. Muscle
weakness & tremors can occur with lithium; tremors can be treated with β blockers or by altering the
lithium regimen.
13. A patient with bipolar disorder who has been taking lithium for several years has developed a
goiter. When the serum tests reveal hypothyroidism what will the provider prescribe for this patient?
a. Levothyroxine therapy
b. Increasing the lithium dose
c. Iodine supplements daily
d. Propylthiouracil - ANSWER: ANS: A
Patients taking lithium may experience reduced incorporation of iodine into the thyroid hormone,
resulting in goiter and hypothyroidism. Administration of levothyroxine or withdrawing the lithium
will reverse both. Increasing the lithium dose or prescribing propylthiouracil will make this worse.
Iodine supplements are not indicated.
16. Azithromycin is prescribed for a patient who develops an infection. The patient's only other
medication is simvastatin. Which patient symptom will create the greatest concern for the provider?
a. Nausea
b. Tiredness
c. Muscle pain
d. Headache - ANSWER: ANS: C
Statins can injure muscle tissue, causing muscle aches and pain known as myopathy/rhabdomyolysis.
Azithromycin also can cause myopathy and therefore should be used with caution in patients
concurrently taking simvastatin. Nausea, tiredness, and headache would not cause the provider as
much concern as the likelihood of myopathy.
Unit 10: Drugs for Endocrine Disorders Rosenthal: Lehne's Pharmacotherapeutics for Advanced
Practice Nurses and Physician Assistants, 2nd Edition - ANSWER:
1. The provider working on a high-acuity medical-surgical unit is prioritizing care for four patients who
were just admitted. Which patient presents with needs that the provider should address first?
a. A patient with diabetes who is NPO and has a blood glucose level of 80 mg/dl needs a change in
diet status after receiving 20 units of 70/30 Novolin insulin.
b. A patient needs a temporary hold placed on digoxin because the heart rate was 58 beats/minute
when digoxin was scheduled to be administered.
c. A patient with hypertension requests an analgesic for a headache. Current blood pressure is 136/92
mm Hg.
d. The patient with an allergy to penicillin who is receiving an infusion of vancomycin is concerned
about the possibility of an allergic reaction. - ANSWER: ANS: A
The NPO patient with hypoglycemia who just received 70/30 Novolin insulin takes priority, because
this patient needs to consume a good source of glucose immediately or perhaps the NPO status will
be discontinued for this shift. The digoxin may be withheld for the patient with a pulse of 58
beats/minute, but this is not a priority action. The patient with a headache needs to be followed up, &
prescription for pain medication but because the blood pressure is 136/92 mm Hg, the headache is
probably not caused by hypertension. The patient with an allergy to penicillin will not have a reaction
to the vancomycin.
2. The provider is assessing a newly diagnosed patient for short-term complications of diabetes. What
evaluation does this assessment include?
