NURP-424: Exam 2 UPDATED ACTUAL
Exam Questions and CORRECT Answers
How do phosphodiesterase type 5 (PDE-5) inhibitors work? - CORRECT ANSWER -
PDE-5 inhibitors work by blocking the catabolism of cyclic GMP which results in an increased
number and duration of erections in men with ED.
Pharmacokinetics: Pediatrics (2) - CORRECT ANSWER - - Blood brain barrier is
incomplete and more permeable
- Small infants have less protein binding capability which leads to more free drug in the body
- Kidneys are not matured so excretion and elimination is slowed
- Skin is thin and more permeable so it absorbs quicker
- Oral bioavailability of weak bases compounds is increased.
( e.g. Beta-lactams)
- Oral bioavailability of weak organic acids is decreased.
(e.g. Phenobarbital and phenytoin)
Which method of contraception has a Black Box Warning due to causing significant bone
mineral density (BMD) loss in adolescents? - CORRECT ANSWER -
Medroxyprogesterone acetate (Depo shot)
A mother asks the APN about using an over-the-counter (OTC) medication for her child because
the label says, "Consult your provider for use instructions as safety and effectiveness have not
been established." Which response by the APN is most appropriate? - CORRECT
ANSWER - "Pediatric studies have shown this drug to be either unsafe or ineffective in
children."
,Which of these would the APN include in teaching for the transmasculine patient starting
testosterone replacement therapy? - CORRECT ANSWER - The patient's periods should
stop within 6 months.
A transfeminine patient is preparing for feminizing hormone therapy. Which of these would the
APN include in teaching about the effects of hormone therapy? - CORRECT ANSWER -
It may take months, and even up to a year, for the patient to see the full effect of the hormones.
Which of these does testosterone replacement therapy (TRT) cause? - CORRECT
ANSWER - Decreased fat mass
Normal aging is associated with a decrease in serum albumin levels. How does this impact drug
distribution? - CORRECT ANSWER - Fewer protein molecules are available for drug
binding, leading to higher levels of free, unbound drug and an increased risk for drug toxicity.
Normal age-related changes alter the absorption of medications from the gastrointestinal (GI)
tract. Which of these is caused by age-related changes? - CORRECT ANSWER -
Decreased acid production
Which of these is a potential pharmacodynamic difference in children as compared with adults? -
CORRECT ANSWER - Unexpected side effect different than an adult
Which of these would the APN need to consider when selecting the best option for the patient
beginning testosterone replacement therapy? - CORRECT ANSWER - Injectable
testosterone is the least expensive.
The APN knows that children are often at higher risk for ADRs for which two reasons? -
CORRECT ANSWER - Inattention to weight-based dosing and immature organ function
in the very young, which makes dosing more complicated
Which statement regarding topical absorption of medications is accurate? - CORRECT
ANSWER - It is increased in children due to larger body surface in relation to their size.
,The APN is following a 68-year-old male who had an acute myocardial infarction (MI) about 4
months ago. He is not seeing a cardiologist anymore. He is doing well and has returned to all his
regular activities. He is tolerating a low dose beta blocker, which was started after the heart
attack. He has never had any chest pain or exercise intolerance. He has a prescription for
sublingual nitroglycerine when necessary but has never needed it. He requests a refill on his
Viagra. Which action taken by the APN is most appropriate? - CORRECT ANSWER -
Tell him he has to wait 6 months after his heart attack to use this medication again.
Gender Differences: Pharmacodynamics - CORRECT ANSWER - - Opioids have a
greater analgesic effects and side effects in women than men (i.e. N/V)
- Aspirin will lower the risk for stroke but will have little effect if given prophylactically for an
MI in women (the opposite is in men)
- Warfarin will have less benefit to women and more susceptible to adverse effects such as
bleeding
- Tricyclic antidepressants will take longer to reach a steady state and will cause more adverse
effects in women
- Antipsychotics will have better outcomes but more side effects in women
- Medication takes longer to be absorbed due to increased adipose tissue/fat, so bioavailability is
higher in women
Pharmacokinetics in Women - CORRECT ANSWER - - Gastric emptying time is slower
d/t estrogen which will give medications more time at the absorption site
- Plasma concentration of alcohol is greater in females with the same amount of alcohol intake
, - Females have a higher proportion of body fat which makes it easier for them to absorb
lipophilic drugs
- Women have a harder time with tricyclic antidepressants which makes them more likely to
experience SE
- Plasma volume is lower in females, drugs with high volumes of distribution will be
concentrated in the plasma
- The pregnancy and lactation risk categories are no longer used, now provides a label before
prescribing
Pharmacokinetics in Pregnancy - CORRECT ANSWER - - Pregnant women need
hydrophilic, high molecular weight, ionized, and high protein binding drugs
- In pregnancy, plasma volume increases, dilutional anemia occurs which leads to the need for
prenatal vitamins and possible iron supplementation
- Increased plasma volumes affect volume of distribution
- Limited caffeine in pregnancy because caffeine puts more work on the heart which is already
taxed due to the pregnancy
- No smoking or vaping during pregnancy because it decreases the oxygen to the fetus
- Drug absorption through the skin, lungs, and mucous membranes are increased due to increased
cardiac output
- Decreased GI motility and gastric emptying times
Exam Questions and CORRECT Answers
How do phosphodiesterase type 5 (PDE-5) inhibitors work? - CORRECT ANSWER -
PDE-5 inhibitors work by blocking the catabolism of cyclic GMP which results in an increased
number and duration of erections in men with ED.
Pharmacokinetics: Pediatrics (2) - CORRECT ANSWER - - Blood brain barrier is
incomplete and more permeable
- Small infants have less protein binding capability which leads to more free drug in the body
- Kidneys are not matured so excretion and elimination is slowed
- Skin is thin and more permeable so it absorbs quicker
- Oral bioavailability of weak bases compounds is increased.
( e.g. Beta-lactams)
- Oral bioavailability of weak organic acids is decreased.
(e.g. Phenobarbital and phenytoin)
Which method of contraception has a Black Box Warning due to causing significant bone
mineral density (BMD) loss in adolescents? - CORRECT ANSWER -
Medroxyprogesterone acetate (Depo shot)
A mother asks the APN about using an over-the-counter (OTC) medication for her child because
the label says, "Consult your provider for use instructions as safety and effectiveness have not
been established." Which response by the APN is most appropriate? - CORRECT
ANSWER - "Pediatric studies have shown this drug to be either unsafe or ineffective in
children."
,Which of these would the APN include in teaching for the transmasculine patient starting
testosterone replacement therapy? - CORRECT ANSWER - The patient's periods should
stop within 6 months.
A transfeminine patient is preparing for feminizing hormone therapy. Which of these would the
APN include in teaching about the effects of hormone therapy? - CORRECT ANSWER -
It may take months, and even up to a year, for the patient to see the full effect of the hormones.
Which of these does testosterone replacement therapy (TRT) cause? - CORRECT
ANSWER - Decreased fat mass
Normal aging is associated with a decrease in serum albumin levels. How does this impact drug
distribution? - CORRECT ANSWER - Fewer protein molecules are available for drug
binding, leading to higher levels of free, unbound drug and an increased risk for drug toxicity.
Normal age-related changes alter the absorption of medications from the gastrointestinal (GI)
tract. Which of these is caused by age-related changes? - CORRECT ANSWER -
Decreased acid production
Which of these is a potential pharmacodynamic difference in children as compared with adults? -
CORRECT ANSWER - Unexpected side effect different than an adult
Which of these would the APN need to consider when selecting the best option for the patient
beginning testosterone replacement therapy? - CORRECT ANSWER - Injectable
testosterone is the least expensive.
The APN knows that children are often at higher risk for ADRs for which two reasons? -
CORRECT ANSWER - Inattention to weight-based dosing and immature organ function
in the very young, which makes dosing more complicated
Which statement regarding topical absorption of medications is accurate? - CORRECT
ANSWER - It is increased in children due to larger body surface in relation to their size.
,The APN is following a 68-year-old male who had an acute myocardial infarction (MI) about 4
months ago. He is not seeing a cardiologist anymore. He is doing well and has returned to all his
regular activities. He is tolerating a low dose beta blocker, which was started after the heart
attack. He has never had any chest pain or exercise intolerance. He has a prescription for
sublingual nitroglycerine when necessary but has never needed it. He requests a refill on his
Viagra. Which action taken by the APN is most appropriate? - CORRECT ANSWER -
Tell him he has to wait 6 months after his heart attack to use this medication again.
Gender Differences: Pharmacodynamics - CORRECT ANSWER - - Opioids have a
greater analgesic effects and side effects in women than men (i.e. N/V)
- Aspirin will lower the risk for stroke but will have little effect if given prophylactically for an
MI in women (the opposite is in men)
- Warfarin will have less benefit to women and more susceptible to adverse effects such as
bleeding
- Tricyclic antidepressants will take longer to reach a steady state and will cause more adverse
effects in women
- Antipsychotics will have better outcomes but more side effects in women
- Medication takes longer to be absorbed due to increased adipose tissue/fat, so bioavailability is
higher in women
Pharmacokinetics in Women - CORRECT ANSWER - - Gastric emptying time is slower
d/t estrogen which will give medications more time at the absorption site
- Plasma concentration of alcohol is greater in females with the same amount of alcohol intake
, - Females have a higher proportion of body fat which makes it easier for them to absorb
lipophilic drugs
- Women have a harder time with tricyclic antidepressants which makes them more likely to
experience SE
- Plasma volume is lower in females, drugs with high volumes of distribution will be
concentrated in the plasma
- The pregnancy and lactation risk categories are no longer used, now provides a label before
prescribing
Pharmacokinetics in Pregnancy - CORRECT ANSWER - - Pregnant women need
hydrophilic, high molecular weight, ionized, and high protein binding drugs
- In pregnancy, plasma volume increases, dilutional anemia occurs which leads to the need for
prenatal vitamins and possible iron supplementation
- Increased plasma volumes affect volume of distribution
- Limited caffeine in pregnancy because caffeine puts more work on the heart which is already
taxed due to the pregnancy
- No smoking or vaping during pregnancy because it decreases the oxygen to the fetus
- Drug absorption through the skin, lungs, and mucous membranes are increased due to increased
cardiac output
- Decreased GI motility and gastric emptying times
