Summary NSG 6005 WEEK 2 CHAPTER 2, 5, 6, 10, 13 STUDY GUIDE (UPDATE)

NSG 6005 WEEK 2 CHAPTER 2, 5, 6, 10, 13 STUDY GUIDE 1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical to prescribing because: Drugs that have a significant first-pass effect: The route of excretion of a volatile drug will likely be the: Medroxyprogesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir of the drug. Storage reservoirs: The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s: Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the: Phenytoin requires that a trough level be drawn. Peak and trough levels are done: A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the: Drugs that are receptor agonists may demonstrate what property? 1. Irreversible binding to the drug receptor site 2. Upregulation with chronic use 3. Desensitization or downregulation with continuous use 4. Inverse relationship between drug concentration and drug action 11. Drugs that are receptor antagonists, such as beta blockers, may cause: 1. Downregulation of the drug receptor 2. An exaggerated response if abruptly discontinued 3. Partial blockade of the effects of agonist drugs Factors that affect gastric drug absorption include: 1. Liver enzyme activity 2. Protein-binding properties of the drug molecule 3. Lipid solubility of the drug 4. Ability to chew and swallow ____ 13. Drugs administered via IV: 1. Need to be lipid soluble in order to be easily absorbed 2. Begin distribution into the body immediately 3. Are easily absorbed if they are nonionized 4. May use pinocytosis to be absorbed ____ 14. When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is: 1. The sum of the effects of each drug individually 2. Greater than the sum of the effects of each drug individually 3. Less than the effect of each drug individually 4. Not predictable, as it varies with each individual ____ 15. Which of the following statements about bioavailability is true? 1. Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained-release mechanisms. 2. All brands of a drug have the same bioavailability. 3. Drugs that are administered more than once a day have greater bioavailability than drugs given once daily. 4. Combining an active drug with an inert substance does not affect bioavailability. Which of the following statements about the major distribution barriers (blood-brain or fetal-placental) is true? 1. Water soluble and ionized drugs cross these barriers rapidly. 2. The blood-brain barrier slows the entry of many drugs into and from brain cells. 3. The fetal-placental barrier protects the fetus from drugs taken by the mother. 4. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women. ____ 17. Drugs are metabolized mainly by the liver via phase I or phase II reactions. The purpose of both of these types of reactions is to: 1. Inactivate prodrugs before they can be activated by target tissues 2. Change the drugs so they can cross plasma membranes 3. Change drug molecules to a form that an excretory organ can excrete 4. Make these drugs more ionized and polar to facilitate excretion ____ 18. Once they have been metabolized by the liver, the metabolites may be: 1. More active than the parent drug 2. Less active than the parent drug 3. Totally “deactivated” so they are excreted without any effect 4. All of the above ____ 19. All drugs continue to act in the body until they are changed or excreted. The ability of the body to excrete drugs via the renal system would be increased by: 1. Reduced circulation and perfusion of the kidney 2. Chronic renal disease 3. Competition for a transport site by another drug 4. Unbinding a nonvolatile drug from plasma proteins ____ 20. Steady state is: 1. The point on the drug concentration curve when absorption exceeds excretion 2. When the amount of drug in the body remains constant 3. When the amount of drug in the body stays below the minimum toxic concentration 4. All of the above ____ 21. Two different pain medications are given together for pain relief. The drug—drug interaction is: 1. Synergistic 2. Antagonistic 3. Potentiative 4. Additive ____ 22. Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT: 1. Reducing the dosage of one of the drugs 2. Scheduling their administration at different times 3. Prescribing a third drug to counteract the adverse reaction of the combination 4. Reducing the dosage of both drugs ____ 23. Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process? 1. Protein malnutrition 2. Iron-deficiency anemia 3. Both 1 and 2 4. Neither 1 nor 2 ____ 24. The time required for the amount of drug in the body to decrease by 50% is called: 1. Steady state 2. Half-life 3. Phase II metabolism 4. Reduced bioavailability time ____ 25. An agonist activates a receptor and stimulates a response. When given frequently over time, the body may: 1. Upregulate the total number of receptors 2. Block the receptor with a partial agonist 3. Alter the drug’s metabolism 4. Downregulate the numbers of that specific receptor ____ 26. Drug antagonism is best defined as an effect of a drug that: 1. Leads to major physiological and psychological dependence 2. Is modified by the concurrent administration of another drug 3. Cannot be metabolized before another dose is administered 4. Leads to a decreased physiological response when combined with another drug ____ 27. Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements? 1. “Avoid any other oral medicines while taking this drug.” 2. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.” 3. “The tablet may be crushed if you have any difficulty taking it.” 4. “To achieve best effect, take the tablet with at least 8 ounces of fluid.” ____ 28. The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in: 1. Disintegration 2. Toxicity 3. Malabsorption 4. Deterioration ____ 29. Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach? 1. Sodium bicarbonate 2. Ascorbic acid 3. Salicylic acid 4. Glucose ____ 30. Which of the following variables is a factor in drug absorption? 1. The smaller the surface area for absorption, the more rapidly the drug is absorbed. 2. A rich blood supply to the area of absorption leads to better absorption. 3. The less soluble the drug, the more easily it is absorbed. 4. Ionized drugs are easily absorbed across the cell membrane. ____ 31. An advantage of prescribing a sublingual medication is that the medication is: 1. Absorbed rapidly 2. Excreted rapidly 3. Metabolized minimally 4. Distributed equally ____ 32. Drugs that use CYP 3A4 isoenzymes for metabolism may: 1. Induce the metabolism of another drug 2. Inhibit the metabolism of another drug 3. Both 1 and 2 4. Neither 1 nor 2 ____ 33. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: 1. After the second dose 2. After four to five half-lives 3. When the patient feels the full effect of the drug 4. One hour after IV administration ____ 34. Upregulation or hypersensitization may lead to: 1. Increased response to a drug 2. Decreased response to a drug 3. An exaggerated response if the drug is withdrawn 4. Refractoriness or complete lack of response Chapter 5. Adverse Drug Reactions ____ 1. Which of the following patients would be at higher risk of experiencing adverse drug reactions (ADRs): 1. A 32-year-old male 2. A 22-year-old female 3. A 3-month-old female 4. A 48-year-old male ____ 2. Infants and young children are at higher risk of ADRs due to: 1. Immature renal function in school-age children 2. Lack of safety and efficacy studies in the pediatric population 3. Children’s skin being thicker than adults, requiring higher dosages of topical medication 4. Infant boys having a higher proportion of muscle mass, leading to a higher volume of distribution ____ 3. The elderly are at high risk of ADRs due to: 1. Having greater muscle mass than younger adults, leading to higher volume of distribution 2. The extensive studies that have been conducted on drug safety in this age group 3. The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect 4. Age-related decrease in renal function ____ 4. The type of adverse drug reaction that is idiosyncratic when a drug given in the usual therapeutic doses is type: 1. A 2. B 3. C 4. D ____ 5. Digoxin may cause a type A adverse drug reaction due to: 1. Idiosyncratic effects 2. Its narrow therapeutic index 3. Being a teratogen 4. Being a carcinogen ____ 6. Sarah developed a rash after using a topical medication. This is a type __ allergic drug reaction. 1. I 2. II 3. III 4. IV ____ 7. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is a(n): 1. Cytotoxic hypersensitivity reaction 2. Immune complex hypersensitivity 3. Immediate hypersensitivity reaction 4. Delayed hypersensitivity reaction ____ 8. Anaphylactic shock is a: 1. Type I reaction, called immediate hypersensitivity reaction 2. Type II reaction, called cytotoxic hypersensitivity reaction 3. Type III allergic reaction, called immune complex hypersensitivity 4. Type IV allergic reaction, called delayed hypersensitivity reaction ____ 9. James has hypothalamic-pituitary-adrenal axis suppression from chronic prednisone (a corticosteroid) use. He is at risk for what type of adverse drug reaction? 1. Type B 2. Type C 3. Type E 4. Type F ____ 10. Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D reaction because they are known: 1. Teratogens 2. Carcinogens 3. To cause hypersensitivity reactions 4. Hypothalamus-pituitary-adrenal axis suppressants ____ 11. A 24-year-old male received multiple fractures in a motor vehicle accident that required significant amounts of opioid medication to treat his pain. He is at risk for a _____ adverse drug reaction when he no longer requires the opioids. 1. Rapid 2. First-dose 3. Late 4. Delayed ____ 12. An example of a first-dose reaction that may occur includes: 1. Orthostatic hypotension that does not occur with repeated doses 2. Purple glove syndrome with phenytoin use 3. Hemolytic anemia from ceftriaxone use 4. Contact dermatitis from neomycin use ____ 13. Drugs that are prone to cause adverse drug effects include: 1. Diuretics 2. Inhaled anticholinergics 3. Insulins 4. Stimulants ____ 14. The U.S. Food and Drug Administration MedWatch system is activated when: 1. There is an adverse event to a vaccine. 2. The patient has a severe reaction that is noted in the “Severe Reaction” section in the medication label. 3. A lactating woman takes a medication that is potentially toxic to the breastfeeding infant. 4. An adverse event or serious problem occurs with a medication that is not already identified on the label. ____ 15. The Vaccine Adverse Events Reporting System is: 1. A mandatory reporting system for all health-care providers when they encounter an adverse vaccine event 2. A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events 3. Utilized to send out safety alerts regarding emerging vaccine safety issues 4. Activated when a vaccine has been proven to cause significant adverse effects Chapter 6. Factors That Foster Positive Outcomes ____ 1. A comprehensive assessment of a patient should be holistic when trying to determine competence in drug administration. Which of the following factors would the NP omit from this type of assessment? 1. Financial status 2. Mobility 3. Social support 4. Sexual practices ____ 2. Elena Vasquez’s primary language is Spanish, and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed? 1. Use correct medical terminology because Spanish has a Latin base. 2. Use a family member who speaks more English to act as an interpreter. 3. Use a professional interpreter or a reliable staff member who can act as an interpreter. 4. Use careful, detailed explanations. ____ 3. Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug? 1. Stand facing him and speak slowly and clearly. 2. Speak in low tones or find a provider who has a lower voice. 3. Write down the instructions as well as speaking them. 4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds. ____ 4. Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen? 1. Complexity of the drug regimen 2. Patient perception of the potential adverse effects of the drugs 3. Both 1 and 2 4. Neither 1 nor 2 ____ 5. The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which of the following system variables creates such a barrier? 1. Increasing copayments for care 2. Unrestricted formularies for drugs, including brand names 3. Increasing the number of people who have access to care 4. Treating a wider range of disorders ____ 6. Ralph’s blood pressure remains elevated despite increased doses of his drug. The NP is concerned that he might not be adhering to his treatment regimen. Which of the following events would suggest that he might not be adherent? 1. Ralph states that he always takes the drug “when I feel my pressure is going up.” 2. Ralph contacts his NP to discuss the need to increase the dosage. 3. Ralph consistently keeps his follow-up appointments to check his blood pressure. 4. All of the above show that he is adherent to the drug regimen. ____ 7. Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that: 1. Has a short half-life so that missing one dose has limited effect 2. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down 3. Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea and dizziness 4. Must be taken no more than twice a day ____ 8. Factors in chronic conditions that contribute to nonadherence include: 1. The complexity of the treatment regimen 2. The length of time over which it must be taken 3. Breaks in the usual daily routine, such as vacations and weekends 4. All of the above ____ 9. While patient education about their drugs is important, information alone does not necessarily lead to adherence to a drug regimen. Patients report greater adherence when: 1. The provider spent a lot of time discussing the drugs with them 2. Their concerns and specific area of knowledge deficit were addressed 3. They were given written material, such as pamphlets, about the drugs 4. The provider used appropriate medical and pharmacological terms ____ 10. Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs: 1. With a longer half-life so that missed doses produce a longer taper on the drug curve 2. In oral formulations that are more easily taken 3. That do not require frequent monitoring 4. Combined with patient education about the need to adhere even when symptoms are absent ____ 11. Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less likely the patient will adhere to it. Which of the following interventions will NOT improve adherence? 1. Have the patient purchase a pill container with compartments for daily or multiple times-per-day dosing. 2. Match the clinic appointment to the next time the drug is to be refilled. 3. Write prescriptions for new drugs with shorter times between refills. 4. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug. ____ 12. Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include: 1. Older adults and those on fixed incomes 2. Patients with chronic illnesses 3. Patients with copayments for drugs on their insurance 4. Patients on public assistance ____ 13. Providers have a responsibility for determining the best plan of care, but patients also have responsibilities. Patients the provider can be assured will carry through on these responsibilities include those who: 1. Are well-educated and affluent 2. Have chronic conditions 3. Self-monitor drug effects on their symptoms 4. None of the above guarantee adherence ____ 14. Monitoring adherence can take several forms, including: 1. Patient reports from data in a drug diary 2. Pill counts 3. Laboratory reports and other diagnostic markers 4. All of the above ____ 15. Factors that explain and predict medication adherence include: 1. Social 2. Financial 3. Health system 4. All of the above Chapter 10. Herbal Therapy and Nutritional Supplements ____ 1. A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products. 1. 10 2. 5 3. 38 4. 70 ____ 2. A potential harmful effect on patients who take some herbal medication is: 1. Constipation 2. Lead poisoning 3. Diarrhea 4. Life-threatening rash ____ 3. A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains: 1. Coumadin, which may lead to bleeding problems 2. Coumarin, which can cause liver and kidney damage 3. Cinnamic aldehyde, which is toxic to the kidney 4. Cinnamate eugenol, which is toxic to the liver ____ 4. Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe: 1. Herbs which are yang in nature 2. Herbs that are yin in nature 3. Ginger 4. Golden seal ____ 5. According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient’s illness will: 1. Get worse 2. Get better 3. Not be adequately treated 4. Need additional herbs to treat the yang ____ 6. In Ayurvedic medicine, treatment is based on the patient’s dominant dosha, which is referred to as the person’s: 1. Vata 2. Pitta 3. Kapha 4. Prakriti ____ 7. Herbs and supplements are regulated by the U.S. Food and Drug Administration. 1. True 2. False ____ 8. When melatonin is used to induce sleep, the recommendation is that the patient: 1. Take 10 mg 30 minutes before bed nightly 2. Take 1 to 5 mg 30 minutes before bed nightly 3. Not take melatonin more than three nights a week 4. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep ____ 9. Valerian tea causes relaxation and can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to: 1. Cardiac disturbances 2. Central nervous system depression 3. Respiratory depression 4. Skin rashes ____ 10. The standard dosage of St John’s wort for the treatment of mild depression is: 1. 300 mg daily 2. 100 mg three times a day 3. 300 mg three times a day 4. 600 mg three times a day ____ 11. Patients need to be instructed regarding the drug interactions with St John’s wort, including: 1. MAO inhibitors 2. Serotonin reuptake inhibitors 3. Over-the-counter cough and cold medications 4. All of the above ____ 12. Ginseng, which is taken to assist with memory, may potentiate: 1. Aricept 2. Insulin 3. Digoxin 4. Propranolol ____ 13. Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include: 1. Antihypertensives, diuretics, and digoxin 2. Antidiarrheals, antihistamines, and omeprazole 3. Penicillin antibiotic class and benzodiazepines 4. None of the above ____ 14. Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to: 1. Respiratory depression 2. Cardiac disturbance 3. Salicylates poisoning 4. Life-threatening rashes ____ 15. The role of the NP in the use of herbal medication is to: 1. Maintain competence in the prescribing of common herbal remedies 2. Recommend common over-the-counter herbs to patients 3. Educate patients and guide them to appropriate sources of care 4. Encourage patients to not use herbal therapy due to the documented dangers Chapter 13. Over-the-Counter Medications ____ 1. Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must: 1. Be safe and labeled for appropriate use 2. Have a low potential for abuse or misuse 3. Be taken for a condition the patient can reliably self-diagnose 4. All of the above ____ 2. In the United States, over-the-counter drugs are regulated by: 1. No one. There is no oversight for over-the-counter medications. 2. The U.S. Food and Drug Administration Center for Drug Evaluation and Research 3. The U.S. Drug Enforcement Administration 4. MedWatch ____ 3. As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to: 1. Get a new patent for the over-the-counter form of the drug 2. Lower the costs because most prescription benefit plans do not cover generics 3. Market the drug to a whole new population, as they are able to market to patients instead of just providers 4. Continue to make large profits from their blockbuster brand-name drug ____ 4. New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do. 1. True 2. False ____ 5. The ailment that generates the greatest over-the-counter annual drug sales is: 1. Constipation 2. Cough and colds 3. Heartburn 4. Acute and chronic pain ____ 6. Common over-the-counter pain relievers such as acetaminophen or ibuprofen: 1. Are always safer for the patient than prescription pain medication 2. Are harmful if taken in higher than recommended amounts 3. Have minimal interaction with prescription medications 4. Should never be given to children unless recommended by their provider ____ 7. When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of: 1. His appropriately only telling you about his regularly prescribed medications 2. His hiding information regarding his inappropriate use of aspirin from you 3. A common misconception that intermittently taken over-the counter medications are not an important part of his drug history 4. A common misuse of over-the-counter aspirin ____ 8. The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act: 1. Requires all providers to screen their patients for methamphetamine use 2. Restricts the prescribing of amphetamines to U.S. citizens 3. Requires a prescription be written for all methamphetamine precursors in all states 4. Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales ____ 9. When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: 1. Not to take their regularly prescribed medications while on these antibiotics 2. Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption 3. Not to take antacids while on these medications, as the antacid decreases absorption 4. That there are no drug interactions with these antibiotics