D027 PRACTICE EXAM | 100+ ACTUAL QUESTIONS WITH RATIONALES CORRECT ANSWERS | A” GUIDE | NEW!!!

1. A patient has endured several dosage adjustments of his tricyclic anti- d
A patient has endured several dosage adjustments of his tricyclic anti-
depressant, 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: a. The CYP2D6 gene influences metabolism of tricyclic antide-
pressants and certain other drugs

Answer/Rationale: CYP2D6 - page 155 Box 4.3 of Chapter 4 Genes and Genetic Dis-
eases, 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.
2. 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 medica-
tions costs to patients. Which CDC recommendation supports your goal?

a. The CDC recommends that payers and employers promote healthy work-
spaces to decrease environmental trigger exposures
b. The CDC recommends that providers prescribe the most cost-efficient
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, 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: d. The CDC recommends that co-pays be
removed for inhaled corticosteroids and other prescribed medications

3. Answer/Rationale: D - The CDC recommends that co-pays be removed for
epressant, 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: a. The CYP2D6 gene influences metabolism of
tricyclic antide- pressants and certain other drugs

Answer/Rationale: CYP2D6 - page 155 Box 4.3 of Chapter 4 Genes and Genetic
Dis- eases, 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.

4. 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
medica- tions costs to patients. Which CDC recommendation supports
your goal?

a. The CDC recommends that payers and employers promote healthy work-
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, spaces 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: 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
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link, https://healthpayerintelligence.com/news/top-10-most-expensive-chronic-dis-
N




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, eases-for-healthcare-payers; Genes, Environmental Lifestyle, and Common Dis- N N N N N N


eases; Unit 2
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5. A female patient has been recently diagnosed with invasive ductal car-
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cinoma. As an advanced practice nurse, you understand that she will be
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undergoing a multi-faceted treatment approach that will include one or
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more medications. Which medication is considered the "gold standard"
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endocrine treatment for breast cancer?
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a. Fulvestrant (Faslodex), an antiestrogen indicated for metastatic estrogen
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receptor-positive breast cancer in post-menopausal women
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b. Tamoxifen (Nolvadex), a prodrug that must be converted to active metabo-
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lites in order to block estrogen receptors in breast tissue
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c. Trastuzumab (Herceptin), a monoclonal antibody approved for HER2-posi-
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tive metastatic breast cancer
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d. Lapatinib (Tykerb), an oral inhibitor of HER2 tyrosine kinase and EGFR
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ty- rosine kinase, resulting in apoptosis and suppression of tumor cell
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growth: b. Tamoxifen (Nolvadex), a prodrug that must be converted to active
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metabolites in order to block estrogen receptors in breast tissue
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Answer/Rationale: Tamoxifen, page 929, Chapter 82 of Lehne, Unit 2, Human N N N N N N N N N N


Structures for Self Defense
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6. A patient reports a maternal family history of Lynch syndrome. Which
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laboratory finding might indicate a need for further testing for the presence of
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Lynch syndrome in this patient?
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a. Elevated thyroid-stimulating hormone N N


b. Low cortisol level N N


c. Positive heme-occult test N N


d. Sputum positive for Pseudomonas Aeruginosa: c. Positive heme-occult test
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Answer/Rationale: Positive heme-occult because Lynch syndrome is a N N N N N N N


hereditary form of colorectal cancer and colorectal bleeding can be a sign of
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cancer, per https://www.healthypeople.gov/2020/topics-
N N N


objectives/topic/genomics, Unit 2, Hu- man Structures for Self Defense N N N N N N N N


7. Your goal as the intensive care unit coordinator is to reduce falls. Upon
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review of hospital data, you find that most of the falls are occurring in the
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patient population, ages 65 and older. As a result, you coordinate a fall reduc-
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tion initiative after researching the etiology of falls in the elderly. Which action
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should be included in the protocol?
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