FINAL D116 PRACTICE TEST
patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which
action should the prescriber take initially?
d. Arrange to schedule an appointment with the patient.
Feedback: Schedule II medications are not eligible for refills, and prescriptions must be
handwritten. It is important to verify the patient’s adherence to the drug regimen and
determine the current dosage of medication and pain level; however, this can be
accomplished by scheduling an appointment and evaluating the patient in person.
A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding
would be most concerning to the provider?
b. The patient drinks two glasses of wine every night.
Feedback: 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.
The provider prepares a patient with newly diagnosed type 1 diabetes for hospital
discharge. Which action by the provider will best support the patient's ability to effectively
manage medication therapy?
c. Asking the patient to demonstrate how to measure and administer insulin
Feedback: Because insulin must be given correctly to control symptoms and prevent an
overdose, it is most important for the patient to know how to measure and administer it.
Asking for a demonstration of technique is the best way to determine whether the patient
has understood the teaching. The other teaching points are important as well, but they are
not as critical.
,A patient reports that a medication prescribed for recurrent migraine headaches is not
working. Which action is the prescriber's priority when addressing the patient's concern?
b. Ask the patient about the number and frequency of tablets taken.
Feedback: When evaluating the effectiveness of a drug, it is important to determine how
often the patient is using the drug. Asking the patient to identify how many tablets are
taken and how often helps the provider determine effective dosages and adherence to the
medication regimen. The patient has already stated that the medication is not working; the
actual level of pain may determine the degree to which it is not working, but it does not
help the provider to determine why it is not working. The assessment process should gather
as much information about compliance, symptoms, and drug effectiveness as possible
before enacting a change in treatment. Biofeedback may be an effective adjunct to
treatment, but it should not be recommended without complete information about drug
effectiveness.
The drug manual states that older adult patients are at increased risk for hepatotoxicity.
Which action is most important when prescribing this medication to an 80-year-old patient?
d. Obtaining baseline liver function studies
Feedback: The drug manual indicates that this drug increases risk of hepatotoxicity for
elderly patients. Getting information about liver function before giving the drug establishes
baseline data that can be compared with posttreatment data to determine whether the
drug is affecting the liver. Taking the correct dose at the correct interval may minimize risk,
but without baseline information, the effects cannot be determined. Drugs are not routinely
contraindicated for an increased risk of adverse effects
A patient with bipolar disorder is prescribed daily lithium. Which action is most important
for the provider to take in order to determine if the therapeutic level is maintained?
. Order periodic laboratory testing
Feedback: Therapeutic serum levels are determined through periodic laboratory testing.
Preadministration blood work may be necessary to obtain baseline status prior to initiating
treatment, but it will not determine therapeutic levels. Scheduling medication
administration at regular intervals will help to ensure medication is absorbed and
metabolized predictably, but it will not determine therapeutic blood levels. Assessing the
patient for signs and symptoms of toxicity will help to determine if the therapeutic level has
been exceeded, not maintained.
When prescribing lovastatin, what will a provider advise to decrease the risk of developing
muscle toxicity?
, B. Substitute grapefruit juice with orange juice.
Feedback: Grapefruit juice can inhibit the metabolism of certain drugs including statins like
lovastatin. The juice raises drug levels decreasing the intestinal metabolism of the drug
resulting in increased drug levels which increases the risk for adverse effects such as muscle
toxicity. Taking the drug with an anti-inflammatory drug and avoiding exercise after
administration are not supported by science. Monitoring AST and ALT detects liver toxicity,
not muscle toxicity.
The provider prescribes hydrocodone with acetaminophen for a patient's postsurgical pain.
What instruction will the prescriber include regarding alcohol intake?
A. “You should avoid drinking alcohol while you are taking the pain medication I’ve
ordered.”
Feedback: Combining a hepatotoxic drug with other hepatotoxic agents increases the risk of
hepatotoxicity. When even therapeutic doses of acetaminophen are taken with alcohol, the
acetaminophen can cause liver damage. Patients should be cautioned not to drink alcohol;
even two drinks with acetaminophen can produce this effect. Hydrocodone does not
contribute to hepatotoxicity. Ibuprofen is not indicated for postoperative pain unless the
pain is mild. Limiting alcohol intake to two servings per day still increases the risk of
hepatotoxicity.
A drug can cause symptoms that resemble those of Parkinson disease. What action should
the prescriber take to minimize the potential patient risk?
A. Thoroughly educate the patient about recognizing such symptoms and the need to notify
the office immediately.
Feedback: Some drugs can cause iatrogenic conditions, which are conditions whose
symptoms are the same as those of a known disease. The patient should be prepared for
this possibility and be prepared to recognize and report the symptoms immediately. Such
effects are not teratogenic, since teratogenic effects affect the fetus. Patients with a genetic
predisposition to respond differently to drugs are known to have idiosyncratic effects.
Although reassurance may dispel some fear on the part of the patient, it does provide the
patient with actions (e.g., notifying the provider) that can allow for symptom management.
A patient reports mild nausea within an hour after taking the first two doses of a newly
approved medication. Nausea is not listed among the known side effects of this drug. What
instructions will the provider give the patient?
. “Take the next dose with food and call the office if the nausea reoccurs or if other
symptoms develop.”
patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which
action should the prescriber take initially?
d. Arrange to schedule an appointment with the patient.
Feedback: Schedule II medications are not eligible for refills, and prescriptions must be
handwritten. It is important to verify the patient’s adherence to the drug regimen and
determine the current dosage of medication and pain level; however, this can be
accomplished by scheduling an appointment and evaluating the patient in person.
A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding
would be most concerning to the provider?
b. The patient drinks two glasses of wine every night.
Feedback: 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.
The provider prepares a patient with newly diagnosed type 1 diabetes for hospital
discharge. Which action by the provider will best support the patient's ability to effectively
manage medication therapy?
c. Asking the patient to demonstrate how to measure and administer insulin
Feedback: Because insulin must be given correctly to control symptoms and prevent an
overdose, it is most important for the patient to know how to measure and administer it.
Asking for a demonstration of technique is the best way to determine whether the patient
has understood the teaching. The other teaching points are important as well, but they are
not as critical.
,A patient reports that a medication prescribed for recurrent migraine headaches is not
working. Which action is the prescriber's priority when addressing the patient's concern?
b. Ask the patient about the number and frequency of tablets taken.
Feedback: When evaluating the effectiveness of a drug, it is important to determine how
often the patient is using the drug. Asking the patient to identify how many tablets are
taken and how often helps the provider determine effective dosages and adherence to the
medication regimen. The patient has already stated that the medication is not working; the
actual level of pain may determine the degree to which it is not working, but it does not
help the provider to determine why it is not working. The assessment process should gather
as much information about compliance, symptoms, and drug effectiveness as possible
before enacting a change in treatment. Biofeedback may be an effective adjunct to
treatment, but it should not be recommended without complete information about drug
effectiveness.
The drug manual states that older adult patients are at increased risk for hepatotoxicity.
Which action is most important when prescribing this medication to an 80-year-old patient?
d. Obtaining baseline liver function studies
Feedback: The drug manual indicates that this drug increases risk of hepatotoxicity for
elderly patients. Getting information about liver function before giving the drug establishes
baseline data that can be compared with posttreatment data to determine whether the
drug is affecting the liver. Taking the correct dose at the correct interval may minimize risk,
but without baseline information, the effects cannot be determined. Drugs are not routinely
contraindicated for an increased risk of adverse effects
A patient with bipolar disorder is prescribed daily lithium. Which action is most important
for the provider to take in order to determine if the therapeutic level is maintained?
. Order periodic laboratory testing
Feedback: Therapeutic serum levels are determined through periodic laboratory testing.
Preadministration blood work may be necessary to obtain baseline status prior to initiating
treatment, but it will not determine therapeutic levels. Scheduling medication
administration at regular intervals will help to ensure medication is absorbed and
metabolized predictably, but it will not determine therapeutic blood levels. Assessing the
patient for signs and symptoms of toxicity will help to determine if the therapeutic level has
been exceeded, not maintained.
When prescribing lovastatin, what will a provider advise to decrease the risk of developing
muscle toxicity?
, B. Substitute grapefruit juice with orange juice.
Feedback: Grapefruit juice can inhibit the metabolism of certain drugs including statins like
lovastatin. The juice raises drug levels decreasing the intestinal metabolism of the drug
resulting in increased drug levels which increases the risk for adverse effects such as muscle
toxicity. Taking the drug with an anti-inflammatory drug and avoiding exercise after
administration are not supported by science. Monitoring AST and ALT detects liver toxicity,
not muscle toxicity.
The provider prescribes hydrocodone with acetaminophen for a patient's postsurgical pain.
What instruction will the prescriber include regarding alcohol intake?
A. “You should avoid drinking alcohol while you are taking the pain medication I’ve
ordered.”
Feedback: Combining a hepatotoxic drug with other hepatotoxic agents increases the risk of
hepatotoxicity. When even therapeutic doses of acetaminophen are taken with alcohol, the
acetaminophen can cause liver damage. Patients should be cautioned not to drink alcohol;
even two drinks with acetaminophen can produce this effect. Hydrocodone does not
contribute to hepatotoxicity. Ibuprofen is not indicated for postoperative pain unless the
pain is mild. Limiting alcohol intake to two servings per day still increases the risk of
hepatotoxicity.
A drug can cause symptoms that resemble those of Parkinson disease. What action should
the prescriber take to minimize the potential patient risk?
A. Thoroughly educate the patient about recognizing such symptoms and the need to notify
the office immediately.
Feedback: Some drugs can cause iatrogenic conditions, which are conditions whose
symptoms are the same as those of a known disease. The patient should be prepared for
this possibility and be prepared to recognize and report the symptoms immediately. Such
effects are not teratogenic, since teratogenic effects affect the fetus. Patients with a genetic
predisposition to respond differently to drugs are known to have idiosyncratic effects.
Although reassurance may dispel some fear on the part of the patient, it does provide the
patient with actions (e.g., notifying the provider) that can allow for symptom management.
A patient reports mild nausea within an hour after taking the first two doses of a newly
approved medication. Nausea is not listed among the known side effects of this drug. What
instructions will the provider give the patient?
. “Take the next dose with food and call the office if the nausea reoccurs or if other
symptoms develop.”
