D027 Practice Questions with Verified answers
A patient has endured several dosage adjustments of his tricyclic
antidepressant, so the provider recommends genetic testing. Which
statement correctly describes the rationale for genetic testing?
a. The CYP2D6 gene influences metabolism of tricyclic antidepressants
and certain other drugs
b. The HER2 gene is a tumor marker that impacts metabolism of
tricyclic antidepressants
c. The BRCA2 gene influences metabolism of certain drugs and
increases the risk for breast cancer
d. The x-linked OPN1MW gene for male color blindness also slows
metabolism of certain drugs Ans ✔✔-a. The CYP2D6 gene influences
metabolism of tricyclic antidepressants and certain other drugs
Answer/Rationale: CYP2D6 - page 155 Box 4.3 of Chapter 4 Genes and
Genetic Diseases, McCance & Huether, Unit 2, Genes, Environmental
Lifestyle, and Common Diseases. HER2 is a gene often implicated with
cancer, as is BRCA2. OPN1MW is the gene that codes for color
blindness in men. Metabolism of 25% of all prescribed drugs, including
tricyclic antidepressants, beta adrenergic receptor blockers, and
neuroleptics, is influenced by variants in a certain gene, requiring
genetic testing to reduce trial-and-error in estimating appropriate drug-
dosage levels.
As an advanced practice nurse, you want to learn more about the CDC's
initiatives relative to asthma care and management in order to advocate
for asthma sufferers at the state legislative level. Your goal is to reduce
,medications costs to patients. Which CDC recommendation supports
your goal?
a. The CDC recommends that payers and employers promote healthy
workspaces to decrease environmental trigger exposures
b. The CDC recommends that providers prescribe the most cost-efficient
long-acting inhalers to lower patient co-pays
c. The CDC recommends that providers deviate from the stepwise
approach to lessen the financial impact to the patient
d. The CDC recommends that co-pays be removed for inhaled
corticosteroids and other prescribed medications Ans ✔✔-d. The CDC
recommends that co-pays be removed for inhaled corticosteroids and
other prescribed medications
Answer/Rationale: D - The CDC recommends that co-pays be removed
for inhaled corticosteroids and other prescribed medications per the
following link, https://healthpayerintelligence.com/news/top-10-most-
expensive-chronic-diseases-for-healthcare-payers; Genes,
Environmental Lifestyle, and Common Diseases; Unit 2
A female patient has been recently diagnosed with invasive ductal
carcinoma. As an advanced practice nurse, you understand that she will
be undergoing a multi-faceted treatment approach that will include one
or more medications. Which medication is considered the "gold
standard" endocrine treatment for breast cancer?
a. Fulvestrant (Faslodex), an antiestrogen indicated for metastatic
estrogen receptor-positive breast cancer in post-menopausal women
,b. Tamoxifen (Nolvadex), a prodrug that must be converted to active
metabolites in order to block estrogen receptors in breast tissue
c. Trastuzumab (Herceptin), a monoclonal antibody approved for HER2-
positive metastatic breast cancer
d. Lapatinib (Tykerb), an oral inhibitor of HER2 tyrosine kinase and
EGFR tyrosine kinase, resulting in apoptosis and suppression of tumor
cell growth Ans ✔✔-b. Tamoxifen (Nolvadex), a prodrug that must be
converted to active metabolites in order to block estrogen receptors in
breast tissue
Answer/Rationale: Tamoxifen, page 929, Chapter 82 of Lehne, Unit 2,
Human Structures for Self Defense
A patient reports a maternal family history of Lynch syndrome. Which
laboratory finding might indicate a need for further testing for the
presence of Lynch syndrome in this patient?
a. Elevated thyroid-stimulating hormone
b. Low cortisol level
c. Positive heme-occult test
d. Sputum positive for Pseudomonas Aeruginosa Ans ✔✔-c. Positive
heme-occult test
Answer/Rationale: Positive heme-occult because Lynch syndrome is a
hereditary form of colorectal cancer and colorectal bleeding can be a
sign of cancer, per https://www.healthypeople.gov/2020/topics-
objectives/topic/genomics, Unit 2, Human Structures for Self Defense
, Your goal as the intensive care unit coordinator is to reduce falls. Upon
review of hospital data, you find that most of the falls are occurring in
the patient population, ages 65 and older. As a result, you coordinate a
fall reduction initiative after researching the etiology of falls in the
elderly. Which action should be included in the protocol?
a. Encourage slow position changes since orthostatic hypotension is a
significant risk factor for falls.
b. Allocate budgetary resources for assistive devices to be in every room
at all times since falls cannot be predicted.
c. Initiate depression screening on all new admissions since depressed
affect has been indicated in fall etiology.
d. Decrease the number of situations that require patient standing and
walking, as upright positions result in higher incidence of falls. Ans ✔✔-
a. Encourage slow position changes since orthostatic hypotension is a
significant risk factor for falls.
Answer/Rationale: Encourage slow position changes since orthostatic
hypotension is a significant risk factor for falls. From page 1067, chapter
33, McCance & Huether, Causes of Pathology in the Cardiovascular
System, Unit 3
A patient who has lung cancer reports facial and neck swelling so severe
that some shirts no longer fit. What question by the healthcare
professional would be most appropriate to screen for superior vena cava
syndrome, a possible complication of cancer tumors?
A patient has endured several dosage adjustments of his tricyclic
antidepressant, so the provider recommends genetic testing. Which
statement correctly describes the rationale for genetic testing?
a. The CYP2D6 gene influences metabolism of tricyclic antidepressants
and certain other drugs
b. The HER2 gene is a tumor marker that impacts metabolism of
tricyclic antidepressants
c. The BRCA2 gene influences metabolism of certain drugs and
increases the risk for breast cancer
d. The x-linked OPN1MW gene for male color blindness also slows
metabolism of certain drugs Ans ✔✔-a. The CYP2D6 gene influences
metabolism of tricyclic antidepressants and certain other drugs
Answer/Rationale: CYP2D6 - page 155 Box 4.3 of Chapter 4 Genes and
Genetic Diseases, McCance & Huether, Unit 2, Genes, Environmental
Lifestyle, and Common Diseases. HER2 is a gene often implicated with
cancer, as is BRCA2. OPN1MW is the gene that codes for color
blindness in men. Metabolism of 25% of all prescribed drugs, including
tricyclic antidepressants, beta adrenergic receptor blockers, and
neuroleptics, is influenced by variants in a certain gene, requiring
genetic testing to reduce trial-and-error in estimating appropriate drug-
dosage levels.
As an advanced practice nurse, you want to learn more about the CDC's
initiatives relative to asthma care and management in order to advocate
for asthma sufferers at the state legislative level. Your goal is to reduce
,medications costs to patients. Which CDC recommendation supports
your goal?
a. The CDC recommends that payers and employers promote healthy
workspaces to decrease environmental trigger exposures
b. The CDC recommends that providers prescribe the most cost-efficient
long-acting inhalers to lower patient co-pays
c. The CDC recommends that providers deviate from the stepwise
approach to lessen the financial impact to the patient
d. The CDC recommends that co-pays be removed for inhaled
corticosteroids and other prescribed medications Ans ✔✔-d. The CDC
recommends that co-pays be removed for inhaled corticosteroids and
other prescribed medications
Answer/Rationale: D - The CDC recommends that co-pays be removed
for inhaled corticosteroids and other prescribed medications per the
following link, https://healthpayerintelligence.com/news/top-10-most-
expensive-chronic-diseases-for-healthcare-payers; Genes,
Environmental Lifestyle, and Common Diseases; Unit 2
A female patient has been recently diagnosed with invasive ductal
carcinoma. As an advanced practice nurse, you understand that she will
be undergoing a multi-faceted treatment approach that will include one
or more medications. Which medication is considered the "gold
standard" endocrine treatment for breast cancer?
a. Fulvestrant (Faslodex), an antiestrogen indicated for metastatic
estrogen receptor-positive breast cancer in post-menopausal women
,b. Tamoxifen (Nolvadex), a prodrug that must be converted to active
metabolites in order to block estrogen receptors in breast tissue
c. Trastuzumab (Herceptin), a monoclonal antibody approved for HER2-
positive metastatic breast cancer
d. Lapatinib (Tykerb), an oral inhibitor of HER2 tyrosine kinase and
EGFR tyrosine kinase, resulting in apoptosis and suppression of tumor
cell growth Ans ✔✔-b. Tamoxifen (Nolvadex), a prodrug that must be
converted to active metabolites in order to block estrogen receptors in
breast tissue
Answer/Rationale: Tamoxifen, page 929, Chapter 82 of Lehne, Unit 2,
Human Structures for Self Defense
A patient reports a maternal family history of Lynch syndrome. Which
laboratory finding might indicate a need for further testing for the
presence of Lynch syndrome in this patient?
a. Elevated thyroid-stimulating hormone
b. Low cortisol level
c. Positive heme-occult test
d. Sputum positive for Pseudomonas Aeruginosa Ans ✔✔-c. Positive
heme-occult test
Answer/Rationale: Positive heme-occult because Lynch syndrome is a
hereditary form of colorectal cancer and colorectal bleeding can be a
sign of cancer, per https://www.healthypeople.gov/2020/topics-
objectives/topic/genomics, Unit 2, Human Structures for Self Defense
, Your goal as the intensive care unit coordinator is to reduce falls. Upon
review of hospital data, you find that most of the falls are occurring in
the patient population, ages 65 and older. As a result, you coordinate a
fall reduction initiative after researching the etiology of falls in the
elderly. Which action should be included in the protocol?
a. Encourage slow position changes since orthostatic hypotension is a
significant risk factor for falls.
b. Allocate budgetary resources for assistive devices to be in every room
at all times since falls cannot be predicted.
c. Initiate depression screening on all new admissions since depressed
affect has been indicated in fall etiology.
d. Decrease the number of situations that require patient standing and
walking, as upright positions result in higher incidence of falls. Ans ✔✔-
a. Encourage slow position changes since orthostatic hypotension is a
significant risk factor for falls.
Answer/Rationale: Encourage slow position changes since orthostatic
hypotension is a significant risk factor for falls. From page 1067, chapter
33, McCance & Huether, Causes of Pathology in the Cardiovascular
System, Unit 3
A patient who has lung cancer reports facial and neck swelling so severe
that some shirts no longer fit. What question by the healthcare
professional would be most appropriate to screen for superior vena cava
syndrome, a possible complication of cancer tumors?
