PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSE
PRESCRIBERS WITH DAVIS EDGE
6th Edition
TEST BANK
1)
Reference: Ch. 1 — The Role of the Advanced Practice Nurse as
Prescriber
Stem: A 78-year-old woman (weight 62 kg) with osteoarthritis
presents with moderate knee pain. Past medical history: stage 4
CKD (eGFR 24 mL/min/1.73 m²), HTN, and chronic heart failure.
Current meds: lisinopril, furosemide, low-dose aspirin. She asks
for something stronger than topical heat. Which medication
strategy is safest to initiate for outpatient analgesia?
A. Prescribe ibuprofen 200 mg PO q6–8h PRN.
B. Initiate acetaminophen 650 mg PO q6h PRN (max 3 g/day)
and counsel on monitoring.
C. Start oral diclofenac 50 mg PO twice daily.
,D. Prescribe naproxen 220 mg PO q12h and advise increased
fluid intake.
Correct Answer: B
Rationale — Correct (B):
Acetaminophen provides analgesia with minimal renal effect
when used at conservative doses; in CKD (eGFR 24) it avoids the
nephrotoxic and sodium-retaining effects of NSAIDs and
cardiovascular/renal risks that worsen heart failure. Limit to ≤3
g/day in older adults and counsel on signs of hepatotoxicity and
avoidance of OTC duplicates. Aligns with safe prescribing
principles in CKD and heart failure.
Rationale — Incorrect:
A. Ibuprofen: NSAIDs inhibit prostaglandin-mediated renal
autoregulation, risking further GFR decline and sodium/water
retention — unsafe in stage 4 CKD and heart failure.
C. Oral diclofenac: Same systemic NSAID risks; not preferred in
advanced CKD or HF.
D. Naproxen: Also an NSAID with renal and HF risks; increased
fluids may worsen HF and do not mitigate nephrotoxicity.
Teaching Point: Prefer acetaminophen in renal impairment;
avoid systemic NSAIDs in advanced CKD/HF.
Citation: Woo, T. M., & Wright, W. L. (2024).
Pharmacotherapeutics for Advanced Practice Nurse Prescribers
with Davis Edge (6th ed.). Ch. 1.
,2)
Reference: Ch. 1 — The Role of the Advanced Practice Nurse as
Prescriber
Stem: A 45-year-old patient with chronic low back pain is
stabilized on alprazolam 0.5 mg BID for anxiety. They request a
short prescription for oxycodone for an acute exacerbation. No
recent urine drug screen is available. What is the best
prescriber decision?
A. Provide oxycodone 5 mg PO q4–6h PRN for 5 days and
schedule follow-up.
B. Decline opioid prescription and recommend nonopioid
therapies and reassess anxiety medication.
C. Prescribe oxycodone and co-prescribe naloxone to mitigate
respiratory risk.
D. Switch alprazolam to lorazepam and then prescribe opioid.
Correct Answer: B
Rationale — Correct (B):
Concurrent benzodiazepine and opioid use significantly
increases risk of respiratory depression and overdose; when
possible, avoid initiating opioids in patients on benzodiazepines.
Prioritize nonopioid analgesics, nonpharmacologic measures,
and re-evaluation of anxiety treatment to reduce polypharmacy
and risk. This reflects safe prescribing and risk–benefit
evaluation.
, Rationale — Incorrect:
A. Starting oxycodone with ongoing benzodiazepine is high risk
without mitigation and recent assessment (urine drug screen)
— unsafe.
C. Co-prescribing naloxone may help harm reduction but does
not eliminate the elevated risk — starting opioid remains less
safe than nonopioid alternatives.
D. Switching benzodiazepines does not reduce
pharmacodynamic risk; substituting or tapering
benzodiazepines requires careful psychiatric planning, not
simultaneous opioid initiation.
Teaching Point: Avoid initiating opioids in patients taking
benzodiazepines; prioritize nonopioid strategies and
reassessment.
Citation: Woo, T. M., & Wright, W. L. (2024).
Pharmacotherapeutics for Advanced Practice Nurse Prescribers
with Davis Edge (6th ed.). Ch. 1.
3)
Reference: Ch. 1 — The Role of the Advanced Practice Nurse as
Prescriber
Stem: A 28-year-old pregnant woman at 14 weeks gestation
presents with dysuria and positive urine nitrite/leukocyte
esterase. No allergy history; vitals stable. Which antibiotic
strategy best balances efficacy and fetal safety?
ADVANCED PRACTICE NURSE
PRESCRIBERS WITH DAVIS EDGE
6th Edition
TEST BANK
1)
Reference: Ch. 1 — The Role of the Advanced Practice Nurse as
Prescriber
Stem: A 78-year-old woman (weight 62 kg) with osteoarthritis
presents with moderate knee pain. Past medical history: stage 4
CKD (eGFR 24 mL/min/1.73 m²), HTN, and chronic heart failure.
Current meds: lisinopril, furosemide, low-dose aspirin. She asks
for something stronger than topical heat. Which medication
strategy is safest to initiate for outpatient analgesia?
A. Prescribe ibuprofen 200 mg PO q6–8h PRN.
B. Initiate acetaminophen 650 mg PO q6h PRN (max 3 g/day)
and counsel on monitoring.
C. Start oral diclofenac 50 mg PO twice daily.
,D. Prescribe naproxen 220 mg PO q12h and advise increased
fluid intake.
Correct Answer: B
Rationale — Correct (B):
Acetaminophen provides analgesia with minimal renal effect
when used at conservative doses; in CKD (eGFR 24) it avoids the
nephrotoxic and sodium-retaining effects of NSAIDs and
cardiovascular/renal risks that worsen heart failure. Limit to ≤3
g/day in older adults and counsel on signs of hepatotoxicity and
avoidance of OTC duplicates. Aligns with safe prescribing
principles in CKD and heart failure.
Rationale — Incorrect:
A. Ibuprofen: NSAIDs inhibit prostaglandin-mediated renal
autoregulation, risking further GFR decline and sodium/water
retention — unsafe in stage 4 CKD and heart failure.
C. Oral diclofenac: Same systemic NSAID risks; not preferred in
advanced CKD or HF.
D. Naproxen: Also an NSAID with renal and HF risks; increased
fluids may worsen HF and do not mitigate nephrotoxicity.
Teaching Point: Prefer acetaminophen in renal impairment;
avoid systemic NSAIDs in advanced CKD/HF.
Citation: Woo, T. M., & Wright, W. L. (2024).
Pharmacotherapeutics for Advanced Practice Nurse Prescribers
with Davis Edge (6th ed.). Ch. 1.
,2)
Reference: Ch. 1 — The Role of the Advanced Practice Nurse as
Prescriber
Stem: A 45-year-old patient with chronic low back pain is
stabilized on alprazolam 0.5 mg BID for anxiety. They request a
short prescription for oxycodone for an acute exacerbation. No
recent urine drug screen is available. What is the best
prescriber decision?
A. Provide oxycodone 5 mg PO q4–6h PRN for 5 days and
schedule follow-up.
B. Decline opioid prescription and recommend nonopioid
therapies and reassess anxiety medication.
C. Prescribe oxycodone and co-prescribe naloxone to mitigate
respiratory risk.
D. Switch alprazolam to lorazepam and then prescribe opioid.
Correct Answer: B
Rationale — Correct (B):
Concurrent benzodiazepine and opioid use significantly
increases risk of respiratory depression and overdose; when
possible, avoid initiating opioids in patients on benzodiazepines.
Prioritize nonopioid analgesics, nonpharmacologic measures,
and re-evaluation of anxiety treatment to reduce polypharmacy
and risk. This reflects safe prescribing and risk–benefit
evaluation.
, Rationale — Incorrect:
A. Starting oxycodone with ongoing benzodiazepine is high risk
without mitigation and recent assessment (urine drug screen)
— unsafe.
C. Co-prescribing naloxone may help harm reduction but does
not eliminate the elevated risk — starting opioid remains less
safe than nonopioid alternatives.
D. Switching benzodiazepines does not reduce
pharmacodynamic risk; substituting or tapering
benzodiazepines requires careful psychiatric planning, not
simultaneous opioid initiation.
Teaching Point: Avoid initiating opioids in patients taking
benzodiazepines; prioritize nonopioid strategies and
reassessment.
Citation: Woo, T. M., & Wright, W. L. (2024).
Pharmacotherapeutics for Advanced Practice Nurse Prescribers
with Davis Edge (6th ed.). Ch. 1.
3)
Reference: Ch. 1 — The Role of the Advanced Practice Nurse as
Prescriber
Stem: A 28-year-old pregnant woman at 14 weeks gestation
presents with dysuria and positive urine nitrite/leukocyte
esterase. No allergy history; vitals stable. Which antibiotic
strategy best balances efficacy and fetal safety?
