NEWEST ADVANCED PHARM NR 567 FINAL EXAM / NR 567
ADVANCED PHARM ACTUAL FINAL EXAM (WEEK 1-7)
COMPLETE REAL QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (CORRECT VERIFIED ANSWERS)
LATEST UPDATED VERSION |GUARANTEED PASS A+
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
ADVANCED PHARM ACTUAL FINAL EXAM (WEEK 1-7)
COMPLETE REAL QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES (CORRECT VERIFIED ANSWERS)
LATEST UPDATED VERSION |GUARANTEED PASS A+
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
