Pharmacotherapeutics for Advanced Practice
Nurse Prescribers Examination.
Drugs that use CYP 3A4 isoenzymes for metabolism may:
B B B B B B B B B
1. Induce the metabolism of another drug
B B B B B B B
2. Inhibit the metabolism of another drug
B B B B B B B
3. Both 1 and 2
B B B B B
4. Neither 1 nor 2 - ANS >> 3
B B B B B B B B
Medication agreements or "Pain Medication Contracts" are recommended to be used:
B B B B B B B B B B B
1. Universally for all prescribing for chronic pain
B B B B B B B B
2. For patients who have repeated requests for pain medication
B B B B B B B B B B
3. When you suspect a patient is exhibiting drug-seeking behavior
B B B B B B B B B B
4. For patients with pain associated with malignancy - ANS >> 1
B B B B B B B B B B B
Drugs that are prone to cause adverse drug effects include:
B B B B B B B B B B
1. Diuretics
B B
2. Inhaled anticholinergics
B B B
3. Insulins
B B
4. Stimulants - ANS >> 3
B B B B B
The U.S. Food and Drug Administration MedWatch system is activated when:
B B B B B B B B B B B
1. There is an adverse event to a vaccine.
B B B B B B B B B
2. The patient has a severe reaction that is noted in the "Severe Reaction" section in the medication
B B B B B B B B B B B B B B B B B
label.
B B
3. A lactating woman takes a medication that is potentially toxic to the breastfeeding infant.
B B B B B B B B B B B B B B B
4. An adverse event or serious problem occurs with a medication that is not already identified on the
B B B B B B B B B B B B B B B B B
label. - ANS >> 4
B B B B B
The Vaccine Adverse Events Reporting System is:
B B B B B B B
1. A mandatory reporting system for all health-care providers when they encounter an adverse vaccine
B B B B B B B B B B B B B B
event
B B
,2. A voluntary reporting system that health-care providers or consumers may use to report vaccine
B B B B B B B B B B B B B B
adverse events
B B B
3. Utilized to send out safety alerts regarding emerging vaccine safety issues
B B B B B B B B B B B B
4. Activated when a vaccine has been proven to cause significant adverse effects - ANS >> 2
B B B B B B B B B B B B B B B B
A comprehensive assessment of a patient should be holistic when trying to determine competence in
B B B B B B B B B B B B B B
drug administration. Which of the following factors would the NP omit from this type of assessment?
B B B B B B B B B B B B B B B B B
1. Financial status
B B B
2. Mobility
B B
3. Social support
B B B
4. Sexual practices - ANS >> 4
B B B B B B
Elena Vasquez's primary language is Spanish, and she speaks very limited English. Which technique
B B B B B B B B B B B B B
would be appropriate to use in teaching her about a new drug you have just prescribed?
B B B B B B B B B B B B B B B B B
1. Use correct medical terminology because Spanish has a Latin base.
B B B B B B B B B B B
2. Use a family member who speaks more English to act as an interpreter.
B B B B B B B B B B B B B B
3. Use a professional interpreter or a reliable staff member who can act as an interpreter.
B B B B B B B B B B B B B B B B
4. Use careful, detailed explanations. - ANS >> 3
B B B B B B B B
Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he
B B B B B B B B B B B B B B B B B
understands teaching about his drug?
B B B B B B
1. Stand facing him and speak slowly and clearly.
B B B B B B B B B
2. Speak in low tones or find a provider who has a lower voice.
B B B B B B B B B B B B B B
3. Write down the instructions as well as speaking them.
B B B B B B B B B B
4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. - ANS >> 4
B B B B B B B B B B B B B B B B
Which of the following factors may adversely affect a patient's adherence to a therapeutic drug
B B B B B B B B B B B B B B
regimen?
B B
1. Complexity of the drug regimen
B B B B B B
2. Patient perception of the potential adverse effects of the drugs
B B B B B B B B B B B
3. Both 1 and 2
B B B B B
4. Neither 1 nor 2 - ANS >> 3
B B B B B B B B
,The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which
B B B B B B B B B B B B B B
of the following system variables creates such a barrier?
B B B B B B B B B B
1. Increasing copayments for care
B B B B B
2. Unrestricted formularies for drugs, including brand names
B B B B B B B B
3. Increasing the number of people who have access to care
B B B B B B B B B B B
4. Treating a wider range of disorders - ANS >> 1
B B B B B B B B B B
Ralph's blood pressure remains elevated despite increased doses of his drug. The NP is concerned that
B B B B B B B B B B B B B B B
he might not be adhering to his treatment regimen. Which of the following events would suggest that
B B B B B B B B B B B B B B B B B
he might not be adherent?
B B B B B B
1. Ralph states that he always takes the drug "when I feel my pressure is going up."
B B B B B B B B B B B B B B B B B
2. Ralph contacts his NP to discuss the need to increase the dosage.
B B B B B B B B B B B B B
3. Ralph consistently keeps his follow-up appointments to check his blood pressure.
B B B B B B B B B B B B
4. All of the above show that he is adherent to the drug regimen. - ANS >> 1
B B B B B B B B B B B B B B B B B
Nonadherence is especially common in drugs that treat asymptomatic conditions, such as
B B B B B B B B B B B
hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug
B B B B B B B B B B B B B B B B B
that:
B B
1. Has a short half-life so that missing one dose has limited effect
B B B B B B B B B B B B B
2. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep
B B B B B B B B B B B B B B B B
costs down
B B B
3. Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as
B B B B B B B B B B B B B B B B
nausea and dizziness
B B B B
4. Must be taken no more than twice a day - ANS >> 3
B B B B B B B B B B B B B
Factors in chronic conditions that contribute to nonadherence include:
B B B B B B B B B
1. The complexity of the treatment regimen
B B B B B B B
2. The length of time over which it must be taken
B B B B B B B B B B B
3. Breaks in the usual daily routine, such as vacations and weekends
B B B B B B B B B B B B
4. All of the above - ANS >> 4
B B B B B B B B
While patient education about their drugs is important, information alone does not necessarily lead to
B B B B B B B B B B B B B B
adherence to a drug regimen. Patients report greater adherence when:
B B B B B B B B B B B
1. The provider spent a lot of time discussing the drugs with them
B B B B B B B B B B B B B
, 2. Their concerns and specific area of knowledge deficit were addressed
B B B B B B B B B B B
3. They were given written material, such as pamphlets, about the drugs
B B B B B B B B B B B B
4. The provider used appropriate medical and pharmacological terms - ANS >> 2
B B B B B B B B B B B B
Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%.
B B B B B B B B B B B B B B
To improve adherence in this population, prescribe drugs:
B B B B B B B B B
1. With a longer half-life so that missed doses produce a longer taper on the drug curve
B B B B B B B B B B B B B B B B B
2. In oral formulations that are more easily taken
B B B B B B B B B
3. That do not require frequent monitoring
B B B B B B B
4. Combined with patient education about the need to adhere even when symptoms are absent - ANS
B B B B B B B B B B B B B B B B
>> 1
B B
Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less
B B B B B B B B B B B B B B B
likely the patient will adhere to it. Which of the following interventions will NOT improve adherence?
B B B B B B B B B B B B B B B B B
1. Have the patient purchase a pill container with compartments for daily or multiple times-per-day
B B B B B B B B B B B B B B
dosing.
B B
2. Match the clinic appointment to the next time the drug is to be refilled.
B B B B B B B B B B B B B B B
3. Write prescriptions for new drugs with shorter times between refills.
B B B B B B B B B B B
4. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug.
B B B B B B B B B B B B B B B B B B
- ANS >> 4
B B B B
Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially
B B B B B B B B B B B
important include:
B B B
1. Older adults and those on fixed incomes
B B B B B B B B
2. Patients with chronic illnesses
B B B B B
3. Patients with copayments for drugs on their insurance
B B B B B B B B B
4. Patients on public assistance - ANS >> 1
B B B B B B B B
Providers have a responsibility for determining the best plan of care, but patients also have
B B B B B B B B B B B B B B
responsibilities. Patients the provider can be assured will carry through on these responsibilities
B B B B B B B B B B B B B
include those who:
B B B B
1. Are well-educated and affluent
B B B B B
2. Have chronic conditions
B B B B
3. Self-monitor drug effects on their symptoms
B B B B B B B
Nurse Prescribers Examination.
Drugs that use CYP 3A4 isoenzymes for metabolism may:
B B B B B B B B B
1. Induce the metabolism of another drug
B B B B B B B
2. Inhibit the metabolism of another drug
B B B B B B B
3. Both 1 and 2
B B B B B
4. Neither 1 nor 2 - ANS >> 3
B B B B B B B B
Medication agreements or "Pain Medication Contracts" are recommended to be used:
B B B B B B B B B B B
1. Universally for all prescribing for chronic pain
B B B B B B B B
2. For patients who have repeated requests for pain medication
B B B B B B B B B B
3. When you suspect a patient is exhibiting drug-seeking behavior
B B B B B B B B B B
4. For patients with pain associated with malignancy - ANS >> 1
B B B B B B B B B B B
Drugs that are prone to cause adverse drug effects include:
B B B B B B B B B B
1. Diuretics
B B
2. Inhaled anticholinergics
B B B
3. Insulins
B B
4. Stimulants - ANS >> 3
B B B B B
The U.S. Food and Drug Administration MedWatch system is activated when:
B B B B B B B B B B B
1. There is an adverse event to a vaccine.
B B B B B B B B B
2. The patient has a severe reaction that is noted in the "Severe Reaction" section in the medication
B B B B B B B B B B B B B B B B B
label.
B B
3. A lactating woman takes a medication that is potentially toxic to the breastfeeding infant.
B B B B B B B B B B B B B B B
4. An adverse event or serious problem occurs with a medication that is not already identified on the
B B B B B B B B B B B B B B B B B
label. - ANS >> 4
B B B B B
The Vaccine Adverse Events Reporting System is:
B B B B B B B
1. A mandatory reporting system for all health-care providers when they encounter an adverse vaccine
B B B B B B B B B B B B B B
event
B B
,2. A voluntary reporting system that health-care providers or consumers may use to report vaccine
B B B B B B B B B B B B B B
adverse events
B B B
3. Utilized to send out safety alerts regarding emerging vaccine safety issues
B B B B B B B B B B B B
4. Activated when a vaccine has been proven to cause significant adverse effects - ANS >> 2
B B B B B B B B B B B B B B B B
A comprehensive assessment of a patient should be holistic when trying to determine competence in
B B B B B B B B B B B B B B
drug administration. Which of the following factors would the NP omit from this type of assessment?
B B B B B B B B B B B B B B B B B
1. Financial status
B B B
2. Mobility
B B
3. Social support
B B B
4. Sexual practices - ANS >> 4
B B B B B B
Elena Vasquez's primary language is Spanish, and she speaks very limited English. Which technique
B B B B B B B B B B B B B
would be appropriate to use in teaching her about a new drug you have just prescribed?
B B B B B B B B B B B B B B B B B
1. Use correct medical terminology because Spanish has a Latin base.
B B B B B B B B B B B
2. Use a family member who speaks more English to act as an interpreter.
B B B B B B B B B B B B B B
3. Use a professional interpreter or a reliable staff member who can act as an interpreter.
B B B B B B B B B B B B B B B B
4. Use careful, detailed explanations. - ANS >> 3
B B B B B B B B
Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he
B B B B B B B B B B B B B B B B B
understands teaching about his drug?
B B B B B B
1. Stand facing him and speak slowly and clearly.
B B B B B B B B B
2. Speak in low tones or find a provider who has a lower voice.
B B B B B B B B B B B B B B
3. Write down the instructions as well as speaking them.
B B B B B B B B B B
4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. - ANS >> 4
B B B B B B B B B B B B B B B B
Which of the following factors may adversely affect a patient's adherence to a therapeutic drug
B B B B B B B B B B B B B B
regimen?
B B
1. Complexity of the drug regimen
B B B B B B
2. Patient perception of the potential adverse effects of the drugs
B B B B B B B B B B B
3. Both 1 and 2
B B B B B
4. Neither 1 nor 2 - ANS >> 3
B B B B B B B B
,The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which
B B B B B B B B B B B B B B
of the following system variables creates such a barrier?
B B B B B B B B B B
1. Increasing copayments for care
B B B B B
2. Unrestricted formularies for drugs, including brand names
B B B B B B B B
3. Increasing the number of people who have access to care
B B B B B B B B B B B
4. Treating a wider range of disorders - ANS >> 1
B B B B B B B B B B
Ralph's blood pressure remains elevated despite increased doses of his drug. The NP is concerned that
B B B B B B B B B B B B B B B
he might not be adhering to his treatment regimen. Which of the following events would suggest that
B B B B B B B B B B B B B B B B B
he might not be adherent?
B B B B B B
1. Ralph states that he always takes the drug "when I feel my pressure is going up."
B B B B B B B B B B B B B B B B B
2. Ralph contacts his NP to discuss the need to increase the dosage.
B B B B B B B B B B B B B
3. Ralph consistently keeps his follow-up appointments to check his blood pressure.
B B B B B B B B B B B B
4. All of the above show that he is adherent to the drug regimen. - ANS >> 1
B B B B B B B B B B B B B B B B B
Nonadherence is especially common in drugs that treat asymptomatic conditions, such as
B B B B B B B B B B B
hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug
B B B B B B B B B B B B B B B B B
that:
B B
1. Has a short half-life so that missing one dose has limited effect
B B B B B B B B B B B B B
2. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep
B B B B B B B B B B B B B B B B
costs down
B B B
3. Has a tolerability profile with fewer of the adverse effects that are considered "irritating," such as
B B B B B B B B B B B B B B B B
nausea and dizziness
B B B B
4. Must be taken no more than twice a day - ANS >> 3
B B B B B B B B B B B B B
Factors in chronic conditions that contribute to nonadherence include:
B B B B B B B B B
1. The complexity of the treatment regimen
B B B B B B B
2. The length of time over which it must be taken
B B B B B B B B B B B
3. Breaks in the usual daily routine, such as vacations and weekends
B B B B B B B B B B B B
4. All of the above - ANS >> 4
B B B B B B B B
While patient education about their drugs is important, information alone does not necessarily lead to
B B B B B B B B B B B B B B
adherence to a drug regimen. Patients report greater adherence when:
B B B B B B B B B B B
1. The provider spent a lot of time discussing the drugs with them
B B B B B B B B B B B B B
, 2. Their concerns and specific area of knowledge deficit were addressed
B B B B B B B B B B B
3. They were given written material, such as pamphlets, about the drugs
B B B B B B B B B B B B
4. The provider used appropriate medical and pharmacological terms - ANS >> 2
B B B B B B B B B B B B
Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%.
B B B B B B B B B B B B B B
To improve adherence in this population, prescribe drugs:
B B B B B B B B B
1. With a longer half-life so that missed doses produce a longer taper on the drug curve
B B B B B B B B B B B B B B B B B
2. In oral formulations that are more easily taken
B B B B B B B B B
3. That do not require frequent monitoring
B B B B B B B
4. Combined with patient education about the need to adhere even when symptoms are absent - ANS
B B B B B B B B B B B B B B B B
>> 1
B B
Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less
B B B B B B B B B B B B B B B
likely the patient will adhere to it. Which of the following interventions will NOT improve adherence?
B B B B B B B B B B B B B B B B B
1. Have the patient purchase a pill container with compartments for daily or multiple times-per-day
B B B B B B B B B B B B B B
dosing.
B B
2. Match the clinic appointment to the next time the drug is to be refilled.
B B B B B B B B B B B B B B B
3. Write prescriptions for new drugs with shorter times between refills.
B B B B B B B B B B B
4. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug.
B B B B B B B B B B B B B B B B B B
- ANS >> 4
B B B B
Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially
B B B B B B B B B B B
important include:
B B B
1. Older adults and those on fixed incomes
B B B B B B B B
2. Patients with chronic illnesses
B B B B B
3. Patients with copayments for drugs on their insurance
B B B B B B B B B
4. Patients on public assistance - ANS >> 1
B B B B B B B B
Providers have a responsibility for determining the best plan of care, but patients also have
B B B B B B B B B B B B B B
responsibilities. Patients the provider can be assured will carry through on these responsibilities
B B B B B B B B B B B B B
include those who:
B B B B
1. Are well-educated and affluent
B B B B B
2. Have chronic conditions
B B B B
3. Self-monitor drug effects on their symptoms
B B B B B B B
