Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants 2nd Ed
Unit 01: Introduction
Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assista
MULTIPLE CHOICE
1. A patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which action s
initially?
a. Fax the renewal order to the pharmacy.
b. Arrange to schedule an appointment with the patient.
c. Verify the patient’s adherence to the prescribed drug regimen.
d. Determine the patient’s current medication dosage and pain level.
ANS: B
Schedule II medications are not eligible for refills, and prescriptions must be handwritten. It is importa
adherence to the drug regimen and determine the current dosage of medication and pain level; however
by scheduling an appointment and evaluating the patient in person.
2. A metered-dose albuterol inhaler is prescribed for asthma management. The patient reports feeling jitte
the medication, and does not feel that the medication is always effective. Which action will the provide
patient risks and maximize medication effectiveness?
a. Ask the patient to demonstrate use of the inhaler and assess effectiveness.
b. Assess the patient’s exposure to first- and second-hand tobacco smoke.
c. Auscultate the patient's lung sounds and obtain other relevant vital signs.
d. Decrease the dosage to reduce side effects.
ANS: C
Assessing and evaluating lung sounds as well as other vital signs helps determine the patient's physical
and allows comparison to the patient's baseline vital signs. Asking the patient to demonstrate inhaler us
patient’s ability to administer the medication properly and is part of an effective evaluation, but is not a
on the patient’s current report. Assessing tobacco smoke exposure helps determine whether nondrug th
avoidance, can be used as an adjunct to drug therapy, but does not relate to the patient’s current proble
to decrease the dosage may address the degree of jitteriness experienced, but does not address the patie
not always effective.
3. A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would be m
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.
ANS: C
Patients taking metronidazole should be educated not to drink alcohol to prevent a disulfiram-like reac
that the patient drinks wine daily. History of a yeast infection may indicate increased risk for recurrenc
antimicrobial. A family history of cervical cancer is not related to administration of metronidazole. Un
lack of insurance coverage, which may limit the patient’s ability to purchase medications; however, ge
the less expensive medications.
4. The provider prepares a patient with newly diagnosed type 1 diabetes for hospital discharge. Which ac
support the patient’s ability to effectively manage medication therapy?
a. Asking the patient to demonstrate how to measure and administer insulin
b. Discussing methods of storing insulin and discarding syringes
, 6. The drug manual states that older adult patients are at increased risk for hepatotoxicity. Which action is
prescribing this medication to an 80-year-old patient?
a. Obtaining baseline liver function studies
b. Ensuring that the drug is taken in the correct dose at the correct time
c. Discontinuing the order; the drug is contraindicated for this patient
d. Giving the medication intravenously to avoid first pass metabolism
ANS: A
The drug manual indicates that this drug increases risk of hepatotoxicity for elderly patients. Getting in
function before giving the drug establishes baseline data that can be compared with posttreatment data
drug is affecting the liver. Taking the correct dose at the correct interval may minimize risk, but withou
effects cannot be determined. Drugs are not routinely contraindicated for an increased risk of adverse e
7. A patient with bipolar disorder is prescribed daily lithium. Which action is most important for the prov
determine if the therapeutic level is maintained?
a. Evaluate preadministration blood work.
b. Prescribe the lithium to be taken at regular intervals.
c. Order periodic laboratory testing.
d. Assess the patient for signs and symptoms of lithium toxicity.
ANS: C
Therapeutic serum levels are determined through periodic laboratory testing. Preadministration blood w
obtain baseline status prior to initiating treatment, but it will not determine therapeutic levels. Scheduli
administration at regular intervals will help to ensure medication is absorbed and metabolized predictab
therapeutic blood levels. Assessing the patient for signs and symptoms of toxicity will help to determin
been exceeded, not maintained.
8. Which factor best supports an increase for full prescriptive authority for both advanced practice registe
physician assistants (PAs)?
a. More patients will have access to health care.
b. Enrollment in medical schools is predicted to decrease.
c. Enrollment in both APRN and PA programs has increased.
d. Physician practices have become so large, quality care is in jeopardy.
ANS: A
Implementation of the Affordable Care Act has increased the number of individuals with health care co
who have access to health care services. The increase in the number of patients creates the need for mo
prescriptive authority. APRNs and physical assistants can fill this practice gap. Enrollment in medical
recent years and shows no indication of decline. While some medical practices have increased in patien
to believe care has suffered. While enrollment for both APRN and PA education has increased, that is
associated with the need for increased prescriptive authority for these providers.
9. A pediatric patient prescribed ampicillin for streptococcal pharyngitis reports new onset of a pruritic, d
on the chest and neck. Which action is most important for the provider to take to minimize this patient’
a. Prescribe azithromycin to replace the ampicillin.
b. Discontinue the ampicillin.
c. Prescribe an antihistamine for the itching.
d. Flag all medical records with an “Allergic to Penicillin” notice.
ANS: B
The priority action is to discontinue the medication to prevent a potential worsening of the patient’s sy
prescription may be indicated depending on the length of treatment. An antihistamine may be administ
a common side effect of ampicillin. Pruritic maculopapular rashes such as the one described occur in 5
ampicillin, especially in the presence of viral infections. They do not contraindicate future administrati
10. Which prescriber action will have the greatest impact on the patient’s commitment to adherence to any
a. Prescribing the medication in oral form whenever possible
b. Scheduling once a day administration
c. Providing medication education that the patient can easily understand
d. Assuring that the medication prescription will be covered by the patient’s
,MULTIPLE RESPONSE
1. How can the prescriber’s regular collaboration with a pharmacist improve positive outcomes for patien
a. Pharmacists can suggest foods that will help with the medications' absorption.
b. Pharmacists have additional information on drug interactions.
c. The pharmacist can suggest adequate medication dosing.
d. Pharmacists have firsthand knowledge of the facility formulary.
e. Pharmacy can alter prescriptions when necessary to prevent patient harm.
ANS: B, C, D
Providers should collaborate with pharmacists because they will likely have additional information on
and suggestions for adequate medication dosing. Dietitians can make food recommendations to treat th
pharmacist can contact the prescriber about questionable prescriptions, but cannot alter the prescription
approval by the provider.
2. Which statements made by the prescriber demonstrate an understanding of effective medication educat
a. “This medication needs to be stored in the refrigerator.”
b. “Take 3 tablets daily: 1 with breakfast, 1 with lunch, and one with dinner.”
c. “You need to take the medication as we discussed until all the tablets are gone.”
d. “Call the office immediately if you begin experiencing any itching, headache, or
difficulty breathing.”
e. “When you call about a medication refill, be sure to let the pharmacist know you
are talking about your heart pill.”
ANS: A, B, C, D
There are basic components that should be included when teaching about any new medication. They ar
purpose, (3) dosing regimen, (4) administration, (5) adverse effects, (6) any special storage needs, (7) a
(8) food or drug interactions, and (9) duration of therapy. The statement suggesting referring to the me
is inappropriate since being familiar with the drug’s name is important in avoiding medication errors.
3. The patient who has been prescribed lithium for a diagnosis of bipolar disorder asks why blood tests ar
Which provider responses demonstrate an understanding of why the patient requires a variety of labora
apply.)
a. “We need to monitor how your thyroid is functioning.”
b. “We need to monitor kidney function while you are on this drug.”
c. This medication can cause you to lose sodium, so we need to measure sodium
levels.”
d. “Your liver can be damaged by lithium; regular testing helps us monitor for that.”
e. “Lithium can cause you to lose potassium; so, we regularly monitor your blood
potassium level.”
ANS: A, B, C
Lithium therapy can affect thyroid and renal function as well as deplete sodium levels. Regular laborat
monitor sodium levels and thyroid and renal function and so allows for modification of the lithium dos
associated with altered liver function or potassium depletion.
, Unit 02: Basic Principles of Pharmacology
Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assista
MULTIPLE CHOICE
1. When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle tox
a. Avoid exercise for 2 hours after administration.
b. Substitute grapefruit juice with orange juice.
c. Monitor aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
d. Take the medication with an NSAID or other anti-inflammatory drug.
ANS: B
Grapefruit juice can inhibit the metabolism of certain drugs including statins like lovastatin. The juice
the intestinal metabolism of the drug resulting in increased drug levels which increases the risk for adv
toxicity. Taking the drug with an anti-inflammatory drug and avoiding exercise after administration are
Monitoring AST and ALT detects liver toxicity, not muscle toxicity.
2. When prescribing drugs with a narrow therapeutic index, what intervention does the provider take to de
a. Schedule drug administration intervals that exceed the drug’s half-life.
b. Order the medication to be administered by the intravenous route.
c. Monitor the patient’s plasma drug levels at regular intervals.
d. Teach the patient that optimal outcomes will require adherence to the medication
regimen.
ANS: C
A drug with a narrow therapeutic range or index is more difficult to administer safely, because the diffe
effective concentration and the toxic concentration is small. Patients taking these medications must hav
monitored closely to ensure that they are getting an effective dose that is not toxic. Administering med
risks increased periods of subtherapeutic levels. Drugs that have a narrow therapeutic range may be giv
administration is not preferable and in most cases will not be feasible. Medication regimen adherence i
individual variation, for drugs with a narrow therapeutic range, what is an effective dose for one patien
another. For this reason, monitoring drug levels remains the primary method for decreasing risk.
3. A patient reports that a medication no longer effectively alleviates symptoms. What process informs th
patient’s concerns?
a. Endogenous antagonists compete with the drug for receptor sites.
b. Decreased selectivity for receptors results in a variety of effects.
c. Desensitization of receptor sites results from continual exposure to the drug.
d. Additional receptor sites are synthesized in response to the medication.
ANS: C
Continual exposure to an agonist would cause the cell to become less responsive or desensitized. The b
antagonists as a response to a medication. Medication tolerance is not related to receptor selectivity. M
receptors to be produced.
4. A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same
informs the prescriber’s response when explaining this phenomenon to the patient?
a. Advertising by pharmaceutical companies can enhance patient expectations of
one brand over another, leading to a placebo effect.
b. Because the drug preparations are chemically equivalent, the actions of the two
brands must be identical.
c. Inactive ingredients used in composition can result in differing rates of
dissolution, which can alter the drug’s onset of action.
d. The bioavailability of a drug is determined by the amount of the drug in each
dose.
ANS: C
Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same c
can have different effects in the body if they differ in bioavailability. Tablets made by different manufa
Unit 01: Introduction
Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assista
MULTIPLE CHOICE
1. A patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which action s
initially?
a. Fax the renewal order to the pharmacy.
b. Arrange to schedule an appointment with the patient.
c. Verify the patient’s adherence to the prescribed drug regimen.
d. Determine the patient’s current medication dosage and pain level.
ANS: B
Schedule II medications are not eligible for refills, and prescriptions must be handwritten. It is importa
adherence to the drug regimen and determine the current dosage of medication and pain level; however
by scheduling an appointment and evaluating the patient in person.
2. A metered-dose albuterol inhaler is prescribed for asthma management. The patient reports feeling jitte
the medication, and does not feel that the medication is always effective. Which action will the provide
patient risks and maximize medication effectiveness?
a. Ask the patient to demonstrate use of the inhaler and assess effectiveness.
b. Assess the patient’s exposure to first- and second-hand tobacco smoke.
c. Auscultate the patient's lung sounds and obtain other relevant vital signs.
d. Decrease the dosage to reduce side effects.
ANS: C
Assessing and evaluating lung sounds as well as other vital signs helps determine the patient's physical
and allows comparison to the patient's baseline vital signs. Asking the patient to demonstrate inhaler us
patient’s ability to administer the medication properly and is part of an effective evaluation, but is not a
on the patient’s current report. Assessing tobacco smoke exposure helps determine whether nondrug th
avoidance, can be used as an adjunct to drug therapy, but does not relate to the patient’s current proble
to decrease the dosage may address the degree of jitteriness experienced, but does not address the patie
not always effective.
3. A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would be m
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.
ANS: C
Patients taking metronidazole should be educated not to drink alcohol to prevent a disulfiram-like reac
that the patient drinks wine daily. History of a yeast infection may indicate increased risk for recurrenc
antimicrobial. A family history of cervical cancer is not related to administration of metronidazole. Un
lack of insurance coverage, which may limit the patient’s ability to purchase medications; however, ge
the less expensive medications.
4. The provider prepares a patient with newly diagnosed type 1 diabetes for hospital discharge. Which ac
support the patient’s ability to effectively manage medication therapy?
a. Asking the patient to demonstrate how to measure and administer insulin
b. Discussing methods of storing insulin and discarding syringes
, 6. The drug manual states that older adult patients are at increased risk for hepatotoxicity. Which action is
prescribing this medication to an 80-year-old patient?
a. Obtaining baseline liver function studies
b. Ensuring that the drug is taken in the correct dose at the correct time
c. Discontinuing the order; the drug is contraindicated for this patient
d. Giving the medication intravenously to avoid first pass metabolism
ANS: A
The drug manual indicates that this drug increases risk of hepatotoxicity for elderly patients. Getting in
function before giving the drug establishes baseline data that can be compared with posttreatment data
drug is affecting the liver. Taking the correct dose at the correct interval may minimize risk, but withou
effects cannot be determined. Drugs are not routinely contraindicated for an increased risk of adverse e
7. A patient with bipolar disorder is prescribed daily lithium. Which action is most important for the prov
determine if the therapeutic level is maintained?
a. Evaluate preadministration blood work.
b. Prescribe the lithium to be taken at regular intervals.
c. Order periodic laboratory testing.
d. Assess the patient for signs and symptoms of lithium toxicity.
ANS: C
Therapeutic serum levels are determined through periodic laboratory testing. Preadministration blood w
obtain baseline status prior to initiating treatment, but it will not determine therapeutic levels. Scheduli
administration at regular intervals will help to ensure medication is absorbed and metabolized predictab
therapeutic blood levels. Assessing the patient for signs and symptoms of toxicity will help to determin
been exceeded, not maintained.
8. Which factor best supports an increase for full prescriptive authority for both advanced practice registe
physician assistants (PAs)?
a. More patients will have access to health care.
b. Enrollment in medical schools is predicted to decrease.
c. Enrollment in both APRN and PA programs has increased.
d. Physician practices have become so large, quality care is in jeopardy.
ANS: A
Implementation of the Affordable Care Act has increased the number of individuals with health care co
who have access to health care services. The increase in the number of patients creates the need for mo
prescriptive authority. APRNs and physical assistants can fill this practice gap. Enrollment in medical
recent years and shows no indication of decline. While some medical practices have increased in patien
to believe care has suffered. While enrollment for both APRN and PA education has increased, that is
associated with the need for increased prescriptive authority for these providers.
9. A pediatric patient prescribed ampicillin for streptococcal pharyngitis reports new onset of a pruritic, d
on the chest and neck. Which action is most important for the provider to take to minimize this patient’
a. Prescribe azithromycin to replace the ampicillin.
b. Discontinue the ampicillin.
c. Prescribe an antihistamine for the itching.
d. Flag all medical records with an “Allergic to Penicillin” notice.
ANS: B
The priority action is to discontinue the medication to prevent a potential worsening of the patient’s sy
prescription may be indicated depending on the length of treatment. An antihistamine may be administ
a common side effect of ampicillin. Pruritic maculopapular rashes such as the one described occur in 5
ampicillin, especially in the presence of viral infections. They do not contraindicate future administrati
10. Which prescriber action will have the greatest impact on the patient’s commitment to adherence to any
a. Prescribing the medication in oral form whenever possible
b. Scheduling once a day administration
c. Providing medication education that the patient can easily understand
d. Assuring that the medication prescription will be covered by the patient’s
,MULTIPLE RESPONSE
1. How can the prescriber’s regular collaboration with a pharmacist improve positive outcomes for patien
a. Pharmacists can suggest foods that will help with the medications' absorption.
b. Pharmacists have additional information on drug interactions.
c. The pharmacist can suggest adequate medication dosing.
d. Pharmacists have firsthand knowledge of the facility formulary.
e. Pharmacy can alter prescriptions when necessary to prevent patient harm.
ANS: B, C, D
Providers should collaborate with pharmacists because they will likely have additional information on
and suggestions for adequate medication dosing. Dietitians can make food recommendations to treat th
pharmacist can contact the prescriber about questionable prescriptions, but cannot alter the prescription
approval by the provider.
2. Which statements made by the prescriber demonstrate an understanding of effective medication educat
a. “This medication needs to be stored in the refrigerator.”
b. “Take 3 tablets daily: 1 with breakfast, 1 with lunch, and one with dinner.”
c. “You need to take the medication as we discussed until all the tablets are gone.”
d. “Call the office immediately if you begin experiencing any itching, headache, or
difficulty breathing.”
e. “When you call about a medication refill, be sure to let the pharmacist know you
are talking about your heart pill.”
ANS: A, B, C, D
There are basic components that should be included when teaching about any new medication. They ar
purpose, (3) dosing regimen, (4) administration, (5) adverse effects, (6) any special storage needs, (7) a
(8) food or drug interactions, and (9) duration of therapy. The statement suggesting referring to the me
is inappropriate since being familiar with the drug’s name is important in avoiding medication errors.
3. The patient who has been prescribed lithium for a diagnosis of bipolar disorder asks why blood tests ar
Which provider responses demonstrate an understanding of why the patient requires a variety of labora
apply.)
a. “We need to monitor how your thyroid is functioning.”
b. “We need to monitor kidney function while you are on this drug.”
c. This medication can cause you to lose sodium, so we need to measure sodium
levels.”
d. “Your liver can be damaged by lithium; regular testing helps us monitor for that.”
e. “Lithium can cause you to lose potassium; so, we regularly monitor your blood
potassium level.”
ANS: A, B, C
Lithium therapy can affect thyroid and renal function as well as deplete sodium levels. Regular laborat
monitor sodium levels and thyroid and renal function and so allows for modification of the lithium dos
associated with altered liver function or potassium depletion.
, Unit 02: Basic Principles of Pharmacology
Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assista
MULTIPLE CHOICE
1. When prescribing lovastatin, what will a provider advise to decrease the risk of developing muscle tox
a. Avoid exercise for 2 hours after administration.
b. Substitute grapefruit juice with orange juice.
c. Monitor aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
d. Take the medication with an NSAID or other anti-inflammatory drug.
ANS: B
Grapefruit juice can inhibit the metabolism of certain drugs including statins like lovastatin. The juice
the intestinal metabolism of the drug resulting in increased drug levels which increases the risk for adv
toxicity. Taking the drug with an anti-inflammatory drug and avoiding exercise after administration are
Monitoring AST and ALT detects liver toxicity, not muscle toxicity.
2. When prescribing drugs with a narrow therapeutic index, what intervention does the provider take to de
a. Schedule drug administration intervals that exceed the drug’s half-life.
b. Order the medication to be administered by the intravenous route.
c. Monitor the patient’s plasma drug levels at regular intervals.
d. Teach the patient that optimal outcomes will require adherence to the medication
regimen.
ANS: C
A drug with a narrow therapeutic range or index is more difficult to administer safely, because the diffe
effective concentration and the toxic concentration is small. Patients taking these medications must hav
monitored closely to ensure that they are getting an effective dose that is not toxic. Administering med
risks increased periods of subtherapeutic levels. Drugs that have a narrow therapeutic range may be giv
administration is not preferable and in most cases will not be feasible. Medication regimen adherence i
individual variation, for drugs with a narrow therapeutic range, what is an effective dose for one patien
another. For this reason, monitoring drug levels remains the primary method for decreasing risk.
3. A patient reports that a medication no longer effectively alleviates symptoms. What process informs th
patient’s concerns?
a. Endogenous antagonists compete with the drug for receptor sites.
b. Decreased selectivity for receptors results in a variety of effects.
c. Desensitization of receptor sites results from continual exposure to the drug.
d. Additional receptor sites are synthesized in response to the medication.
ANS: C
Continual exposure to an agonist would cause the cell to become less responsive or desensitized. The b
antagonists as a response to a medication. Medication tolerance is not related to receptor selectivity. M
receptors to be produced.
4. A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount of the same
informs the prescriber’s response when explaining this phenomenon to the patient?
a. Advertising by pharmaceutical companies can enhance patient expectations of
one brand over another, leading to a placebo effect.
b. Because the drug preparations are chemically equivalent, the actions of the two
brands must be identical.
c. Inactive ingredients used in composition can result in differing rates of
dissolution, which can alter the drug’s onset of action.
d. The bioavailability of a drug is determined by the amount of the drug in each
dose.
ANS: C
Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of the same c
can have different effects in the body if they differ in bioavailability. Tablets made by different manufa
