TEST BANK for Pharmacotherapeutics for Advanced Practice Nurse Prescribers, 6th Edition by Teri Mose

TABLE OF CONTENT Chapter 1. The Role of the Advanced Practice Nurse as Prescriber ..................................................................... 4 Chapter 2. Review of Basic Principles of Pharmacology ..................................................................................... 5 Chapter 3. Rational Drug Selection .................................................................................................................... 11 Chapter 4. Legal and Professional Issues in Prescribing .................................................................................... 14 Chapter 5. Adverse Drug Reactions.................................................................................................................... 16 Chapter 6. An Introduction to Pharmacogenomics ............................................................................................. 19 Chapter 7. Nutrition and Nutraceuticals ............................................................................................................. 22 Chapter 8. Herbal Therapies ............................................................................................................................... 28 Chapter 9. Cannabis ............................................................................................................................................ 31 Chapter 10. Pharmacoeconomics ........................................................................................................................ 35 Chapter 11. Drugs Affecting the Autonomic Nervous System........................................................................... 38 Chapter 12. Drugs Affecting the Central Nervous System ................................................................................. 45 Chapter 13. Drugs Affecting the Cardiovascular and Renal Systems ................................................................ 53 Chapter 14. Drugs Affecting the Respiratory System ........................................................................................ 61 Chapter 15. Drugs Affecting the Hematological System.................................................................................... 65 Chapter 16. Drugs Affecting the Immune System: Vaccines and Immunoglobulins ......................................... 69 Chapter 17. Drugs Affecting the Immune System: Immunomodulators ............................................................ 75 Chapter 18. Drugs Affecting the Gastrointestinal System .................................................................................. 77 Chapter 19. Drugs Affecting the Endocrine System: Pancreatic Hormones and Antidiabetic Drugs ................. 80 Chapter 20. Drugs Affecting the Endocrine System: Pituitary, Thyroid, and Adrenal Drugs ........................... 83 Chapter 21. Drugs Affecting the Reproductive System...................................................................................... 86 Chapter 22. Drugs Affecting the Bones and Joints ............................................................................................. 92 Chapter 23. Drugs Affecting the Integumentary System .................................................................................... 96 Chapter 24. Drugs Used to Treat Bacterial Infections ...................................................................................... 101 Chapter 25. Drugs Used to Treat Viral, Fungal, and Protozoal Infections ....................................................... 105 Chapter 26. Drugs Used to Treat Inflammatory Processes ............................................................................... 108 Chapter 27. Drugs Used to Treat Eye and Ear Disorders ................................................................................. 111 Chapter 28. Anemia .......................................................................................................................................... 113 Chapter 29. Anxiety and Depression ................................................................................................................ 116 Chapter 30. Attention Deficit-Hyperactivity Disorder ..................................................................................... 120 Chapter 31. Asthma and Allergy ...................................................................................................................... 122 Chapter 32. Chronic Obstructive Pulmonary Disease ...................................................................................... 125 Chapter 33. Contraception ................................................................................................................................ 127 Chapter 34. COVID-19: Acute and Chronic..................................................................................................... 130 Chapter 35. Dermatological Conditions ........................................................................................................... 134 Chapter 36. Diabetes Management ................................................................................................................... 138 Chapter 37. Gastroesophageal Reflux and Peptic Ulcer Disease ..................................................................... 146 Chapter 38. Headaches...................................................................................................................................... 149 Chapter 39. Heart Failure .................................................................................................................................. 153 Chapter 40. HIV Disease and Acquired Immunodeficiency Syndrome ........................................................... 158 Chapter 41. Menopausal Hormone Therapy ..................................................................................................... 161

Chapter 42. Hyperlipidemia .............................................................................................................................. 164 Chapter 43. Hypertension ................................................................................................................................. 169 Chapter 44. Hyperthyroidism and Hypothyroidism.......................................................................................... 174 Chapter 45. Obesity .......................................................................................................................................... 177 Chapter 46. Pain Management: Acute and Chronic Pain ................................................................................. 181 Chapter 47. Pneumonia ..................................................................................................................................... 185 Chapter 48. Sexually Transmitted Diseases and Vaginitis ............................................................................... 187 Chapter 49. Substance Use Disorders ............................................................................................................... 190 Chapter 50. Tuberculosis .................................................................................................................................. 195 Chapter 51. Upper Respiratory Tract Infection, Pharyngitis, Sinusitis, Otitis Media, and Otitis Externa ........ 197 Chapter 52. Urinary Tract Infections ................................................................................................................ 200 Chapter 53. Women as Patients ........................................................................................................................ 203 Chapter 54. Men as Patients.............................................................................................................................. 207 Chapter 55. Pediatric Patients ........................................................................................................................... 209 Chapter 57. Geriatric Patients ........................................................................................................................... 213

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Chapter 1. The Role of the Advanced Practice Nurse as Prescriber MULTIPLE CHOICE 1. Nurse practitioner prescriptive authority is regulated by: A. The National Council of State Boards of Nursing B. The U.S. Drug Enforcement Administration C. The State Board of Nursing for each state D. The State Board of Pharmacy ANS: C

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2. The benefits to the patient of having an advanced practice registered nurse (APRN) prescriber

include: A. Nurses know more about pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program.

B. Nurses care for the patient from a holistic approach and include the patient in decision-making regarding their care.

C. APRNs are less likely to prescribe narcotics and other controlled substances.

D. APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice.

ANS: B

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3. Clinical judgment in prescribing includes: A. Factoring in the cost to the patient of the medication prescribed B. Always prescribing the newest medication available for the disease process C. Handing out drug samples to poor patients D. Prescribing all generic medications to cut costs ANS: A

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4. The process for choosing an effective drug for a disorder includes: A. Asking the patient what drug they think would work best for them B. Consulting nationally recognized guidelines for disease management C. Prescribing medications that are available as samples before writing a prescription D. Following U.S. Drug Enforcement Administration guidelines for prescribing ANS: B

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5. Nonintentional nonadherence of drug therapy may occur due to: A. Belief that medication does not work B. Adverse drug reactions C. Chronic conditions that require daily therapy D. Forgetfulness or distraction ANS: D

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Chapter 2. Review of Basic Principles of Pharmacology MULTIPLE CHOICE 1. A patient’s nutritional intake and laboratory results reflect hypoalbuminemia. This is critical

to prescribing because: A. Distribution of drugs to target tissue may be affected.

B. The solubility of the drug will not match the site of absorption.

C. There will be less free drug available to generate an effect.

D. Drugs bound to albumin are readily excreted by the kidneys.

ANS: A

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2. Drugs that have a significant first-pass effect: A. Must be given by the enteral (oral) route only B. Bypass the hepatic circulation C. Are rapidly metabolized by the liver and may have little, if any, desired action D. Are converted by the liver to more active and fat-soluble forms ANS: C

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3. The route of excretion of a volatile drug will likely be the: A. Kidneys B. Lungs C. Bile and feces D. Skin ANS: B

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4. A major disadvantage to IV administration is that: A. First-pass metabolism is eliminated.

B. Needles and sterility are required.

C. Absorption of the drug cannot be slowed after administration.

D. It is significantly more expensive than other routes.

ANS: C

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5. The nurse practitioner (NP) chooses to give cephalexin every 8 hours based on knowledge of

the drug’s: A. Propensity to go to the target receptor B. Biological half-life C. Pharmacodynamics D. Safety and side effects ANS: B

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6. Deferasirox is a chelating agent used to treat iron overload by binding iron to render it

biologically inactive. This is best characterized as a(n):

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A. Nonreceptor mechanism B. Partial agonist C. Full agonist D. Noncompetitive antagonist ANS: A

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7. The point in time on the drug concentration curve that indicates the first sign of a therapeutic

effect is the: A. Minimum adverse effect level B. Peak of action C. Onset of action D. Therapeutic range ANS: C

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8. Phenytoin requires that a trough level be drawn. Peak and trough levels are done: A. When the drug has a wide therapeutic range B. When the drug will be administered for a short time only C. When there is a high correlation between the dose and saturation of receptor sites D. To determine if a drug is in the therapeutic range ANS: D

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9. A laboratory result indicates that the peak level for a drug is above the minimum toxic

concentration. This means that the: A. Concentration will produce therapeutic effects.

B. Concentration will produce an adverse response.

C. Time between doses must be shortened.

D. Duration of action of the drug is too long.

ANS: B

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10. Drugs that are receptor agonists may demonstrate what property?

A. Irreversible binding to the drug receptor site B. Up-regulation with chronic use C. Desensitization or down-regulation with continuous use D. Inverse relationship between drug concentration and drug action ANS: C

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11. Drugs that are receptor antagonists, such as beta blockers, may cause: A. Down-regulation of the drug receptor B. An exaggerated response if abruptly discontinued C. Partial blockade of the effects of agonist drugs D. An exaggerated response to competitive drug agonists ANS: B

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12. Factors that affect gastric drug absorption include: A. Liver enzyme activity B. Protein-binding properties of the drug molecule C. Lipid solubility of the drug D. Ability to chew and swallow ANS: C

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13. Drugs administered via IV: A. Need to be lipid soluble in order to be easily absorbed B. Begin distribution into the body immediately C. Are easily absorbed if they are nonionized D. May use pinocytosis to be absorbed ANS: B

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14. When a medication is added to a regimen for a synergistic effect, the combined effect of the

drugs is: A. The sum of the effects of each drug individually B. Greater than the sum of the effects of each drug individually C. Less than the effect of each drug individually D. Not predictable, as it varies with each individual ANS: B

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15. Which of the following statements about bioavailability is true?

A. Bioavailability issues are especially important for drugs with narrow therapeutic

ranges or sustained-release mechanisms.

B. All brands of a drug have the same bioavailability.

C. Drugs that are administered more than once a day have greater bioavailability than

drugs given once daily.

D. Combining an active drug with an inert substance does not affect bioavailability.

ANS: A

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16. Which of the following statements about the major distribution barriers (blood–brain or fetal–

placental) is true?

A. Water soluble and ionized drugs cross these barriers rapidly.

B. The blood–brain barrier slows the passage of many drugs into and out of brain cells.

C. The fetal–placental barrier protects the fetus from drugs taken by the mother.

D. Lipid-soluble drugs do not pass these barriers and are safe for pregnant women.

ANS: B

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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: A. Inactivate prodrugs before they can be activated by target tissues

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B. Change the drugs so they can cross plasma membranes C. Change drug molecules to a form that an excretory organ can excrete D. Make these drugs more ionized and polar to facilitate excretion ANS: C

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18. Once they have been metabolized by the liver, the metabolites may be: A. More active than the parent drug B. Less active than the parent drug C. Totally “deactivated” so they are excreted without any effect D. All of the above ANS: D

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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: A. Reduced circulation and perfusion of the kidney B. Chronic renal disease C. Competition for a transport site from another drug D. Increased renal blood flow ANS: D

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20. Steady state is: A. The point on the drug concentration curve when absorption exceeds excretion B. When the peak and trough remain constant C. When the amount of drug in the body stays below the minimum toxic

concentration D. All of the above ANS: B

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21. A patient is being treated for pain with hydrocodone. If the patient is then prescribed a

CYP2D6 inhibitor, the likely clinical result is: A. Hydrocodone toxicity B. Prolonged action of hydrocodone C. Parasympathetic adverse effects D. Inadequate pain control ANS: D

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22. Actions taken to reduce drug–drug interaction problems include all of the following EXCEPT: A. Reducing the dosage of one of the drugs B. Scheduling their administration at different times C. Prescribing a third drug to counteract the adverse reaction of the combination D. Reducing the dosage of both drugs ANS: C

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23. The time required for the amount of drug in the body to decrease by 50% is called: A. Steady state B. Half-life C. Phase II metabolism D. Reduced bioavailability time ANS: B

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24. An agonist activates a receptor and stimulates a response. When given frequently over time,

the body may: A. Up-regulate the total number of receptors B. Block the receptor with a partial agonist C. Alter the drug’s metabolism D. Down-regulate the numbers of that specific receptor ANS: D

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25. Antagonists are best characterized as: A. Medications that lead to major physiological and psychological dependence B. Medications that do not produce a response C. Medications that are incapable of metabolism before another dose is administered D. Medications that produce a decreased physiological response when combined with

another drug ANS: B

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26. Instructions to a patient regarding self-administration of oral enteric-coated tablets should

include which of the following statements?

A. “Avoid any other oral medicines while taking this drug.”

B. “If swallowing this tablet is difficult, dissolve it in 3 ounces of orange juice.”

C. “The tablet may be crushed if you have any difficulty taking it.”

D. “To achieve best effect, take the tablet with at least 8 ounces of fluid.”

ANS: D

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27. A patient takes 650 mg of acetaminophen and achieves reduction of pain from 7 to 3 on a

scale of 1 to 10. The next day, the patient takes 400 mg of ibuprofen and achieves reduction of the pain from 7 to 2. The ibuprofen is more: A. Potent B. Efficacious C. Absorbed D. Responsive ANS: B

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28. Which of the following substances is the most likely to be absorbed in the intestines rather

than in the stomach?

A. Enteric-coated medications

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B. Long-acting agents C. ETOH D. Acidic products ANS: A

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29. Which of the following variables is a factor in drug absorption?

A. The smaller the surface area for absorption, the more rapidly the drug is absorbed.

B. A rich blood supply to the area of absorption leads to better absorption.

C. The less soluble the drug, the more easily it is absorbed.

D. Ionized drugs are easily absorbed across the cell membrane.

ANS: B

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30. An advantage of prescribing a sublingual medication is that the medication is: A. Absorbed rapidly B. Excreted rapidly C. Metabolized minimally D. Distributed equally ANS: A

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31. Drugs that are CYP3A4 substrates may: A. Induce the metabolism of another drug B. Inhibit the metabolism of another drug C. Both A and B D. Neither A nor B ANS: D

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32. Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state: A. After the second dose B. After four to five half-lives C. When the patient feels the full effect of the drug D. One hour after IV administration ANS: B

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Chapter 3. Rational Drug Selection MULTIPLE CHOICE 1. In deciding which drug to use to treat a condition, the NP chooses to prescribe drug A because

it: A. Has serious side effects and it is not being used for a life-threatening condition B. Will not impact comorbid diagnoses C. Is expensive but covered by health insurance D. None of these are important in choosing a drug ANS: B

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2. A client asks the NP about the differences in drug effects between men and women. What is

known about the differences between the pharmacokinetics of men and women?

A. Body temperature varies between men and women.

B. Muscle mass is greater in women.

C. Percentage of fat differs between genders.

D. Proven subjective factors exist between the genders.

ANS: C

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3. The first step in the prescribing process according to the World Health Organization is: A. Choosing the treatment B. Educating the patient about the medication C. Defining the patient’s problem D. Starting the treatment ANS: C

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4. Treatment goals in prescribing should: A. Always be curative B. Be patient-centered C. Be convenient for the provider D. Focus on the cost of therapy ANS: B

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5. The therapeutic goals when prescribing include(s): A. Curative B. Palliative C. Preventive D. All of the above ANS: D

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6. When determining drug treatment the NP prescriber should:

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A. Always use evidence-based guidelines B. Individualize the drug choice for the specific patient C. Rely on his or her experience when prescribing for complex patients D. Use the newest drug on the market for the condition being treated ANS: B

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7. Patient education regarding prescribed medication includes: A. Instructions written at the high school reading level B. Discussion of expected adverse drug reactions C. How to store leftover medication such as antibiotics D. Verbal instructions that are always in English ANS: B

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8. Passive monitoring of drug effectiveness includes: A. Ordering therapeutic drug levels B. Adding or subtracting medications from the treatment regimen C. Suggesting ongoing provider visits D. Instructing the patient to report if the drug is not effective ANS: D

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9. Pharmacokinetic factors that affect prescribing include: A. Therapeutic index B. Minimum effective concentration C. CYP450 metabolism D. Ease of titration ANS: C

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10. Pharmaceutical promotion may affect prescribing. To address the impact of pharmaceutical

promotion, the following recommendations have been made by the Institute of Medicine: A. Conflicts of interest and financial relationships should be disclosed by those providing education.

B. Providers should ban all pharmaceutical representatives from their office setting.

C. Drug samples should be used for patients who have the insurance to pay for them to ensure the patient can afford the medication.

D. Providers should only accept low-value gifts, such as pens and pads of paper, from the pharmaceutical representative.

ANS: A

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11. Under new U.S. Food and Drug Administration labeling, pregnancy categories have been: A. Strengthened with a new coding, such as C+ or C-, to discern when a drug is more

or less toxic to the fetus B. Changed to incorporate a pregnancy risk summary and clinical considerations on the drug label

Woo Pharmacotherapeutics for APN Prescribers, 6e C. Eliminated and replaced with a link to the National Library of Medicine TOXNET

Web site for in-depth information regarding pregnancy concerns D. Clarified to include information such as safe dosages in each trimester of

pregnancy ANS: B

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Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 4. Legal and Professional Issues in Prescribing MULTIPLE CHOICE 1. The U.S. Food and Drug Administration regulates: A. Prescribing of drugs by medical doctors (MDs) and nurse practitioners (NPs) B. The official labeling for all prescription and over-the-counter drugs C. Off-label recommendations for prescribing D. Pharmaceutical educational offerings ANS: B

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2. U.S. Food and Drug Administration approval is required for: A. Medical devices, including artificial joints B. Over-the-counter vitamins C. Herbal products, such as St. John’s Wort D. Dietary supplements, such as Ensure ANS: A

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3. An investigational new drug is filed with the U.S. Food and Drug Administration: A. When the manufacturer has completed phase III trials B. When a new drug is discovered C. Prior to animal testing of any new drug entity D. Prior to human testing of any new drug entity ANS: D

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4. Phase IV clinical trials in the United States are also known as: A. Human bioavailability trials B. Postmarketing research C. Human safety and efficacy studies D. The last stage of animal trials before the human trials begin ANS: B

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5. Off-label prescribing is: A. Regulated by the U.S. Food and Drug Administration B. Illegal for NPs in all states and provinces C. Legal if there is scientific evidence for the use of the drug D. Regulated by the Drug Enforcement Administration ANS: C

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6. The U.S. Drug Enforcement Administration: A. Registers manufacturers and prescribers of controlled substances B. Regulates NP prescribing at the state level C. Sanctions providers who prescribe drugs off-label

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Woo Pharmacotherapeutics for APN Prescribers, 6e D. Provides prescribers with a number they can use for insurance billing ANS: A

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7. Drugs that are designated “Schedule II” by the U.S. Drug Enforcement Administration: A. Are known teratogens during pregnancy B. May not be refilled; a new prescription must be written C. Have a low abuse potential D. May be dispensed without a prescription unless regulated by the state ANS: B

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8. Strategies prescribers can use to prevent misuse of controlled prescription drugs include: A. Using chemical dependency screening tools B. Practicing firm limit-setting regarding prescribing controlled substances C. Practicing “just say no” to deal with patients who are pushing the provider to

prescribe controlled substances D. All of the above ANS: D

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9. Behaviors predictive of addiction to controlled substances include the patient: A. Stealing or borrowing another patient’s drugs B. Requiring increasing doses of opiates for pain associated with malignancy C. Receiving refills of a Schedule II prescription on a regular basis D. Requesting that only their own primary care provider prescribes for them ANS: A

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10. Medication agreements or “pain medication contracts” are recommended to be used: A. Universally for all prescribing for chronic pain B. For patients who have repeated requests for pain medication C. When you suspect a patient is exhibiting drug-seeking behavior D. For patients with pain associated with malignancy ANS: A

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11. A prescription needs to be written for: A. Legend drugs B. Most controlled drugs C. Medical devices D. All of the above ANS: D

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Chapter 5. Adverse Drug Reactions MULTIPLE CHOICE 1. Which of the following patients would be at higher risk of experiencing adverse drug

reactions (ADRs)?

A. A 32-year-old male B. A 22-year-old female C. A 3-month-old female D. A 48-year-old male ANS: C

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2. Infants and young children are at higher risk of ADRs due to: A. Immature renal function in school-age children B. The fact that doses must be tailored to specific weight or BMI C. Children’s skin being thicker than adults, requiring higher dosages of topical

medication D. Infant boys having a higher proportion of muscle mass, leading to a higher volume

of distribution ANS: B

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3. The elderly are at high risk of ADRs due to: A. The elderly having greater muscle mass than younger adults, leading to higher

volume of distribution B. The extensive studies that have been conducted on drug safety in this age group C. The blood–brain barrier being less permeable, requiring higher doses to achieve

therapeutic effect D. The age-related decrease in renal function ANS: D

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4. The type of ADR that is idiosyncratic when a drug is given in the usual therapeutic doses is

type: A. A B. B C. C D. D ANS: B

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5. Digoxin may cause a type A ADR because: A. It has idiosyncratic effects.

B. It has a narrow therapeutic index.

C. It is a teratogen.

D. It is a carcinogen.

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ANS: B

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6. Sarah developed a rash after using a topical medication. This is a type allergic drug

reaction.

A. I B. II C. III D. IV ANS: D

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7. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is

a(n): A. Cytotoxic hypersensitivity reaction B. Immune complex hypersensitivity C. Immediate hypersensitivity reaction D. Delayed hypersensitivity reaction ANS: A

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8. Anaphylactic shock is a: A. Type I reaction, called “immediate hypersensitivity reaction” B. Type II reaction, called “cytotoxic hypersensitivity reaction” C. Type III allergic reaction, called “immune complex hypersensitivity” D. Type IV allergic reaction, called “delayed hypersensitivity reaction” ANS: A

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9. Medical conditions that can predispose a patient to ADRs include: A. Chronic kidney disease B. Asthma C. Chronic daily headache D. Pneumonia ANS: A

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10. Malignant hyperthermia after administration of anesthesia is an example of: A. A hypersensitivity reaction B. A late-onset reaction C. A genetic receptor abnormality D. A drug–drug reaction ANS: C

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11. A 24-year-old male receives multiple fractures in a motor vehicle accident and requires

significant amounts of opioid medication to treat his pain. He is at risk for a he no longer requires the opioids.

A. Rapid

ADR when

Woo Pharmacotherapeutics for APN Prescribers, 6e B. First-dose C. Late D. Delayed ANS: C

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12. A first-dose reaction may include: A. Orthostatic hypotension that does not occur with repeated doses B. Purple glove syndrome with phenytoin use C. Hemolytic anemia from ceftriaxone use D. Contact dermatitis from neomycin use ANS: A

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13. Drugs that are prone to cause adverse drug effects include: A. Diuretics B. Inhaled anticholinergics C. Insulins D. Stimulants ANS: C

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14. The U.S. Food and Drug Administration MedWatch system is activated when: A. There is an adverse event to a vaccine.

B. A patient has a severe reaction that is noted in the “Severe Reaction” section on the

medication label.

C. A lactating woman takes a medication that is potentially toxic to the breastfeeding

infant.

D. An adverse event or serious problem that is not already identified on the label

occurs.

ANS: D

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15. The Vaccine Adverse Events Reporting System is: A. A mandatory reporting system for all health-care providers for when they

encounter an adverse vaccine event B. A voluntary reporting system that health-care providers or consumers may use to report vaccine adverse events C. Utilized to send out safety alerts regarding emerging vaccine safety issues D. Activated when a vaccine has been proven to cause significant adverse effects ANS: B

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Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 6. An Introduction to Pharmacogenomics MULTIPLE CHOICE 1. Genetic polymorphisms account for differences in metabolism, including: A. Poor metabolizers, who lack a working enzyme B. Intermediate metabolizers, who have one working, wild-type allele and one mutant

allele C. Extensive metabolizers, with two normally functioning alleles D. All of the above ANS: D

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2. Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to: A. A need to monitor drugs metabolized by 2D6 for toxicity B. Increased dosages needed of drugs metabolized by 2D6, such as the selective

serotonin reuptake inhibitors C. Decreased conversion of codeine to morphine by CYP2D6 D. The need for lowered dosages of drugs, such as beta blockers ANS: B

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3. Rifampin is a nonspecific CYP450 inducer that may: A. Lead to toxic levels of rifampin and so must be monitored closely B. Cause toxic levels of drugs, such as oral contraceptives, when coadministered C. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic

failure D. Cause nonspecific changes in drug metabolism ANS: C

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4. Inhibition of P-glycoprotein by a drug such as quinidine may lead to: A. Decreased therapeutic levels of quinidine B. Increased therapeutic levels of quinidine C. Decreased levels of a coadministered drug, such as digoxin, that requires P-

glycoprotein for absorption and elimination D. Increased levels of a coadministered drug, such as digoxin, that requires P-

glycoprotein for absorption and elimination ANS: D

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5. Warfarin resistance may be seen in patients with a VKORC1 mutation, leading to: A. Toxic levels of warfarin building up B. Decreased response to warfarin C. Increased risk for significant drug interactions with warfarin D. Less risk of drug interactions with warfarin

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Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: B

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6. Genetic testing for a VKORC1 mutation to assess potential warfarin resistance is required

prior to prescribing warfarin.

A. True B. False ANS: B

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7. Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to

prescribing: A. Erythromycin B. Digoxin C. Cetuximab D. Rifampin ANS: C

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8. Carbamazepine has a black box warning recommending testing for the HLA-B*1502 allele in

patients with Asian ancestry prior to starting therapy due to: A. Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele B. Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele C. Increased risk for Stevens-Johnson syndrome in Asian patients with the HLAB*1502 allele D. Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine ANS: C

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9. A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated

by the body may lead to: A. Decreased effectiveness of irinotecan in the treatment of cancer B. Increased adverse drug reactions, such as neutropenia C. Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38 D. Increased concerns for irinotecan being carcinogenic ANS: B

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10. Patients who have a poor metabolism phenotype will have: A. Slowed metabolism of a prodrug into an active drug, leading to accumulation of

prodrug B. Accumulation of inactive metabolites of drugs C. A need for increased dosages of medications D. Increased elimination of an active drug ANS: A

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11. Ultra-rapid metabolizers of drugs may have:

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A. To have dosages of drugs adjusted downward to prevent drug accumulation B. Active drug rapidly metabolized into inactive metabolites, leading to potential

therapeutic failure C. Increased elimination of active, nonmetabolized drug D. Slowed metabolism of a prodrug into an active drug, leading to an accumulation of prodrug ANS: B

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12. A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast

cancer to: A. Ensure the patient will not have increased adverse drug reactions to the tamoxifen B. Identify potential drug–drug interactions that may occur with tamoxifen C. Reduce the likelihood of therapeutic failure with tamoxifen treatment D. Identify poor metabolizers of tamoxifen ANS: C

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Chapter 7. Nutrition and Nutraceuticals MULTIPLE CHOICE 1. The most frequent type of drug–food interaction is food: A. Causing increased therapeutic drug levels B. Affecting the metabolism of the drug C. Altering the volume of distribution of drugs D. Affecting the gastrointestinal absorption of drugs ANS: D

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2. Food in the gastrointestinal tract affects drug absorption by: A. Altering the pH of the colon, which decreases absorption B. Competing with the drug for plasma proteins C. Altering gastric emptying time D. Altering the pH of urine ANS: C

PTS: 1

3. Food can alter the pH of the stomach, leading to: A. Enhanced drug metabolism B. Altered vitamin K absorption C. Increased vitamin D absorption D. Altered drug bioavailability ANS: D

PTS: 1

4. Fasting for an extended period can: A. Increase drug absorption due to lack of competition between food and the drug B. Alter the pH of the gastrointestinal tract, affecting absorption C. Cause vasoconstriction, leading to decreased drug absorption D. Shrink the stomach, causing decreased surface area for drug absorption ANS: C

PTS: 1

5. Tetracycline needs to be given on an empty stomach because it chelates with: A. Calcium B. Magnesium C. Iron D. All of the above ANS: D

PTS: 1

6. A low-carbohydrate, high-protein diet may: A. Increase drug-metabolizing enzymes B. Decrease drug absorption from the gastrointestinal (GI) tract C. Alter drug binding to plasma proteins

1 Ch07

Woo Pharmacotherapeutics for APN Prescribers, 6e D. Enhance drug elimination ANS: A 7.

PTS: 1

Grapefruit juice contains furanocoumarins that have been found to: A. Alter absorption of drugs through competition for binding sites B. Inhibit CYP3A4, leading to decreased first-pass metabolism of drugs C. Alter vitamin K metabolism, leading to prolonged bleeding D. Enhance absorption of calcium and vitamin D ANS: B

PTS: 1

8. Cruciferous vegetables may alter drug pharmacokinetics by: A. Enhancing absorption of weakly acidic drugs B. Altering CYP3A4 activity, leading to elevated levels of drugs, such as the statins C. Inducing CYP1A2, possibly leading to therapeutic failure of drugs metabolized by

CYP1A2 D. Decreasing first-pass metabolism of drugs ANS: C

PTS: 1

9. Milk and other foods that alkalinize the urine may: A. Result in basic drugs being reabsorbed in the renal tubule B. Increase the elimination of basic drugs in the urine C. Decrease the elimination of acidic drugs D. Not alter drug elimination due to the minimal change in urine pH ANS: A

PTS: 1

10. Antacids such as calcium carbonate (Tums) can reduce the absorption of which of the

following nutrients?

A. Protein B. Calcium C. Iron D. Vitamin K ANS: C

PTS: 1

11. Phenytoin decreases folic acid absorption by: A. Altering the pH of the stomach B. Increasing gastric emptying time C. Inhibiting intestinal enzymes required for folic acid absorption D. Chelating the folic acid into inactive ingredients ANS: C

PTS: 1

12. Patients taking warfarin need to be educated about the vitamin K content of foods to avoid

therapeutic failure. Foods high in vitamin K that should be limited to no more than one serving per day include:

2 Ch07

Woo Pharmacotherapeutics for APN Prescribers, 6e A. Spinach B. Milk C. Romaine lettuce D. Cauliflower ANS: A

PTS: 1

13. The American Dietetic Association has recommended the use of specific nutritional

supplements in the following population(s): A. 400 IU per day of vitamin D in all infants and children B. 1,000 IU per day of vitamin D for all pregnant women C. 60 mg per day of iron for all adults over age 50 years D. All of the above ANS: A

PTS: 1

14. The American Dietetic Association recommends pregnant women take a supplement

including: A. 1,000 IU daily of vitamin D B. 2.4 mcg/day of vitamin B12 C. 600 mcg/day of folic acid D. 8 mg/day of iron ANS: C

PTS: 1

15. The American Heart Association and the American Dietetic Association recommend a

minimum daily fiber intake of A. 10 mg/day B. 15 mg/day C. 20 mg/day D. 25 mg/day ANS: D

for cardiovascular health.

PTS: 1

16. Which of the following vitamin or mineral supplements may be teratogenic if a pregnant

woman takes more than the recommended amount?

A. Iron B. Vitamin A C. Vitamin B6 D. Vitamin C ANS: B

PTS: 1

17. Vitamin B2 (riboflavin) may be prescribed to: A. Decrease the incidence of beriberi B. Reduce headaches and migraines C. Prevent pernicious anemia D. Treat hyperlipidemia

3 Ch07

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: B

PTS: 1

18. Isoniazid (INH) may induce a deficiency of which vitamin?

A.

B6

B. C C. D D. E ANS: A

PTS: 1

19. Pregnant patients who are taking INH should take 25 mg/day of vitamin B6 (pyridoxine) to

prevent: A. Beriberi B. Peripheral neuropathy C. Rickets D. Megaloblastic anemia ANS: B

PTS: 1

20. Vitamin B12 deficiency may lead to: A. Hair loss B. Insomnia C. Dry scales on the scalp D. Numbness and tingling of the hands ANS: D

PTS: 1

21. Smokers are at risk for vitamin C deficiency. It is recommended that smokers take

vitamin C supplement.

A. 100 mg/day B. 500 mg/day C. 1,000 mg/day D. 35 mg/day more than nonsmokers ANS: D

PTS: 1

22. There is strong evidence to support that adequate vitamin C intake prevents: A. The common cold B. Breast cancer C. Scurvy D. All of the above ANS: C

PTS: 1

23. Adequate vitamin D is needed for: A. Absorption of calcium from the gastrointestinal tract B. Regulation of serum calcium levels C. Regulation of serum phosphate levels D. All of the above

4 Ch07

Woo Pharmacotherapeutics for APN Prescribers, 6e

ANS: D

5 Ch07

PTS: 1

24. Newborns are at risk for early vitamin K deficiency bleeding and the American Academy of

Pediatrics recommends that all newborns receive: A. Intramuscular (IM) vitamin K (phytonadione) within 24 hours of birth B. Oral vitamin K supplementation in the first 3 weeks of life C. Formula containing vitamin K or breast milk D. Oral vitamin K in the first 24 hours after birth ANS: A

PTS: 1

25. Symptoms of folate deficiency include: A. Thinning of the hair B. Bruising easily C. Glossitis D. Numbness and tingling of the hands and feet ANS: C

PTS: 1

26. A patient with a new onset of systolic ejection murmur should be assessed for which

nutritional deficiency?

A. Vitamin B12 B. Vitamin C C. Folate D. Niacin ANS: C

PTS: 1

27. According to the 2003 to 2006 National Health and Nutrition Examination Survey study of

dietary intake, the group at highest risk for inadequate calcium intake was: A. The elderly (over age 60 years) B. Teenage females C. Teenage males D. Preschoolers ANS: B

PTS: 1

28. Patients with iron deficiency will develop: A. Hemolytic anemia B. Megaloblastic anemia C. Macrocytic-hypochromic anemia D. Microcytic-hypochromic anemia ANS: D

PTS: 1

29. Dietary supplementation or adequate intake of fish oils and omega-3 fatty acids have well-

documented: A. Effects on cardiac rhythm

Woo Pharmacotherapeutics for APN Prescribers, 6e

6 Ch07

B. Anti-inflammatory effects C. Total cholesterol-lowering effects D. Effects on fasting blood sugar ANS: B

PTS: 1

30. There is enough preliminary evidence to recommend that children with autism should receive

which supplemental nutrient?

A. Vitamin B1 (thiamine) B. Vitamin B2 (riboflavin) C. Calcium D. Omega-3 fatty acids ANS: D

PTS: 1

31. There is sufficient evidence to support the use of omega-3 fatty acids to treat the following

disease(s): A. Asthma B. Autism C. Arthritis D. All of the above ANS: B

PTS: 1

32. It is reasonable to recommend supplementation with

in the treatment of

hyperlipidemia.

A. Omega-3 fatty acids B. Probiotics C. Plant sterols D. Calcium ANS: C

PTS: 1

33. Probiotics are recommended to be coadministered when A. Antacids B. Antihypertensives C. Antidiarrheals D. Antibiotics ANS: D

PTS: 1

34. It is reasonable to add

eradication rates of H pylori.

A. Probiotics B. Omega-3 fatty acids C. Plant sterols D. Fiber ANS: A

are prescribed.

PTS: 1

to a Helicobacter pylori treatment regimen to improve

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch08

Chapter 8. Herbal Therapies MULTIPLE CHOICE 1. A good patient history of herb and supplement use is critical before prescribing because

approximately % of adults in the United States have used some form of complimentary or alternative medicine in the last 12 months.

A. 10 B. 5 C. 40 D. 70 ANS: C

PTS: 1

2. A potential harmful effect on patients who take some kinds of herbal medication is: A. Constipation B. Lead poisoning C. Diarrhea D. Life-threatening rash ANS: B

PTS: 1

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: A. Coumadin, which may lead to bleeding problems B. Coumarin, which can cause liver and kidney damage C. Cinnamic aldehyde, which is toxic to the kidney D. Cinnamate eugenol, which is toxic to the liver ANS: B

PTS: 1

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: A. Herbs that are yang in nature B. Herbs that are yin in nature C. Ginger D. Golden seal ANS: B

PTS: 1

5. According to traditional Chinese medicine, if a person who has a fever is given an herb that is

yang in nature, such as golden seal, the patient will: A. Get worse B. Get better C. Not be adequately treated

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch08

D. Need additional herbs to treat the yang ANS: A

PTS: 1

6. In Ayurvedic medicine, treatment is based upon maintaining a doshic constitution. A patient

intolerant of dry, bitter foods would be experiencing a A. Vata B. Pitta C. Kapha D. Prakriti ANS: A

imbalance.

PTS: 1

7. Herbs and supplements are regulated by the U.S. Food and Drug Administration.

A. True B. False ANS: B

PTS: 1

8. When melatonin is used to induce sleep, the recommendation is that the patient: A. Take 10 mg 30 minutes before bed nightly B. Take 1 to 5 mg 30 minutes before bed nightly C. Not take melatonin more than 3 nights a week D. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep ANS: C

PTS: 1

9. Valerian tea can be used to help a patient relax and fall asleep. Overdosage of valerian (more

than 2.5 gm/dose) may lead to: A. Cardiac disturbances B. Central nervous system depression C. Respiratory depression D. Skin rashes ANS: A

PTS: 1

10. When discussing considerations for treatment with St. John’s Wort, the NP should advise

patients that: A. Storage in a dark place ensures long shelf-life.

B. It is more effective than most antidepressant medications.

C. Potency is lost over time.

D. Adverse effects of long-term use are minimal.

ANS: C

PTS: 1

11. Patients need to be instructed regarding drug interactions with St. John’s Wort, including: A. Birth control pills B. Serotonin reuptake inhibitors C. HIV medications

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch08

D. All of the above ANS: D

PTS: 1

12. Ginseng, which is taken to assist with memory, may potentiate: A. Aricept B. Insulin C. Digoxin D. Propranolol ANS: B

PTS: 1

13. Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains,

as overapplication can lead to: A. Respiratory depression B. Cardiac disturbance C. Salicylate poisoning D. Life-threatening rashes ANS: C

PTS: 1

14. The role of the nurse practitioner (NP) with regards to herbal medication is to: A. Maintain competence in the prescribing of common herbal remedies B. Recommend common over-the-counter herbs to patients C. Educate patients and guide them to appropriate sources of care D. Encourage patients to not use herbal therapy due to the documented dangers ANS: C

PTS: 1

15. Kava is used to treat which disorder?

A. Gastroesophageal reflux disease (GERD) B. Attention deficit-hyperactivity disorder (ADHD) C. Seizures D. Depression ANS: C

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch09

Chapter 9. Cannabis MULTIPLE CHOICE 1. An interest in the therapeutic potential of CB2 receptors developed because they are: A. Psychoactive when stimulated B. Located in the neocortex and limbic system C. Expressed during inflammatory and neurogenic conditions D. Implicit in appetite and gastric motility ANS: C

PTS: 1

2. The primary difference between Cannabis sativa and Cannabis indica is the: A. Labeling for medical use B. Psychoactive properties C. Cost D. Therapeutic potential ANS: B

PTS: 1

3. The cannabinoid product approved for use in multiple sclerosis in >30 countries is: A. Sativex B. Epidiolex C. Nabilone D. Cesamet ANS: A

PTS: 1

4. When counseling a patient about various administration modalities of cannabinoid products,

the NP advises that: A. There is a greater pharmacodynamic effect with inhaled delivery.

B. Orally ingested products have a duration of 5-8 hours or longer.

C. Vaporized products are safer than smoked formulations.

D. Inhaled formulations reach maximum concentration in 1 hour.

ANS: B

PTS: 1

5. Literature review on the use of cannabinoid products for appetite stimulation reveal that: A. There are no scientifically sound studies on the use of cannabinoids for appetite

stimulation.

B. Dronabinol produced a weight gain of 3 kg in a 4-week period in patients with

cachexia.

C. Sativa products stimulate appetite but indica products do not.

D. There is no evidence of significant weight gain in patients with AIDS or cancer.

ANS: D

PTS: 1

6. The most common reason for the use of medical cannabinoids is:

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch09

A. Chemotherapy-induced nausea and vomiting B. AIDS-related cachexia C. Anorexia nervosa D. Chronic pain ANS: D

PTS: 1

7. Medical cannabinoid use has demonstrated efficacy in neuropathic pain. The primary concern

is that it requires: A. Sustained use B. Inhaled administration C. The THC component D. Concomitant NSAID use ANS: C

PTS: 1

8. When considering medical cannabinoid use for chemotherapy-induced nausea and vomiting,

the NP acknowledges that: A. There is evidence that oral formulations are as effective as standard antiemetics.

B. CBD products are more effective than THC products.

C. There is no conclusive evidence of any benefit in controlled trials.

D. There is evidence of efficacy in children but not adult patients.

ANS: A

PTS: 1

9. A 34-year-old female patient asks for an opinion on the use of medical cannabinoids for the

treatment of her depression. The NP responds that: A. Sativa products may have some efficacy but indica can exacerbate lack of motivation.

B. CBD products are more effective than THC or combination formulations.

C. Anecdotal reports do not support the assertion of clinical improvement.

D. Cannabinoids can have a negative impact on depressive disorders.

ANS: D

PTS: 1

10. With respect to the utility of medical cannabinoids for insomnia, the Committee on Health

Effects of Marijuana finds that cannabinoids are effective for insomnia, except for insomnia caused by: A. Sleep apnea B. Epilepsy C. Fibromyalgia D. Multiple sclerosis ANS: B

PTS: 1

11. Which of the following medical cannabinoids has demonstrated utility in the management of PTSD? A. Cesamet B. THC/CBD combination C. Nabilone

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch09

D. CBD alone ANS: C

PTS: 1

12. When counseling a patient about the common adverse effect profile of nabilone, the NP

advises that A. Paranoia B. Fatigue C. Vertigo D. Headache ANS: C

occurs in 52% of patients.

PTS: 1

13. Which of the following is the most common observed consequence of medical cannabinoid

use during pregnancy?

A. Cardiac anomalies B. Fetal withdrawal C. Low birth weight infants D. Preterm labor ANS: C

PTS: 1

14. Current evidence suggests that the relationship between cannabis use and cancers is best

characterized by which statement?

A. The risk of lung cancer is analogous to that in cigarette smokers.

B. Cervical cancer occurs less commonly in women who use cannabinoids.

C. Increased cancer use is directly proportional to volume of exposure.

D. There is a statistically insignificant increase in testicular germ cell tumors.

ANS: D

PTS: 1

15. When considering the impact of cannabinoid use on cognitive function, the NP considers that: A. There is no evidence of sustained impairment after cessation of use.

B. Ongoing impairment has not been demonstrated in adult patients.

C. Impairment is significantly higher with THC formulations.

D. The primary concern is the effect on the developing adolescent brain.

ANS: D

PTS: 1

16. When considering medical cannabinoid use in patients with mental health diagnoses, the NP

should consider that: A. Cannabinoids may exacerbate bipolar disorder and schizophrenia.

B. There is no increased risk of developing schizophrenia.

C. Occasional users report a higher incidence of suicidal ideation.

D. Sustained use increases risk of developing depression and anxiety disorders.

ANS: A

PTS: 1

17. When discussing medical cannabinoid use with patients, the NP emphasizes that:

Woo Pharmacotherapeutics for APN Prescribers, 6e

4 Ch09

A. There is no strong evidence that cannabinoids are better than standard therapies.

B. Oral formulations are safer than inhaled formulations.

C. Best practices suggest use as a part of multi-modal regimen.

D. Long-term consequences are not a concern with appropriate use.

ANS: C

PTS: 1

18. A patient asks about the use of medical cannabinoids for treatment of his Tourette syndrome.

He has not had good results with traditional medications and read an article online about this treatment. Which of the following is the most appropriate reply?

A. There are no clear adverse effects.

B. It is unclear if it helps, but it will not hurt.

C. There is limited evidence of efficacy with capsules.

D. Medical cannabinoids are not approved for Tourette syndrome.

ANS: C

PTS: 1

19. When counseling a patient about the use of medical cannabinoids for PTSD, the NP advises

that it has some demonstrated utility with all of the following symptoms except: A. General well-being B. Nightmares C. Reexperiencing events D. General clinical status ANS: C

PTS: 1

20. The most compelling evidence supports the use of medical cannabinoids in all of the

following conditions except: A. Chemotherapy-induced nausea and vomiting B. Epilepsy C. Chronic pain D. Insomnia ANS: C

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 10. Pharmacoeconomics MULTIPLE CHOICE 1. Pharmacoeconomics is: A. The study of the part of the U.S. economy devoted to drug use B. The study of the impact of prescription drug costs on the overall economy C. The analysis of the costs and consequences of any health-care-related treatment or

service D. The analysis of the clinical efficacy of a drug ANS: C

PTS: 1

2. The direct costs of drug therapy include: A. The actual cost of acquiring the medication B. The loss of income due to illness C. Pain and suffering due to inadequate drug therapy D. The cost of a funeral associated with premature death ANS: A

PTS: 1

3. Indirect costs associated with drug therapy include: A. The cost of diagnostic tests to monitor therapeutic levels B. Health-care provider time to prescribe the drug and educate the patient C. Childcare expenses incurred while receiving therapy D. Loss of wages while undergoing drug therapy ANS: D

PTS: 1

4. The intangible costs of drug therapy include: A. Loss of wages while undergoing therapy B. Inconvenience, pain, and suffering incurred with therapy C. Cost of medical equipment in the laboratory used to monitor therapeutic drug

levels D. Cost of prescription drug coverage, such as Medicare Part D ANS: B

PTS: 1

5. When a pharmacoeconomic analysis looks at two or more treatment alternatives that are

considered equal in efficacy and compares the costs of each it is referred to as: A. Cost-minimization analysis B. Cost-of-illness analysis C. Cost-effectiveness analysis D. Cost-benefit analysis ANS: A

PTS: 1

6. Cost-effectiveness analysis compares two or more treatments or programs that are:

1 Ch10

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch10

A. Not necessarily therapeutically equivalent B. Considered equal in efficacy C. Compared with the dollar value of the benefit received D. Expressed in terms of patient preference or quality-adjusted life years ANS: A

PTS: 1

7. When the costs of a specific treatment or intervention are calculated and then compared with

the dollar value of the benefit received it is referred to as: A. Cost-minimization analysis B. Cost-of-illness analysis C. Cost-effectiveness analysis D. Cost-benefit analysis ANS: D

PTS: 1

8. Mary has a two-tiered prescription benefit plan, which means: A. She can receive differing levels of care based on whether she chooses an in-plan

provider or not.

B. She is eligible for the new Medicare Part D “donut hole” reduction of costs program.

C. She pays a higher copay for brand-name drugs than for generic drugs.

D. She must always choose to be treated with generic drugs first.

ANS: C

PTS: 1

9. Prescribing less-expensive generic drugs or drugs off the $4 retail pharmacy list: A. Increases the complexity of the pharmacoeconomics of prescribing for the

individual patient B. Increases compliance by reducing the financial burden of drug costs to the patient C. Is not sound prescribing practice due to the inferiority of the generic products D. Will increase the overall cost of drugs to the system due to the ease of

overprescribing less-expensive drugs ANS: B

PTS: 1

10. James tells you that he is confused by his Medicare Part D coverage plan. An appropriate

intervention would be: A. Order cognitive testing to determine the source of his confusion.

B. Sit down with him and explain the whole Medicare Part D process.

C. Refer him to the Medicare specialist in his insurance plan to explain his benefits to him.

D. Request his son come to the next appointment so you can explain the benefits to him.

ANS: C

PTS: 1

11. The Inflation Reduction Act:

Woo Pharmacotherapeutics for APN Prescribers, 6e A. Was totally eliminated with the federal health-care reform enacted in 2023 B. Refers to the period of time when annual individual drug costs are between $250

and $2,250 and drug costs are covered 75% C. Caps medication expenditures to $2,000 for all Medicare Part D beneficiaries beginning in 2025 D. Has no effect on whether patients continue to fill their prescriptions during the coverage gap ANS: C

PTS: 1

12. To gain FDA approval a generic drug must be: A. Taken orally B. Identical in strength to the innovator drug C. Manufactured by the same company or its subsidiary D. Without adverse effects ANS: B

PTS: 1

3 Ch10

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch11

Chapter 11. Drugs Affecting the Autonomic Nervous System MULTIPLE CHOICE 1. Charlie is a 65-year-old male who has been diagnosed with hypertension and benign prostatic

hyperplasia. Doxazosin has been chosen to treat his hypertension because it: A. Increases peripheral vasoconstriction B. Decreases detrusor muscle contractility C. Lowers supine blood pressure more than standing pressure D. Relaxes smooth muscle in the bladder neck ANS: D

PTS: 1

2. To reduce potential adverse effects, patients taking a peripherally acting 1 antagonist should

do all of the following EXCEPT: A. Take the dose at bedtime B. Sit up slowly and dangle their feet before standing C. Monitor their blood pressure and skip a dose if the pressure is less than 120/80 D. Weigh themselves daily and report weight gain of greater than 2 pounds in 1 day ANS: C

PTS: 1

3. John has been prescribed clonidine, a centrally acting adrenergic blocker, for his hypertension.

He should: A. Not miss a dose or stop taking the drug because of potential rebound hypertension B. Increase fiber in his diet to treat any diarrhea that may occur C. Reduce fluid intake to less than 2 L per day to prevent fluid retention D. Avoid sitting for long periods, as this can lead to deep vein thrombosis ANS: A

PTS: 1

4. Clonidine has several off-label uses, including: A. Attention deficit disorder B. Opioid withdrawal C. Both A and B D. Neither A nor B ANS: C

PTS: 1

5. Jim is being treated for hypertension. Because he has a history of heart attack, the drug

prescribed is atenolol. Beta blockers treat hypertension by: A. Increasing heart rate to improve cardiac output B. Decreasing peripheral resistance C. Increasing aldosterone-mediated volume activity D. Reducing aqueous humor production ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch11

6. Which of the following adverse effects is less likely in a 1-selective blocker?

A. Dysrhythmias B. Bronchospasm C. Reflex orthostatic changes D. Decreased triglycerides and cholesterol ANS: B

PTS: 1

7. Richard is 70 years old and has a history of cardiac dysrhythmias. He has been prescribed

nadolol. You do his annual laboratory work and find a CrCl of 25 mL/min. What action should you take related to his nadolol?

A. Extend the dosage interval B. Decrease the dose by 75% C. Take no action because this value is expected in an older adult D. Schedule a serum creatinine level to validate the CrCl value ANS: A

PTS: 1

8. Beta blockers are the drugs of choice for exertional angina because they: A. Improve myocardial oxygen supply by vasodilating the coronary arteries B. Decrease myocardial oxygen demand by decreasing heart rate and vascular

resistance C. Both A and B D. Neither A nor B ANS: B

PTS: 1

9. Adherence to beta blocker therapy may be affected by their: A. Short half-lives requiring twice daily dosing B. Tendency to elevate lipid levels C. Effects on the male genitalia, which may produce impotence D. None of the above ANS: C

PTS: 1

10. Beta blockers have favorable effects on survival and disease progression in patients with heart

failure. Treatment should be initiated when the: A. Symptoms are severe.

B. Patient has not responded to other therapies.

C. Patient has concurrent hypertension.

D. Left ventricular dysfunction is diagnosed.

ANS: D

PTS: 1

11. Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious

consequences of rapid withdrawal are those with: A. Angina

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch11

B. Coronary artery disease C. Both A and B D. Neither A nor B ANS: C

PTS: 1

12. To prevent life-threatening events resulting from rapid withdrawal of a beta blocker: A. The dosage interval should be increased by 1 hour each day.

B. An alpha blocker should be added to the treatment regimen before withdrawal.

C. The dosage should be tapered over a period of weeks.

D. The dosage should be decreased by one-half every 4 days.

ANS: D

PTS: 1

13. Beta blockers are prescribed with caution for diabetics because they may block the common

symptoms of hypoglycemia. Which of the following symptoms of hypoglycemia is not blocked by these drugs and so can be used to warn diabetics of possible decreased blood glucose?

A. Dizziness B. Increased heart rate C. Nervousness and shakiness D. Diaphoresis ANS: D

PTS: 1

14. Combined alpha-beta antagonists are used to reduce the progression of heart failure because

they: A. Vasodilate the peripheral vasculature B. Decrease cardiac output C. Increase renal vascular resistance D. Reduce atherosclerosis secondary to elevated serum lipoproteins ANS: A

PTS: 1

15. Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with

which of the following drug classes?

A. Histamine 2 blockers B. Quinolones C. Serotonin reuptake inhibitors D. All of the above ANS: D

PTS: 1

16. Bethanechol: A. Increases detrusor muscle tone to empty the bladder B. Decreases gastric acid secretion to treat peptic ulcer disease C. Stimulates voluntary muscle tone to improve strength D. Reduces bronchial airway constriction to treat asthma

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: A

PTS: 1

17. Clinical dosing of bethanechol: A. Begins at the highest effective dose to obtain a rapid response B. Starts at 5 to 10 mg PO and is repeated every hour until a satisfactory clinical

response is achieved C. Requires dosing only once daily D. Is the same for both the oral and parenteral route ANS: B

PTS: 1

18. Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic

effects?

A. Levothyroxine B. Prilosec C. Dulcolax D. Diphenhydramine ANS: D

PTS: 1

19. Cholinesterase inhibitors are used to treat: A. Peptic ulcer disease B. Myasthenia gravis C. Both A and B D. Neither A nor B ANS: B

PTS: 1

20. Which of the following drugs used to treat Alzheimer disease is not an anticholinergic?

A. Donepezil B. Memantine C. Rivastigmine D. Galantamine ANS: B

PTS: 1

21. Taking which drug with food maximizes its bioavailability?

A. Donepezil B. Galantamine C. Rivastigmine D. Memantine ANS: C

PTS: 1

22. Common adverse effects of cholinesterase inhibitors include: A. Tachycardia B. Urinary retention C. Decreased salivation

4 Ch11

Woo Pharmacotherapeutics for APN Prescribers, 6e

5 Ch11

D. Diarrhea ANS: D

PTS: 1

23. Adherence is improved when a drug can be given once daily. Which of the following drugs

can be given once daily?

A. Tacrine B. Donepezil C. Memantine D. Pyridostigmine ANS: B

PTS: 1

24. Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the

following is NOT an effect of nicotine?

A. Vasodilation and decreased heart rate B. Increased secretion of gastric acid and motility of the gastrointestinal (GI) smooth muscle C. Release of dopamine at the pleasure center D. Stimulation of the locus coeruleus ANS: A

PTS: 1

25. Cholinergic blockers are used to: A. Counteract the extrapyramidal symptom (EPS) effects of phenothiazines B. Control tremors and relax smooth muscle in Parkinson disease C. Inhibit the muscarinic action of ACh on bladder muscle D. All of the above ANS: D

PTS: 1

26. Several classes of drugs have interactions with cholinergic blockers. Which of the following is

true about these interactions?

A. Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.

B. Additive antimuscarinic effects may occur with antihistamines.

C. Cholinergic blockers may decrease the sedative effects of hypnotics.

D. Cholinergic blockers are contraindicated with antipsychotics.

ANS: B

PTS: 1

27. Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness.

The patient is taught to: A. Apply the transdermal disk at least four hours before the antiemetic effect is desired B. Swallow the tablet 1 hour before traveling when motion sickness is possible C. Place the tablet under the tongue and allow it to dissolve D. Change the transdermal disk daily for maximal effect

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: A

6 Ch11

PTS: 1

28. You are managing the care of a patient recently diagnosed with benign prostatic hyperplasia

(BPH). He is taking tamsulosin but reports dizziness when standing abruptly. The best option for this patient is: A. Continue the tamsulosin because the side effect will resolve with continued treatment B. Discontinue the tamsulosin and start doxazosin C. Have him double his fluid intake and stand more slowly D. Prescribe meclizine as needed for the dizziness ANS: B

PTS: 1

29. You are treating a patient with Alzheimer disease. The patient’s wife mentions difficulty with

transportation to the clinic. Which medication is the best choice?

A. Donepezil B. Tacrine C. Doxazosin D. Verapamil ANS: A

PTS: 1

30. A patient presents with a complaint of abdominal pain, flushing, and increased salivation.

Which of these medications is the most likely cause?

A. Acetaminophen B. Estradiol C. Donepezil D. Bethanechol ANS: D

PTS: 1

31. Your patient calls for an appointment before going on vacation. Which medication should you

ensure he has an adequate supply of before leaving to avoid life-threatening complications?

A. Carvedilol B. Donepezil C. Bethanechol D. Tacrine ANS: A

PTS: 1

32. Activation of central 2 receptors results in inhibition of cardioacceleration and

centers in the brain.

A. Vasodilation B. Vasoconstriction C. Cardiovascular D. Respiratory ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

33. Which of these drugs is considered as a treatment for hypertension in women during

pregnancy?

A. Atenolol B. Methyldopa C. Guanfacine D. None of the above ANS: B

PTS: 1

34. Which class of drugs has off-label uses for ureteral stones?

A. Selective 1 antagonists B. Nonselective antagonists C. Beta-adrenergic antagonists D. Cholinergic agonists ANS: A

PTS: 1

35. Which of these hypertension drugs has also been approved for the treatment of attention

deficit-hyperactivity disorder (ADHD)?

A. Guanabenz B. Clonidine C. Lisinopril D. Doxazosin ANS: B

PTS: 1

7 Ch11

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch12

Chapter 12. Drugs Affecting the Central Nervous System MULTIPLE CHOICE 1. A 42-year-old female requests a prescription for an anorexiant to treat her obesity. A trial of

phentermine is prescribed. Prescribing precautions include: A. Obesity is a contraindication to prescribing phentermine.

B. Anorexiants may cause tolerance and should only be prescribed for 6 months.

C. Patients should be monitored for postural hypotension.

D. Renal function should be monitored closely while on anorexiants.

ANS: B

PTS: 1

2. Before prescribing phentermine, a thorough drug history should be taken, including assessing

for the use of serotonergic agents such as selective serotonin reuptake inhibitors (SSRIs) and St. John’s Wort due to: A. The risk of additive respiratory depression B. The risk of additive effects affecting liver function C. The risk of serotonin syndrome D. The risk of altered cognitive functioning ANS: C

PTS: 1

3. A 3-year-old child has a history of status epilepticus. Along with her routine antiseizure

medication, she should also have a home prescription for of status epilepticus.

A. IV phenobarbital B. Rectal diazepam (Diastat) C. IV phenytoin (Dilantin) D. Oral carbamazepine (Tegretol) ANS: B

to be used for an episode

PTS: 1

4. A child is prescribed phenytoin for seizures. Monitoring includes assessing: A. For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment B. For pedal edema throughout therapy C. Heart rate at each visit, as therapy may have to be altered if heart rate is less than

60 beats per minute (bpm) D. For vision changes, such as red-green blindness, at least annually ANS: A

PTS: 1

5. A child, Dwayne, has recently started on carbamazepine to treat seizures. He comes to see you

and you note that while his carbamazepine levels had been in the therapeutic range, they are now low. The possible cause for the low carbamazepine levels may be: A. Dwayne hasn’t been taking his carbamazepine because it causes insomnia.

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch12

B. Carbamazepine auto-induces metabolism, leading to lower levels in spite of good

compliance.

C. Dwayne was not originally prescribed the correct amount of carbamazepine.

D. Carbamazepine is probably not the right antiseizure medication for Dwayne.

ANS: B

PTS: 1

6. Carbamazepine has a black box warning due to life threatening: A. Renal toxicity, leading to renal failure B. Hepatotoxicity, leading to liver failure C. Dermatologic reactions, including Stevens-Johnson and toxic epidermal necrolysis D. Cardiac effects, including supraventricular tachycardia ANS: C

PTS: 1

7. Long-term monitoring of patients who are taking carbamazepine includes: A. Routine testing of troponin levels to assess for cardiac damage B. Annual eye examinations to assess for cataract development C. Monthly pregnancy tests for all women of childbearing age D. Complete blood count every 3 to 4 months ANS: D

PTS: 1

8. A 6-year-old has recently started taking ethosuximide (Zarontin) for seizures. The patient

should be monitored for: A. Increased seizure activity, as this drug may auto-induce seizures B. Altered renal function, including renal failure C. Blood dyscrasias, which is uncommon but possible D. Central nervous system (CNS) excitement, leading to insomnia ANS: C

PTS: 1

9. A patient has been prescribed gabapentin to treat neuropathic pain and is complaining of

feeling depressed and having “strange” thoughts. The appropriate initial action would be: A. Increase her dose B. Assess for suicidal ideation C. Discontinue the medication immediately D. Decrease her dose to half then slowly titrate up the dose ANS: B

PTS: 1

10. An overweight patient recently started taking topiramate for seizures and at her follow-up visit

you note she has lost 3 kg. The appropriate action would be: A. Tell her to increase her caloric intake to counter the effects of the topiramate B. Consult with a neurologist, as this is not a common adverse effect of topiramate C. Decrease her dose of topiramate D. Reassure her that this is a normal side effect of topiramate and continue to monitor her weight

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: D

PTS: 1

11. Monitoring of a patient on gabapentin to treat seizures includes: A. Routine testing of therapeutic drug levels every 3 to 4 months B. Assessing for dermatologic reactions, including Stevens-Johnson C. Routine testing of serum electrolytes, especially in hot weather D. Assessing for emergence or worsening of depression, changes in behavior, or

suicidal ideation ANS: D

PTS: 1

12. Scott’s seizures are well controlled on topiramate and he wants to start playing baseball.

Education for Scott regarding his topiramate includes: A. Telling him he should not play sports due to the risk of increased seizures B. Telling him he should monitor his temperature and ability to sweat in the heat while playing C. Reminding him that he may need higher doses of topiramate when exercising D. Encouraging him to use sunscreen due to photosensitivity from topiramate ANS: B

PTS: 1

13. A patient is taking levetiracetam (Keppra) to treat seizures. Routine education for

levetiracetam includes reminding them: A. To not abruptly discontinue levetiracetam due to risk for withdrawal seizures B. To wear sunscreen due to photosensitivity from levetiracetam C. To get an annual eye exam while on levetiracetam D. To report weight loss if it occurs ANS: A

PTS: 1

14. Levetiracetam has known drug interactions with: A. Combined oral contraceptives B. Carbamazepine C. Warfarin D. Few, if any, drugs ANS: D

PTS: 1

15. A patient is taking lamotrigine (Lamictal) and presents to the clinic with fever and

lymphadenopathy. Initial evaluation and treatment includes: A. Reassuring her she has a viral infection and telling her to call if she isn’t better in 4 or 5 days B. Ruling out a hypersensitivity reaction that may lead to multiorgan failure C. Performing a rapid strep test and symptomatic care if the strep test is negative D. Observing only, with further assessment if she worsens ANS: B

PTS: 1

3 Ch12

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4 Ch12

16. A patient is taking lamotrigine (Lamictal) for seizures and requests a prescription for

combined oral contraceptives (COCs), which interact with lamotrigine and may cause: A. Contraceptive failure B. Excessive weight gain C. Reduced lamotrigine levels, requiring doubling the dose of lamotrigine D. Induction of estrogen metabolism, requiring higher estrogen content OCs to be prescribed ANS: C

PTS: 1

17. Tricyclic antidepressants should be prescribed cautiously in patients with: A. Eczema B. Asthma C. Diabetes D. Heart disease ANS: D

PTS: 1

18. A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for

recalcitrant depression. The nurse practitioner (NP) managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs): A. He should not be prescribed any serotonergic drug, such as sumatriptan (Imitrex).

B. MAOIs interact with many common foods, including yogurt, sour cream, and soy sauce.

C. Symptoms of hypertensive crisis (headache, tachycardia, sweating) require immediate treatment.

D. All of the above ANS: D

PTS: 1

19. A 10-year-old child is diagnosed with major depression. The appropriate first-line

antidepressant for children is: A. Fluoxetine B. Fluvoxamine C. Sertraline D. Escitalopram ANS: A

PTS: 1

20. A patient is started on paroxetine (Paxil), an SSRI, for depression. Education regarding

antidepressants includes: A. SSRIs may take 2 to 6 weeks before they show maximum drug effects.

B. Red-green color blindness may occur and should be reported.

C. If she experiences dry mouth or a heart rate greater than 80, she should stop taking the drug immediately.

D. She should eat lots of food high in fiber to prevent constipation.

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: A

5 Ch12

PTS: 1

21. A patient presents with sluggish depression associated with complaints of fatigue, sleeping all

the time, and lack of motivation. An appropriate initial antidepressant for the patient would be: A. Fluoxetine (Prozac) B. Paroxetine (Paxil) C. Amitriptyline (Elavil) D. Duloxetine (Cymbalta) ANS: D

PTS: 1

22. A 45-year-old patient with schizophrenia was recently hospitalized for acute psychosis due to

medication noncompliance. The patient was treated with intramuscular (IM) long-acting haloperidol. Besides monitoring schizophrenia symptoms, the patient should be assessed: A. By his primary care provider for excessive weight loss B. By his primary care provider, using the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal symptoms (EPS) C. By his primary care provider, monthly for tolerance to the haloperidol D. Only by a mental health provider, as most NPs in primary care do not care for mentally ill patients ANS: B

PTS: 1

23. Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to: A. Reduce the chance of extrapyramidal effects B. Potentiate the effects of the drug C. Reduce the tolerance that tends to occur D. Increase CNS depression ANS: A

PTS: 1

24. Patients who are prescribed olanzapine (Zyprexa) should be monitored for: A. Insomnia B. Weight gain C. Hypertension D. Galactorrhea ANS: A

PTS: 1

25. A 19-year-old male was started on risperidone. Monitoring for risperidone includes watching

for common side effects, including: A. Bradykinesia, akathisia, and agitation B. Excessive weight gain C. Hypertension D. Potentially fatal agranulocytosis ANS: A

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

6 Ch12

26. In choosing a benzodiazepam to treat anxiety, the prescriber needs to be aware of the

possibility of dependence. The benzodiazepam with the greatest likelihood of causing rapidly developing dependence is: A. Chlordiazepoxide (Librium) B. Clonazepam (Klonopin) C. Alprazolam (Xanax) D. Oxazepam (Serax) ANS: C

PTS: 1

27. When prescribing temazepam (Restoril) for insomnia, patient education includes: A. Take temazepam nightly approximately 15 minutes before bedtime.

B. Do not use temazepam more than three times a week and for not more than 3

months.

C. Drink 1 ounce of alcohol, which will cause additive effects so the patient will sleep

better.

D. Exercise for at least 30 minutes within 2 hours of bedtime to enhance the effects of temazepam.

ANS: B

PTS: 1

28. Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because: A. Zolpidem should be taken just before going to bed.

B. Zolpidem may cause dry mouth and constipation.

C. They may need to double the dose for effectiveness.

D. They should stop drinking alcohol at least 30 minutes before taking zolpidem.

ANS: A

PTS: 1

29. One major drug used to treat bipolar disease is lithium. Because lithium has a narrow

therapeutic range, it is important to recognize symptoms of toxicity, such as: A. Orthostatic hypotension B. Agitation and irritability C. Drowsiness and nausea D. Painful urination and abdominal distention ANS: C

PTS: 1

30. An adult is taking lithium for bipolar disorder. They should be taught to: A. Take lithium with food B. Eat a diet with consistent levels of salt (sodium) C. Drink at least 2 quarts of water if they are in a hot environment D. Monitor blood glucose levels ANS: B

PTS: 1

31. An adult female is taking valproate (Depakote) for seizures and would like to get pregnant.

What advice would you give her?

Woo Pharmacotherapeutics for APN Prescribers, 6e

7 Ch12

A. Valproate is safe during all trimesters of pregnancy.

B. She can get pregnant while taking valproate, but she should take adequate folic

acid.

C. Valproate is not safe at any time during pregnancy.

D. Valproate is a known teratogen, but it may be taken after the first trimester if

necessary.

ANS: D

PTS: 1

32. When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3),

instructions to the patient should include: A. The medication may cause sedation and they should not drive.

B. Constipation is a common side effect and they should increase fluids and fiber.

C. They should not take any other acetaminophen-containing medications at the same time.

D. All of the above ANS: D

PTS: 1

33. A patient sprained his ankle and is asking for pain medication for his mild-to-moderate pain.

The appropriate first-line medication would be: A. Ibuprofen (Advil) B. Acetaminophen with hydrocodone (Vicodin) C. Oxycodone (Oxycontin) D. Oral morphine (Roxanol) ANS: A

PTS: 1

34. A patient fractured his ankle in two places and is asking for medication for his pain. The

appropriate first-line medication would be: A. Ibuprofen (Advil) B. Acetaminophen with hydrocodone (Vicodin) C. Oxycodone (Oxycontin) D. Oral morphine (Roxanol) ANS: B

PTS: 1

35. An 8-year-old male has attention deficit disorder (ADD) and is prescribed methylphenidate

(Ritalin). He and his parents should be educated about the side effects of methylphenidate, which are: A. Slurred speech and insomnia B. Bradycardia and confusion C. Dizziness and orthostatic hypotension D. Insomnia and decreased appetite ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

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36. Monitoring for a child on methylphenidate for attention deficit-hyperactivity disorder

(ADHD) includes: A. Assessing ADHD symptoms B. Checking height and weight routinely C. Assessing the amount of methylphenidate being used D. All of the above ANS: D

PTS: 1

37. When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the

NP will need to monitor: A. Blood pressure B. Blood glucose levels C. Urine ketone levels D. Liver function ANS: A

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

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Chapter 13. Drugs Affecting the Cardiovascular and Renal Systems MULTIPLE CHOICE 1. Ray has been diagnosed with hypertension, and it is determined that an angiotensin-

converting enzyme inhibitor is needed. Prior to prescribing this drug, the nurse practitioner (NP) should assess for: A. Hypokalemia B. Impotence C. Pregnancy D. Inability to concentrate ANS: C

PTS: 1

2. Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating

hypertension in diabetic patients because they: A. Improve insulin sensitivity B. Improve renal hemodynamics C. Reduce the production of angiotensin II D. All of the above ANS: D

PTS: 1

3. A potentially life-threatening adverse response to an ACE inhibitor is angioedema. Which of

the following statements is true about this adverse response?

A. Swelling of the tongue and hoarseness are the most common symptoms.

B. It appears to be related to the decrease in aldosterone production.

C. Presence of a dry, hacking cough indicates a high risk for this adverse response.

D. Because it takes time to build up in the blood, it occurs after being on the drug for about 1 week.

ANS: A

PTS: 1

4. ACE inhibitors are useful in a variety of disorders. Which of the following statements is true

about both their usefulness in a particular disorder and the reason for their use?

A. They are useful in preventing stable angina because they decrease the thickening of vascular walls due to decreased modified release.

B. They are useful in preventing heart failure because they reduce remodeling of injured myocardial tissues.

C. Both A and B are true.

D. Neither A nor B is true.

ANS: C

PTS: 1

5. Despite good blood pressure control, an NP might change a patient’s drug from an ACE

inhibitor to an angiotensin II receptor blocker (ARB) because the ARB: A. Is stronger than the ACE inhibitor

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch13

B. Does not produce a dry, hacking cough C. Has no effect on the renal system D. Reduces sodium and water retention ANS: B

PTS: 1

6. While taking an ARB, patients need to avoid certain over-the-counter drugs without first

consulting the provider because: A. Cimetidine is metabolized by the CYP3A4 isoenzymes.

B. Nonsteroidal anti-inflammatory drugs reduce prostaglandin levels.

C. Both A and B D. Neither A nor B ANS: C

PTS: 1

7. Laboratory monitoring for patients on ACE inhibitors or ARBs should include: A. White blood cell counts with the drug dosage increased for elevations above

10,000 feet B. Liver function tests with the drug dosage stopped for alanine aminotransferase

values twice that of normal C. Serum creatinine levels with the drug dosage reduced for values greater than 2.5

mg/dL D. Serum glucose levels with the drug dosage increased for levels greater than 120

mg/dL ANS: C

PTS: 1

8. Jacob has hypertension, for which a calcium channel blocker has been prescribed. This drug

helps control blood pressure because it: A. Decreases the amount of calcium inside the arterial smooth muscle B. Reduces stroke volume C. Increases the activity of the Na+/K+/ATPase pump indirectly D. Decreases heart rate ANS: A

PTS: 1

9. Which of the following adverse effects may occur due to a dihydropyridine-type calcium

channel blocker?

A. Bradycardia B. Hepatic impairment C. Increased contractility D. Edema of the hands and feet ANS: D

PTS: 1

10. Patient teaching related to amlodipine includes: A. Increase calcium intake to prevent osteoporosis from a calcium blockade

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch13

B. Do not crush the tablet; it must be given in liquid form if the patient has trouble

swallowing it.

C. Avoid grapefruit juice as it affects the metabolism of this drug D. Rise slowly from a supine position to reduce orthostatic hypotension ANS: C

PTS: 1

11. Vera, age 70, has isolated systolic hypertension. Calcium channel blocker dosages for her

should be: A. Started at about half the usual dosage B. Not increased over the usual dosage for an adult C. Given once daily because of memory issues in the older adult D. Withheld if she experiences gastroesophageal reflux ANS: A

PTS: 1

12. Larry has heart failure, which is being treated with digoxin because it exhibits: A. Negative inotropism B. Positive chronotropism C. Both A and B D. Neither A nor B ANS: D

PTS: 1

13. Furosemide is added to a treatment regimen for heart failure that includes digoxin. Monitoring

for this combination includes: A. Hemoglobin B. Serum potassium C. Blood urea nitrogen D. Serum glucose ANS: B

PTS: 1

14. Which of the following creates a higher risk for digoxin toxicity?

A. Administrating to older adults because of reduced renal function B. Giving digoxin with aldosterone antagonist diuretics because of decreased

potassium levels C. Taking an antacid for gastroesophageal reflux disease because it increases the absorption of digoxin D. Taking doses between 0.25 and 0.5 mg/day ANS: A

PTS: 1

15. Serum digoxin levels are monitored for potential toxicity. Monitoring should occur: A. Within 6 hours of the last dose B. Because a reference point is needed to adjust dosage C. After three half-lives from the starting of the drug D. When a patient has stable renal function

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: B

4 Ch13

PTS: 1

16. Amiodarone has been prescribed in a patient with a supraventricular dysrhythmia. Patient

teaching should include all of the following EXCEPT: A. Notify your health-care provider immediately if you have change in vision B. Monitor your own blood pressure and pulse daily C. Take a hot shower or bath if you feel dizzy D. Use sunscreen on exposed body surfaces ANS: C

PTS: 1

17. The NP orders a thyroid panel for a patient on amiodarone. The patient tells the NP that he

does not have thyroid disease and wants to know why the test has been ordered. Which is the correct response?

A. Amiodarone inhibits an enzyme that is important in making thyroid hormone and can cause hypothyroidism.

B. Amiodarone damages the thyroid gland and can result in inflammation of that gland, causing hyperthyroidism.

C. Amiodarone is a broad spectrum drug with many adverse effects. Many different tests need to be done before it is given.

D. Amiodarone can cause corneal deposits in up to 25% of patients.

ANS: A

PTS: 1

18. Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is

administered twice daily, but the schedule is 7 a.m. and 2 p.m. because: A. It is a long-acting drug with potential for toxicity.

B. Nitrate tolerance can develop.

C. Orthostatic hypotension is a common adverse effect.

D. It must be taken with milk or food.

ANS: B

PTS: 1

19. Art is a 55-year-old smoker who has been diagnosed with angina and placed on nitrates. He

complains of headaches after using his nitrate. An appropriate reply might be: A. This is a parasympathetic response to the vasodilating effects of the drug.

B. Headaches are common side effects with these drugs. How severe are they?

C. This is associated with your smoking. Let’s work on having you stop smoking.

D. This is not related to your medication. Are you under a lot of stress?

ANS: B

PTS: 1

20. In teaching about the use of sublingual nitroglycerine, the patient should be instructed: A. To swallow the tablet with a full glass of water B. To place one tablet under the tongue if chest pain occurs and allow it to dissolve C. To take one tablet every 5 minutes until the chest pain goes away D. To observe if it “burns” when placed under the tongue; if not it is no longer

effective

Woo Pharmacotherapeutics for APN Prescribers, 6e

5 Ch13

ANS: B PTS: 1 21. Donald has been diagnosed with hyperlipidemia. Based on his lipid profile, atorvastatin is

prescribed. Rhabdomyolysis is a rare but serious adverse response to this drug. Donald should be told to: A. Become a vegetarian because this disorder is associated with eating red meat B. Stop taking the drug if abdominal cramps and diarrhea develop C. Report muscle weakness or tenderness and dark urine to his provider immediately D. Expect “hot flash” sensations during the first 2 weeks of therapy ANS: C

PTS: 1

22. Which of the following diagnostic results would NOT indicate a problem related to an HMG-

CoA reductase inhibitor?

A. Elevated serum transaminase B. Increased serum creatinine C. Elevated creatinine kinase D. Increased white blood cell count ANS: D

PTS: 1

23. Because of the pattern of cholesterol synthesis, reductase inhibitors are ideally given: A. In the evening in a single daily dose B. Twice daily in the morning and the evening C. With each meal and at bedtime D. In the morning before eating ANS: A

PTS: 1

24. Dulcea has type 2 diabetes and a high triglyceride level. She has been prescribed fenofibrate

to treat her hypertriglyceridemia. A history of which of the following might contraindicate the use of this drug?

A. Reactive airway disease/asthma B. Inflammatory bowel disease C. Allergy to aspirin D. Rhabdomyolysis ANS: D

PTS: 1

25. Many patients with hyperlipidemia are treated with more than one drug. Combining a fibric

acid derivative with which of the following is not recommended?

A. Reductase inhibitors, due to an increased risk for rhabdomyolysis B. Bile-acid sequestering resins, due to interference with folic acid absorption C. Grapefruit juice, due to interference with metabolism D. Calcium channel blocker, due to decreased gemfibrozil activity ANS: A

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e 26. Felicity has been prescribed a PCSK9 inhibitor to treat her hyperlipidemia. Unlike other

antilipidemics, this drug: A. Blocks synthesis of cholesterol in the liver B. Augments activity of the LDL receptor C. Increases HDL levels the most among the classes D. Blocks the lipoprotein lipase pathway ANS: B

PTS: 1

27. Because of their site of action, cholesterol absorption inhibitors: A. Do not have a significant adverse effect profile B. Must be taken with at least a 300-calorie meal C. Both A and B D. Neither A nor B ANS: A

PTS: 1

28. Colestipol comes in a powdered form. The patient is taught to: A. Take the powder dry and follow it with at least 8 ounces of water B. Take it with a meal to enhance its action on fatty food C. Mix the powder with 4 to 6 ounces of milk or fruit juice D. Take after the evening meal to coincide with cholesterol synthesis ANS: C

PTS: 1

29. The choice of diuretic to use in treating hypertension is based on: A. Presence of diabetes with loop diuretics being used for these patients B. Level of kidney function with a thiazide diuretic being used for an estimated

glomerular filtration rate higher than the mid-40 mL/min range C. Ethnicity with aldosterone antagonists best for African Americans and older adults D. Presence of hyperlipidemia with higher doses needed for patients with low-density

lipoproteins (LDL) above 130 mg/dL ANS: B

PTS: 1

30. Direct renin inhibitors have the following properties. They: A. Are primarily generic drugs B. Are a renin-angiotensin-aldosterone system (RAAS) medication that is safe during

pregnancy C. Can be used with ACE and ARB medications for stronger impact D. “Shut down” the entire RAAS cycle ANS: D

PTS: 1

31. When comparing ACE and ARB medications, which of the following holds true?

A. Both may produce a dry, irritating cough.

B. Both contribute to some retention of potassium.

C. ARBs have a stronger impact on hypertension control than ACE medications.

6 Ch13

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7 Ch13

D. ARBs have stronger diabetes mellitus renal protection properties than ACE

medications.

ANS: B

PTS: 1

32. How is diabetic renal protection affected by ACE medications? Diabetes mellitus patients: A. Have a reduced rate of renal progression, but ACE medications still need to be

discontinued when advanced renal issues are present B. Who start these medications never progress to renal nephropathy C. Who have early renal dysfunction will see it reverse when on ACE medications D. Without renal issues are the only ones who benefit from ACE protection ANS: A

PTS: 1

33. What dermatological issue is linked to Amiodarone use?

A. Increased risk of basal cell carcinoma B. Flare up of any prior psoriasis problems C. Development of plantar warts D. Progressive change of skin tone toward a blue spectrum ANS: D

PTS: 1

34. Commercials on TV for erectile dysfunction (ED) medications warn about mixing them with

nitrates. Why? A. Increased risk of priapism B. Profound hypotension C. Development of blue discoloration to the visual field D. Inactivation of the ED medication effect ANS: B

PTS: 1

35. Which formulation of nitrate is appropriate for acute anginal pain?

A. Transdermal B. Sublingual C. Oral extended release D. Ointment ANS: B

PTS: 1

36. Which comment by a patient indicates a need for more education concerning his nitrate

medication?

A. I have several bottles because I live in a multilevel home.

B. I keep a tablet on the bedside table in case I awaken with chest pain.

C. I learned not to keep my bottle on top of the fridge because the last one “cooked” due to the heat.

D. I read that the old formula of take three every 5 minutes and call emergency medical services (EMS) is now take two and call EMS. ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

37. Which precautions are shared with family members who will be assisting the patient with

application of nitro patches?

A. Wear gloves to prevent getting a headache B. Soak the patch in warm water to get the glue to come off C. Keep replacing the patch on the same place daily to keep a steady titer D. If you cut the patch for a lower dose, glue the open end ANS: A

PTS: 1

38. What physical assessment is required prior to initiating a new hypertensive patient on an

ACE? A. Distal pulse intensity B. Carotid bruits C. Pulse deficit D. Renal bruits ANS: D

PTS: 1

39. Which drug class is replacing beta blockers as the “go to” post-myocardial infarction (MI)

medication?

A. Ca channel blockers B. Central acting alpha blockers C. ACE inhibitors D. Newer generation aldosterone inhibitors ANS: C

PTS: 1

8 Ch13

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 14. Drugs Affecting the Respiratory System MULTIPLE CHOICE 1. Digoxin levels need to be monitored closely when the following medication is started: A. Loratadine B. Diphenhydramine C. Ipratropium D. Albuterol ANS: D

PTS: 1

2. Patients with pheochromocytoma should avoid which of the following classes of drugs

because of the possibility of developing hypertensive crisis?

A. Expectorants B. Beta-2 agonists C. Antitussives D. Antihistamines ANS: B

PTS: 1

3. A 42-year-old patient has moderate persistent asthma. Which of the following asthma

medications should be used cautiously, if at all?

A. Betamethasone, an inhaled corticosteroid B. Salmeterol, an inhaled long-acting beta agonist (LTBA) C. Albuterol, a short-acting beta agonist D. Montelukast, a leukotriene modifier ANS: B

PTS: 1

4. LTBAs must display a boxed warning from the U.S. Food and Drug Administration due to

the: A. Risk of life-threatening dermatological reactions B. Increased incidence of cardiac events when LTBAs are used C. Increased risk of asthma-related deaths when LTBAs are used D. Risk for life-threatening alterations in electrolytes ANS: C

PTS: 1

5. The bronchodilator of choice for patients taking propranolol is: A. Albuterol B. Pirbuterol C. Formoterol D. Ipratropium ANS: D

PTS: 1

1 Ch14

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2 Ch14

6. A 52-year-old overweight smoker taking theophylline for his persistent asthma tells you he is

going to start the Atkins diet for weight loss. The appropriate response would be: A. Congratulate him on making a positive change in his life B. Recommend he try stopping smoking instead of the Atkins diet C. Schedule him for regular testing of serum theophylline levels during his diet due to increased excretion of theophylline D. Decrease his theophylline dose because a high-protein diet may lead to elevated theophylline levels ANS: B

PTS: 1

7. A patient taking theophylline for his persistent asthma calls the office with a complaint of

nausea, vomiting, and headache. The best advice for him would be to: A. Reassure him this is probably a viral infection and he should be better soon B. Have him proceed directly to an outpatient laboratory for theophylline level testing C. Schedule him for an appointment to evaluate for theophylline toxicity D. Order a theophylline level at the laboratory for him ANS: C

PTS: 1

8. Tiotropium bromide (Spiriva) is an inhaled anticholinergic: A. Used for the treatment of chronic obstructive pulmonary disease (COPD) B. Used in the treatment of asthma in patients not controlled with an ICS/LABA C. Both A and B D. Neither A nor B ANS: A

PTS: 1

9. A patient with exercise-induced and mild persistent asthma is prescribed two puffs of

albuterol 15 minutes before exercise and as needed for wheezing. One puff per day of beclomethasone (Qvar) is also prescribed. Teaching regarding her inhaler includes: A. Use one to two puffs of albuterol per day to prevent an attack with no more than eight puffs per day B. Use beclomethasone every day to treat her asthma C. Report any systemic side effects she experiences, such as weight gain D. Use the albuterol metered-dose inhaler (MDI) immediately after her corticosteroid MDI to facilitate bronchodilation ANS: B

PTS: 1

10. When prescribing montelukast (Singulair) for asthma, patients or parents of patients should be

instructed: A. Montelukast should be used twice a day when there is an asthma exacerbation.

B. Patients may experience weight gain on montelukast.

C. Aggression, anxiety, depression, and/or suicidal thoughts may occur when taking montelukast.

D. Lethargy and hypersomnia may occur when taking montelukast.

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: C

3 Ch14

PTS: 1

11. Montelukast (Singulair) may be prescribed for: A. A 6-year-old child with exercise-induced asthma B. A 2-year-old child with moderate persistent asthma C. An 18-month-old child with seasonal allergic rhinitis D. None of the above; montelukast is not approved for use in children ANS: B

PTS: 1

12. The known drug interactions with the inhaled corticosteroid beclomethasone (Qvar) include: A. Albuterol B. Measles, mumps, and rubella (MMR) vaccine C. Insulin D. None of the above ANS: D

PTS: 1

13. When educating patients who are starting on inhaled corticosteroids, the provider should tell

them that: A. They should get any needed live vaccines before starting the medication.

B. Inhaled corticosteroids need to be used daily during asthma exacerbations to be effective.

C. Patients should rinse their mouths out after using the inhaled corticosteroid to prevent thrush.

D. They can triple the dose number of inhalations of medication during colds to prevent needing systemic steroids.

ANS: C

PTS: 1

14. Patients with allergic rhinitis may benefit from a prescription of: A. Fluticasone (Flonase) B. Cetirizine (Zyrtec) C. Over-the-counter (OTC) cromolyn nasal spray (Nasalcrom) D. Any of the above ANS: D

PTS: 1

15. A 72-year-old male occasionally takes diphenhydramine for his seasonal allergies. Monitoring

for this patient would include assessing for: A. Urinary retention B. Cardiac output C. Peripheral edema D. Skin rash ANS: A

PTS: 1

16. Second-generation antihistamines such as loratadine (Claritin) are prescribed for seasonal

allergies because they are:

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4 Ch14

A. More effective than first-generation antihistamines B. Less sedating than the first-generation antihistamines C. Prescription products, and therefore covered by insurance D. Able to be taken with central nervous system (CNS) sedatives, such as alcohol ANS: B

PTS: 1

17. When recommending dimenhydrinate (Dramamine) to treat motion sickness, patients should

be instructed to: A. Take the dimenhydrinate after they get nauseated B. Drink lots of water while taking the dimenhydrinate C. Take the dimenhydrinate 15 minutes before it is needed D. Double the dose if one tablet is not effective ANS: C

PTS: 1

18. Decongestants such as pseudoephedrine (Sudafed): A. Are schedule III drugs in all states B. Should not be prescribed or recommended for children under 4 years of age C. Are effective in treating the congestion children experience with the common cold D. May cause drowsiness in patients of all ages ANS: B

PTS: 1

19. Cough and cold medications that contain a sympathomimetic decongestant such as

phenylephrine should be used cautiously in which population: A. Older adults B. Hypertensive patients C. Infants D. All of the above ANS: D

PTS: 1

20. The first-line decongestant to prescribe for a 60-year-old patient with hypertension would be: A. Oral pseudoephedrine B. Oral phenylephrine C. Nasal oxymetazoline D. Nasal azelastine ANS: C

PTS: 1

21. The first-line treatment for cough related to an upper respiratory tract infection (URI) in a 5-

year-old child is: A. Fluids and symptomatic care B. Dextromethorphan and guaifenesin syrup (Robitussin DM for Kids) C. Guaifenesin and codeine syrup (Tussin AC) D. Chlorpheniramine and dextromethorphan syrup (Nyquil for Kids) ANS: A

PTS: 1

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Ch15

Chapter 15. Drugs Affecting the Hematological System MULTIPLE CHOICE 1. A patient is taking warfarin and is asking about what they can take for minor aches and pains.

The best recommendation is: A. Ibuprofen 400 mg three times a day B. Acetaminophen, not to exceed 4 g per day C. Prescription acetaminophen with codeine D. Aspirin 640 mg three times a day ANS: B

PTS: 1

2. A patient had a deep vein thrombosis (DVT) and was on heparin and warfarin in the hospital

and discharged home on warfarin. She asks her primary care nurse practitioner (NP) why she was getting both medications while in the hospital. The best response is to: A. Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case B. Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness C. Encourage the patient to contact the customer service department at the hospital, as this was most likely a medication error during her admission D. Draw anticoagulation studies to make sure she does not have dangerously high bleeding times ANS: B

PTS: 1

3. The safest drug to use to treat pregnant women who require anticoagulant therapy is: A. Low molecular weight heparin B. Warfarin C. Aspirin D. Heparin ANS: A

PTS: 1

4. The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be

considered in which patients?

A. Pregnant women B. Elderly men C. Overweight or obese patients D. Patients with multiple comorbidities ANS: C

PTS: 1

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5. A patient is traveling to Southeast Asia on vacation and has come into the clinic to review

their medications. They are healthy with only mild hypertension that is well-controlled. They ask about getting “a shot” to prevent blood clots like their friend did before international travel. The correct response would be to: A. Administer one dose of low molecular weight heparin 24 hours before travel B. Prescribe one dose of warfarin to be taken the day of travel C. Consult with a hematologist regarding a treatment plan for the patient D. Explain that they are not at high risk of a blood clot and provide education about how to prevent blood clots while traveling ANS: D

PTS: 1

6. A 51-year-old male has been told by his PCP to take an aspirin a day. Why would this be

recommended?

A. He has arthritis and this will help with the inflammation and pain.

B. Aspirin has antiplatelet activity and prevents clots that cause strokes.

C. Aspirin acidifies the urine and he needs this for prostrate health.

D. He has a history of gastrointestinal (GI) bleed, and one aspirin a day is a safe dosage.

ANS: B

PTS: 1

7. A patient has been prescribed aspirin 325 mg per day for their atrial fibrillation. They also

take aspirin four or more times a day for arthritis pain. What are the symptoms of aspirin toxicity for which they would need to be evaluated?

A. Tinnitus B. Diarrhea C. Hearing loss D. Photosensitivity ANS: A

PTS: 1

8. Patient education when prescribing clopidogrel includes: A. Herbal products should not be taken without first discussing this with the provider.

B. Urine output should be monitored closely and the provider contacted if it

decreases.

C. Clopidogrel can be constipating; a stool softener should be used if needed.

D. The patient will need regular anticoagulant studies while on clopidogrel.

ANS: A

PTS: 1

9. For patients taking warfarin, international normalized ratios (INRs) are best drawn: A. Monthly throughout therapy B. Three times a week throughout therapy C. Two hours after the last dose of warfarin to get an accurate peak level D. In the morning if the patient takes their warfarin at night

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Pharmacotherapeutics for APN Prescribers, 6e

Ch15

ANS: D PTS: 1 10. Patients receiving heparin therapy require monitoring of: A. Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of

therapy B. Electrolytes for elevated potassium levels in the first 24 hours of therapy C. INR throughout therapy to stay within the range of 2.0 D. Blood pressure for hypertension that may occur in the first 2 days of treatment ANS: A

PTS: 1

11. The routine monitoring recommended for low molecular weight heparin is: A. INR every 2 days until stable, then weekly B. Activated partial thromboplastin time (aPTT) every week while on therapy C. Factor Xa levels if the patient is pregnant D. White blood cell count every 2 weeks ANS: C

PTS: 1

12. Education of patients who are taking warfarin includes discussing their diet. Instructions

include: A. Avoid any food containing vitamin K B. Avoid foods high in vitamin K C. Increase intake of iron-containing foods D. Eat 35 g of fiber daily ANS: B

PTS: 1

13. Patients who are being treated with epoetin alfa need to be monitored for the development of: A. Thrombocytopenia B. Neutropenia C. Hypertension D. Gout ANS: A

PTS: 1

14. If a patient is taking darbepoetin alfa (Aranesp), their blood counts should be monitored to

determine if a dosage adjustment is needed. How soon should this be done after starting the drug?

A. Six weeks if they are a cancer patient B. One week if they have chronic renal failure C. Two weeks if they are taking it for allogenic transfusion D. Each week throughout therapy ANS: A

PTS: 1

15. A patient is having hip replacement surgery and would like to self-donate blood for the

surgery. In addition to being prescribed epogen alfa, he should also be prescribed:

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Pharmacotherapeutics for APN Prescribers, 6e

Ch15

A. Folic acid to prevent megaloblastic anemia B. Iron to start when the epogen starts C. An antihypertensive to counter the adverse effects of epogen D. Vitamin B12 to prevent pernicious anemia ANS: B

PTS: 1

16. Patients with pernicious anemia require treatment with: A. Iron B. Folic acid C. Epogen alfa D. Vitamin B12 ANS: D

PTS: 1

17. A patient taking carbamazepine needs to be started on a direct factor Xa inhibitor for

antithrombotic therapy. Which of the direct factor Xa inhibitors should be avoided due to drug interactions?

A. Betrixaban B. Apixaban C. Rivaroxaban D. Edoxaban ANS: C

PTS: 1

18. The recommended long-term antithrombotic therapy for a patient with a DVT in the leg is: A. Low molecular weight heparin B. Warfarin, tapered monthly C. Aspirin, 325 mg daily D. Direct factor Xa inhibitor ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch16

Chapter 16. Drugs Affecting the Immune System: Vaccines and Immunoglobulins MULTIPLE CHOICE 1. Attenuated vaccines are also known as: A. Killed vaccines B. Booster vaccines C. Inactivated vaccines D. Live vaccines ANS: D

PTS: 1

2. Live attenuated influenza vaccine (FluMist) may be administered to: A. All patients over 6 months of age B. Patients between ages 2 and 49 with no risk factors C. Patients with an upper respiratory infection (URI) or asthma D. Pregnant women ANS: A

PTS: 1

3. The reason that two measles, mumps, and rubella (MMR) vaccines at least a month apart are

recommended is: A. The second dose of MMR “boosts” the immunity built from the first dose.

B. Two vaccines 1 month apart is the standard dosing for all live virus vaccines.

C. If the two MMR vaccine doses are given too closely together there is a greater likelihood of severe localized reaction to the vaccine.

D. Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR. ANS: D

PTS: 1

4. The MMR vaccine is not recommended for pregnant women because: A. Pregnant women do not build adequate immunity to the vaccine.

B. There is a risk of pregnant women developing measles encephalopathy.

C. There is a risk of the fetus developing congenital rubella syndrome.

D. Pregnant women can receive the MMR vaccine.

ANS: C

PTS: 1

5. If the measles, mumps, rubella, and varicella (MMRV) combined vaccine is ordered to be

given as the first MMR and varicella dose to a child, the Centers for Disease Control and Prevention (CDC) recommends: A. Parents should be informed of the increased risk of fever and febrile seizures over the MMR plus varicella two-shot regimen.

B. Patients must also receive MMRV as the second dose of MMR and varicella in order to build adequate immunity.

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch16

C. Patients should be premedicated with acetaminophen 15 minutes before the

vaccine is given.

D. Patients should not be around pregnant women for the first 48 hours after the

vaccine is given.

ANS: A

PTS: 1

6. The rotavirus vaccine (RotaTeq, Rotarix): A. Is a live vaccine that replicates in the small intestine, providing active immunity

against rotavirus B. Should not be administered to infants who are or may be immunocompromised C. Is not given to an infant who has a febrile illness (temperature greater than 100.5oF) D. All of the above ANS: D

PTS: 1

7. Varicella vaccine may be given to patients who are: A. HIV positive with a CD4+ T-lymphocyte percentage less than 15% B. Taking corticosteroids (up to 2 mg/kg/day or less than 20 mg/day) C. Pregnant D. Immunocompromised ANS: B

PTS: 1

8. Zoster vaccine (Zostavax) is: A. A live varicella zoster vaccine from the same strain used to develop the varicella

vaccine B. Effective in preventing varicella zoster in patients of all ages C. Recommended for patients aged 40 to 80 who have had chickenpox D. Administered at the same time as other live vaccines, as long as they are given the same day ANS: B

PTS: 1

9. True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine

include: A. Fever up to 104oF (40.5oC) after previous DTaP vaccine B. Family history of seizures after DTaP vaccine C. Adolescent pregnancy D. Anaphylactic reaction with a previous dose ANS: D

PTS: 1

10. Hepatitis B vaccine is contraindicated in patients who: A. Were born at less than 32 weeks of gestation B. Are pregnant C. Are on hemodialysis

Woo Pharmacotherapeutics for APN Prescribers, 6e D. Are allergic to yeast ANS: D

PTS: 1

11. Human papillomavirus (HPV) vaccine (Gardasil): A. Is a live virus vaccine that provides immunity to six strains of HPV virus B. Has a common adverse effect of syncope within 15 minutes of getting the vaccine C. Should not be given to males younger than age 12 years D. May be given to pregnant women ANS: B

PTS: 1

12. Recombinant influenza vaccine (Flucelvax, Flublok) may be administered annually to: A. Patients with an egg allergy B. Pregnant adolescent patients C. Patients aged 6 weeks or older D. Patients with acute febrile illness ANS: A

PTS: 1

13. Immune globulin serums: A. Provide active immunity against infectious diseases B. Are contraindicated during pregnancy C. Are heated to above body temperature to kill most hepatitis, HIV, and other viruses

such as parvovirus D. Are derived from pooled plasma of adults and contain specific antibodies in proportion to the donor population ANS: D

PTS: 1

14. Hepatitis B immune globulin is administered to provide passive immunity to: A. Infants born to HBsAg-positive mothers B. Sexual contacts of those infected with hepatitis B virus C. Persons exposed to blood containing hepatitis B virus D. All of the above ANS: A

PTS: 1

15. Rho(D) immune globulin (RhoGAM) is given to: A. Infants born to women who are Rh-positive B. Sexual partners of Rh-positive women C. Rh-negative women after a birth, miscarriage, or abortion D. Rh-negative women at 36 weeks of gestation ANS: C

PTS: 1

16. Tuberculin purified protein derivative: A. Is administered to patients who are known tuberculin-positive reactors B. May be administered to patients who are on immunosuppressives

3 Ch16

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4 Ch16

C. Should be administered 2 to 3 weeks after an MMR or varicella vaccine D. May be administered the same day as the MMR and/or varicella vaccine ANS: D PTS: 1 17. Pregnant women should receive the Tdap vaccine: A. In the first trimester B. Once every 10 years C. In the third trimester of every pregnancy D. Tdap is contraindicated in pregnancy ANS: C

PTS: 1

18. Meningococcal B vaccine is administered to: A. Infants and children traveling to Saudi Arabia or other hyperendemic areas B. Pregnant adolescents who are attending school C. Patients 10 to 25 years of age during an outbreak D. Infants with functional asplenia ANS: C

PTS: 1

19. The following pediatric patients should receive meningococcal ACWY conjugate vaccine: A. Infants who are HIV infected B. All school-age children C. Children who attend daycare D. Infants with congenital hearing defects ANS: A

PTS: 1

20. Hepatitis A virus (HAV) vaccination is recommended for: A. All infants traveling internationally, but the dose is not counted B. All health-care providers C. Members of a household with children adopted from Africa D. Immunocompromised patients ANS: C

PTS: 1

21. A 2-year-old child recently immigrated and has presented for immunization review. Their

immunization record indicates they have received three doses of bivalent oral polio (bOPV).

What polio vaccine(s) does the child need?

A. None, they are fully vaccinated for polio as recommended B. Three doses of inactivated poliovirus (IPV) C. One dose of IPV after 4 years of age D. One dose of trivalent oral polio virus (tOPV) ANS: B

PTS: 1

22. Who should receive a third dose of MMR vaccine?

A. Children traveling internationally who have had two doses of MMR

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5 Ch16

B. Pregnant women who are exposed to measles C. People who have had two doses of MMR and are at risk during a mumps outbreak D. No one; a third dose is never recommended ANS: C

PTS: 1

23. The NP is evaluating a patient who recently immigrated to the U.S. The patient’s mother, who lives with his family, is a carrier of typhoid fever. The patient is advised that: A. All household contacts should receive typhoid fever immunization.

B. The vaccine is contraindicated in persons > age 65.

C. He should be vaccinated and then have antibody levels assessed annually.

D. Blood and body fluid precautions should be practiced by household members.

ANS: A

PTS: 1

24. A 35-year-old male patient is planning travel to Africa and asks if he should be vaccinated against the plague. He reports that a relative who lives there died of the plague and he wants to be protected. The NP advises: A. The plague vaccine is only available to persons traveling to South America.

B. The plague vaccine is not available in the United States.

C. The three-series vaccine should begin 6 months prior to travel.

D. The vaccine is contraindicated in patients with immune compromise.

ANS: B

PTS: 1

25. A patient presents to urgent care immediately following a penetrating bite from a fox in her residential neighborhood. She states that the fox was unusually aggressive, and there is concern for rabies. The patient is a veterinary assistant and had a primary rabies vaccine series 13 months ago that is documented and verified. The NP recommends: A. No further vaccination indicated B. Rabies immune globulin C. A dose of vaccine today and again in 3 days D. Four doses of vaccine beginning today, then days 3, 7, and 14 ANS: C

PTS: 1

26. A new health-care worker is having a physical examination to ensure all appropriate screenings and vaccines are on board. The NP recognizes he cannot administer the PPD because the patient: A. Has had the BCG vaccine B. Has never had a PPD before C. Had an MMR booster 2 weeks ago D. Is allergic to neomycin ANS: C

PTS: 1

27. A family is traveling to Mexico and inquires about vaccination for dengue fever because

Woo Pharmacotherapeutics for APN Prescribers, 6e

6 Ch16

the last time they were there the oldest daughter contracted it. The NP advises that: A. Everyone in the family should receive dengue immune globulin within 30 days of travel.

B. The vaccine is only effective if there is no history of previous dengue infection.

C. There is no vaccine for dengue fever.

D. The vaccine is not licensed for patients over 16 years old in the United States.

ANS: A

PTS: 1

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1 Ch17

Chapter 17. Drugs Affecting the Immune System: Immunomodulators MULTIPLE CHOICE 1. A patient taking cyclosporine is struggling with depressive symptoms but does not want to

take medication. She found on the internet that St. John’s wort can be helpful for patients with depressed mood. The NP advises the patient that: A. St. John’s wort is not as effective as traditional medications.

B. The depression is likely a side effect of cyclosporine.

C. It is not approved for use in the United States.

D. Using this medication can decrease blood levels of cyclosporine.

ANS: D

PTS: 1

2. Which of the following statements best describes monoclonal antibodies?

A. They are produced in a laboratory from a B cell clone.

B. They are heterogenous antibodies containing a variety of biologic components.

C. They are used as an augment to allopathic therapies.

D. They are not capable of producing hypersensitivity responses.

ANS: A

PTS: 1

3. Several monoclonal antibodies are available for the treatment of asthma. Which one of them

targets IgE? A. Mepolizumab (Nucala) B. Benralizumab (Fasenra) C. Dupilumab (Dupixent) D. Omalizumab (Xolair) ANS: D

PTS: 1

4. Prior to starting any biologic agent the NP should assess a patient for: A. Pregnancy B. A history of anaphylaxis C. Hepatitis B and C D. Depression ANS: C

PTS: 1

5. A patient is being treated for cancer with monoclonal antibody therapy. Patient education

about cytokine release syndrome should include that: A. Anaphylaxis is a common manifestation.

B. It can occur up to 14 days following the infusion.

C. Premedicating with hydroxyzine should occur with subsequent infusions.

D. It is more common in persons of Western European descent.

ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e 6. Azathioprine has significant adverse drug effects, including: A. Hypertension B. Hirsutism C. Risk of cancer D. Gingival hyperplasia ANS: D

PTS: 1

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1 Ch18

Chapter 18. Drugs Affecting the Gastrointestinal System MULTIPLE CHOICE 1. Many patients self-medicate with antacids. Which patients should be counseled to not take

calcium carbonate antacids without discussing it with their provider or a pharmacist first?

A. Patients with kidney stones B. Pregnant patients C. Patients with heartburn D. Postmenopausal women ANS: A

PTS: 1

2. Patients taking antacids should be educated regarding antacids, including: A. They may cause constipation or diarrhea.

B. Many are high in sodium.

C. They should separate antacids from other medications by 1 hour.

D. All of the above ANS: D

PTS: 1

3. A patient has diarrhea and is wondering if they can take loperamide (Imodium). Loperamide: A. Can be given to patients of all ages, including infants and children, for viral

gastroenteritis B. Slows gastric motility and reduces fluid and electrolyte loss from diarrhea C. Is the treatment of choice for the diarrhea associated with E. coli 0157 D. May be used in pregnancy and by lactating women ANS: B

PTS: 1

4. Bismuth subsalicylate (Pepto-Bismol) is a common over-the-counter (OTC) remedy for

gastrointestinal complaints. Bismuth subsalicylate: A. May lead to toxicity if taken with ibuprofen B. Is contraindicated in children with flulike illness C. Has no antimicrobial effects against bacterial and viral enteropathogens D. May cause stools to turn gray or black in color ANS: D

PTS: 1

5. A young adult will be traveling to Mexico with her church group over spring break to build

houses. She is concerned she may develop traveler’s diarrhea. Advice includes following normal food and water precautions as well as taking: A. Loperamide four times a day throughout the trip B. Bismuth subsalicylate before each meal and at bedtime C. Prescription diphenoxylate with atropine if she gets diarrhea D. Calcium carbonate (Tums) four times a day for stomach upset

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: B

2 Ch18

PTS: 1

6. A 15-year-old patient presents to the clinic with a 48-hour history of nausea, vomiting, and

some diarrhea. She is unable to keep fluids down, and her weight is 4 pounds less than her last recorded weight. Besides intravenous (IV) fluids, the exam warrants the use of an antinausea medication. Which of the following would be the appropriate drug to order?

A. Prochlorperazine (Compazine) B. Meclizine (Antivert) C. Promethazine (Phenergan) D. Ondansetron (Zofran) ANS: D

PTS: 1

7. A patient presents with complaints of heartburn that is minimally relieved with Tums (calcium

carbonate) and is diagnosed as gastroesophageal reflux disease (GERD). An appropriate ondemand therapy would be: A. Omeprazole (Prilosec) twice a day B. Ranitidine (Zantac) twice a day C. Famotidine (Pepcid) once a day D. Metoclopramide (Reglan) four times a day ANS: C

PTS: 1

8. Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for: A. Iron deficiency anemia, vitamin B12 and calcium deficiency B. Folate and magnesium deficiency C. Elevated uric acid levels leading to gout D. Hypokalemia and hypocalcemia ANS: A

PTS: 1

9. A 72-year-old patient takes omeprazole for their chronic GERD. Chronic long-term

omeprazole use places them at increased risk for: A. Megaloblastic anemia B. Osteoporosis C. Hypertension D. Strokes ANS: A

PTS: 1

10. A 10-year-old patient presents with uncomfortable constipation. Along with diet changes, a

laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be: A. PEG 3350 (Miralax) B. Bisacodyl (Dulcolax) suppository C. Docusate (Colace) suppository D. Methylnaltrexone

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: B

3 Ch18

PTS: 1

11. Methylnaltrexone is used to treat constipation in: A. Patients with functional constipation B. Patients with constipation associated with irritable bowel syndrome C. Children with encopresis D. Patients with opioid-associated constipation ANS: D

PTS: 1

12. An elderly person has been prescribed lactulose for treatment of chronic constipation.

Monitoring with long-term treatment would include: A. Electrolytes, including potassium and chloride B. Bone mineral density for osteoporosis C. Magnesium level D. Liver function ANS: A

PTS: 1

13. Which of the following medications places a patient at increased risk of developing chronic

kidney disease?

A. Ranitidine B. Omeprazole C. Loperamide D. Ondansetron ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch19

Chapter 19. Drugs Affecting the Endocrine System: Pancreatic Hormones and Antidiabetic Drugs MULTIPLE CHOICE 1. When given subcutaneously, how long until neutral protamine Hagedorn (NPH) insulin

begins to take effect (onset of action) after administration?

A. Fifteen to 30 minutes B. Sixty to 90 minutes C. Three to 4 hours D. Six to 8 hours ANS: B

PTS: 1

2. Hypoglycemia can result from the action of either insulin or an oral hypoglycemic. Signs and

symptoms of hypoglycemia include: A. “Fruity” breath odor and rapid respiration B. Diarrhea, abdominal pain, weight loss, and hypertension C. Dizziness, confusion, diaphoresis, and tachycardia D. Easy bruising, palpitations, cardiac dysrhythmias, and coma ANS: C

PTS: 1

3. Nonselective beta blockers and alcohol create serious drug interactions with insulin because

they: A. Increase blood glucose levels B. Produce unexplained diaphoresis C. Interfere with the ability of the body to metabolize glucose D. Mask the signs and symptoms of altered glucose levels ANS: D

PTS: 1

4. Lispro is an insulin analogue produced by recombinant DNA technology. Which of the

following statements about this form of insulin is NOT true?

A. Optimal time of preprandial injection is 15 minutes.

B. Duration of action is increased when the dose is increased.

C. It is compatible with NPH insulin.

D. It has no pronounced peak.

ANS: B

PTS: 1

5. The decision may be made to switch from twice daily NPH insulin to insulin glargine to

improve glycemia control throughout the day. If this is done: A. The initial dose of glargine is reduced by 20% to avoid hypoglycemia.

B. The initial dose of glargine is 2 to 10 units per day.

C. Patients who have been on high doses of NPH will need tests for insulin antibodies.

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch19

D. Obese patients may require more than 100 units per day.

ANS: A

PTS: 1

6. When blood glucose levels are difficult to control in type 2 diabetes, some form of insulin

may be added to the treatment regimen to control blood glucose and limit complication risks.

Which of the following statements is accurate based on research?

A. Premixed insulin analogues are better at lowering HbA1C and have less risk for hypoglycemia.

B. Premixed insulin analogues and the newer premixed insulins are associated with more weight gain than the oral antidiabetic agents.

C. Newer premixed insulins are better at lowering HbA1C and postprandial glucose levels than long-acting insulins.

D. Patients who are not controlled on oral agents and have postprandial hyperglycemia can have NPH insulin added at bedtime.

ANS: C

PTS: 1

7. Metformin is a primary choice of drug to treat hyperglycemia in type 2 diabetes because it: A. Substitutes for insulin usually secreted by the pancreas B. Decreases gluconeogenesis and glycogenolysis by the liver C. Increases the release of insulin from beta cells D. Decreases peripheral glucose utilization ANS: B

PTS: 1

8. Prior to prescribing metformin, the provider should: A. Order an eGFR to assess renal function B. Try the patient on insulin C. Tell the patient to increase iodine intake D. Have the patient stop taking any sulfonylurea to avoid dangerous drug interactions ANS: A

PTS: 1

9. The action of gliptins is different from other antidiabetic agents because they: A. Have a low risk for hypoglycemia B. Are not associated with weight gain C. Close ATP-dependent potassium channels in the beta cell D. Act on the incretin system to indirectly increase insulin production ANS: D

PTS: 1

10. Sitagliptin has been approved for: A. Monotherapy in once-daily doses B. Combination therapy with metformin C. Both A and B D. Neither A nor B ANS: C

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e 11. GLP-1 agonists: A. Directly bind to a receptor in the pancreatic beta cell B. Have been approved for monotherapy C. Speed gastric emptying to decrease appetite D. Can be given orally once daily ANS: B

PTS: 1

12. Administration of exenatide is by subcutaneous injection: A. Thirty minutes prior to the morning meal B. Sixty minutes prior to the morning and evening meal C. Fifteen minutes after the evening meal D. Sixty minutes before each meal daily ANS: B

PTS: 1

13. When is metformin typically initiated for glucose metabolism issues?

A. Only after the HgA1C is greater than 8.0 B. When the patient is diagnosed with prediabetes C. When metabolic syndrome ensues D. When true diabetes mellitus (DM) is diagnosed ANS: B

PTS: 1

14. Which characteristic of metformin makes it a popular selection for diabetes care?

A. No gastrointestinal (GI) side effects B. Only rarely causes hypoglycemia C. Pain-free injections due to the micro needle D. Once-weekly dosing ANS: B

PTS: 1

15. All of the following are options for insulin injections when each dose is close to 100 units

except: A. Move to split dosing B. Move to insulin pen use C. Change to U500 insulin D. Stop injectable insulin and change to oral methods only ANS: D

PTS: 1

16. Long-term injection site skin changes are called: A. Lipodystrophy B. Tuberous sclerosis C. Telangiectasia D. Medication caveronosa ANS: A

PTS: 1

3 Ch19

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch20

Chapter 20. Drugs Affecting the Endocrine System: Pituitary, Thyroid, and Adrenal Drugs MULTIPLE CHOICE 1. Patients with cystic fibrosis are often prescribed enzyme replacement for pancreatic

secretions. Each replacement drug has lipase, protease, and amylase components, but the drug is prescribed in units of: A. Lipase B. Protease C. Amylase D. Pancreatin ANS: A

PTS: 1

2. Different brands of pancreatic enzyme replacement drugs are: A. Bioequivalent B. About the same in cost per unit of lipase across brands C. Able to be interchanged between generic and brand-name products to reduce cost D. None of the above ANS: B

PTS: 1

3. Potentially fatal granulocytopenia has been associated with treatment of hyperthyroidism with

propylthiouracil. Patients should be taught to report: A. Tinnitus and decreased salivation B. Fever and sore throat C. Hypocalcemia and osteoporosis D. Laryngeal edema and difficulty swallowing ANS: B

PTS: 1

4. Elderly patients who are on levothyroxine for thyroid replacement should be monitored for: A. Excessive sedation B. Tachycardia and angina C. Weight gain D. Cold intolerance ANS: B

PTS: 1

5. Which of the following is not an indication that growth hormone supplements should be

discontinued?

A. Imaging indication of epiphyseal closure B. Growth curve increases that have plateaued C. Complaints of mild bone pain D. Achievement of anticipated height goals

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: C

2 Ch20

PTS: 1

6. Which of the following statements about pancreatic enzymes is true?

A. Dosing may be titrated according to the decrease of steatorrhea.

B. The amount of carbohydrates in a meal drives the amount of enzyme used.

C. The amount of medication used increases with a cystic fibrosis pulmonary flare.

D. The U.S. Food and Drug Administration (FDA) and internet-available

formulations are bioequivalent.

ANS: A

PTS: 1

7. Besides cystic fibrosis, which other medical state may trigger the need for pancreatic

enzymes?

A. Paget disease B. Pulmonary cancers C. Gallbladder surgery D. Some bariatric surgeries ANS: D

PTS: 1

8. A precaution when sprinkling pancreatic enzymes on food is: A. Wash off any “dust” that gets on the hands to decrease potential dermatology

issues B. Keep it on top of food instead of mixing it in C. Do not drink fluids during the meal D. Keep the powder primarily on the carbohydrate-rich foods ANS: A

PTS: 1

9. A postsurgical patient may experience water balance issues for a while due to alteration in

which hypothalamic, pituitary, adrenal hormone: A. Prolactin B. Thyroid-stimulating hormone (TSH) C. Antidiuretic hormone (ADH) D. Oxytocin ANS: C

PTS: 1

10. Why must steroids be tapered after long-term use?

A. Chronic use intensifies adrenal response.

B. The resolution of longer-term adrenal suppression must not be rapid.

C. Tapering reduces the sequela of “moon facies” and lipomas.

D. Abrupt cessation causes tachyphylaxis.

ANS: B

PTS: 1

11. A woman who is not pregnant and not breastfeeding has unexplained “milk production” from

her left breast. Which endocrine abnormality is the most likely cause?

Woo Pharmacotherapeutics for APN Prescribers, 6e A. Adrenal tumor B. Pancreatic cancer C. Cushing syndrome D. Pituitary tumor ANS: D

PTS: 1

3 Ch20

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch21

Chapter 21. Drugs Affecting the Reproductive System MULTIPLE CHOICE 1. Men who use transdermal testosterone gel (AndroGel) should be advised to avoid: A. Washing their hands after applying the gel B. Wearing occlusive clothing while using the gel C. Exposure to estrogens while using the gel D. Skin-to-skin contact with pregnant women while using the gel ANS: D

PTS: 1

2. Education when prescribing androgens to male patients includes advising that: A. Short-term use places the patient at risk for hepatocellular carcinoma.

B. Cholestatic hepatitis and jaundice may occur with low doses of androgens.

C. Gynecomastia is a rare occurrence with the use of androgens.

D. Low sperm levels only occur with long-term use of androgens.

ANS: B

PTS: 1

3. Patients who are prescribed exogenous androgens need to be warned that decreased libido: A. Is an unusual side effect of androgens and should be reported to the provider B. Is treated with increased doses of androgens, so the patient should let the provider

know if he is having problems C. May be a sign of early prostate cancer, so he should make an appointment for a

prostate screening exam D. May occur with androgen therapy ANS: D

PTS: 1

4. The U.S. Food and Drug Administration warns that androgens may cause: A. Peliosis hepatis B. Orthostatic hypotension C. Menstrual irregularities D. Acne ANS: A

PTS: 1

5. Monitoring for a patient who is using androgens includes evaluation of: A. Complete blood count (CBC) and C-reactive protein levels B. Lipid levels and liver function tests C. Serum potassium and magnesium levels D. Urine protein and potassium levels ANS: B

PTS: 1

6. Male patients require A. A digital prostate exam

before and during androgen therapy.

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch21

B. A Doppler exam of testicular blood flow C. Urine analysis for proteinuria D. Serial orthostatic blood pressures ANS: A

PTS: 1

7. Absolute contraindications to estrogen therapy include: A. History of any type of cancer B. Clotting disorders C. History of tension headaches D. Orthostatic hypotension ANS: B

PTS: 1

8. Postmenopausal women with an intact uterus should not be prescribed: A. An estrogen/progesterone combination B. Intramuscular (IM) medroxyprogesterone (Depo-Provera) C. Estrogen alone D. Androgens ANS: C

PTS: 1

9. Women who have migraines with an aura should not be prescribed estrogen because: A. There is an interaction between triptans and estrogen, limiting migraine therapy

choices.

B. There is an increased incidence of migraines with the use of estrogen.

C. There is an increased risk of stroke occurring with estrogen use.

D. Patients with migraines may be prescribed estrogen without any concerns.

ANS: C

PTS: 1

10. A 22-year-old woman receives a prescription for oral contraceptives. Education for this

patient includes: A. Counseling regarding decreasing or not smoking while taking oral contraceptives B. Advising a monthly pregnancy test for the first 3 months she is taking the contraceptive C. Advising that she may miss two pills in a row and not be concerned about pregnancy D. Recommending the next follow-up visit in 1 year for a refill and annual exam ANS: A

PTS: 1

11. A 19-year-old female is a nasal Staph aureus carrier and is placed on 5 days of rifampin for

treatment. Her only other medication is combined oral contraceptives. What education should she receive regarding her medications?

A. She should separate the oral ingestion of the rifampin and oral contraceptive by at least an hour.

B. Both medications are best tolerated if taken on an empty stomach.

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch21

C. She should use a back-up method of birth control such as condoms for the rest of

the current pill pack to avoid the low possibility of birth control pill (BCP) ineffectiveness.

D. If she gets nauseated with the medications, she should call the office for an antiemetic prescription.

ANS: C

PTS: 1

12. A 56-year-old woman is complaining of vaginal dryness and dyspareunia. To treat her

symptoms with the lowest adverse effects she should be prescribed: A. Low-dose oral estrogen B. A low-dose estrogen/progesterone combination C. A vaginal estradiol ring D. Vaginal progesterone cream ANS: D

PTS: 1

13. Shana is receiving her first medroxyprogesterone (Depo-Provera) injection. Shana will need

to be monitored for: A. Depression B. Hypertension C. Weight gain D. Cataracts ANS: C

PTS: 1

14. When prescribing medroxyprogesterone (Depo-Provera) injections, essential education would

include advising of the following potential adverse drug effects: A. Hypertension and dysuria B. Bone demineralization and osteoporosis C. Abdominal pain and constipation D. Orthostatic hypotension and dermatitis ANS: B

PTS: 1

15. The medroxyprogesterone (Depo-Provera) injection has a black box warning due to: A. The potential development of significant hypertension B. Increased risk of strokes C. Decreased bone density D. The risk of a life-threatening rash such as Stevens-Johnson syndrome ANS: C

PTS: 1

16. Shana received her first medroxyprogesterone (Depo-Provera) injection 6 weeks ago and calls

the clinic, concerned that she has been having a light period off and on since receiving her Depo shot. What should the provider do?

A. Reassure her that some spotting is normal the first few months of Depo and it should improve

Woo Pharmacotherapeutics for APN Prescribers, 6e

4 Ch21

B. Schedule an appointment for an exam as this is not normal C. Prescribe 4 weeks of estrogen to treat the abnormal vaginal bleeding D. Order a pregnancy test and suggest she use a back-up method of contraception

until she has her next shot ANS: A

PTS: 1

17. William is a 62-year-old male who is requesting a prescription for sildenafil (Viagra). He

should be screened for A. Renal dysfunction B. Unstable coronary artery disease C. Benign prostatic hypertrophy D. History of priapism ANS: B

before receiving a prescription for sildenafil.

PTS: 1

18. Men who are prescribed sildenafil (Viagra) need ongoing monitoring for: A. Development of chest pain or dizziness B. Weight gain C. Priapism D. Renal function ANS: A

PTS: 1

19. Men who are prescribed an erectile dysfunction drug such as sildenafil (Viagra) should be

warned about the risk for: A. Impotence when combined with antihypertensives B. Fatal hypotension if combined with nitrates C. Weight gain if combined with antidepressants D. All of the above ANS: B

PTS: 1

20. Androgens are indicated for: A. Symptomatic treatment for male deficiency B. Female libido, endometriosis, and postmenopausal symptoms treatment C. Increased muscle mass in frail women D. Symptomatic treatment in both sexes for cancer and HIV ANS: A

PTS: 1

21. Long-term use of androgens requires specific laboratory monitoring of: A. Glucose, calcium, testosterone, and thyroid function B. Calcium, testosterone, prostate-specific antigen (PSA), and liver function C. Calcium, testosterone, PSA, liver function, glucose, and lipids D. CBC, testosterone, PSA, and thyroid level ANS: C PTS: 1 22. Effects of estrogen include all of the following except:

Woo Pharmacotherapeutics for APN Prescribers, 6e

5 Ch21

A. Regulation of the menstrual cycle B. Maintenance of bone density C. Maintenance of the normal structure of the skin and blood vessels D. Decreased prothrombin activation ANS: D

PTS: 1

23. Absolute contraindications that clinicians must consider when initiating estrogen therapy

include: A. Undiagnosed dysfunctional uterine bleeding B. Uncontrolled hypertension C. Seizure disorder D. Migraine headache ANS: A

PTS: 1

24. Patients taking hormonal contraceptives and hormone replacement therapy need to take the

drug daily at the same time to prevent: A. Nausea B. Breakthrough bleeding C. Breast tenderness D. Pregnancy ANS: B

PTS: 1

25. What medication can be used to help treat hyperprolactinemia?

A. Addyi B. A PDE-5 C. Bromocriptine D. Progesterone ANS: C

PTS: 1

26. Reexamination of the women’s health study has modified guidelines for the use of estrogen in

menopause. Which of the following is true?

A. Supplementation for the first 5 years is considered to have a reasonable risk/benefit profile for selected groups of women.

B. Estrogen can once again be given solely for its bone health benefits.

C. The risk of deep vein thrombosis (DVT) is not as high as previously thought.

D. Supplementation has a great CV benefit if started after the first 5 years of menopause.

ANS: A

PTS: 1

27. Fertility drugs linked with female infertility treatments can also be used for: A. Male spermatogenesis issues B. Lactation suppression C. Pituitary tumor suppression

Woo Pharmacotherapeutics for APN Prescribers, 6e

6 Ch21

D. An abortifacient ANS: A

PTS: 1

28. The newer dyspareunia drugs are required by the U.S. Food and Drug Administration (FDA)

to carry the same risk warnings as: A. Progestins B. Estrogens C. Testosterone D. Androgen antagonists ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch22

Chapter 22. Drugs Affecting the Bones and Joints MULTIPLE CHOICE 1. Both men and women experience bone loss with aging. The bones most likely to demonstrate

significant loss that results in major impairment are: A. Cortical bones B. Femoral neck bones C. Cervical vertebrae D. Pelvic bones ANS: B

PTS: 1

2. Bisphosphonates treat or prevent osteoporosis by: A. Inhibiting osteoclastic activity B. Fostering bone resorption C. Enhancing calcium uptake in the bone D. Strengthening the osteoclastic proton pump ANS: A

PTS: 1

3. Prophylactic use of bisphosphonates is recommended for patients with advancing osteopenia

related to long-term use of which of the following drugs?

A. Selective estrogen receptor modulators B. Aspirin C. Glucocorticoids D. Calcium supplements ANS: C

PTS: 1

4. Besides osteoporosis, intravenous (IV) bisphosphonates are also indicated for: A. Paget disease B. Early osteopenia C. Renal cancer D. Early closure of cranial sutures ANS: A

PTS: 1

5. What is the role of calcium supplements when patients take bisphosphonates?

A. They must be restricted to allow the medication to work.

B. They must be taken at least 1 hour after bisphosphonates.

C. They must be taken at the same time as the bisphosphonates.

D. They only work with bisphosphonates if daily intake is unrestricted.

ANS: B

PTS: 1

6. Angela is a black woman who has heard that women of African descent do not need to worry

about osteoporosis. What education would you provide to Angela about her risk?

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch22

A. She is correct; black women do not have much risk of developing osteoporosis due

to their dark skin.

B. Black women are more likely to die from hip fracture than white women.

C. If she doesn’t drink alcohol, her risk of developing osteoporosis is low.

D. If she has not lost more than 10% of her weight lately, her risk is low.

ANS: B

PTS: 1

7. Drugs that increase the risk of osteoporosis include: A. Oral combined contraceptives B. Carbamazepine C. Calcium channel blockers D. High doses of vitamin D ANS: B

PTS: 1

8. Selective estrogen receptor modifiers (SERMs) treat osteoporosis by selectively: A. Inhibiting magnesium resorption in the kidneys B. Increasing calcium absorption from the gastrointestinal (GI) tract C. Acting on the bone to inhibit osteoblast activity D. Acting on the estrogen receptors in the bone ANS: D

PTS: 1

9. Why are SERMs generally not ordered for women early into menopause?

A. The rapid onset of severe hot flashes can be unbearable.

B. The bone remodeling effect results in osteoporosis.

C. They tend to induce intermittent spotting.

D. The increased risk of breast cancer isn’t worth the benefits of a SERM. ANS: A

PTS: 1

10. How do bisphosphonates treat osteoporosis?

A. By selectively activating estrogen pathways in the bone B. By reducing bone resorption by inhibiting parathyroid hormone (PTH) C. By reducing bone resorption and inhibiting osteoclastic activity D. By increasing PTH production ANS: C

PTS: 1

11. Inadequate vitamin D intake can contribute to the development of osteoporosis by: A. Increasing calcitonin production B. Decreasing calcium absorption from the intestine C. Altering calcium metabolism D. Stimulating bone formation ANS: B

PTS: 1

12. The drug recommended as the primary treatment for osteoporosis in women over age 70 is:

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch22

A. Alendronate (Fosamax) B. Premarin (estrogen) C. Calcium carbonate D. Raloxifene (Evista) ANS: A

PTS: 1

13. The drug recommended as treatment for osteoporosis in men over age 70 is: A. Alendronate (Fosamax) B. Ibandronate (Boniva) C. Calcium carbonate D. Raloxifene (Evista) ANS: A

PTS: 1

14. The ongoing monitoring for patients over age 65 taking alendronate (Fosamax) or any other

bisphosphonate includes all except: A. Annual dual-energy x-ray absorptiometry (DEXA) scans B. Annual vitamin D level C. Annual renal function evaluation D. Electrolytes every 3 months ANS: A

PTS: 1

15. Bisphosphonate administration education includes: A. Taking it on a full stomach B. Sitting erect for at least 30 minutes afterward C. Drinking it with orange juice D. Taking it with H2 blockers or proton pump inhibitors (PPIs) to protect the stomach ANS: B

PTS: 1

16. IV forms of bisphosphonates are used for all of the following except: A. Severe gastric irritation with oral forms B. Known cancer metastasis into the bone C. Advancing renal dysfunction D. Progression of bone loss with oral formulations ANS: C

PTS: 1

17. What is the established frequency of repeating DEXA imaging for a patient on

bisphosphonates?

A. This should be done every 2 years.

B. This should be done every 5 years.

C. There is no evidence-based timeline for monitoring after the first 2 years.

D. There should be annual exams.

ANS: C

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

4 Ch22

18. The parathyroid analogue teriparatide is indicated for use: A. As combination therapy with bisphosphonates B. To increase bone mass in men with primary osteoporosis C. In black women with osteopenia D. When parathormone levels are low ANS: B PTS: 1 19. RANKL inhibitors inhibit osteoclastic survival and function and have been associated with: A. Osteonecrosis of the jaw B. An adjunct to bisphosphonate C. Lower incidence of death from hip fracture D. Decreased cost burden ANS: A PTS:

1

20. The newest treatment option for osteoporosis that decreases bone formation while simultaneously decreasing bone reabsorption is: A. RANKL inhibitors B. Vitamin D analogues C. Sclerostin inhibitors D. Human parathyroid hormone drugs ANS:

C

PTS: 1

21. Fluoride has been found to stimulate bone growth. With respect to osteoporosis, which of the following is a true statement?

A. Fluoride is not approved by the FDA for primary osteoporosis treatment.

B. Fluoride supplements are superior to natural fluoride for bone development.

C. Fluoride supplementation has a greater impact on teeth than bones.

D. Fluoride is contraindicated in patients >65 years of age.

ANS: A 22.

PTS: 1

The least expensive drug for osteoporosis therapy is: A. Alendronate B. Romosozumab C. Denosumab D. TUMS

ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch23

Chapter 23. Drugs Affecting the Integumentary System MULTIPLE CHOICE 1. A child presents with one golden-crusted lesion at the site of an insect bite consistent with

impetigo. Their parents have limited finances and request the least expensive treatment.

Which medication would be the best choice for treatment?

A. Mupirocin (Bactroban) B. Bacitracin and polymyxin B (generic double antibiotic ointment) C. Retapamulin (Altabax) D. Oral cephalexin (Keflex) ANS: B

PTS: 1

2. A patient is a nasal methicillin-resistant staphylococcus aureus (MRSA) carrier. Treatment to

eradicate nasal MRSA is mupirocin. Patient education regarding treating nasal MRSA includes: A. The oral medication should be taken exactly as prescribed.

B. One-half of the dose should be inserted in each nostril twice a day.

C. Treatment should alternate, treating one nare in the morning and the other in the evening.

D. Nasal MRSA eradication requires at least 4 weeks of therapy, with up to 8 weeks needed in some patients.

ANS: B

PTS: 1

3. Instructions for applying a topical antibiotic or antiviral ointment include: A. It should be applied thickly to the infected area, spreading the medication well past

the borders of the infection.

B. If the rash worsens, apply a thicker layer of medication to settle down the

infection.

C. Hands should be washed before and after application of topical antimicrobials.

D. Crusted lesions can be scrubbed off with a clean nailbrush.

ANS: C

PTS: 1

4. A patient who used clotrimazole (Lotrimin AF) for athlete’s foot developed a red, itchy rash

consistent with a hypersensitivity reaction. They now have athlete’s foot again. What would be a good choice of antifungal?

A. Miconazole (Micatin) powder B. Ketoconazole (Nizoral) cream C. Terbinafine (Lamisil) cream D. Griseofulvin (Grifulvin V) suspension ANS: C

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch23

5. When prescribing griseofulvin (Grifulvin V) to treat tinea capitis it is critical to instruct the

patient or parent to: A. Mix the griseofulvin with ice cream before administering B. Take the griseofulvin until the tinea clears, in approximately 4 to 5 weeks C. Shampoo with baby shampoo daily while taking the griseofulvin D. Take the griseofulvin with a high-fat food ANS: D

PTS: 1

6. First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or

tinea pedis (athlete’s foot) would be: A. Over-the-counter (OTC) topical azole (clotrimazole, miconazole) B. Oral terbinafine C. Oral griseofulvin microsize D. Nystatin cream or ointment ANS: A

PTS: 1

7. When prescribing topical penciclovir (Denavir) for the treatment of herpes labialis (cold

sores) patient education would include: A. Penciclovir should be spread liberally all over lips and the area surrounding lips.

B. Penciclovir therapy is started at the first sign of a cold sore outbreak.

C. Skin irritation is normal with penciclovir and it should resolve.

D. Penciclovir should be used a minimum of 2 weeks to prevent recurrence.

ANS: B

PTS: 1

8. An adolescent has been prescribed isotretinoin (Accutane) by dermatology and is presenting

to the primary care provider with symptoms of sadness and depression. The Beck Depression Inventory results indicate mild to moderate depression. What would be the best option at this point?

A. Prescribe a select serotonin reuptake inhibitor (SSRI) antidepressant B. Refer them to a mental health therapist C. Contact their dermatologist about discontinuing the isotretinoin D. Reassure them that mood swings are normal and schedule follow-up in a week ANS: C

PTS: 1

9. A 17-year-old competitive runner presents with hip pain that began after falling while

running. Their only medical problem is severe acne for which they take isotretinoin (Accutane). What should the provider be concerned about?

A. The patient may have pulled a muscle and needs to rest to recover.

B. They are at risk for bone injuries and need to be evaluated for fracture.

C. Isotretinoin interacts with ibuprofen, which is the pain medication of choice.

D. Teen athletes are at risk for repetitive stress injuries.

ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch23

10. An adolescent female calls the clinic with concerns that her acne is worse 1 week after starting

topical tretinoin. What would be the appropriate care for her?

A. Change her to a different topical acne medication as she is having an adverse reaction to the tretinoin B. Switch her to an oral antibiotic to treat her acne C. Advise her to apply an oil-based lotion to her face to soothe the redness D. Reassure her that the worsening of acne is normal, and it should improve with continued use ANS: D

PTS: 1

11. A 6-month-old infant with severe eczema would benefit from topical corticosteroid therapy.

Instructions for using topical corticosteroids in children include: A. Apply liberally to all areas with eczema B. Double the frequency of application when the eczema is severe C. Apply sparingly to eczema areas D. Cover the eczema area with an occlusive dressing after applying a corticosteroid ANS: C

PTS: 1

12. A patient who has had eczema for many years reports that their corticosteroid cream is not

working as well as it was previously. They may be experiencing tolerance to the corticosteroid. Treatment options include: A. Increase the potency of the corticosteroid cream B. Recommend an interrupted or cyclic schedule of application C. Increase the frequency of dosing of the corticosteroid D. Discontinue the corticosteroid because it isn’t working any longer ANS: B

PTS: 1

13. When prescribing tacrolimus (Protopic) to treat atopic dermatitis patients should be informed

that: A. Tacrolimus is most effective if it is used continuously for 4 to 6 months.

B. Tacrolimus should be spread generously over the affected area.

C. The U.S. Food and Drug Administration (FDA) has issued a black box warning about the use of tacrolimus and the development of cancer in animals and humans.

D. The FDA recommends that patients be screened for cancer before prescribing tacrolimus.

ANS: C

PTS: 1

14. Patients who are treated with more than 100 g per week of topical calcipotriene for psoriasis

need to be monitored for: A. High vitamin D levels B. Hyperkalemia C. Hypercalcemia D. Hyperuricemia

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: C

4 Ch23

PTS: 1

15. A patient is prescribed tazarotene for their psoriasis. Patient education regarding topical

tazarotene includes: A. Tazarotene is applied in a thin film to the psoriasis plaque lesions.

B. It should be applied liberally to all psoriatic lesions.

C. Tazarotene should be applied to nonaffected areas to prevent breakout.

D. Tazarotene may cause hypercalcemia if it is overused.

ANS: A

PTS: 1

16. Instructions for the use of selenium sulfide shampoo (Selsun) to treat scalp seborrhea include: A. It should be used daily and rinsed well.

B. Worsening of seborrhea for the first week is normal.

C. Seborrhea usually clears up after a few weeks of treatment.

D. It should be used twice a week for 2 weeks, then weekly.

ANS: D

PTS: 1

17. Topical diphenhydramine (Benadryl) is available OTC to treat itching. Regarding the use of

topical diphenhydramine, patients or parents should be instructed that: A. For maximum effectiveness in treating itching, combine topical with oral diphenhydramine.

B. Topical diphenhydramine is the treatment of choice in treating poison ivy or poison oak.

C. Topical diphenhydramine should not be used in children younger than age 2.

D. When applying topical diphenhydramine, apply the cream liberally to all areas that itch.

ANS: C

PTS: 1

18. A patient has been prescribed silver sulfadiazine (Silvadene) cream to treat burns on his leg.

Normal adverse effects of silver sulfadiazine cream include: A. Transient leukopenia on days 2 to 4 that should resolve B. Worsening of burn symptoms briefly before resolution C. A red, scaly rash that will resolve with continued use D. Hypercalcemia ANS: A

PTS: 1

19. Instructions for the use of malathion (Ovide) for head lice include: A. Use a blow dryer to dry the hair after applying B. Use malathion (Ovide) daily for a week until all lice are dead C. Rinse the malathion (Ovide) off and shampoo hair after 8 to 12 hours D. Use gloves to apply the malathion (Ovide) ANS: C

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

5 Ch23

20. When writing a prescription of permethrin 5% cream (Elimite) for scabies, patient education

would include: A. All members of the household and personal contacts should also be treated.

B. Infants should have permethrin applied from the neck down.

C. The permethrin is washed off after 10 to 20 minutes.

D. Permethrin is flammable and open flame should be avoided while the medication is applied.

ANS: A

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch24

Chapter 24. Drugs Used to Treat Bacterial Infections MULTIPLE CHOICE 1. Factors that place a patient at risk of developing an antimicrobial-resistant organism include: A. Age over 50 years B. School attendance C. Travel within the United States D. Inappropriate use of antimicrobials ANS: D

PTS: 1

2. Infants and young children are at higher risk of developing antibiotic-resistant infections due

to: A. Developmental differences in pharmacokinetics of the antibiotics in children B. The fact that children this age are more likely to be in daycare and exposed to

pathogens from other children C. Parents of young children insisting on preventive antibiotics so they don’t miss work when their child is sick D. Immunosuppression from the multiple vaccines they receive in the first 2 years of life ANS: B

PTS: 1

3. A child has been diagnosed with strep throat and needs a prescription for an antibiotic. The

parent says the last time they had penicillin, they developed a pink, blotchy rash 5 or 6 days after starting the antibiotic. An appropriate antibiotic to prescribe would be: A. Clindamycin B. Amoxicillin C. Cefadroxil (Duricef) D. Azithromycin ANS: B

PTS: 1

4. A 25-year-old female is 8 weeks pregnant and has a urinary tract infection. What would be the

appropriate antibiotic to prescribe for her?

A. Ciprofloxacin (Cipro) B. Amoxicillin (Trimox) C. Doxycycline D. Trimethoprim-sulfamethoxazole (Septra) ANS: B

PTS: 1

5. A 12-month-old child is being treated with amoxicillin for acute otitis media. His parents call

the clinic and say he has developed diarrhea. The appropriate action would be to: A. Advise the parents that some diarrhea is normal with amoxicillin and recommend probiotics daily

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch24

B. Change the antibiotic to one that is less of a gastrointestinal irritant C. Order stool cultures for suspected viral pathogens not treated by the amoxicillin D. Recommend increased fluids and fiber in his diet ANS: A

PTS: 1

6. A 13-year-old child comes to the clinic with a 4-day history of cough, low-grade fever, and

rhinorrhea. When she blows her nose or coughs the mucus is greenish-yellow. The appropriate treatment would be: A. Amoxicillin B. Amoxicillin/clavulanate C. TMP/SMZ (Septra) D. Symptomatic care ANS: D

PTS: 1

7. A patient had a small ventricle septal defect (VSD) that was repaired at 3 years old and has no

residual cardiac problems. The patient is now 28 and requesting prophylactic antibiotics for an upcoming dental visit. The appropriate antibiotic to prescribe according to current American College of Cardiology and American Heart Association guidelines is: A. None, no antibiotic is required for dental procedures B. Amoxicillin 2 grams 1 hour before the procedure C. Ampicillin 2 grams given intramuscularly (IM) or intravenously (IV) 30 minutes before the procedure D. Azithromycin 1 gram 1 hour before the procedure ANS: A

PTS: 1

8. To prevent further development of antibacterial resistance, it is recommended that

fluoroquinolones be reserved for treatment of: A. Urinary tract infections in young women B. Upper respiratory infections in adults C. Skin and soft tissue infections in adults D. Community-acquired pneumonia in patients with comorbidities ANS: D

PTS: 1

9. Fluoroquinolones have a black box warning regarding A. Renal dysfunction B. Hepatic toxicity C. Tendon rupture D. Development of glaucoma ANS: C

even months after treatment.

PTS: 1

10. A patient who was recently treated with clindamycin for an infection calls the advice nurse

because she is having frequent diarrhea that she thinks may have blood in it. What would be the appropriate care for her?

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch24

A. Encourage increased fluids and fiber B. Assess her for pseudomembranous colitis C. Advise her to eat yogurt daily to help restore her gut bacteria D. Start her on an antidiarrheal medication ANS: B

PTS: 1

11. A patient with chronic hepatitis that has led to mildly impaired liver function has an infection

that would be best treated by a macrolide. Which would be the best choice for a patient with liver dysfunction?

A. Azithromycin (Zithromax) B. Clarithromycin (Biaxin) C. Erythromycin (E-mycin) D. None of the above ANS: B

PTS: 1

12. A patient with glucose-6-phosphate dehydrogenase deficiency (G6PD) requires an antibiotic.

Which class of antibiotics should be avoided in this patient?

A. Penicillins B. Macrolides C. Cephalosporins D. Sulfonamides ANS: D

PTS: 1

13. If a patient is allergic to sulfonamide antibiotics, he or she will most likely have cross-

sensitivity to: A. Loop diuretics B. Sulfonylureas C. Thiazide diuretics D. All of the above ANS: D

PTS: 1

14. Tetracyclines such as minocycline are safe to use in: A. Pregnant women B. Adolescents C. Patients with renal dysfunction D. Patients with hepatic dysfunction ANS: B

PTS: 1

15. Tetracyclines should not be prescribed to children younger than 8 years due to: A. Risk of developing cartilage problems B. Development of significant diarrhea C. Risk of kernicterus D. Adverse effects on bone growth

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: D

4 Ch24

PTS: 1

16. A 16-year-old female who is taking minocycline for acne comes to the clinic complaining of a

headache. What would be the appropriate care?

A. Advise acetaminophen or ibuprofen as needed for headaches B. Prescribe sumatriptan (Imitrex) to be taken at the onset of headache C. Evaluate her for pseudotumor cerebri D. Assess her caffeine intake and sleep patterns ANS: C

PTS: 1

17. An adult female has been prescribed doxycycline for a chlamydia infection. She is healthy and

her only medication is an oral combined contraceptive. Education would include: A. She should use a back-up method of birth control (condom) until her next menses.

B. Doxycycline may cause tendonitis and she should report any joint pain.

C. Her partner will need treatment if her infection doesn’t clear with the doxycycline.

D. Doxycycline is used for one-dose treatment of sexually transmitted infections (STIs); take the whole prescription at once.

ANS: A

PTS: 1

18. To prevent the development of peripheral neuropathy in patients taking isoniazid for

tuberculosis, the patient is also prescribed: A. Niacin (vitamin B3) B. Pyridoxine (vitamin B6) C. Riboflavin (vitamin B2) D. Thiamine (vitamin B1) ANS: B

PTS: 1

19. Every antibiotic drug class has resistant organisms that influence prescribing decisions.

A. True B. False ANS: A

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch25

Chapter 25. Drugs Used to Treat Viral, Fungal, and Protozoal Infections MULTIPLE CHOICE 1. An 82-year-old patient has herpes zoster (shingles) and would benefit from an antiviral such

as valacyclovir. Prior to prescribing valacyclovir they will need an assessment of: A. Complete blood count B. Liver function C. Renal function D. Immunocompetence ANS: C

PTS: 1

2. When prescribing acyclovir, patients should be educated regarding the: A. High risk of developing diarrhea B. Need to drink lots of fluids during treatment C. Risk for life-threatening rash such as Stevens-Johnson syndrome D. Eccentric dosing schedule ANS: B

PTS: 1

3. A patient has been diagnosed with type A influenza. Appropriate prescribing of oseltamivir

(Tamiflu) would include: A. Starting oseltamivir within the first 48 hours of influenza symptoms B. Advising the patient he can stop the oseltamivir when his symptoms resolve C. Educating the patient that oseltamivir will cure influenza D. Starting prophylactic treatment for all family members ANS: A

PTS: 1

4. Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes: A. Platelet count B. Blood urea nitrogen (BUN) and creatinine (Cr) C. White blood cell count D. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline

phosphatase, and bilirubin ANS: D

PTS: 1

5. When prescribing metronidazole (Flagyl) to treat bacterial vaginosis, patient education would

include: A. Metronidazole is safe in the first trimester of pregnancy.

B. Consuming alcohol in any form may cause a severe reaction.

C. Sexual partners need concurrent therapy.

D. Headaches are a sign of a serious adverse reaction and need immediate evaluation.

ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch25

6. Education for elderly persons prescribed famciclovir includes: A. The drug may cause confusion or dizziness.

B. Gloves should be worn when handling tablets.

C. Take the antiviral with milk to decrease gastrointestinal upset.

D. Famciclovir may cause tendon problems.

ANS: A

PTS: 1

7. Pharmacological treatment for uncomplicated chicken pox in an immunocompetent child is: A. Acyclovir, which should be given within 48 hours of onset of varicella rash.

B. Varicella-zoster immune globulin, which should be given within 72 hours of onset

of varicella rash.

C. Famciclovir, which should be given within 24 hours of onset of varicella rash.

D. No pharmacologic treatment is indicated.

ANS: D

PTS: 1

8. Selection of drug therapy for hepatitis C (HCV) infection is based on: A. Patient cardiac function B. Genotype and stage of disease C. Age of the patient D. Availability of generic preparation ANS: B

PTS: 1

9. A pregnant patient is diagnosed with HCV. Recommendations for treatment include: A. Sofosbuvir-velpatasvir (Epclusa) should be initiated as soon as possible.

B. Treatment with famciclovir should be used until delivery to prevent transmission

to fetus.

C. Immunoglobulin (IG) should be administered immediately after delivery to prevent

transmission to the newborn.

D. Treatment of pregnant women with HCV is delayed until after delivery.

ANS: D

PTS: 1

10. Prior to starting HCV antivirals the following laboratory tests should be conducted: A. Complete blood count B. Serum lipids C. Hepatitis B surface antigen (HBsAg) D. Thyroid function (TSH and free T4) ANS: C

PTS: 1

11. A 2-year-old child with asthma has been diagnosed with influenza A. Appropriate treatment

would be: A. Amantadine (Symmetrel) B. Zanamivir (Relenza) C. Oseltamivir phosphate (Tamiflu)

Woo Pharmacotherapeutics for APN Prescribers, 6e D. Symptomatic care ANS: C PTS: 1 12. Effective treatment for pinworms in children is: A. Over-the-counter (OTC) pyrantel pamoate B. Ivermectin C. Itraconazole D. Metronidazole ANS: A

PTS: 1

3 Ch25

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch26

Chapter 26. Drugs Used to Treat Inflammatory Processes MULTIPLE CHOICE 1. A patient who has been taking 10 mg per day of prednisone for the past 6 months should be

assessed for: A. Gout B. Iron deficiency anemia C. Osteoporosis D. Renal dysfunction ANS: C

PTS: 1

2. Patients whose total dose of prednisone exceeds 1 g will most likely need a second

prescription for: A. Metformin, a biguanide to prevent diabetes B. Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease C. Naproxen, a nonsteroidal anti-inflammatory drug (NSAID) to treat joint pain D. Furosemide, a diuretic to treat fluid retention ANS: B

PTS: 1

3. A patient has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation.

It is time to discontinue the prednisone. How is prednisone discontinued?

A. Patients with asthma are transitioned directly off the prednisone onto inhaled corticosteroids.

B. Prednisone can be abruptly discontinued with no adverse effects.

C. A tapering schedule should be developed to slowly wean them off the prednisone.

D. Prednisone should be substituted with another anti-inflammatory such as ibuprofen.

ANS: B

PTS: 1

4. Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need

cotreatment with which medication to prevent adverse effects?

A. A bisphosphonate B. Calcium supplementation C. Vitamin D D. All of the above ANS: D

PTS: 1

5. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of: A. Serum glucose B. Stool cultures C. Folate levels D. Vitamin B12

Woo Pharmacotherapeutics for APN Prescribers, 6e

ANS: A

2 Ch26

PTS: 1

6. Patients who are on chronic long-term corticosteroid therapy need education regarding: A. Receiving all vaccinations, especially the live flu vaccine B. Reporting black tarry stools or abdominal pain C. Eating a high carbohydrate diet with plenty of fluids D. Drinking alcohol, small amounts of which are generally tolerated ANS: B

PTS: 1

7. All NSAIDs have a U.S. Food and Drug Administration (FDA) black box warning regarding: A. Potential for causing life-threatening gastrointestinal (GI) bleeds B. Increased risk of developing systemic arthritis with prolonged use C. Risk of life-threatening rashes, including Stevens-Johnson syndrome D. Potential for transient changes in serum glucose ANS: A

PTS: 1

8. A patient has a fractured ankle and has received a prescription for acetaminophen and

hydrocodone (Vicodin). Education when prescribing Vicodin includes: A. It is okay to double the dose of Vicodin if the pain is severe.

B. Vicodin is not habit forming.

C. They should not take any other acetaminophen-containing medications.

D. Vicodin may cause diarrhea, and they should increase fluid intake.

ANS: C

PTS: 1

9. When prescribing NSAIDs, a complete drug history should be conducted as NSAIDs interact

with these drugs: A. Omeprazole, a proton pump inhibitor B. Combined oral contraceptives C. Diphenhydramine, an antihistamine D. Warfarin, an anticoagulant ANS: D

PTS: 1

10. A 2-year-old child is diagnosed with acute otitis media and an upper respiratory infection.

Along with an antibiotic they receive a recommendation to treat the ear pain with ibuprofen.

What education would their parent need regarding ibuprofen?

A. They can cut an adult ibuprofen tablet in half to give the child.

B. The ibuprofen dose can be doubled for severe pain.

C. The child needs to be well hydrated while taking ibuprofen.

D. Ibuprofen is completely safe in children with no known adverse effects.

ANS: C

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch26

11. An 82-year-old takes two aspirin every morning to treat the arthritis pain in his back. The

patient states the aspirin helps him to “get going” each day. Lately, the patient has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for him?

A. Add an H2 blocker such as ranitidine to his therapy B. Discontinue the aspirin and switch him to Vicodin for the pain C. Decrease the aspirin dose to one tablet daily D. Instruct the patient to take an antacid 15 minutes before taking the aspirin each day ANS: A

PTS: 1

12. The trial period to determine effective anti-inflammatory activity when starting a patient on

aspirin for rheumatoid arthritis is: A. 48 hours B. 4 to 6 days C. Four weeks D. Two months ANS: B

PTS: 1

13. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity.

An early sign of aspirin toxicity is: A. Black tarry stools B. Vomiting C. Tremors D. Tinnitus ANS: D

PTS: 1

14. Monitoring a patient on a high-dose aspirin includes: A. Salicylate level B. Complete blood count C. Urine pH D. All of the above ANS: D

PTS: 1

15. Patients who are on long-term aspirin therapy should have A. Complete blood count B. Liver function test C. Amylase D. Urine analysis ANS: A

PTS: 1

annually.

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch27

Chapter 27. Drugs Used to Treat Eye and Ear Disorders MULTIPLE CHOICE 1. The Centers for Disease Control recommends all newborn infants receive prophylactic

administration of within 1 hour of birth.

A. Gentamicin ophthalmic ointment B. Ciprofloxacin ophthalmic drops C. Erythromycin oral suspension D. Erythromycin ophthalmic ointment ANS: D

PTS: 1

2. Conjunctivitis in a child that is accompanied by acute otitis media is treated with: A. Sulfacetamide 10% ophthalmic solution (Bleph-10) B. Bacitracin/polymyxin B (Polysporin) ophthalmic drops C. Ciprofloxacin (Ciloxan) ophthalmic drops D. High-dose oral amoxicillin-clavulanate ANS: D

PTS: 1

3. A young adult patient comes to the clinic complaining of copious yellow-green eye discharge.

Gram stain indicates she most likely has gonococcal conjunctivitis. While awaiting the culture results, the plan of care should be: A. None, wait for the culture results to determine the course of treatment B. Ciprofloxacin (Ciloxan) ophthalmic drops C. Intramuscular (IM) ceftriaxone D. High-dose oral amoxicillin ANS: C

PTS: 1

4. Education of women who are being treated with ophthalmic antibiotics for conjunctivitis

includes: A. They should throw away eye makeup and purchase new.

B. Redness and intense burning is normal with ophthalmic antibiotics.

C. When applying eye ointment, set the tip of the tube on the lower lid and squeeze in 1/4 inch medication.

D. They should use a cotton swab to apply ointment, spreading the ointment all over the lid and in the conjunctival sac.

ANS: A

PTS: 1

5. A patient was prescribed betaxolol ophthalmic drops by their ophthalmologist to treat

glaucoma. Oral beta blockers should be avoided in patients who use ophthalmic beta blockers because: A. There may be an antagonistic reaction between the two.

B. The additive effects may include bradycardia.

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch27

C. They may potentiate each other and cause respiratory depression.

D. The additive effects may cause metabolic acidosis.

ANS: B

PTS: 1

6. An adult patient presents to the clinic with symptoms of allergic conjunctivitis and is

prescribed cromolyn sodium (Opticrom) eye drops. The education regarding cromolyn eye drops includes: A. They should not wear soft contacts while using the cromolyn eye drops.

B. Cromolyn drops are instilled once a day to prevent allergy symptoms.

C. Long-term use may cause glaucoma.

D. They may experience bradycardia as an adverse effect.

ANS: A

PTS: 1

7. Ciprofloxacin otic drops are contraindicated in: A. Children B. Patients with acute otitis externa C. Patients with a perforated tympanic membrane D. Patients with swimmer’s ear ANS: C

PTS: 1

is/are prescribed to prevent swimmer’s ear.

8.

A. Ciprofloxacin otic drops (Ciloxan) B. Isopropyl ear drops (EarSol) C. Colistin (Coly-Mycin S Otic) D. Gentamicin otic drops ANS: B

PTS: 1

9. Patient education regarding the use of ciprofloxacin-hydrocortisone (Cipro HC otic) ear drops

includes: A. The patient should fill the canal with the drops with each dose.

B. Some redness and itching around the ear canal is normal.

C. The patient should warm the bottle of ear drops in his or her hand before administering.

D. Cipro HC otic may cause ototoxicity.

ANS: C

PTS: 1

10. A patient presents to the clinic with hard earwax in both ear canals. Instructions regarding

home removal of hard cerumen include: A. Moisten a cotton swab (Q-tip) and swab the ear canal twice daily B. Instill tap water in both ears while bathing C. Squirt hydrogen peroxide into ears with each bath D. Instill carbamide peroxide (Debrox) twice daily until canals are clear ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 28. Anemia MULTIPLE CHOICE 1. Pernicious anemia is treated with: A. Folic acid supplements B. Thiamine supplements C. Vitamin B12 D. Iron ANS: C

PTS: 1

2. Premature infants require iron supplementation with: A. 10 mg/day of iron B. 2 mg/kg per day until age 12 months C. 7 mg/day in their diet D. 1 mg/kg per day until they are receiving adequate intake of iron from foods ANS: B

PTS: 1

3. Breastfed infants aged 4 to 6 months should receive iron supplementation of: A. 3 mg/kg per day B. 6 mg/kg per day C. 1 mg/kg per day D. Breastfed babies do not need iron supplementation.

ANS: C

PTS: 1

4. An adult female presents to the clinic with menorrhagia. Her hemoglobin is 10.2 and her

ferritin is 15 ng/mL. Initial treatment for her anemia is: A. 18 mg/day of iron supplementation B. 6 mg/kg per day of iron supplementation C. 325 mg ferrous sulfate per day D. 325 mg ferrous sulfate tid ANS: D

PTS: 1

5. A 15-month-old male has a screening hemoglobin of 10.4 g/dL. Treatment for anemia in

toddlers is: A. 18 mg/day of iron supplementation B. 6 mg/kg per day of elemental iron C. 325 mg ferrous sulfate per day D. 325 mg ferrous sulfate tid ANS: B

PTS: 1

6. Monitoring for a patient taking iron to treat iron deficiency anemia includes: A. Hemoglobin, hematocrit, and ferritin 4 weeks after treatment is started

1 Ch28

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch28

B. Complete blood count every 4 weeks throughout treatment C. Annual complete blood count D. Reticulocyte count 4 weeks after treatment is started ANS: A

PTS: 1

7. An adult female has been prescribed iron to treat her anemia. Education of patients prescribed

iron would include: A. She should take the iron with milk if it upsets her stomach.

B. Antacids may help with the nausea and gastrointestinal (GI) upset caused by iron.

C. She should increase fluids and fiber to treat constipation.

D. Iron is best tolerated if it is taken at the same time as her other medications.

ANS: C

PTS: 1

8. A patient has just had her pregnancy confirmed and is asking about how to ensure a healthy

baby. What is the folic acid requirement during pregnancy?

A. 40 mcg/day B. 200 mcg/day C. 600 mcg/day D. 2 g/day ANS: C

PTS: 1

9. A patient with Crohn disease has a documented folate deficiency. Drug therapy for folate

deficiency anemia is: A. Oral folic acid 1 to 2 mg per day B. Oral folic acid 1 g per day C. Intramuscular (IM) folate weekly for at least 6 months D. Oral folic acid 400 mcg daily ANS: A

PTS: 1

10. Patients who are being treated for folate deficiency require monitoring of: A. Complete blood count every 4 weeks B. Hematocrit and hemoglobin at 1 week and then at 8 weeks C. Reticulocyte count at 1 week D. Folate levels every 4 weeks until hemoglobin stabilizes ANS: B

PTS: 1

11. The treatment of vitamin B12 nutritional deficiency is: A. 1,000 mcg daily of oral cobalamin B. 2 g per day of oral cobalamin C. Vitamin B12 100 mcg/day IM D. 500 mcg/dose nasal cyanocobalamin two sprays once a week ANS: A

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e 12. The dosage of vitamin B12 to initially treat pernicious anemia is: A. Nasal cyanocobalamin 1 g spray in each nostril daily for 1 week then weekly for 1

month B. Vitamin B12 IM monthly C. Vitamin B12 1,000 mcg IM daily for 1 week then 1,000 mg IM weekly for a month D. Oral cobalamin 1,000 mcg daily ANS: C

PTS: 1

13. Before beginning IM vitamin B12 therapy, which laboratory values should be obtained?

A. Reticulocyte count, hemoglobin, and hematocrit B. Iron C. Vitamin B12 D. All of the above ANS: D

PTS: 1

should be monitored when vitamin B12 therapy is started.

14.

A. Serum calcium B. Serum potassium C. Ferritin D. C-reactive protein ANS: B

PTS: 1

15. Anemia due to chronic renal failure is treated with: A. Epoetin alfa (Epogen) B. Ferrous sulfate C. Vitamin B12 D. Hydroxyurea ANS: A

PTS: 1

3 Ch28

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch29

Chapter 29. Anxiety and Depression MULTIPLE CHOICE 1. Common mistakes practitioners make in treating anxiety disorders include: A. Switching medications after an 8- to 12-week trial B. Maximizing dosing of antianxiety medications C. Encouraging exercise and relaxation therapy before starting medication D. Thinking a partial response to medication is acceptable ANS: D

PTS: 1

2. An appropriate first-line drug to try for mild-to-moderate generalized anxiety disorder is: A. Alprazolam (Xanax) B. Diazepam (Valium) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ANS: C

PTS: 1

3. An appropriate drug to initially treat panic disorder is: A. Alprazolam (Xanax) B. Diazepam (Valium) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ANS: B

PTS: 1

4. Prior to starting antidepressants, patients should have laboratory testing to rule out: A. Hypothyroidism B. Anemia C. Diabetes mellitus D. Low estrogen levels ANS: A

PTS: 1

5. David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s

education regarding his medication would include: A. Paroxetine may cause intermittent diarrhea.

B. He may experience sexual dysfunction beginning a month after he starts therapy.

C. He may have constipation, and he should increase fluids and fiber.

D. Paroxetine has a long half-life so he may occasionally skip a dose.

ANS: B

PTS: 1

6. Jamison has been prescribed citalopram (Celexa) to treat his depression. Appropriate

education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch29

A. Appetite and concentration typically improve before depressed mood.

B. Sleep should improve almost immediately upon starting citalopram.

C. Full response to the SSRI may take 2 to 4 months after he reaches the full

therapeutic dose.

D. His dysphoria will improve in 1 to 2 weeks.

ANS: A

PTS: 1

7. An appropriate drug for the treatment of depression with anxiety would be: A. Alprazolam (Xanax) B. Escitalopram (Lexapro) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ANS: B

PTS: 1

8. An appropriate first-line drug for the treatment of depression with fatigue and low energy

would be: A. Fluoxetine (Prozac) B. Escitalopram (Lexapro) C. Buspirone (Buspar) D. Amitriptyline (Elavil) ANS: A

PTS: 1

9. The laboratory monitoring required when a patient is on an SSRI is: A. A complete blood count should be checked every 3 to 4 months.

B. Therapeutic blood levels should be checked every 6 months after a steady state is

achieved.

C. Blood glucose should be checked every 3 to 4 months.

D. There is no laboratory monitoring required.

ANS: D

PTS: 1

10. Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the

SSRI. What is the initial dosage adjustment when tapering off antidepressants?

A. Dose should be changed to every other day dosing for a week.

B. Tapering should occur over several weeks.

C. Dose should be reduced by 50% every other day.

D. Escitalopram (Lexapro) can be stopped abruptly due to its long half-life.

ANS: B

PTS: 1

11. The long-term Xanax patient comes in and requests a dose increase. The patient denies any

additional, new, or accelerating triggers of anxiety. The NP suspects which most likely reason for the request?

A. The patient has become tolerant of the medication.

B. The patient is drug seeking.

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch29

C. The patient is experiencing suicidal ideation.

D. The patient needs additional counseling on lifestyle modification.

ANS: A

PTS: 1

12. What “onset of action” symptoms should be reviewed with patients who have been newly

prescribed an SSRI? A. They will have insomnia for a week.

B. They may feel a bit of nausea, but this will resolve quickly.

C. They will have an “onset seizure,” but this is considered normal.

D. They will no longer dream.

ANS: B

PTS: 1

13. Which of the following should be avoided while taking an SSRI? A. Aged blue cheese B. Grapefruit C. Alcohol D. Green leafy vegetables ANS: C

PTS: 1

14. Why is taking paroxetine (Paxil) consistently and never running out of medication more

important with this drug than with most other SSRIs? A. It has a shorter half-life and withdrawal syndrome has a faster onset without taper.

B. Abrupt cessation of this SSRI is very likely to produce significant GI symptoms.

C. There is a quasi-addictive component due to the dopaminergic reward system.

D. It is the most activating of SSRI medications and a sudden stop to taking it will cause the person to have sudden, deep sadness.

ANS: A

PTS: 1

15. The patient shares with the provider that he is taking his Prozac at night before going to bed.

What is the best response?

A. This is a good idea because this class of medications generally makes people sleepy.

B. Have you noticed that you are having more sleep issues since you started that?

C. A common side effect of Prozac is nightmares.

D. This is a good plan because you can eat grapefruit as long as Prozac and grapefruit are ingested 8 to 12 hours apart.

ANS: B

PTS: 1

16. Low-dose tricyclic antidepressants taken only at bedtime are routinely used for: A. Sleep issues B. Mild depression C. Restless leg syndrome D. Acute pain control

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: A PTS: 1 17. Trazodone has an adverse drug effect in men called: A. Priapism B. Diarrhea C. Blue vision syndrome D. Peyronie disease ANS: A

PTS: 1

18. What herbal supplement must be avoided when taking SSRI or serotonin-norepinephrine

reuptake inhibitors (SNRI) medications?

A. Saw palmetto B. Niacin C. St. John’s wort D. Ginseng ANS: C

PTS: 1

19. The black box warnings concerning teens and young adults taking antidepressants include: A. Rapid weight loss B. Suicidal ideation C. Growth retardation D. Increased use of recreational drugs ANS: B

PTS: 1

20. Middle-aged women report the following side effect of taking the SNRI desvenlafaxine: A. Increased libido B. Reduction of hot flashes C. Excessive weight loss D. Easier glucose metabolism control ANS: B

PTS: 1

4 Ch29

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 30. Attention Deficit-Hyperactivity Disorder MULTIPLE CHOICE 1. First-line therapy for a school-aged child diagnosed with attention deficit-hyperactivity

disorder (ADHD) is: A. Atomoxetine B. Clonidine patch C. Methylphenidate D. Lisdexamfetamine ANS: C

PTS: 1

2. A 5-year-old child does not demonstrate improvement in ADHD symptoms while taking

methylphenidate. Treatment options include: A. Change to dextroamphetamine B. Add clonidine patch C. Add atomoxetine D. Switch to bupropion ANS: A

PTS: 1

3. Baseline assessment prior to starting a child on stimulants for ADHD includes: A. Height, weight, and blood pressure B. Fasting glucose C. Liver enzymes D. Electrocardiogram ANS: A

PTS: 1

4. The evidence-based first-line treatment of preschoolers with ADHD includes: A. Methylphenidate B. Atomoxetine C. Dexamphetamine D. Behavioral therapy ANS: D

PTS: 1

5. First-line therapy for an adult with ADHD is: A. Methylphenidate B. Atomoxetine C. Clonidine D. Behavioral therapy ANS: A

PTS: 1

6. An adult taking methylphenidate for ADHD reports problems with insomnia. Treatment

options include:

1 Ch30

Woo Pharmacotherapeutics for APN Prescribers, 6e A. Add an evening dose of clonidine B. Decrease dose of methylphenidate C. Prescribe zolpidem to use as needed for sleep D. Recommend a sleep study ANS: A

PTS: 1

7. Recommended monitoring for children who are started on stimulants for ADHD includes: A. Height, weight, and blood pressure every 3 months for the first year B. Monthly monitoring of symptoms until under control C. Prescription refill pattern D. All of the above ANS: D

PTS: 1

8. After an adult is started on stimulants for ADHD the following should be monitored: A. Height and weight for increased body mass index (BMI) B. Blood pressure for hypotension C. Refill pattern for diversion D. All of the above ANS: C

PTS: 1

9. Discontinuation of ADHD medication involves: A. Tapering dose of alpha 2 agonist B. Switching from a stimulant to a nonstimulant then weaning off C. Tapering off dexamphetamine slowly to prevent withdrawal symptoms D. Switching to every other day methylphenidate for a month then discontinuing ANS: A

PTS: 1

2 Ch30

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch31

Chapter 31. Asthma and Allergy MULTIPLE CHOICE 1. Prior to developing a plan for the treatment of asthma, the patient’s asthma should be

classified according to the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel 3 guidelines. In adults, mild-persistent asthma is classified as asthma symptoms that occur: A. Daily B. Daily and limit physical activity C. Less than twice a week D. More than twice a week and less than once a day ANS: D

PTS: 1

2. In children aged 5 to 11 years mild-persistent asthma is diagnosed when asthma symptoms

occur: A. At nighttime one to two times a month B. At nighttime three to four times a month C. Less than twice a week D. Daily ANS: B

PTS: 1

3. One goal of asthma therapy outlined by the NHLBI Expert Panel 3 guidelines is: A. Control symptoms using albuterol daily B. Minimize exacerbations to once a month C. Keep nighttime symptoms to a maximum of twice a week D. Require infrequent use of beta 2 agonists (albuterol) for relief of symptoms ANS: D

PTS: 1

4. A stepwise approach to the pharmacologic management of asthma: A. Begins with determining the severity of asthma and assessing asthma control B. Is used when asthma is severe and requires daily steroids C. Allows for each provider to determine their personal approach to the care of

asthmatic patients D. Provides a framework for the management of severe asthmatics, but is not as

helpful when patients have intermittent asthma ANS: A

PTS: 1

5. Treatment for mild-intermittent asthma is: A. Daily inhaled medium-dose corticosteroids B. Short-acting beta 2 agonists (albuterol) as needed C. Long-acting beta 2 agonists every morning as a preventative measure D. Montelukast (Singulair) daily

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: B

2 Ch31

PTS: 1

6. The first-line therapy for mild-persistent asthma is: A. High-dose montelukast B. Theophylline C. Low-dose inhaled corticosteroids D. Long-acting beta 2 agonists ANS: C

PTS: 1

7. Monitoring a patient with persistent asthma includes: A. Monitoring how frequently the patient has an upper respiratory infection (URI)

during treatment B. Spirometry testing monthly in-office C. Determining if the patient has increased use of his or her long-acting beta 2 agonist

due to exacerbations D. Evaluating the patient every 2 to 3 months to determine if the patient needs to step

up or down in their therapy ANS: D

PTS: 1

8. Asthma exacerbations at home are managed by the patient by: A. Increasing frequency of beta 2 agonists and contacting their provider B. Tripling inhaled corticosteroid dose C. Using inhaled beta 2 agonists every 20 minutes for 2 hours D. Starting montelukast (Singulair) ANS: A

PTS: 1

9. Patients who are at risk of a fatal asthma attack include those: A. With moderate-persistent asthma B. With a history of requiring intubation or intensive care unit (ICU) admission for

asthma C. Who are on daily inhaled corticosteroid therapy D. Who are pregnant ANS: B

PTS: 1

10. Pregnant patients with asthma may safely use A. Oral terbutaline B. Prednisone C. Inhaled corticosteroids (budesonide) D. Montelukast (Singulair) ANS: C

PTS: 1

11. One goal of asthma management in children is: A. They can independently manage their asthma.

B. They can participate in school and sports activities.

throughout their pregnancy.

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch31

C. They have no exacerbations.

D. They have minimal use of inhaled corticosteroids.

ANS: B

PTS: 1

12.

SMART dosing as introduced by the GINA guidelines includes which of the following as the mainstay of both reliever and controller therapy?

A. The short acting beta agonist B. ICS/formoterol only C. The ICS/LABA combination D. The inhaled corticosteroid ANS: B. PTS: 1 13.

The focus of patient education for patients with allergies is: A. Reducing trigger exposure B. Using oral immunologic medications C. Carrying and using injectable epinephrine appropriately D. Identifying food allergens

ANS:

A.

14.

The mainstay of immunotherapy for allergies involves: A. Injectable therapy B. Eosinophil suppression C. Exposure to allergen D. Mast cell stabilization

ANS:

C.

15.

The most common allergy triggers include all of the following except: A. Medications B. Insect stings C. Food D. Infection

ANS:

D.

16.

The best outcome evaluation for patients with asthma is: A. Improvement of FEV1 of >200 mL after SABA therapy B. The ability to accomplish ADLs with minimal impairment C. Subjective satisfaction with symptom control D. Resolution of nocturnal symptoms

ANS: B. PTS: 1

PTS:

1

PTS: 1

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch32

Chapter 32. Chronic Obstructive Pulmonary Disease MULTIPLE CHOICE

1. Medications used in the management of chronic obstructive pulmonary disease (COPD)

include: A. Inhaled beta 2 agonists B. Inhaled anticholinergics (ipratropium) C. Inhaled corticosteroids D. All of the above ANS: D

PTS: 1

2. Patients with a COPD exacerbation may require: A. Doubling of inhaled corticosteroid dose B. Systemic corticosteroid burst C. Continuous inhaled beta 2 agonists D. Leukotriene therapy ANS: B

PTS: 1

3. Patients with COPD require monitoring of: A. Beta 2 agonist use B. Serum electrolytes C. Blood pressure D. Neuropsychiatric effects of montelukast ANS: A

PTS: 1

4. Education of patients with COPD who use inhaled corticosteroids includes: A. Doubling the dose at the first sign of a URI B. Using their inhaled corticosteroid first and then their bronchodilator C. Rinsing their mouth after inhaler use D. Abstaining from smoking for at least 30 minutes after using ANS: C

PTS: 1

5. Education for patients who use an inhaled beta agonist and an inhaled corticosteroid includes: A. Use the inhaled corticosteroid first, followed by the inhaled beta agonist B. Use the inhaled beta agonist first, followed by the inhaled corticosteroid C. Increase fluid intake to 3 L per day D. Avoid use of aspirin or ibuprofen while using inhaled medications ANS: B

6.

PTS: 1

The preferred choice of therapy for most patients with COPD includes:

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch32

A. A LABA/LAMA combination B. Monotherapy with a LABA C. Monotherapy with a LAMA D. A SABA/SAMA combination ANS:

A

PTS:

1

7.

According to the most current GOLD guidelines, which of the following best characterizes the role of ICS use in the patient with COPD? A. There is no role for the routine use of ICS in patients with COPD. B. ICSs are indicated when LABA/LAMA combination fails to achieve remission.

C. ICSs are considered when the eosinophil count is >300 cells.

D. The ICS should be avoided when the patient has concomitant pneumonia.

ANS:

C

PTS: 1

8.

Newer proposed taxonomy for COPD classification includes all of the following except: A. COPD-A B. COPD-D C. COPD-J D. COPD-P

ANS:

C

PTS: 1

9.

Patients are classified as group A, B, or E for COPD treatment, with group E being the group at high risk for exacerbation. High risk for exacerbation is defined as the patient with: A. >2 or more mild exacerbations B. An FEV1 < 50% predicted C. No measurable improvement with LABA/LAMA combination D. >1 exacerbation requiring hospitalization ANS:

D

PTS: 1

10.

Which of the following statements best characterizes the use of antibiotics in COPD? A. Several studies have demonstrated the utility of azithromycin for prophylactic use.

B. Antibiotics are typically indicated in COPD exacerbation.

C. They are more beneficial in patients who continue to smoke.

D. There is no clear role for the use of antibiotics in COPD.

ANS:

A.

PTS:

1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch33

Chapter 33. Contraception MULTIPLE CHOICE 1. Women who are taking an oral contraceptive containing the progesterone drospirenone may

require monitoring of: A. Hemoglobin B. Serum calcium C. White blood cell count D. Serum potassium ANS: D

PTS: 1

2. The mechanism of action of oral combined contraceptives that prevents pregnancy is: A. Estrogen prevents the luteinizing hormone surge necessary for ovulation.

B. Progestins thicken cervical mucus and slow tubal motility.

C. Estrogen thins the endometrium, making implantation difficult.

D. Progestin suppresses follicle stimulating hormone release.

ANS: B

PTS: 1

3. To improve actual effectiveness of oral contraceptives, women should be educated regarding: A. They should use a back-up method if they have vomiting or diarrhea during a pill

packet.

B. Pills should be doubled if they have diarrhea during the middle of a pill pack.

C. They will have a normal menstrual cycle if they miss two pills.

D. Mid-cycle spotting is not normal and the provider should be contacted

immediately.

ANS: A

PTS: 1

4. A contraindication to the use of combined contraceptives is: A. Adolescence (not approved for this age) B. A history of clotting disorder C. Recent pregnancy D. Being overweight ANS: B

PTS: 1

5. Obese women may have increased risk of failure with which contraceptive method?

A. Combined oral contraceptives B. Progestin-only oral contraceptive pill C. Injectable progestin D. Combined topical patch ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch33

6. Ashley comes to the clinic with a request for oral contraceptives. She has successfully used

oral contraceptives before and has recently started dating a new boyfriend so would like to restart contraception. She denies recent intercourse and has a negative urine pregnancy test in the clinic. An appropriate plan of care would be: A. Recommend she return to the clinic at the start of her next menses to get a DepoProvera shot B. Prescribe oral combined contraceptives and recommend she start them at the beginning of her next period and use a back-up method for the first 7 days C. Prescribe oral contraceptives and have her start them the same day as the visit with a back-up method used for the first 7 days D. Discuss the advantages of using the topical birth control patch and recommend she consider using it ANS: C

PTS: 1

7. When discussing with a patient the different start methods used for oral combined

contraceptives, the advantage of a Sunday start over the other start methods is: A. Immediate protection against pregnancy the first week of using the pill.

B. No back-up method is needed when starting.

C. Menses occur during the week.

D. They can start the pill on the Sunday after the office visit.

ANS: C

PTS: 1

8. The topical patch combined contraceptive (Ortho Evra) is: A. Started on the first day of the menstrual cycle B. Recommended for women over 200 pounds C. Not as effective as oral combined contraceptives D. Known to have more adverse effects, such as nausea, than the oral combined

contraceptives ANS: A

PTS: 1

9. Progesterone-only pills are recommended for women who: A. Are breastfeeding B. Have a history of migraine C. Have a medical history that contradicts the use of estrogen D. All of the above ANS: D

PTS: 1

10. Women who are prescribed progestin-only contraception need education regarding which

common adverse drug effects?

A. Increased migraine headaches B. Increased risk of developing blood clots C. Irregular vaginal bleeding for the first few months D. Increased risk for hypercalcemia

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: C

PTS: 1

11. An advantage of using the NuvaRing vaginal ring for contraception is: A. It does not require fitting and is easy to insert.

B. It is inserted once a week, eliminating the need to remember to take a daily pill.

C. Patients get a level of estrogen and progestin equal to combined oral

contraceptives.

D. It also provides protection against vaginal infections.

ANS: A

PTS: 1

12. Oral emergency contraception (Plan B) is contraindicated in women who: A. Had intercourse within the past 72 hours B. May be pregnant C. Are taking combined oral contraceptives D. Are using a diaphragm ANS: B

PTS: 1

13. Adverse effects of depot medroxyprogesterone acetate (DMPA) (Depo-Provera) include: A. Decrease in bone mineral density with longer-term use B. Increase in migraines C. Increased risk for venous thromboembolism (VTE) D. Increased risk of cardiovascular events ANS: A

PTS: 1

3 Ch33

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 34. COVID-19: Acute and Chronic MULTIPLE CHOICE 1. Coronaviruses were first identified in: A. The 1960s B. The 1980s C. The 2000s D. In 2019 ANS: A

PTS: 1

2. By January of 2021 the death rate due to SARS-CoV-2 exceeded: A. 500,000 B. 1,000,000 C. 2,000,000 D. 2,500,000 ANS: C

PTS: 1

3. The steps of viral infection include all of the following except: A. Attachment B. Penetration C. Uncoating D. Expression ANS: D

PTS: 1

4. The SARS-CoV-2 virus attaches to what type of receptor?

A. Zinc fingers B. Reverse transcriptase C. Chemokines D. Angiotensin converting enzyme ANS: D

PTS: 1

5. An important mechanism of cellular damage inflicted by SARS-CoV-2 is the fact that it: A. Inhibits physiologic inflammation in the gas exchange spaces B. Attenuates vascular remodeling C. Suppresses complement cascade D. Dysregulates the renin-angiotensin system ANS: D

PTS: 1

6. The goals of treatment for SARS-CoV-2 include all of the following except: A. Preventing unnecessary morbidity and mortality

1 Ch34

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch34

B. Reducing patient disease burden C. Limiting transmission D. Intervening early and aggressively ANS: D PTS: 1 7. The most appropriate care setting for the majority of patients with SARS-CoV-2 is: A. Telehealth B. Outpatient office C. Hospital without ICU D. Hospital with ICU ANS:

A

PTS:

1

8. Early evaluation with diagnostic testing for symptomatic patients is critically important in the management of SARS-CoV-2. Which of the following statements best characterizes elements of diagnostic testing?

A. Diagnostic testing is not indicated for patients who have been vaccinated.

B. Antibody testing is the most cost-effective modality for diagnostic evaluation.

C. Repeat testing has little value in patients with a negative test result.

D. Diagnostic testing reduces morbidity, mortality, and spread.

ANS:

D

PTS:

1

9. One of the highest risk factors for poor outcomes in the patient with SARS-CoV-2 is: A. Autoimmune disease B. Severe initial symptoms C. Advancing age D. Lack of prophylaxis ANS:

C

PTS:

1

10. The CDC now recommends which of the following booster vaccines for patients after completing a primary vaccination series against SARS-CoV-2?

A. The bivalent mRNA vaccine B. The adenoviral vector vaccine C. The adjuvant recombinant vaccine D. The monovalent vaccine ANS:

A

PTS:

1

11. The primary adverse risk associated with the mRNA vaccine is:

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch34

A. Thrombosis and embolus B. Myocarditis C. Guillain-Barre syndrome D. Sudden death ANS:

B

PTS:

1

12. Pre-exposure prophylaxis against SARS-CoV-2 is indicated in which of the following clinical circumstances?

A. Patients over the age of 65 years B. Patients under the age of 6 years C. Patients over 12 with severe immunocompromise D. Patients who are vaccinated with imminent exposure ANS:

C

PTS:

1

13. Nirmatrelvir and ritonavir (Paxlovid) are used in the outpatient setting for those patients at risk for progression to severe SARS-CoV-2. A contraindication to this option is: A. An eGFR < 30 mL/min B. Myocarditis following vaccination C. Age > 50 years D. Chronic obstructive pulmonary disease (COPD) ANS:

A

PTS:

1

14. A thorough medication history is necessary before starting patients on Nirmatrelvir and ritonavir (Paxlovid) because patients on CYP3A inducers will: A. Become inducer toxic B. Become Paxlovid toxic C. Become inducer subtherapeutic D. Become Paxlovid subtherapeutic ANS:

D

PTS:

1

15. When counseling patients about remdesivir therapy, the NP counsels that it is: A. More efficacious than Paxlovid B. Administered intravenously C. Desirable in areas with limited resources D. Not advised in long-term care facilities ANS:

B.

PTS:

1

16. Men of reproductive potential should use reliable contraception for 3 months following administration of: A. Paxlovid

Woo Pharmacotherapeutics for APN Prescribers, 6e

4 Ch34

B. Remdesivir C. Molnupiravir D. Bivalent vaccine ANS:

C

PTS:

1

17. The final therapeutic option for patients with SARS-CoV-2 who are not eligible for any other treatment modality is: A. Paxlovid B. Remdesivir C. Molnupiravir D. Convalescent plasma ANS:

D

PTS:

1

18. Monoclonal antibody therapies such as bebtelovimab: A. Are highly effective against the omicron variant of SARS-CoV-2 B. Are limited to very high-risk patients C. Demonstrate decreased efficacy D. Must be given within 72 hours of symptom onset ANS:

C

PTS:

1

19. The Janus kinase (JAK) inhibitor baricitinib is used to treat patients with SARS-CoV-2 who: A. Are not eligible for other therapies B. Are in the inpatient setting C. Have failed interleukin 6 therapy D. Have advanced renal disease ANS:

B

PTS:

1

20. The interleukin 1 inhibitor anakinra is used in patients with severe SARS-CoV-2.

Candidates for treatment include patients with all of the following except: A. Age < 75 years B. Severe pneumonia C. BUN > 50 mg/dL D. Hgb < 10.5 g/dL ANS:

A

PTS:

1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch35

Chapter 35. Dermatological Conditions MULTIPLE CHOICE 1. When choosing a topical corticosteroid cream to treat diaper dermatitis, the ideal medication

would be: A. Intermediate potency corticosteroid ointment (Kenalog) B. A combination of a corticosteroid and an antifungal (Lotrisone) C. A low-potency corticosteroid cream applied sparingly (hydrocortisone 1%) D. A high-potency corticosteroid cream (Diprolene AF) ANS: C

PTS: 1

2. Topical immunomodulators such as pimecrolimus (Elidel) or tacrolimus (Protopic) are used

for: A. Short-term or intermittent treatment of atopic dermatitis B. Topical treatment of fungal infections (Candida) C. Chronic, inflammatory seborrheic dermatitis D. Recalcitrant nodular acne ANS: A

PTS: 1

3. Long-term treatment of moderate atopic dermatitis includes: A. Topical corticosteroids and emollients B. Topical corticosteroids alone C. Topical antipruritics D. Oral corticosteroids for exacerbations of atopic dermatitis ANS: A

PTS: 1

4. Severe contact dermatitis caused by poison ivy or poison oak exposure often requires

treatment with: A. Topical antipruritics B. Oral corticosteroids for 2 to 3 weeks C. Thickly applied topical intermediate-dose corticosteroids D. Isolation of the patient to prevent spread of the dermatitis ANS: B

PTS: 1

5. When a patient has contact dermatitis, wet dressings with Domeboro solution are used for: A. Cleaning the weeping area of dermatitis B. Bathing the patient to prevent infection C. Relieving the inflammation D. Providing a barrier layer to protect the surrounding skin ANS: C

PTS: 1

6. Appropriate initial treatment for psoriasis would be:

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch35

A. An immunomodulator (Protopic or Elidel) B. Wet soaks with Burow’s or Domeboro solution C. Intermittent therapy with intermediate potency topical corticosteroids D. Anthralin (Drithocreme) ANS: C

PTS: 1

7. Patient education when prescribing the vitamin D3 derivative calcipotriene for psoriasis

includes: A. It should be applied thickly to affected psoriatic areas two to three times a day.

B. A maximum of 100 g per week may be applied.

C. Calcipotriene should not be used in combination with other topical corticosteroids.

D. Calcipotriene may be augmented with the use of coal tar products.

ANS: B

PTS: 1

8. Mild acne may be initially treated with: A. Topical combined antibiotic B. Minocycline C. Topical retinoid D. Over-the-counter (OTC) benzoyl peroxide ANS: D

PTS: 1

9. An adolescent presents to the clinic with moderate acne. They have been using OTC benzoyl

peroxide at home with minimal improvement. A topical antibiotic (clindamycin) and a topical retinoid adapalene (Differin) are prescribed. Education would include: A. He should see an improvement in his acne within the first 2 weeks of treatment.

B. If there is no response in a week, the daily application of adapalene (Differin) should be doubled.

C. He may see an initial worsening of his acne that will improve in 6 to 8 weeks.

D. Adapalene may cause bleaching of clothing.

ANS: C

PTS: 1

10. A young adult female has severe cystic acne and is requesting treatment with Accutane. The

appropriate treatment for her would be: A. Order a pregnancy test and if it is negative prescribe the isotretinoin (Accutane) B. Prescribe Accutane after educating her on the adverse effects C. Recommend she try oral antibiotics (minocycline) D. Refer her to a dermatologist for treatment ANS: D

PTS: 1

11. The most cost-effective treatment for two or three impetigo lesions on the face is: A. Mupirocin ointment B. Retapamulin (Altabax) ointment C. Topical clindamycin solution

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch35

D. Oral amoxicillin/clavulanate (Augmentin) ANS: A

PTS: 1

12. A child has classic tinea capitis. Treatment for tinea on the scalp is: A. Miconazole cream thoroughly rubbed in for 4 weeks B. Oral griseofulvin for 6 to 8 weeks C. Ketoconazole shampoo daily for 6 weeks D. Ciclopirox cream daily for 4 weeks ANS: B

PTS: 1

13. An adolescent football player presents to the clinic with athlete’s foot. Patients with tinea

pedis may be treated with: A. OTC miconazole cream for 4 weeks B. Oral ketoconazole for 6 weeks C. Mupirocin ointment for 2 weeks D. Nystatin cream for 2 weeks ANS: A

PTS: 1

14. A patient presents with fungal infection of two of their toenails (onychomycosis). Treatment

for fungal infections of the nail includes: A. Miconazole cream B. Ketoconazole cream C. Oral griseofulvin D. Mupirocin cream ANS: C

PTS: 1

15. Scabies treatment for a 4-year-old child includes a prescription for: A. Permethrin 5% cream applied from the neck down B. Pyrethrin lotion C. Lindane 1% shampoo D. All of the above ANS: A

PTS: 1

16. A patient has been diagnosed with scabies. Education would include: A. She should leave the scabies treatment cream on for an hour and then wash it off.

B. Scabies may need to be retreated in a week after initial treatment.

C. All members of the household and close personal contacts should be treated.

D. Malathion is flammable and she should take care until the solution dries.

ANS: C

PTS: 1

17. A child has head lice and the mother is asking which products are available that are not

neurotoxic. The only nonneurotoxic head lice treatment is: A. Permethrin 1% (Nix)

Woo Pharmacotherapeutics for APN Prescribers, 6e

4 Ch35

B. Lindane shampoo C. Malathion (Ovide) D. Benzoyl alcohol (Ulesfia) ANS: D

PTS: 1

18. An adult male has male pattern baldness on the vertex of his head and has been using Rogaine

for 2 months. He asks how effective minoxidil (Rogaine) is. Minoxidil: A. Provides a permanent solution to male pattern baldness if used for at least 4 months B. Will show results after 4 months of twice-a-day use C. May not work for his type of baldness D. Works better if he also uses hydrocortisone cream daily on his scalp ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch36

Chapter 36. Diabetes Management MULTIPLE CHOICE 1. Type 1 diabetes results from autoimmune destruction of the beta cells. Eighty-five percent to

90% of type 1 diabetics have: A. Autoantibodies to two tyrosine phosphatases B. Mutation of the hepatic transcription factor on chromosome 12 C. A defective glucokinase molecule due to a defective gene on chromosome 7p D. Mutation of the insulin promoter factor ANS: A

PTS: 1

2. Type 2 diabetes is a complex disorder involving: A. Absence of insulin production by the beta cells B. A suboptimal response of insulin-sensitive tissues in the liver C. Increased levels of glucagonlike peptide in the postprandial period D. Too much fat uptake in the intestine ANS: B

PTS: 1

3. Diagnostic criteria for diabetes include: A. Fasting blood glucose greater than 140 mg/dL on two occasions B. Postprandial blood glucose greater than 140 mg/dL C. Fasting blood glucose 100 to 125 mg/dL on two occasions D. A hemoglobin A1c of >6.5% ANS: D

PTS: 1

4. Routine screening of asymptomatic adults for diabetes is appropriate for: A.

Individuals who are older than 45 and have a body mass index (BMI) of less than 25 kg/m2 B. Adults of any age who are overweight or obese C. Persons with high-density lipoprotein (HDL) cholesterol greater than 100 mg/dL D. Persons with prediabetes confirmed on at least two occasions ANS: B

PTS: 1

5. Diabetes screening for children who meet the following criteria should begin at age 10 and

occur every 3 years thereafter: A. BMI above the 85th percentile for age and sex B. Family history of diabetes in first- or second-degree relative C. Hypertension based on criteria for children D. Any of the above ANS: D

PTS: 1

6. Insulin is used to treat both type 1 and type 2 diabetes. It acts by:

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch36

A. Increasing beta cell response to low blood glucose levels B. Stimulating hepatic glucose production C. Increasing peripheral glucose uptake by skeletal muscle and fat D. Improving the circulation of free fatty acids ANS: C

PTS: 1

7. Adam has type 1 diabetes and plays tennis for his university. He exhibits a knowledge deficit

about his insulin and his diagnosis. He should be taught that: A. He should increase his carbohydrate intake during times of exercise.

B. Each brand of insulin is equal in bioavailability, so he can buy the least expensive.

C. Alcohol produces hypoglycemia and can help control his diabetes when taken in small amounts.

D. If he does not want to learn to give himself injections, he may substitute an oral hypoglycemic to control his diabetes.

ANS: A

PTS: 1

8. The drug of choice for type 2 diabetics is metformin. Metformin: A. Decreases glycogenolysis by the liver B. Increases the release of insulin from beta cells C. Increases intestinal uptake of glucose D. Prevents weight gain associated with hyperglycemia ANS: A

PTS: 1

9. Before prescribing metformin, the provider should: A. Assess renal function B. Try the patient on insulin C. Prescribe a thyroid preparation if the patient needs to lose weight D. All of the above ANS: A

PTS: 1

10. Dipeptidyl peptidase-4 inhibitors (gliptins) act on the incretin system to improve glycemic

control. Advantages of these drugs include: A. Better reduction in glucose levels than other classes B. Less weight gain than with sulfonylurea use C. Low risk for hypoglycemia D. Can be given twice daily ANS: C

PTS: 1

11. Control targets for patients with diabetes include: A. HbA1C between 7 and 8 B. Fasting blood glucose levels between 100 and 120 mg/dL C. Blood pressure less than 130/80 mm Hg D. Low-density lipoprotein (LDL) lipids less than 130 mg/dL

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: C

3 Ch36

PTS: 1

12. Establishing glycemic targets is the first step in treatment of both types of diabetes. For type 1

diabetes: A. Tight control/intensive therapy can be given to adults who are willing to test their blood glucose at least twice daily.

B. Tight control is acceptable for older adults if they are without complications.

C. Plasma glucose levels are the same for children as adults.

D. Conventional therapy has a fasting plasma glucose target between 80 and 130 mg/dL. ANS: D

PTS: 1

13. Treatment with insulin for type 1 diabetics: A. Starts with a total daily dose of 0.5 units per kilogram of body weight daily B. Divides the total doses into three injections based on meal size C. Uses a total daily dose of insulin glargine given once daily with no other insulin

required D. Is based on the level of blood glucose ANS: A

PTS: 1

14. When the total daily insulin dose is split and given twice daily, which of the following rules

may be followed?

A. Give two-thirds of the total dose in the morning and one-third in the evening B. Give 0.3 units per kilogram of premixed 70/30 insulin with one-third in the morning and two-thirds in the evening C. Give 50% of an insulin glargine dose in the morning and 50% in the evening D. Give long-acting insulin in the morning and short-acting insulin at bedtime ANS: A

PTS: 1

15. Studies have shown that control targets that reduce the HbA1C to less than 7% are associated

with fewer long-term complications of diabetes. Patients who should have such a target include: A. Those with long-standing diabetes B. Older adults C. Those with no significant cardiovascular disease D. Young children who are early in their disease ANS: C

PTS: 1

16. Prevention of conversion from prediabetes to diabetes in young children must take highest

priority and should focus on: A. Manipulating diet aggressively to prevent obesity B. Fostering LDL levels less than 100 mg/dL and total cholesterol less than 170 mg/dL to prevent cardiovascular disease

Woo Pharmacotherapeutics for APN Prescribers, 6e C. Maintaining a blood pressure that is less than 80% based on weight and height to

prevent hypertension D. All of the above ANS: B

PTS: 1

17. The drugs recommended by the American Academy of Pediatrics for use in children with

diabetes (depending upon type of diabetes) are: A. Metformin and insulin B. Sulfonylureas and insulin glargine C. Split-mixed dose insulin and glucagonlike peptide-1 (GLP-1) agonists D. Biguanides and insulin lispro ANS: A

PTS: 1

18. Unlike most type 2 diabetics where obesity is a major issue, older adults with low body

weight have higher risks for morbidity and mortality. The most reliable indicator of poor nutritional status in older adults is: A. Weight loss in previously overweight persons B. Involuntary loss of 10% of body weight in less than 6 months C. Decline in lean body mass over a 12 month period D. Increase in central versus peripheral body adiposity ANS: B

PTS: 1

19. The drugs recommended for older adults with type 2 diabetes include: A. Second-generation sulfonylureas B. Metformin C. Pioglitazone D. Third-generation sulfonylureas ANS: D

PTS: 1

20. Ethnic groups differ in their risk for and presentation of diabetes. Hispanics: A. Have a high incidence of obesity, elevated triglycerides, and hypertension B. Do best with drugs that foster weight loss, such as metformin C. Both A and B D. Neither A nor B ANS: C

PTS: 1

21. The American Heart Association states that people with diabetes have a two- to fourfold

increase in risk of dying from cardiovascular disease. Treatments and targets that do not appear to decrease risk for micro- and macro-vascular complications include: A. Glycemic targets between 7% and 7.5% B. Use of insulin in type 2 diabetics C. Control of hypertension and hyperlipidemia D. Cessation of smoking

4 Ch36

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: A PTS: 1 22. All diabetic patients with known cardiovascular disease should be treated with: A. Beta blockers to prevent myocardial infarctions (MIs) B. Angiotensin-converting enzyme inhibitors to reduce risk of cardiovascular events C. Sulfonylureas to decrease cardiovascular mortality D. Pioglitazone to decrease atherosclerotic plaque buildup ANS: B

PTS: 1

23. All diabetic patients with hyperlipidemia should be treated with: A. HMG-CoA reductase inhibitors B. Fibric acid derivatives C. Nicotinic acid D. Colestipol ANS: A

PTS: 1

24. Both angiotensin-converting enzyme inhibitors and some angiotensin II receptor blockers

have been approved in treating: A. Hypertension in diabetic patients B. Diabetic nephropathy C. Both A and B D. Neither A nor B ANS: C

PTS: 1

25. Protein restriction helps slow the progression of albuminuria, glomerular filtration rate,

decline, and end-stage renal disease in some patients with diabetes. It is useful for patients who: A. Cannot tolerate angiotensin-converting enzyme inhibitors or angiotensin receptor blockers B. Have uncontrolled hypertension C. Have HbA1C levels above 7% D. Show progression of diabetic nephropathy despite optimal glucose and blood pressure control ANS: D

PTS: 1

26. Diabetic autonomic neuropathy (DAN) is the earliest and most common complication of

diabetes. Symptoms associated with DAN include: A. Resting tachycardia, exercise intolerance, and orthostatic hypotension B. Gastroparesis, cold intolerance, and moist skin C. Hyperglycemia, erectile dysfunction, and deficiency of free fatty acids D. Pain, loss of sensation, and muscle weakness ANS: A

PTS: 1

27. Drugs used to treat diabetic peripheral neuropathy include:

5 Ch36

Woo Pharmacotherapeutics for APN Prescribers, 6e

6 Ch36

A. Metoclopramide B. Cholinergic agonists C. Cardioselective beta blockers D. Gabapentin ANS: D

PTS: 1

28. The American Diabetic Association has recommended which of the following tests for

ongoing management of diabetes?

A. Fasting blood glucose B. HbA1C C. Thyroid function tests D. Electrocardiograms ANS: B

PTS: 1

29. Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and

NovoLog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine?

A. Delay eating the midday meal until after the swimming class B. Increase the morning dose of NPH insulin on days of the swimming class C. Adjust the morning insulin injection so that the peak occurs while swimming D. Check glucose level before, during, and after swimming ANS: D

PTS: 1

30. Jeffrey is a 23-year-old graduate student with type 1 diabetes. His premeal blood glucose

(BG) at 11:30 a.m. is 130. He eats an apple and has a sugar-free soft drink. At 1 p.m. before swimming his BG is 80. What should he do?

A. Proceed with the swimming class B. Recheck his BG immediately C. Eat a granola bar or other snack with carbohydrates (CHO) D. Take an additional dose of insulin ANS: C

PTS: 1

31. Bart is a 67-year-old male with type 2 diabetes mellitus (T2 DM). He is on glipizide and

metformin. He presents to the clinic with confusion, sluggishness, and extreme thirst. His wife tells you Bart does not follow his meal plan or exercise regularly, and he hasn’t checked his BG for 1 week. A random glucose is drawn and it is 500. What is a likely diagnosis based on preliminary assessment?

A. Diabetic keto acidosis (DKA) B. Hyperglycemic hyperosmolar syndrome (HHS) C. Infection D. Hypoglycemia ANS: B

PTS: 1

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7 Ch36

32. What would one expect to find during an assessment for HHS? A. Low hemoglobin B. Ketones in the urine C. Deep, labored breathing D. pH of 7.35 ANS: B

PTS: 1

33. A patient on metformin and glipizide arrives at her 11:30 a.m. clinic appointment diaphoretic

and dizzy. She reports taking her medication that morning and having a bagel and coffee for breakfast. Blood pressure (BP) is 110/70 and random finger-stick glucose is 64. How should this patient be treated?

A. 12 oz apple juice with 1 tsp sugar B. 10 oz diet soda C. 8 oz milk or 4 oz orange juice D. 4 cookies and 8 oz chocolate milk ANS: C

PTS: 1

34. Documented reduction in cardiovascular (CV) risk is linked with: A. Selective sodium-dependent glucose cotransporter-2 (SGLT-2) medications B. Metformin replacement with insulin C. Early adoption of basal insulin D. Sulfonylurea reduction ANS: A

PTS: 1

35. Thyroid medullary cancer risk has been linked with: A. Chronic sulfonylurea use B. Later addition of basal insulin to oral therapy C. GLP-1 therapies D. SGLT-2 medication ANS: C

PTS: 1

36. Genital yeast infections are increased with: A. GLP-1 therapies B. SGLT-2 therapies C. Amylin-based treatment D. Weekly noninsulin-based therapies ANS: B

PTS: 1

37. The dipeptidyl peptidase 4 (DPP-4) inhibitors have the following suffix in their names: A. Gliptin B. Urea C. Exenatide

Woo Pharmacotherapeutics for APN Prescribers, 6e D. Flozin ANS: A

PTS: 1

38. Which type of insulin is used in insulin pumps?

A. Only regular insulin B. Basal insulin C. Rapid acting insulin D. Any type is okay depending on rate and pattern of infusion ANS: C

PTS: 1

8 Ch36

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1 Ch37

Chapter 37. Gastroesophageal Reflux and Peptic Ulcer Disease MULTIPLE CHOICE 1. Gastroesophageal reflux disease (GERD) may be aggravated by the following medication that

affects lower esophageal sphincter (LES) tone: A. Calcium carbonate B. Estrogen C. Furosemide D. Metoclopramide ANS: B

PTS: 1

2. Lifestyle changes are the first step in treatment of GERD. Food or drink that may decease

lower esophageal sphincter tone and aggravate GERD includes: A. Eggs B. Caffeine C. Chocolate D. Soda pop ANS: C

PTS: 1

3. Metoclopramide improves GERD symptoms by: A. Reducing acid secretion B. Increasing gastric pH C. Increasing lower esophageal tone D. Decreasing lower esophageal tone ANS: C

PTS: 1

4. Antacids treat GERD by: A. Increasing lower esophageal tone B. Increasing gastric pH C. Inhibiting gastric acid secretion D. Increasing serum calcium level ANS: B

PTS: 1

5. A patient with mild GERD is started on A. Antacids B. Histamine-2 receptor antagonists C. Prokinetics D. Proton pump inhibitors (PPIs) ANS: B

first.

PTS: 1

6. If a patient with symptoms of GERD states that he has been self-treating at home with over-

the-counter (OTC) famotidine daily, the appropriate treatment would be:

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2 Ch37

A. Prokinetic (metoclopramide) for 4 to 8 weeks B. PPI (omeprazole) for 12 weeks C. Histamine-2 receptor antagonist (famotidine) for 4 to 8 weeks D. Cytoprotective drug (misoprostol) for 2 weeks ANS: B

PTS: 1

7. If a patient with GERD who is taking a PPI daily is not improving, the plan of care would be: A. Prokinetic (metoclopramide) for 8 to 12 weeks B. PPI (omeprazole) twice a day for 4 to 8 weeks C. Histamine-2 receptor antagonist (famotidine) for 4 to 8 weeks D. Cytoprotective drug (misoprostol) for 4 to 8 weeks ANS: B

PTS: 1

8. The next step in treatment when a patient has been on PPIs twice daily for 12 weeks and is not

improving is: A. Add a prokinetic (metoclopramide) B. Refer the patient for endoscopy C. Switch to another PPI D. Add a cytoprotective drug ANS: B

PTS: 1

9. Infants with reflux are initially treated with: A. Histamine-2 receptor antagonist (famotidine) B. PPI (omeprazole) C. Antireflux maneuvers (such as elevating the head of the bed) D. Prokinetic (metoclopramide) ANS: C

PTS: 1

10. Long-term use of PPIs may lead to: A. Hip fractures in at-risk persons B. Vitamin B6 deficiency C. Liver cancer D. All of the above ANS: A

PTS: 1

11. An acceptable first-line treatment for peptic ulcer disease with positive Helicobacter pylori (H

pylori) test is: A. Histamine-2 receptor antagonists for 4 to 8 weeks B. PPI bid for 12 weeks until healing is complete C. PPI bid plus clarithromycin plus amoxicillin for 14 days D. PPI bid and levofloxacin for 14 days ANS: C

PTS: 1

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12. Treatment failure in patients with peptic ulcer disease associated with H pylori may be

because of: A. Antimicrobial resistance B. An ineffective antacid C. Overuse of PPIs D. All of the above ANS: A

PTS: 1

13. After H pylori treatment is completed, the next step in peptic ulcer disease therapy for high-

risk patients is: A. Test for H pylori eradication with a serum enzyme-linked immunosorbent assay (ELISA) test B. Endoscopy by a specialist to document healing in 12 weeks C. PPI for 8 to 12 weeks until healing is complete D. All of the above ANS: B

PTS: 1

14. What would be the appropriate treatment for H pylori in a patient who recently took

azithromycin for “bronchitis”?

A. PPI bid plus clarithromycin plus amoxicillin for 14 days B. Quadruple therapy with a PPI, bismuth, tetracycline, and metronidazole for 10 to 14 days C. PPI and levofloxacin for 14 days D. Triple therapy with PPI, bismuth, and levofloxacin ANS: B

PTS: 1

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Chapter 38. Headaches MULTIPLE CHOICE 1. A patient with a history of chronic migraines would benefit from preventive medication.

Education regarding migraine preventive medication includes: A. Medication is taken at the beginning of the headache to prevent it from getting worse.

B. Medication alone is the best preventative against migraines occurring.

C. Medication should not be used more than four times a month.

D. The goal of treatment is to reduce migraine occurrence by 50%.

ANS: D

PTS: 1

2. A first-line drug for abortive therapy in simple migraine is: A. Sumatriptan (Imitrex) B. Naproxen (Aleve) C. Butorphanol nasal spray (Stadol NS) D. Butalbital and acetaminophen (Fioricet) ANS: B

PTS: 1

3. A 56-year-old female comes to the clinic requesting a refill of her Fiorinal (aspirin and

butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her?

A. Switch her to sumatriptan (Imitrex) to treat her migraines B. Assess how often she is using Fiorinal and refill her medication C. Switch her to a beta blocker such as propranolol to prevent her migraines D. Recommend she take the Fiorinal daily to prevent her migraines ANS: A

PTS: 1

4. When prescribing ergotamine suppositories (Wigraine) to treat acute migraine, patient

education would include: A. Ergotamine will briefly make the migraine worse before the migraine resolves.

B. The patient may experience bradycardia and dizziness.

C. They may need premedication with an antinausea medication.

D. Ergotamine works best if the patient starts off with a full suppository to get the full effect.

ANS: C

PTS: 1

5. Migraines in pregnancy can be safely treated with: A. Acetaminophen B. Sumatriptan C. Ergotamine tablets

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D. Dihydroergotamine ANS: A

PTS: 1

6. A 54-year-old female has a history of migraines that do not respond well to over-the-counter

(OTC) migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Appropriate decision-making would be: A. Prescribe the rizatriptan, but only give her four tablets with no refills to monitor the use B. Prescribe rizatriptan and arrange to have her observed in the clinic or urgent care with the first dose C. Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital) D. Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan ANS: B

PTS: 1

7. A 14-year-old patient presents to the clinic with a classic migraine. She says she is having a

headache two to three times a month. The initial plan would be: A. Prescribe nonsteroidal anti-inflammatory drug (NSAIDs) as abortive therapy and have her keep a headache diary to identify her triggers B. Prescribe zolmitriptan (Zomig) as abortive therapy and recommend relaxation therapy to reduce her stress C. Prescribe acetaminophen with codeine (Tylenol #3) for her to take at the first onset of her migraine D. Prescribe sumatriptan (Imitrex) nasal spray and arrange for her to receive the first dose in the clinic ANS: A

PTS: 1

8. A 9-year-old patient has been diagnosed with migraines for almost 2 years. She is missing up

to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?

A. Prescribe amitriptyline (Elavil) daily; start at a low dose and increase dosage slowly every 2 weeks until it’s effective in eliminating migraines B. Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache C. Prescribe propranolol (Inderal) to be taken daily for at least 3 months D. Explain that it is rare for a 9-year-old child to get migraines and she needs magnetic resonance imaging (MRI) to rule out a brain tumor ANS: C

PTS: 1

9. A 24-year-old patient has had migraines for 10 years. She reports a migraine on average of

once a month. The migraines are effectively aborted with naratriptan (Amerge). When refilling her naratriptan, education would include:

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3 Ch38

A. Naratriptan will interact with antidepressants, including selective serotonin

reuptake inhibitors (SSRIs) and St. John’s wort, and she should inform any providers she sees that she has migraines.

B. She should continue to monitor her headaches, and if the migraines are consistently happening around her menses there is preventive therapy available.

C. Pregnancy is contraindicated when taking a triptan.

D. All of the above ANS: D

PTS: 1

10. When prescribing for migraines, patient education includes: A. Triptans are safe to use as often as needed as long as the patient is healthy.

B. Triptans should be used before trying OTC meds such as acetaminophen or

naproxen.

C. Stress reduction and regular sleep are integral to migraine treatment.

D. If migraines worsen, the medication should be increased.

ANS: C

PTS: 1

11. A patient presents to the clinic with a complaint of headaches off and on for months. She

reports she feels like someone is “squeezing” her head. She occasionally takes Tylenol for the pain but usually just “toughs it out.” Initial treatment for tension headache includes asking her to keep a headache diary and giving her a prescription for: A. Sumatriptan (Imitrex) B. Naproxen (Aleve) C. Ergotamine (Ergostat) D. Tylenol with codeine (Tylenol #3) ANS: B

PTS: 1

12. Nonpharmacologic therapy for tension headaches includes: A. Biofeedback B. Stress management C. Massage therapy D. All of the above ANS: D

PTS: 1

13. A patient has been diagnosed with cluster headaches. Appropriate acute therapy would be: A. Butalbital and aspirin (Fiorinal) B. Intramuscular (IM) meperidine (Demerol) C. Oxygen 100% for 15 to 30 minutes D. Indomethacin (Indocin) ANS: C

PTS: 1

14. Preventative therapy for cluster headaches includes: A. Massage or relaxation therapy

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4 Ch38

B. Ergotamine nightly before bed C. Intranasal lidocaine four times a day during “clusters” of headaches D. Propranolol (Inderal) daily ANS: B

PTS: 1

15. When prescribing any headache therapy, appropriate use of medications needs to be discussed

to prevent medication-overuse headaches. A clinical characteristic of medication-overuse headaches is that they: A. Increase in frequency B. Increase in intensity C. Occur more than 15 days a month D. Begin to “cluster” into a pattern ANS: C

PTS: 1

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1 Ch39

Chapter 39. Heart Failure MULTIPLE CHOICE 1. Angiotensin-converting-enzyme (ACE) inhibitors are a central part of the treatment of heart

failure (HF) because they have more than one action to address the pathological changes in this disorder. Which of the following pathological changes that take place in HF is NOT addressed by ACE inhibitors?

A. Changes in the structure of the left ventricle so that it dilates, hypertrophies, and uses energy less efficiently B. A vasoconstriction-mediated increase in afterload C. Activation of the sympathetic nervous system that increases heart rate and preload D. Decreased renal blood flow that decreases oxygen supply to the kidneys ANS: C

PTS: 1

2. One of the three types of HF involves systolic dysfunction. Potential causes of this most

common form of HF include: A. Myocardial ischemia and injury secondary to myocardial infarction (MI) B. Inadequate relaxation and loss of muscle fiber secondary to valvular dysfunction C. Increased demands of the heart beyond its ability to adapt secondary to anemia D. Slower filling rate and elevated systolic pressures secondary to uncontrolled hypertension ANS: A

PTS: 1

3. The American Heart Association (AHA) and the American College of Cardiology (ACC)

have devised a classification system for HF that can be used to direct treatment. Patients with symptoms and underlying disease are classified as stage: A. A B. B C. C D. D ANS: C

PTS: 1

4. Diagnosis of HF cannot be made by symptoms alone because many disorders share the same

symptoms. The most specific and sensitive diagnostic test for HF is: A. Chest x-rays that show cephalization and measure heart size B. Two-dimensional echocardiograms that identify structural anomalies and cardiac dysfunction C. Complete blood count, blood urea nitrogen, and serum electrolytes that facilitate staging for end-organ damage D. Measurement of brain natriuretic peptide to distinguish between systolic and diastolic dysfunction ANS: B

PTS: 1

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2 Ch39

5. Treatments for HF, including drug therapy, are based on the stages developed by the

ACC/AHA. Stage A patients are treated with: A. Drugs for hypertension and hyperlipidemia, if they exist B. Lifestyle management including diet, exercise, and smoking cessation only C. ACE inhibitors to directly prevent the HF only D. No drugs are used in this early stage ANS: A

PTS: 1

6. Class I recommendations for stage A HF include: A. Aerobic exercise within tolerance levels to prevent the development of HF B. Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention C. Beta blockers for all patients regardless of cardiac history D. Optimal blood pressure control ANS: D

PTS: 1

7. Stage B patients should have a beta blocker added to the HF treatment regimen when: A. There is confirmed HFrEF B. They have had a recent MI C. Both A and B D. Neither A nor B ANS: C

PTS: 1

8. In the later part of the 20th century, increased life expectancy for patients with HF has been

associated with the use of: A. ACE inhibitors, especially when started early in the disease process B. All beta blockers regardless of selectivity C. Thiazide and loop diuretics D. Cardiac glycosides ANS: A

PTS: 1

9. Stage C patients usually require a combination of three to four drugs to manage their HF. In

addition to ACE inhibitors and beta blockers, diuretics may be added. Which of the following statements about diuretics is NOT true?

A. Diuretics reduce preload associated with fluid retention.

B. Diuretics can be used earlier than stage C when the goal is hypertension control.

C. Diuretics may produce problems with electrolyte imbalances, abnormal glucose, and lipid metabolism.

D. Diuretics from the potassium-sparing class should be used when using an angiotensin receptor blocker (ARB).

ANS: D

PTS: 1

10. Digoxin has a very limited role in treatment of HF. It is used mainly for patients with: A. Ejection fractions above 40%

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3 Ch39

B. Symptoms despite optimal GDMT C. Mitral stenosis as a primary cause for HF D. Renal insufficiency ANS: B

PTS: 1

11. The NICE guidelines suggest that which class of medication should not be routinely used in

HF? A. Nitrates B. Long-acting dihydropyridines C. Calcium channel blockers D. Alpha-beta blockers ANS: C

PTS: 1

12. HF is a leading cause of death and hospitalization in older adults (greater than 65 years old).

The drug of choice for this population is: A. Aldosterone antagonists B. Eplerenone C. ACE inhibitors D. ARBs ANS: C

PTS: 1

13. HF is a chronic condition that can be adequately managed in primary care. However,

consultation with or referral to a cardiologist is appropriate when: A. Symptoms markedly worsen or the patient becomes hypotensive and has syncope.

B. There is evidence of progressive renal insufficiency or failure.

C. The patient remains symptomatic on optimal doses of an ACE inhibitor, a beta blocker, and a diuretic.

D. Any of the above ANS: D

PTS: 1

14. ACE inhibitors are a foundational medication in HF. For which group of patients are they

contraindicated?

A. The elderly B. Pregnant women C. Patients with gout D. Those with concomitant DM ANS: B

PTS: 1

15. What assessment that can be done at home is the most reliable to use for making decisions to

change HF medications?

A. Weight B. Blood pressure (BP) C. Heart rate

Woo Pharmacotherapeutics for APN Prescribers, 6e D. Serum glucose ANS: A

PTS: 1

16. Evidence is strong that HF interventions are best initiated when: A. The person enters stage C. B. The person has functional disabilities.

C. The earliest indication is given.

D. Stage IV is determined.

ANS: C

PTS: 1

17. HF patients frequently take more than one drug. When are anticoagulants typically used?

A. When the patient enters stage III B. Only in cases of diastolic failure C. When there is concurrent AFib D. In all cases ANS: C

PTS: 1

18. What can chest x-rays contribute to the diagnosis and management of HF? A. They have no role.

B. They can give very precise pictures of pulmonary fluid status.

C. They provide an idea of general cardiac size and pulmonary great vessel

distribution.

D. They can confirm the diagnosis.

ANS: C

PTS: 1

19. Changing a diuretic to the aldosterone agonist class is frequently beneficial to HF patients

except in the following circumstance: A. When they are advancing to a later stage of failure B. When they have moderate to severe symptoms C. When they have persistent hyperkalemia D. Prior to the advance of renal dysfunction ANS: C

PTS: 1

20. Once the fluid overload of a HF flare is corrected, what is the proper role of diuretics?

A. They should only be used intermittently when fluid becomes an issue.

B. They can maintain a baseline level of therapy.

C. Only the aldosterone agonist class should be used.

D. The dosing should be increased aggressively to ensure maintenance of a dry

weight status.

ANS: A

PTS: 1

21. Eplerenone, an aldosterone antagonist medication, differs from the classic aldosterone

medication because it doesn’t create the following troublesome side effect:

4 Ch39

Woo Pharmacotherapeutics for APN Prescribers, 6e

5 Ch39

A. Gynecomastia B. Retention of potassium C. Promotion of myocardial fibrosis D. Relaxation of the cardiac sphincter ANS: A

PTS: 1

22. The sensitivity of the myocardium to low potassium levels when a patient takes Digoxin can

be offset by changing the treatment plan if the patient has frequent drops in potassium levels on their loop diuretic. What is the change that should be made?

A. Increase the dose of the loop diuretic B. Add potassium supplements C. Use a combination of thiazide and loop diuretic D. Decrease the digoxin dose ANS: B

PTS: 1

23. Digoxin is used as the classic medication to demonstrate loading dose methods to get a patient

to therapeutic doses of a medication. When should a loading dose approach NOT be used for this medication?

A. When the patient is frail and elderly B. When the HF symptoms are rapidly accelerating C. When the renal status is stable D. When the patient has never been on digoxin before ANS: A

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch40

Chapter 40. HIV Disease and Acquired Immunodeficiency Syndrome MULTIPLE CHOICE 1. The goals of treatment when prescribing antiretroviral therapy (ART) medication to patients

with HIV include: A. Prevention of vertical HIV transmission B. Improvement in quality of life C. Prolonging of survival D. All of the above ANS: D

PTS: 1

2. A challenge faced with ART is: A. Patients abusing ART B. Drug-resistant mutations of HIV C. Reduction of transmissibility of HIV D. Lack of efficacy data ANS: B

PTS: 1

3. Predictors for successful treatment with ART in HIV-positive patients include: A. They respond to a low-potency treatment regimen.

B. They have demonstrated resistance in the past and should respond to newer ART

drugs.

C. The patient is strictly adherent to the ART treatment regimen.

D. The patient has a lower baseline CD4 T-cell count.

ANS: C

PTS: 1

4. The goal of ART in HIV-positive patients is: A. Maximum suppression of HIV replication B. Eradication of HIV from the body C. Determination of a treatment regimen that is free of adverse effects D. Suppression of CD4 T-cell count ANS: A

PTS: 1

5. Pregnant women who are HIV positive: A. Are treated with azidothymidine (AZT) alone to prevent birth defects B. Are treated with a combination ART regimen C. Should not be treated with ART due to teratogenicity of the drugs D. Are at high risk of developing resistance to ART drugs ANS: B

PTS: 1

6. ART is recommended for HIV-positive patients who: A. Have a history of AIDS-defining illness

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch40

B. Are pregnant C. Have a hepatitis B coinfection D. All of the above ANS: D

PTS: 1

7. Before starting a patient on the nucleoside reverse transcriptase inhibitor abacavir, the

following is recommended: A. Renal function testing B. HLA B*5701 testing C. Pancreatic enzyme level testing D. CYP450 enzyme activity testing ANS: B

PTS: 1

8. A female patient is pregnant and has tested HIV positive. Which ART drug should be avoided

in women who are pregnant?

A. Dolutegravir B. Zidovudine C. Ritonavir D. Lopinavir/ritonavir ANS: A

PTS: 1

9. The cost of HIV treatment can be prohibitive for any patient. Patients can receive assistance

from the: A. Best Pharmaceuticals for HIV/AIDS Patient Act B. Ryan White HIV/AIDS Treatment Modernization Act C. National Institutes of Health HIV/AIDS Assistance Fund D. Centers for Disease Control HIV/AIDS Treatment Fund ANS: B

PTS: 1

10. Resistance to ART is measured by: A. Measuring the DNA viral load in the serum B. Determining plasma viral ribonucleic (RNA) on two successive measurements C. Performing phenotype assays of the combination of ART the patient is on D. Measuring elevation of T4 counts ANS: B

PTS: 1

11. Phenotype assays are used to measure A. Effectiveness B. Genotype C. Sensitivity D. Hypersensitivity susceptibility ANS: C

PTS: 1

of ART.

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch40

12. Patient factors that contribute to ART failure include: A. Being a male who has sex with males B. HIV diagnosis in pregnancy C. Good compliance with the ART treatment regimen D. ART adverse effects ANS: D

PTS: 1

13. Patients who are taking ART require monitoring for: A. Lipid levels B. Sexual functioning C. Platelet count D. All of the above ANS: A

PTS: 1

14. Successful ART in an HIV-positive patient is determined by: A. HIV virus eradication B. Lowering of HIV viral load to immeasurable amounts C. Individual measures of success based on their personal situation D. Normal blood hematologic factors ANS: C

PTS: 1

15. An adolescent who admits to a high amount of sexual behavior and is prescribed tenofovir and

emtricitabine (Truvada) pre-exposure prophylaxis (PrEP) should be educated regarding: A. A high risk of developing hypertension, requiring blood pressure check every 3 months B. The unique dosing schedule of taking the medication just before high risk activity C. The need for annual HIV and hepatitis B testing D. The possibility of developing kidney problems, requiring monitoring of renal function every 6 months ANS: D

PTS: 1

16. Postexposure prophylaxis (PEP) to prevent HIV infection is effective: A. When taken within 72 hours of exposure B. In preventing perinatal HIV transmission C. In preventing hepatitis C infections D. When taken within 7 days of exposure ANS: A

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch41

Chapter 41. Menopausal Hormone Therapy MULTIPLE CHOICE 1. The goals of therapy when prescribing hormone replacement therapy (HRT) include reducing: A. Cardiovascular risk B. Risk of stroke or other thromboembolic event C. Risk of breast cancer D. Vasomotor symptoms ANS: D

PTS: 1

2. The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is: A. Two years B. Five years C. Ten years D. Fifteen years ANS: B

PTS: 1

3. Dosage changes of conjugated equine estrogen (Premarin) are made at A. 1 to 2 week B. 2 to 4 week C. 6 to 8 week D. 12 week ANS: C

intervals.

PTS: 1

4. The advantage of vaginal estrogen preparations in the treatment of vulvovaginal atrophy and

dryness is: A. They can deliver higher doses of estrogen in a nonoral form.

B. The vaginal cream formula provides moisture to the vaginal area.

C. They offer relief of symptoms without increasing cardiovascular risk.

D. All of the above ANS: C

PTS: 1

5. Women with an intact uterus should be treated with HRT with both estrogen and progestin

due to: A. Increased risk for endometrial cancer if estrogen alone is used B. Combination therapy providing the best relief of menopausal vasomotor symptoms C. Reduced risk for colon cancer with combined therapy D. Lower risk of developing blood clots with combined therapy ANS: A

PTS: 1

6. Ongoing monitoring for women on ERT includes: A. Lipid levels, repeated annually if abnormal

Woo Pharmacotherapeutics for APN Prescribers, 6e B. Annual health history and review of risk profile C. Annual mammogram D. All of the above ANS: D

PTS: 1

7. Kristine would like to start HRT to treat the significant vasomotor symptoms she is

experiencing during menopause. Education for a woman considering HRT includes: A. Explaining that HRT is totally safe if used short term B. Telling her to ignore media hype regarding HRT C. Discussing the advantages and risks of HRT D. Encouraging her to use phytoestrogens with HRT ANS: C

PTS: 1

8. Which of the following is not an indication for starting hormone therapy?

A. Symptomatic hot flashes B. Treatment or prevention of vaginal atrophy C. Prevention of osteoporosis D. Reduction of cardiovascular risk ANS: D

PTS: 1

9. Menopause is diagnosed when: A. The patient has no menses for 12 months.

B. The patient has onset of vasomotor symptoms with irregular menses.

C. The patient has no bleeding cycle for 6 months.

D. Precise laboratory values are documented.

ANS: A

PTS: 1

10. All of the following are risks of exogenous hormones except: A. Breast cancer B. Uterine cancer C. Increased cardiovascular problems D. Vaginal atrophy ANS: D

PTS: 1

11. Herbals that have proven efficacy for improving vasomotor symptoms include: A. Black cohosh B. Red clover C. Evening primrose D. None of the above ANS: D

PTS: 1

2 Ch41

Woo Pharmacotherapeutics for APN Prescribers, 6e 12. Reevaluation of the Women’s Health Study has resulted in what changes in HRT

implementation?

A. A combination of estrogen and progestin is no longer required in patients with an intact uterus.

B. Women with breast cancer survivorship over 10 years are no longer considered “at risk.”

C. HRT can be used in the first 5 years of menopause without major risk increase.

D. Low-dose estrogen can be used again in women over 65.

ANS: C

PTS: 1

3 Ch41

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch42

Chapter 42. Hyperlipidemia MULTIPLE CHOICE 1. The overall goal of treating hyperlipidemia is: A. Maintain a low-density lipoprotein (LDL) level of less than 160 mg/dL B. Reduce atherogenesis C. Lower apo-B, one of the apolipoproteins D. All of the above ANS: B

PTS: 1

2. When considering which cholesterol-lowering drug to prescribe, which factor determines the

type and intensity of treatment?

A. Total LDL B. Fasting high-density lipoprotein (HDL) C. Coronary artery disease risk level D. Fasting total cholesterol ANS: C

PTS: 1

3. First-line therapy for hyperlipidemia is: A. Statins B. Niacin C. Lifestyle changes D. Bile acid-binding resins ANS: C

PTS: 1

4. James is a 45-year-old patient with a very high cardiovascular (CV) risk profile, an LDL level

of 120, and normal triglycerides. Appropriate first-line therapy for James may include diet counseling, increased physical activity, and: A. A statin B. Niacin C. Sterols D. A fibric acid derivative ANS: A

PTS: 1

5. Joanne is a 60-year-old patient with an LDL of 132 and a family history of coronary artery

disease. She has already tried diet changes (increasing fiber and plant sterols) to lower her LDL but after 6 months her LDL is slightly higher. The next step in her treatment would be: A. A statin B. Niacin C. Sterols D. A fibric acid derivative

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: A

2 Ch42

PTS: 1

6. Sharlene is a 65-year-old patient who has been on a lipid-lowering diet and using plant sterol

margarine daily for the past 3 months. Her LDL is 135 mg/dL. An appropriate treatment for her would be: A. A statin B. Niacin C. A fibric acid derivative D. Determined by her risk factors ANS: D

PTS: 1

7. Phil is a 54-year-old male with a history of myocardial infarction and multiple risk factors. He

has been on a high-dose statin for 3 months to treat his high LDL level. His LDL is 140 mg/dL and his triglycerides are elevated. A reasonable change in therapy would be to: A. Discontinue the statin and change to a fibric acid derivative B. Discontinue the statin and change to ezetimibe C. Continue the statin and add in ezetimibe D. Refer him to a specialist in managing patients with recalcitrant hyperlipidemia ANS: C

PTS: 1

8. Jamie is a 34-year-old pregnant woman with familial hyperlipidemia and elevated LDL levels.

What is the appropriate treatment for a pregnant woman?

A. A statin B. Niacin C. Fibric acid derivative D. Bile acid-binding resins ANS: D

PTS: 1

9. Han is a 48-year-old diabetic with hyperlipidemia and high triglycerides. His LDL is 112

mg/dL and he has not tolerated statins. He warrants a trial of a: A. Sterol B. Niacin C. Fibric acid derivative D. Bile acid-binding resin ANS: C

PTS: 1

10. Monitoring of a patient who is on a lipid-lowering drug includes: A. Performing a fasting total cholesterol every 6 months B. Monitoring 4-6 weeks after a dose change C. Performing a complete blood count, C-reactive protein, and erythrocyte

sedimentation rate after 6 weeks of therapy D. All of the above ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch42

11. Before starting therapy with a statin, the following baseline laboratory values should be

evaluated: A. Complete blood count B. Liver function (alanine aminotransferase/aspartate aminotransferase [ALT/AST]) and creatine kinase C. C-reactive protein D. All of the above ANS: B

PTS: 1

12. When starting a patient on a statin, education would include: A. If they stop the medication their lipid levels will return to pretreatment levels.

B. Medication is a supplement to diet therapy and exercise.

C. If they have any muscle aches or pain, they should contact their provider.

D. All of the above ANS: D

PTS: 1

13. Omega-3 fatty acids are best used to help treat: A. High HDL B. Low LDL C. High triglycerides D. Any high lipid value ANS: C

PTS: 1

14. When are statins traditionally ordered to be taken?

A. At bedtime B. At noon C. At breakfast D. With the evening meal ANS: D

PTS: 1

15. Which of the following patients should not have a statin medication ordered?

A. Someone with three first- or second-degree family members with history of muscle

issues when started on statins B. Someone with high lipids but low body mass index (BMI) C. Premenopausal woman who have had a recent hysterectomy D. A prediabetic male with known metabolic syndrome ANS: A

PTS: 1

16. Fiber supplements are great options for elderly patients who have the concurrent problem of: A. End-stage renal failure on fluid restriction B. Recurrent episodes of diarrhea several times a day C. Long-term issues of constipation D. Needing to take multiple medications around the clock every 2 hours

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: C

PTS: 1

17. What is considered the order of statin strength from lowest effect to highest?

A. Lovastatin, simvastatin, rosuvastatin B. Rosuvastatin, lovastatin, atorvastatin C. Atorvastatin, rosuvastatin, simvastatin D. Simvastatin, atorvastatin, lovastatin ANS: A

PTS: 1

18. The most recent treatment guidelines strongly recommend dosing primarily based on: A. Family history B. Personal CV risk C. Specific lipid levels D. Twenty-year risk of CV event ANS: B

PTS: 1

19. Which statins are most associated with soft plaque regression?

A. Lovastatin and simvastatin B. Rosuvastatin and atorvastatin C. Atorvastatin and pravastatin D. Lovastatin and rosuvastatin ANS: B

PTS: 1

20. The first step in responding to a patient who complains of muscular pain with statins is: A. Review the history and characteristics of the pain B. Stop the medication and draw liver function tests C. Switch them to another statin D. Draw a lipid level to determine if dosing is still indicated ANS: A

PTS: 1

21. Omega-3 supplements can come from animal or plant sources. Which of the following is

correct?

A. Both sources have equal efficacy.

B. Plant sources have more rapid impact on LDL levels than fish sources.

C. Fish sources have potential contamination with mercury.

D. Marine creature-derived supplements are safe for patients with shellfish allergies.

ANS: C

PTS: 1

22. Why has nonfasting lipid testing become popular?

A. Results are close enough to fasting results and help in observing trends of the

therapeutic response.

B. Screening helps identify larger numbers of patients who should be treated.

C. More patients tend to keep lab appointments when fasting is not required.

D. All of the above

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Woo Pharmacotherapeutics for APN Prescribers, 6e

ANS: D

PTS: 1

5 Ch42

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch43

Chapter 43. Hypertension MULTIPLE CHOICE 1. Because primary hypertension has no identifiable cause, treatment is based on targeting the

physiological mechanisms that regulate blood pressure. Thiazide diuretics reduce blood pressure by: A. Increasing renin secretion B. Decreasing the production of aldosterone C. Reducing fluid volume D. Decreasing blood viscosity ANS: C

PTS: 1

2. Because of its mechanism of action, the patient taking a diuretic may also need to take the

following supplement: A. Potassium B. Calcium C. Magnesium D. Phosphate ANS: A

PTS: 1

3. All patients with hypertension benefit from diuretic therapy, but those who benefit the most

are: A. Those with orthostatic hypertension B. African Americans C. Those with stable angina D. Diabetics ANS: B

PTS: 1

4. Beta blockers reduce blood pressure by: A. Decreasing cardiac output B. Vasoconstricting coronary arteries C. Reducing norepinephrine D. Reducing angiotensin II production ANS: A

PTS: 1

5. Which of the following disease processes could be made worse by taking a nonselective beta

blocker?

A. Asthma B. Diabetes C. Both A & B might worsen D. Beta blockade does not affect these disorders.

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: C

2 Ch43

PTS: 1

6. Comorbidities in a patient with hypertension that may benefit from beta blockade include: A. Diabetes mellitus B. Asthma C. Myocardial infarction D. Dyslipidemia ANS: C

PTS: 1

7. Angiotensin-converting enzyme (ACE) inhibitors reduce blood pressure because they: A. Reduce sodium and water retention B. Decrease vasoconstriction C. Increase vasodilation D. All of the above ANS: D

PTS: 1

8. Based on clinical trials, compelling indications for an ACE inhibitor as treatment for

hypertension include: A. Pregnancy B. Renal parenchymal disease C. Stable angina D. Dyslipidemia ANS: B

PTS: 1

9. If not chosen as the first drug in hypertension treatment, which drug class should be added as

a second step because it will enhance the effects of most other agents?

A. ACE inhibitors B. Beta blockers C. Calcium channel blockers D. Diuretics ANS: D

PTS: 1

10. Treatment costs are important for patients with hypertension. Which of the following

statements about cost is NOT true?

A. Hypertension is a chronic disease where patients may be taking drugs for a long time.

B. Most patients will require more than one drug to treat hypertension.

C. The cost includes the price of any routine or special laboratory tests that a specific drug may require.

D. Few antihypertensive drugs come in generic formulations.

ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch43

11. Caffeine, exercise, and smoking should be avoided for at least how many minutes before

blood pressure measurement?

A. 15 B. 30 C. 60 D. 90 ANS: B

PTS: 1

12. Blood pressure checks in children: A. Should occur with their annual physical examinations after 6 years of age B. Require a blood pressure cuff that is one-third the diameter of the child’s arm C. Should be done during every health-care visit after 3 years of age D. Require additional laboratory tests such as serum creatinine ANS: C

PTS: 1

13. Lack of adherence to blood pressure management is very common. Reasons for this lack of

adherence include: A. Lifestyle changes are difficult to achieve and maintain.

B. A patient can have adverse drug reactions.

C. Drugs and monitoring with laboratory tests can be expensive.

D. All of the above ANS: D

PTS: 1

14. Lifestyle modifications for patients with early hypertension include: A. Diet and increase exercise to achieve a body mass index (BMI) greater than 25 B. Drink 4 oz of red wine at least once per week C. Adopt the dietary approaches to stop hypertension (DASH) diet D. Increase potassium intake ANS: C

PTS: 1

15. Which diuretic agents typically do not need potassium supplementation?

A. Loop diuretics B. Thiazide diuretics C. Aldosterone inhibitors D. They all need supplementation.

ANS: C

PTS: 1

16. Black patients with hypertension typically demonstrate a less robust therapeutic response to

which class of medication?

A. ACE inhibitors B. Calcium channel blockers C. Diuretics D. Vasodilators

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: A

4 Ch43

PTS: 1

17. What educational point concerning fluid intake must be covered when prescribing diuretics?

A. Fluid should be restricted when on a diuretic.

B. Fluids should contain at least one salty item daily.

C. Fluid intake should remain near normal for optimal performance.

D. Avoidance of potassium-rich fluids is encouraged.

ANS: C

PTS: 1

18. What is a common adverse effect concern with hypertensive medications for the older adult?

A. Risk of falls B. Triggering of a hypertensive crisis C. Erectile priapism D. Risk for bladder cancer development ANS: A

PTS: 1

19. Which drug class is recommended for first-line treatment of hypertension in black

Americans?

A. Beta blockers B. Angiotensin II receptor blocker (ARB) medications C. Calcium channel blockers D. Alpha blockers ANS: C

PTS: 1

20. Current guidelines for blood pressure treatment in geriatric patients include: A. Keep readings close to 120/80 B. Accept the systolic pressure to be “age + 10” C. Loosen strict adherence to reduction below 1400 systolic D. Discontinue medications at age 90 ANS: C

PTS: 1

21. Potassium excess risk is highest with which combination of medications: A. Aldactone and a beta blocker B. An ACE and a loop diuretic C. An ARB and an aldosterone antagonist D. A direct renin inhibitor and a thiazide ANS: C

PTS: 1

22. Which antihypertensive is safe during pregnancy?

A. ACE B. Beta blocker C. Direct renin inhibitor D. ARB

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: B

PTS: 1

23. Once-daily diuretics are typically suggested to be taken: A. At bedtime B. With every meal C. Upon awakening D. Whenever convenient ANS: C

PTS: 1

5 Ch43

Woo Pharmacotherapeutics for APN Prescribers, 6e

1 Ch44

Chapter 44. Hyperthyroidism and Hypothyroidism MULTIPLE CHOICE 1. When methimazole is started for hyperthyroidism it may take

to see a total reversal

of hyperthyroid symptoms.

A. 2 to 4 weeks B. 1 to 2 months C. 3 to 4 months D. 6 to 12 months ANS: D

PTS: 1

2. In addition to methimazole, a symptomatic patient with hyperthyroidism may need which

additional class of medication?

A. A calcium channel blocker B. A beta blocker C. Liothyronine D. An alpha blocker ANS: B

PTS: 1

3. After starting a patient with Graves disease on an antithyroid agent such as methimazole,

patient monitoring includes thyroid-stimulating hormone (TSH) and free thyroxine (T4) every: A. 1 to 2 weeks B. 3 to 4 weeks C. 2 to 3 months D. 6 to 9 months ANS: B

PTS: 1

4. A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who

will most likely treat her with: A. Methimazole B. Propylthiouracil (PTU) C. Radioactive iodine D. Nothing, because treatment is best delayed until after her pregnancy ends.

ANS: B

PTS: 1

5. Goals when treating hypothyroidism with thyroid replacement include: A. Normal TSH and free T4 levels B. Resolution of fatigue C. Weight loss to baseline D. All of the above

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: D

2 Ch44

PTS: 1

6. When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up

measurement of thyroid function in: A. Two weeks B. Four weeks C. Two months D. Six months ANS: C

PTS: 1

7. Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH

levels, he or she should be monitored for TSH and free T4 levels every: A. Four weeks B. Two months C. Six months D. Annually ANS: D

PTS: 1

8. Treatment of a patient with hypothyroidism and cardiovascular disease consists of: A. Levothyroxine B. Liothyronine C. Liotrix D. Methimazole ANS: A

PTS: 1

9. Infants with congenital hypothyroidism are treated with: A. Levothyroxine B. Liothyronine C. Liotrix D. Methimazole ANS: A

PTS: 1

10. When starting a patient with hypothyroidism on thyroid replacement hormones, patient

education would include: A. They should feel symptomatic improvement in 1 to 2 weeks.

B. Drug adverse effects such as lethargy and dry skin may occur.

C. It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing.

D. Because of its short half-life, levothyroxine doses should not be missed.

ANS: C

PTS: 1

11. Why are “natural” thyroid products not readily prescribed for most patients?

A. There is no reliability for the amount of hormone per dose.

B. There is higher incidence of allergic reactions.

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch44

C. There is a more reliable dose of triiodothyronine (T3) to T4 per batch lot of

preparation.

D. All of the above ANS: D

PTS: 1

12. What happens to the typical thyroid hormone replacement dose when a woman becomes

pregnant?

A. Most women need less medication.

B. Most women do not require a dose change.

C. It should be increased as soon as pregnancy is confirmed.

D. The average woman needs more medication only if carrying multiples.

ANS: C

PTS: 1

13. Hyperthyroid patients require which specialty consultation even when asymptomatic for that

organ system?

A. Hepatology B. Pulmonary C. Ophthalmology D. Rheumatology ANS: C

PTS: 1

14. Patients without thyroid disease should be routinely screened for hypothyroidism when taking

all of the following medications except: A. Angiotensin converting enzyme inhibitors B. Lithium C. Amiodarone D. Interferon ANS: A

PTS: 1

15. Which body system is most impacted if congenital hypothyroid is not rapidly recognized after

birth?

A. Central nervous system B. CV system C. Gastrointestinal (GI) system D. Immune system ANS: A

PTS: 1

16. Long-term use of levothyroxine therapy has been associated with: A. Cataracts B. Osteoporosis C. Cancer D. Dementia ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 45. Obesity MULTIPLE CHOICE 1. Obesity is a complex neuroendocrine disorder characterized by adipocyte: A. Mobilization followed by orexin resistance B. Overproduction of adipokines and cytokines C. Hypertrophy followed by hyperplasia D. Biological defense mechanisms ANS: C

PTS: 1

2. Obesity increases risk for type 2 diabetes mellitus by which of the following mechanisms?

A. Ectopic fat deposition in the solid organs B. Secretion of inflammatory factors C. Increased leptin production D. Decreased cytokine production ANS: B

PTS: 1

3. The only known orexigenic hormone is: A. Ghrelin B. Leptin C. Insulin D. Glucagon ANS: A

PTS: 1

4. Who among the following patients often has a higher level of basal insulin?

A. Those with a family history of diabetes B. Those with visceral adiposity C. Those with leptin-ghrelin imbalance D. Those with increased hepatic insulin clearance ANS: B

PTS: 1

5. The neurological components of obesity include all of the following except: A. Lower levels of natriuretic peptides B. Central leptin resistance C. Chronic inflammation of the HPA axis D. Ghrelin insensitivity ANS: D

PTS: 1

6. Patients with monogenic obesity typically have which characteristic?

A. Severe obesity as young as age 1 B. Hypophagia C. Insulin resistance

1 Ch45

Woo Pharmacotherapeutics for APN Prescribers, 6e

2 Ch45

D. Hypercortisolism ANS:

A

PTS:

1

7. When counseling patients with obesity about the health benefits of weight reduction, the NP advises that a reduction in the impact of complications and comorbidities can be appreciated at what point?

A. After losing 5% of starting weight B. After losing 10% of starting weight C. After 30 days of slow, consistent loss D. After 3 months of sustained weight loss ANS:

A

PTS:

1

8. A patient with type 2 diabetes mellitus implements therapeutic lifestyle changes and loses 10% of starting weight. The NP recognizes that this could: A. Motivate the patient to continue healthy habits B. Lead to obsessive weight loss efforts C. Resolve fatty liver disease D. Put the type 2 diabetes in remission ANS:

D

PTS:

1

9. When considering pharmacotherapy for the management of obesity, the NP must consider that: A. Most medications will be paid for out of pocket.

B. The majority of medications have significant adverse effects.

C. Pharmacotherapy is a safe alternative to lifestyle modifications.

D. Weight loss surgery is safer than pharmacotherapy.

ANS:

A

PTS:

1

10. A 29-year-old female presents for management of obesity. She has repeatedly tried diet and exercise but cannot sustain her weight loss goals. While reviewing her chart the NP learns that she has had migraine headaches since she was 17 years old. A good choice of weight loss medication might include: A. A GLP-1 agonist B. A triglyceride absorption inhibitor C. Phentermine/topiramate D. Naltrexone/bupropion ANS: C PTS: 1

11. An important barrier to antiobesity medication is: A. Patient disinterest B. Patient aversion to pharmacotherapy C. Lack of provider education D. Lack of options ANS:

D

PTS:

1

12. Current guidelines for obesity management support offering pharmacotherapy to patients

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch45

with: A BMI > 30 kg/m2 B. A BMI > 25 kg/m2 and an obesity-related complication or comorbidity A.

C. A documented history of nonpharmacologic failure D. A weight loss of >10% starting weight

ANS:

A

PTS:

1

13. All weight loss medications are contraindicated in patients who are: A. Over 65 years of age B. Depressed C. Pregnant D. Under 21 years of age ANS:

C

PTS:

1

14. Phentermine is the most commonly prescribed stimulant for weight loss. Which of the following is true with respect to phentermine?

A. It is FDA approved for only 13 weeks.

B. It is contraindicated in patients under 18 years old.

C. It produces withdrawal symptoms after extended use.

D. It should be coadministered with bupropion.

ANS:

A

PTS:

1

15. The NP is considering options for pharmacologic management of obesity in a 13-year-old girl. Her mother does not want her to take a stimulant. When considering orlistat, the NP knows that which of the following is a contraindication?

A. A history of cardiac dysrhythmia B. Chronic malabsorption syndrome C. Age < 18 years D. Family history of IBD ANS:

B

PTS:

1

16. A patient recently started on naltrexone/bupropion SR (Contrave) is complaining of profound nausea. The appropriate response would be to: A. Slow the titration schedule B. Prescribe ondansetron for the first 4 weeks of therapy C. Reassure the patient that this is a normal response D. Change to a different weight loss medication ANS:

C

PTS:

1

Woo Pharmacotherapeutics for APN Prescribers, 6e

4 Ch45

17. A patient requesting weight loss medication has chronic pancreatitis. Which of the following treatment options is contraindicated?

A. Stimulants B. Triglyceride absorption inhibitors C. GLP-1 agonists D. Topiramate/phentermine ANS:

C

PTS:

1

18. Monitoring patients on weight loss pharmacotherapy includes frequent monitoring of all of the following except: A. Comorbidities B. Eating and activity patterns C. Safety and effectiveness D. Sleep patterns ANS:

D

PTS:

1

19. Patient education for the persons with obesity who are on weight loss medication includes instruction that: A. Cessation of pharmacotherapy will likely result in weight regain B. Pharmacotherapy will be titrated to off after 13 weeks of consistent weight loss C. Stimulant therapy requires intermittent urine drug screening D. Stimulant therapy requires concomitant counseling ANS:

A

PTS:

1

20. The most common adverse effects of stimulant medications include: A. Nausea B. Fatigue C. Dry mouth D. Fecal incontinence ANS:

C

PTS:

1

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1 Ch46

Chapter 46. Pain Management: Acute and Chronic Pain MULTIPLE CHOICE 1. Patients need to be questioned about all pain sites because: A. Patients tend to report the most severe or important in their perception.

B. Pain tolerance generally decreases with repeated exposure.

C. The reported pain site is usually the most important to treat.

D. Pain may be referred from a different site to the one reported.

ANS: A

PTS: 1

2. The chemicals that promote the spread of pain locally include: A. Serotonin B. Norepinephrine C. Enkephalin D. Neurokinin A ANS: D

PTS: 1

3. Opioids are exogenous enkephalins. They act by: A. Inhibiting pain transmission in the spinal cord B. Attaching to receptors in the afferent neuron to inhibit the release of substance P C. Blocking neurotransmitters in the midbrain D. Increasing beta-lipoprotein excretion from the pituitary gland ANS: C

PTS: 1

4. Age is a factor in different responses to pain. Which of the following age-related statements

about pain is NOT true?

A. Preterm and newborn infants do not yet have functional pain pathways.

B. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child.

C. Increases in the pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness.

D. Decreases in pain tolerance are evident in older adults.

ANS: A

PTS: 1

5. Which of the following statements is true about acute pain?

A. Somatic pain comes from body surfaces and is sharp and well-localized.

B. Visceral pain comes from the internal organs and is most responsive to

acetaminophen and opiates.

C. Referred pain is present at a distant site from the pain source and is based on activation of the same spinal segment as the actual pain site.

D. Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area.

Woo Pharmacotherapeutics for APN Prescribers, 6e

ANS: C

2 Ch46

PTS: 1

6. One of the main drug classes used to treat acute pain is nonsteroidal anti-inflammatory drugs

(NSAIDs). They are used because: A. They have less risk for liver damage than acetaminophen.

B. Inflammation is a common cause of acute pain.

C. They have minimal gastrointestinal (GI) irritation.

D. Regulation of blood flow to the kidneys is not affected by these drugs.

ANS: B

PTS: 1

7. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true

about these drugs?

A. All opiates are scheduled drugs, which require a Drug Enforcement Administration (DEA) license to prescribe.

B. Opiates stimulate only  receptors for the control of pain.

C. Most of the adverse effects of opiates are related to  receptor stimulation.

D. Naloxone is an antagonist to opiates.

ANS: B

PTS: 1

8. If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are

insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use?

A. NSAIDs, opiates, corticosteroids B. Low-dose opiates, salicylates, increased dose of opiates C. Opiates, nonopiates, increased dose of nonopiates D. Nonopiates, increased dose of nonopiates, opiates ANS: D

PTS: 1

9. The goal of treatment of acute pain is: A. Pain at a tolerable level where the patient may return to activities of daily living B. Elimination of all pain C. Reduction of pain with minimum adverse reactions D. Adequate pain relief without constipation or nausea from the drugs ANS: C

PTS: 1

10. Which of the following statements is true about age and pain?

A. Use of drugs that depend heavily on the renal system for excretion may require

dosage adjustments in very young children.

B. Among the NSAIDs, indomethacin is the preferred drug because of a lower adverse effect profile than other NSAIDs. C. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.

Woo Pharmacotherapeutics for APN Prescribers, 6e

3 Ch46

D. Acetaminophen is especially useful in both children and adults because it has no

effect on platelets and has fewer adverse effects than NSAIDs. ANS: D

PTS: 1

11. Pain assessment to determine adequacy of pain management is important for all patients. This

assessment is done to: A. Determine if the diagnosis of the source of pain is correct B. Determine if the current regimen is adequate or if different combinations of drugs and nondrug therapy are required C. Determine if the patient is willing and able to be an active participant in his or her pain management D. All of the above ANS: D

PTS: 1

12. Which statement is true regarding acute and chronic pain?

A. Both have decreased levels of endorphins.

B. Chronic pain has a predominance of C-neuron stimulation.

C. Acute pain is most commonly associated with irritation of peripheral nerves.

D. Acute pain is diffuse and hard to localize.

ANS: B

PTS: 1

13. A treatment plan for management of chronic pain should include: A. Negotiation with the patient to set personal goals for pain management B. Discussion of ways to improve sleep and stress levels C. An exercise program to improve function and fitness D. All of the above ANS: D

PTS: 1

14. Chronic pain is a complex problem. Some specific strategies to deal with it include: A. Telling the patient to “let pain be your guide” to using treatment therapies B. Prescribing pain medication on a pro re nata (PRN) basis to keep the amount used

as low as possible C. Scheduling return visits on a regular basis rather than waiting for poor pain control

to drive the need for an appointment D. All of the above ANS: C

PTS: 1

15. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which

of the following raises a “red flag” about potential chemical dependency?

A. Use of more than one drug to treat the pain B. When prescriptions are lost multiple times with requests to refill C. Preferences for treatments that include alternative medicines D. Presence of a family member who has abused drugs

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: B

PTS: 1

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1 Ch47

Chapter 47. Pneumonia MULTIPLE CHOICE 1. The most common bacterial pathogen in community-acquired pneumonia is: A. Haemophilus influenzae B. Staphylococcus aureus C. Mycoplasma pneumoniae D. Streptococcus pneumoniae ANS: D

PTS: 1

2. The first-line drug choice for a previously healthy adult patient diagnosed with community-

acquired pneumonia would be: A. Ciprofloxacin B. Azithromycin C. Trimethoprim/sulfamethoxazole D. Dicloxacillin ANS: B

PTS: 1

3. The first-line antibiotic choice for a patient with comorbidities or who is immunosuppressed

who has pneumonia and can be treated as an outpatient would be: A. Levofloxacin B. Amoxicillin C. Ciprofloxacin D. Cephalexin ANS: A

PTS: 1

4. If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia,

an appropriate initial treatment option would be: A. Intravenous (IV) or intramuscular (IM) B. IV or IM ceftriaxone C. IV amoxicillin D. IV ciprofloxacin ANS: B

PTS: 1

5. A 34-week-pregnant female has been diagnosed with pneumonia. She is stable enough to be

treated as an outpatient. What would be an appropriate antibiotic to prescribe?

A. Levofloxacin B. Azithromycin C. Amoxicillin D. Doxycycline ANS: B

PTS: 1

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2 Ch47

6. Adults with pneumonia who are responding to antimicrobial therapy should show

improvement in their clinical status in: A. 12 to 24 hours B. 24 to 36 hours C. 48 to 72 hours D. Four or 5 days ANS: C

PTS: 1

7. Along with prescribing antibiotics, adults with pneumonia should be instructed on lifestyle

modifications to improve outcomes, including: A. Adequate fluid intake B. Increased fiber intake C. Bedrest for the first 24 hours D. All of the above ANS: A

PTS: 1

8. A 4-week-old infant has been diagnosed with chlamydial pneumonia. An appropriate

treatment for his pneumonia would be: A. Levofloxacin B. Amoxicillin C. Azithromycin D. Cephalexin ANS: C

PTS: 1

9. A 4-year-old patient has suspected bacterial pneumonia. He has a temperature of 102°F,

oxygen saturation level of 95%, and is taking fluids adequately. What would be appropriate initial treatment for his pneumonia?

A. Ceftriaxone B. Amoxicillin C. Cephalexin D. Levofloxacin ANS: A

PTS: 1

10. A 14-year-old patient presents to the clinic with symptoms consistent with mycoplasma

pneumonia. What is the treatment for suspected mycoplasma pneumonia in an adolescent?

A. Ceftriaxone B. Azithromycin C. Ciprofloxacin D. Levofloxacin ANS: B

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 48. Sexually Transmitted Diseases and Vaginitis MULTIPLE CHOICE 1. The goals of treatment when prescribing for sexually transmitted infections include: A. Treatment of infection B. Prevention of disease spread C. Prevention of long-term sequelae from the infection D. All of the above ANS: D

PTS: 1

2. The drug of choice for treatment of primary or secondary syphilis is: A. Ceftriaxone intramuscular (IM) B. Benzathine penicillin G IM C. Oral azithromycin D. Oral ciprofloxacin ANS: B

PTS: 1

3. The drug of choice for treatment of tertiary syphilis is: A. Ceftriaxone IM B. Benzathine penicillin G IM C. Oral azithromycin D. Oral ciprofloxacin ANS: B

PTS: 1

4. A 24-year-old female patient is 32 weeks pregnant and has tested positive for syphilis. The

best treatment for her would be: A. IM ceftriaxone B. IM benzathine penicillin G C. Oral azithromycin D. Any of the above ANS: B

PTS: 1

5. Treatment for suspected gonorrhea is: A. Ceftriaxone 500 mg IM x 1 B. Ceftriaxone 2 g IM x 1 C. Ciprofloxacin 500 mg PO x 1 D. Doxycycline 100 mg bid x 7 days ANS: A

PTS: 1

6. When treating suspected gonorrhea in a nonpregnant patient, the patient should be

concurrently treated for chlamydia with: A. Azithromycin 1 g PO x 1

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2 Ch48

B. Amoxicillin 500 mg PO x 1 C. Ciprofloxacin 500 mg PO x 1 D. Penicillin G 2.4 million units IM x 1 ANS: A

PTS: 1

7. Ongoing monitoring is essential after treating for gonorrhea. The patient should be rescreened

for gonorrhea and chlamydia in: A. Four weeks B. 3 to 6 weeks C. 3 to 6 months D. One year ANS: C

PTS: 1

8. A test of cure is recommended after treating chlamydia in which patient population?

A. Men who have sex with men B. Adolescent females C. Pregnant patients D. All of the above ANS: C

PTS: 1

9. Treatment for chancroid in a nonpregnant patient would be: A. Oral azithromycin B. IM ceftriaxone C. Oral ciprofloxacin D. Any of the above ANS: D

PTS: 1

10. Follow-up testing after treatment of chancroid would be: A. Syphilis and HIV testing at 3-month intervals B. Chancroid-specific antigen test every 3 months C. Urine testing for Haemophilus ducreyi in 3 to 6 months for test of cure D. Annual HIV testing if the patient engages in high-risk sexual behavior ANS: A

PTS: 1

11. A female patient presents with a complaint of vaginal discharge that when tested meets the

criteria for bacterial vaginosis. Treatment of bacterial vaginosis in nonpregnant symptomatic women would be: A. Metronidazole 500 mg PO bid x 7 days B. Doxycycline 100 mg PO bid x 7 days C. Intravaginal tinidazole daily x 5 days D. Metronidazole 2 g PO x 1 dose ANS: A

PTS: 1

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3 Ch48

12. Besides prescribing antimicrobial therapy, patients with bacterial vaginosis require education

regarding the fact that: A. The most recent partners in the past 60 days should also be treated.

B. Alcohol should not be consumed during and for 72 hours after metronidazole therapy.

C. Condoms should be used during intercourse if intravaginal clindamycin cream is used.

D. Cotreatment for chlamydia is necessary.

ANS: B

PTS: 1

13. An adult female patient presents to the clinic with vulvovaginal candidiasis. Appropriate

treatment for her would be: A. Over-the-counter (OTC) intravaginal clotrimazole B. OTC intravaginal miconazole C. Oral fluconazole one-time dose D. Any of the above ANS: D

PTS: 1

14. An adult female presents with genital warts on her labia. Patient-applied topical therapy for

genital warts includes: A. Podofilox 0.5% gel B. Podophyllin 10% resin C. Trichloroacetic acid D. Any of the above ANS: A

PTS: 1

15. An adult female presents with a malodorous vaginal discharge and is confirmed to have a

Trichomonas infection. Treatment for her would include: A. Metronidazole 500 mg bid x 7 days B. Topical intravaginal metronidazole daily x 7 days C. Intravaginal clindamycin daily x 7 days D. Azithromycin 2 g PO x 1 dose ANS: A

PTS: 1

16. In addition to antimicrobial therapy, patients treated for Trichomonas infection should be

educated regarding: A. Necessity of treating sexual partner simultaneously B. Abstaining from intercourse until both partners are treated C. Need for retesting in 3 months due to high reinfection rate D. All of the above ANS: D

PTS: 1

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Chapter 49. Substance Use Disorders MULTIPLE CHOICE 1. The first-line medication(s) for alcohol withdrawal is/are: A. Valproates B. Benzodiazepines C. Carbamazepine D. Clonidine ANS: B

PTS: 1

2. Which of the following medications prevents the seizures and delirium tremens associated

with alcohol withdrawal?

A. Clonidine B. Lorazepam C. Ethanol supplementation D. Barbiturates ANS: B

PTS: 1

3. Patients with chronic alcoholism in severe alcohol withdrawal should be treated with: A. Thiamine 100 mg orally daily for 7 days B. Thiamine 200 to 500 mg parenterally for 3 to 5 days C. Calcium 500 mg parenterally daily for 7 days D. Calcium 1000 mg orally daily for 3 to 5 days ANS: B

PTS: 1

4. A patient asking for medication to assist with maintaining abstinence from alcohol also takes

oxycodone for back pain. Which medication would be appropriate to prescribe?

A. Acamprosate (Campral) 666 mg tid B. Naltrexone extended-release injection (Vivitrol) 380 mg every 4 weeks C. Diazepam 5 mg orally every 6 hours D. Naloxone extended-release intramuscular (IM) (Narcan EX) 500 mg every 4 weeks ANS: A

PTS: 1

5. A patient who is receiving medication-assisted treatment for opioid use disorder with

buprenorphine should start the buprenorphine: A. Two weeks before the quit date B. Eight hours after the last opioid dose C. Thirty-six hours after the last opioid dose D. When withdrawal symptoms start ANS: B

PTS: 1

6. Methadone to treat a patient with opioid use disorder is started:

Woo Pharmacotherapeutics for APN Prescribers, 6e A. Two weeks before the quit date B. Eight hours after the last opioid dose C. Thirty-six hours after the last opioid dose D. When withdrawal symptoms start ANS: D

PTS: 1

7. Monitoring of a patient who is initiating methadone treatment includes monitoring for: A. Delirium tremens B. Seizures C. Prolonged QT D. Psychosis ANS: C

PTS: 1

8. A patient who is receiving medication-assisted treatment for opioid use disorder with

injectable naltrexone should start the naltrexone: A. Two weeks before the quit date B. Seven to 10 days after the last opioid dose C. Before withdrawal symptoms start D. When withdrawal symptoms start ANS: B

PTS: 1

9. A patient who is receiving medication-assisted treatment for opioid use disorder with

clonidine should begin treatment by: A. Applying a clonidine patch 3 days before quit date B. Using oral clonidine for 3 days until the clonidine patch reaches effective dosing C. Taking clonidine 0.2 mg three times a day if the Clinical Opiate Withdrawal Scale (COWS) score is over 12 D. Maintaining clonidine dose at a steady state for a week then tapering over 2 weeks ANS: B

PTS: 1

10. A 58-year-old patient has been taking alprazolam daily for many years for anxiety. The

recommended method to discontinue long-term alprazolam use is: A. Discontinue “cold turkey” and monitor for withdrawal symptoms B. Wean alprazolam dose over 3 to 7 days, then every other day dosing for a week C. Switch to long-acting diazepam and then wean over 8 to 12 weeks D. Switch to diazepam and wean over 3 to 4 weeks ANS: C

PTS: 1

11. Nicotine withdrawal symptoms include: A. Somnolence B. Decreased appetite C. Diarrhea

2 Ch49

Woo Pharmacotherapeutics for APN Prescribers, 6e D. Irritability ANS: D

PTS: 1

12. If a patient wants to quit smoking, nicotine replacement therapy is recommended if the

patient: A. Smokes more than 10 cigarettes a day B. Smokes within 30 minutes of awakening in the morning C. Smokes when drinking alcohol D. “Binge smokes” while out with friends ANS: B

PTS: 1

13. Instructions for a patient who is starting nicotine replacement therapy include: A. They should smoke fewer than 10 cigarettes a day when starting nicotine

replacement.

B. Nicotine replacement will help with the withdrawal cravings associated with

quitting tobacco.

C. Nicotine replacement can be used indefinitely.

D. Nicotine replacement therapy is generally safe for all patients.

ANS: B

PTS: 1

14. Nicotine replacement therapy should not be used in which patients?

A. Pregnant women B. Patients with worsening angina pectoris C. Patients who have just suffered an acute myocardial infarction D. All of the above ANS: D

PTS: 1

15. Instructions for the use of nicotine gum include: A. The patient should chew the gum quickly to get a peak effect.

B. The gum should be “parked” in the buccal space between chews.

C. Acidic drinks such as coffee help with the absorption of the nicotine.

D. The highest abstinence rates occur if the patient chews the gum when he or she is

having cravings.

ANS: B

PTS: 1

16. Patients who choose the nicotine lozenge to assist in quitting tobacco should be instructed: A. They should chew the lozenge well.

B. They should drink at least 8 oz of water after the lozenge dissolves.

C. They should use one lozenge every 1 to 2 hours (at least nine per day with a

maximum of 20 per day).

D. A tingling sensation in the mouth should be reported to the provider.

ANS: C

PTS: 1

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4 Ch49

17. Transdermal nicotine replacement (the patch) is an effective choice in tobacco cessation

because: A. The patch provides a steady level of nicotine without reinforcing oral aspects of smoking.

B. There is the ability to “fine tune” the amount of nicotine that is delivered to the patient at any one time.

C. There is less of a problem with nicotine toxicity than with other forms of nicotine replacement.

D. Transdermal nicotine is safer in pregnancy.

ANS: A

PTS: 1

18. The most common adverse effect of the transdermal nicotine replacement patch is: A. Nicotine toxicity B. Tingling at the site of patch application C. Skin irritation under the patch site D. Life-threatening dysrhythmias ANS: C

PTS: 1

19. If a patient is exhibiting signs of nicotine toxicity when using transdermal nicotine, they

should remove the patch and: A. Wash the area thoroughly with soap and water B. Flush the area with clear water C. Reapply a new patch in 8 hours D. Take acetaminophen for the headache associated with toxicity ANS: B

PTS: 1

20. When a patient is prescribed nicotine nasal spray for tobacco cessation, instructions include: A. They should inhale deeply with each dose to ensure deposition in the lungs.

B. The dose is one to two sprays in each nostril per hour, up to 40 sprays per day.

C. A sensation of “head rush” indicates the medication is working well.

D. Nicotine spray may be used daily for up to 12 continuous months.

ANS: B

PTS: 1

21. If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include: A. Bupropion (Zyban) is started 1 to 2 weeks before the quit date.

B. Nicotine replacement products should not be used with bupropion.

C. If they smoke when taking bupropion they may have increased anxiety and

insomnia.

D. Because they are not using bupropion as an antidepressant, they do not need to

worry about increased suicide ideation when starting therapy.

ANS: A

PTS: 1

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5 Ch49

22. Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to a patient who is

starting varenicline include: A. The maximum time varenicline can be used is 12 weeks.

B. Nausea is a sign of varenicline toxicity and should be reported to the provider.

C. The starting regimen for varenicline is 1 mg twice a day a week before the quit date.

D. Neuropsychiatric symptoms may occur.

ANS: D

PTS: 1

23. The most appropriate smoking cessation prescription for pregnant women is: A. A nicotine replacement patch at the lowest dose available B. Bupropion (Zyban) C. Varenicline (Chantix) D. Nonpharmacologic measures ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 50. Tuberculosis MULTIPLE CHOICE 1. Drug-resistant tuberculosis (TB) is defined as TB that is resistant to at least: A. Fluoroquinolones B. Rifampin and isoniazid C. Amoxicillin D. Ceftriaxone ANS: B

PTS: 1

2. Goals when treating TB include: A. Completion of recommended therapy B. Negative purified protein derivative (PPD) at the end of therapy C. Completely normal chest x-ray D. All of the above ANS: A

PTS: 1

3. The principles of drug therapy for the treatment of TB include: A. Patients are treated with a drug that M tuberculosis is sensitive to.

B. Drugs need to be taken on a regular basis for a sufficient amount of time.

C. Treatment continues until the patient’s PPD is negative.

D. All of the above ANS: B

PTS: 1

4. A patient has confirmed TB and is placed on a 6-month treatment regimen. This regimen

consists of: A. Two months of four drug therapy (isoniazid [INH], rifampin, pyrazinamide, and ethambutol) followed by 4 months of INH and rifampin B. Six months of INH with daily pyridoxine throughout therapy C. Six months of INH, rifampin, pyrazinamide, and ethambutol D. Any of the above ANS: A

PTS: 1

5. Treatment for drug-resistant TB would include: A. INH, rifampin, pyrazinamide, and ethambutol for at least 12 months B. INH, ethambutol, kanamycin, and rifampin C. Treatment with at least two drugs that the TB is susceptible to D. Levofloxacin ANS: C

PTS: 1

6. Treatment regimens for a pregnant patient with TB would include: A. Streptomycin

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2 Ch50

B. Levofloxacin C. Kanamycin D. Pyridoxine ANS: D

PTS: 1

7. A 5-year-old patient has been diagnosed with primary pulmonary TB. His treatment would

include: A. Pyridoxine B. Ethambutol C. Levofloxacin D. Rifabutin ANS: A

PTS: 1

8. A 9-year-old lives with a family member newly diagnosed with TB. To prevent the patient

from developing TB, they should be treated with: A. Six months of INH and rifampin B. Two months of INH, rifampin, pyrazinamide, and ethambutol, followed by 4 months of INH C. Nine months of INH D. 12 months of INH ANS: C

PTS: 1

9. Leonard is completing a 6-month regimen to treat TB. Monitoring of a patient on TB therapy

includes: A. Monthly sputum cultures B. Monthly chest x-ray C. Bronchoscopy every 3 months D. All of the above ANS: A

PTS: 1

10. Compliance with directly observed therapy can be increased by offering: A. Convenient clinic times B. Incentives such as food, clothing, and transportation costs C. Gifts for compliance D. All of the above ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 51. Upper Respiratory Tract Infection, Pharyngitis, Sinusitis, Otitis Media, and Otitis Externa MULTIPLE CHOICE 1. An adult presents with an upper respiratory infection (URI). Treatment for his URI would

include: A. Amoxicillin B. Diphenhydramine C. Phenylpropanolamine D. Topical oxymetazoline ANS: D

PTS: 1

2. A 3-year-old patient presents with a URI. Treatment for their URI would include: A. Amoxicillin B. Diphenhydramine C. Pseudoephedrine D. Nasal saline spray ANS: D

PTS: 1

3. Patients who should be cautious about using decongestants for a URI include: A. School-age children B. Patients with asthma C. Patients with cardiac disease D. Patients with allergies ANS: C

PTS: 1

4. Treatment for a low-risk child with sinusitis is: A. Amoxicillin B. Azithromycin C. Cephalexin D. Levofloxacin ANS: A

PTS: 1

5. Treatment for bacterial sinusitis in an adult who has a child in daycare is: A. Azithromycin 500 mg a day for 5 days B. Amoxicillin-clavulanate 500 mg bid for 7 days C. Ciprofloxacin 500 mg bid for 5 days D. Cephalexin 500 mg qid for 5 days ANS: B

PTS: 1

6. The length of treatment for sinusitis in a low-risk adult patient should be:

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A. Five to 7 days B. Seven to 10 days C. Fourteen to 21 days D. Seven days beyond when symptoms cease ANS: A

PTS: 1

7. Patient education for a patient who is prescribed antibiotics for sinusitis includes: A. Using nasal saline washes B. Using inhaled corticosteroids C. Avoiding the use of ibuprofen while ill D. Using laxatives to treat constipation ANS: A

PTS: 1

8. First-line treatment for an afebrile 2-year-old with otitis media would include: A. Azithromycin B. Amoxicillin C. Ceftriaxone D. Trimethoprim/sulfamethoxazole ANS: B

PTS: 1

9. A 15-month-old patient has been on amoxicillin for 2 days for acute otitis media. She is still

febrile and there is no change in her tympanic membrane examination. What would be the plan of care for the child?

A. Continue the amoxicillin for the full 10 days B. Change the antibiotic to azithromycin C. Change the antibiotic to amoxicillin/clavulanate D. Change the antibiotic to trimethoprim/sulfamethoxazole ANS: C

PTS: 1

10. A child may warrant “watchful waiting” instead of an antibiotic prescription for acute otitis

media if they: A. Are low risk with temperature of less than 39oC or 102.2oF B. Have reliable parents with transportation C. Are older than 2 years D. All of the above ANS: D

PTS: 1

11. Whether prescribing an antibiotic for a child with acute otitis media or not, the parents should

be educated about: A. Using decongestants to provide faster symptom relief B. Providing adequate pain relief for at least the first 24 hours C. Using complementary treatments for acute otitis media, such as garlic oil

Woo Pharmacotherapeutics for APN Prescribers, 6e D. Administering an antihistamine/decongestant combination (Dimetapp) so the child

can sleep better ANS: B

PTS: 1

12. First-line therapy for a patient with acute otitis externa (swimmer’s ear) and an intact

tympanic membrane includes: A. Swim-Ear drops B. Ciprofloxacin and hydrocortisone drops C. Amoxicillin D. Gentamicin ophthalmic drops ANS: B

PTS: 1

13. First-line therapy for a school-age child with group A streptococcal pharyngitis is: A. Azithromycin 10 mg/kg on day 1, then 5 mg/kg/day on days 2 to 5 B. Amoxicillin 80 mg/kg/day (maximum of 2 g/day) for 10 days C. Clindamycin 20 mg/kg/dose bid for 10 days D. Amoxicillin 50 mg/kg/day (maximum 1,000 mg/day) for 10 days ANS: D

PTS: 1

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1 Ch52

Chapter 52. Urinary Tract Infections MULTIPLE CHOICE 1. The treatment goals when treating urinary tract infection (UTI) include: A. Eradication of the infecting organism B. Relief of symptoms C. Prevention of recurrence of the UTI D. All of the above ANS: D

PTS: 1

2. A 6-year-old female presents with a UTI. She is healthy, afebrile, with no use of antibiotics in

the previous 6 months and no drug allergies. An appropriate first-line antibiotic choice for her would be: A. Azithromycin B. Trimethoprim/sulfamethoxazole C. Nitrofurantoin D. Cefdinir ANS: B

PTS: 1

3. A 24-year-old female presents with a UTI. She is healthy, afebrile, and her only drug allergy

is sulfa, which gives her a rash. An appropriate first-line antibiotic choice for her would be: A. Azithromycin B. Trimethoprim/sulfamethoxazole C. Nitrofurantoin D. Ciprofloxacin ANS: C

PTS: 1

4. A 28-year-old pregnant woman at 38 weeks of gestation is diagnosed with a lower UTI. She is

healthy with no drug allergies. Appropriate first-line therapy for her UTI would be: A. Azithromycin B. Trimethoprim/sulfamethoxazole C. Nitrofurantoin D. Ciprofloxacin ANS: B

PTS: 1

5. Which of the following patients may be treated with a 5-day course of therapy for their UTI? A. A 28-year-old pregnant woman B. A 6-year-old healthy female C. A 24-year-old female D. A 26-year-old female diabetic ANS: C

PTS: 1

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6. Appropriate initial therapy for a 4-year-old female with a febrile UTI would be: A. Azithromycin B. Trimethoprim/sulfamethoxazole C. Ceftriaxone D. Ciprofloxacin ANS: C

PTS: 1

7. Monitoring for a healthy, nonpregnant adult patient being treated for a UTI is: A. Symptom resolution in 48 hours B. Follow-up urine culture at completion of therapy C. Test of cure urinary analysis at completion of therapy D. Follow-up urine culture 2 months after completion of therapy ANS: A

PTS: 1

8. Monitoring for a child who has had a UTI is: A. Symptom resolution in 48 hours B. Follow-up urine culture at completion of therapy C. Test of cure urinary analysis at completion of therapy D. Follow-up urine culture 2 months after completion of therapy ANS: B

PTS: 1

9. Monitoring for a pregnant woman who has had a UTI is: A. Symptom resolution in 48 hours B. Follow-up urine culture at completion of therapy C. Test of cure urinary analysis at completion of therapy D. Follow-up urine culture 1 week after completion of therapy ANS: D

PTS: 1

10. Along with an antibiotic prescription, lifestyle education for a nonpregnant adult female who

has had a UTI includes: A. Increasing her intake of vitamin-C–containing orange juice B. Voiding 10 to 15 minutes after intercourse C. Avoiding ingesting urinary irritants, such as asparagus D. All of the above ANS: B

PTS: 1

11. Lisa is a healthy nonpregnant adult woman who recently had a UTI. She is asking about

drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be: A. Sixteen ounces per day of cranberry juice cocktail will prevent UTIs. B. Cranberry juice will decrease UTIs. C. There is no clear evidence that cranberry juice helps prevent UTIs. D. Cranberry juice only works to prevent UTIs in children.

Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: C

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Chapter 53. Women as Patients MULTIPLE CHOICE 1. Intimate partner violence is a serious public health problem. It should be screened for: A. At every encounter within the health-care system B. When a woman is being seen for symptoms of depression C. Throughout pregnancy D. If a sexually transmitted disease is diagnosed ANS: A

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2. Because of their longer life expectancy, women are more likely than men to experience a

disabling condition. Common conditions in older women that can produce disability include: A. Depression B. Panic disorders C. Dementia D. All of the above ANS: D

PTS: 1

3. Gender differences between men and women in pharmacokinetics include: A. Women have more rapid gastric emptying so that drugs absorbed in the stomach

have less exposure to absorption sites.

B. Women have a higher proportion of body fat so that lipophilic drugs have

relatively greater volumes of distribution.

C. Women have increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations.

D. Women have slower organ blood flow rates, so drugs tend to take longer to be excreted.

ANS: B

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4. Which of the following drug classes is associated with significant differences in metabolism

based on gender?

A. Beta blockers B. Antibiotics C. Serotonin reuptake inhibitors D. Angiotensin-converting-enzyme (ACE) inhibitors ANS: C

PTS: 1

5. Because 40% of bone accrual occurs during adolescence, building bone during this time is

critical. Ways to improve bone accrual in adolescents include: A. Using bisphosphonates early if dual energy x-ray absorptiometry (DEXA) scans show limited bone accrual

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B. Encouraging a daily dietary intake of 1,300 mg of calcium and 400 IU of vitamin

D C. Avoiding all birth control methods that include progesterone D. Fostering the intake of iron mainly from green and leafy vegetables ANS: B

PTS: 1

6. Hot flashes are often a concern during menopause. Which of the following may help in

reducing them?

A. Drink one caffeinated drink per day B. Take progesterone supplementation C. Exercise 20 to 40 minutes/day D. Increase intake of carrots, yams, and soy products ANS: D

PTS: 1

7. Factors common in women that can affect adherence to a treatment regimen include all of the

following EXCEPT: A. Number of drugs taken: Women tend to take fewer drugs over longer periods of time.

B. Fear that medications can cause disease: Information obtained from social networks may be inaccurate for a specific woman.

C. Nutritional status: Worries about possible weight gain from a given drug may result in nonadherence.

D. Religious differences: A patient’s belief system that is not congruent with the treatment regimen presents high risk for nonadherence.

ANS: A

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8. Dysmenorrhea is one of the most common gynecological complaints in young women. The

first line of drug treatment for this disorder is: A. Oral contraceptive pills B. Caffeine C. Nonsteroidal anti-inflammatory drug (NSAIDs) D. Aspirin ANS: C

PTS: 1

9. Premenstrual dysphoric disorder (PMDD) occurs in a fairly small number of patients.

Theories of the pathology behind PMDD that are supported in research include: A. There is altered sensitivity in the serotoninergic system.

B. There is an inhibition of the cyclooxygenase system.

C. There are fluctuations of the gonadal hormones.

D. All of these are theories supported by research.

ANS: A

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10. Treatment of PMDD that affects all or most of the symptoms includes:

Woo Pharmacotherapeutics for APN Prescribers, 6e A. Tryptophan up to 6 g/day B. Vitamin E 200 to 400 mg/day C. Evening primrose oil 500 mg/day D. Fluoxetine 20 mg/day ANS: D

PTS: 1

11. Which of the following holds true for the pharmacokinetics of women?

A. Gastric emptying is faster than that of men.

B. Organ blood flow is the same as that of men.

C. Evidence is strong concerning renal differences in elimination.

D. Medications that involve binding globulins are impacted by estrogen levels.

ANS: D

PTS: 1

12. The metabolism of drugs in women is primarily impacted by: A. Hepatic blow flow B. Enzymes of the CYP450 system C. The amount of gastric secretions D. Whether they are pre- or postmenopausal ANS: B

PTS: 1

13. DEXA score interpretation in the rare cases of adolescent osteoporosis: A. Is done using the same T scores that are established for women B. Is impossible because of less-than-mature bones C. Must be done using special Z scores for adolescents D. Can only be done if bisphosphonates have already been started ANS: C

PTS: 1

14. The best way to use nonsteroidal anti-inflammatory drugs (NSAIDs) for severe menstrual

cramps is: A. The patient should take them for 2 to 3 days prior to the start of bleeding.

B. The patient should take them two to three times a day during the first 2 days.

C. The patient should take them every 2 to 3 hours.

D. They have not been found to be helpful at all.

ANS: A

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15. Women who present with the classic chest pressure, diaphoresis, and left arm pain of a

cardiovascular (CV) event are: A. Probably having a myocardial infarction B. Experiencing a panic attack C. Exaggerating an angina episode D. Needing to belch and get an antacid ANS: A

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16. All of the following are reasons why women experience worse CV outcomes than men

except: A. There is a failure of the system to aggressively treat risk factors on par with men.

B. They do not take early action, believing they are not at risk.

C. Women have smaller hearts and vessels compared to men, resulting in easier blockages with plaque over the same time period.

D. Women do not like to take medications.

ANS: D

PTS: 1

17. Which of the following may signal a cardiac event in a woman?

A. There is a sudden, profound weakness.

B. There is pain or pressure in the back.

C. Both A and B are correct.

D. Women have the same symptoms as men.

ANS: C

PTS: 1

18. Compared to men, it takes fewer drugs or less alcohol for women to become intoxicated due

to which of the following?

A. Women’s livers process chemicals at a faster rate of speed.

B. Women tend to start experimenting with alcohol and drugs at a later age so have not yet “adapted” like their male peers.

C. Females have a natural higher percentage of body fat.

D. None of these are correct.

ANS: D

PTS: 1

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Chapter 54. Men as Patients MULTIPLE CHOICE 1. The factor that has the greatest effect on males developing male sexual characteristics is: A. Cultural beliefs B. Effective male role models C. Adequate intake of testosterone in the diet D. Androgen production ANS: D

PTS: 1

2. When assessing a male for hypogonadism prior to prescribing testosterone replacement,

serum testosterone levels are drawn: A. Without regard to time of day B. First thing in the morning C. Late afternoon D. In the evening ANS: B

PTS: 1

3. Some research supports that testosterone replacement therapy may be indicated in which of

the following diagnoses in men?

A. Age-related decrease in cognitive functioning B. Metabolic syndrome C. Decreased muscle mass in aging men D. All of the above ANS: D

PTS: 1

4. The goal of testosterone replacement therapy is: A. Absence of all hypogonadism symptoms B. Testosterone levels in the mid to normal range 1 week after an injection C. Testosterone levels in the mid to normal range just prior to the next injection D. Avoidance of high serum testosterone levels during therapy ANS: B

PTS: 1

5. While on testosterone replacement, hemoglobin and hematocrit levels should be monitored.

Levels suggestive of excessive erythrocytosis or abuse are: A. Hemoglobin 14 g/dL or hematocrit 39% B. Hemoglobin 11.5 g/dL or hematocrit 31% C. Hemoglobin 13 g/dL or hematocrit 38% D. Hemoglobin 17.5 g/dL or hematocrit 54% ANS: D

PTS: 1

6. Monitoring of an older male patient on testosterone replacement includes:

Woo Pharmacotherapeutics for APN Prescribers, 6e A. Oxygen saturation levels at every visit B. Serum cholesterol and lipid profile every 3 to 6 months C. Digital rectal prostate screening exam at 3 and 6 months after starting therapy D. Bone mineral density at 3 and 6 months after starting therapy ANS: C

PTS: 1

7. When prescribing phosphodiesterase type 5 (PDE-5) inhibitors such as sildenafil (Viagra)

patients should be screened for use of: A. Statins B. Nitrates C. Insulin D. Opioids ANS: B

PTS: 1

8. Men who are prescribed PDE-5 inhibitors for erectile dysfunction should be educated

regarding the adverse effects of the drug, which include: A. Hearing loss B. Prostate enlargement C. Delayed ejaculation D. Dizziness ANS: A

PTS: 1

9. Male patients who should not be prescribed PDE-5 inhibitors include: A. Diabetics B. Those who have had an acute myocardial infarction in the past 6 months C. Those who are deaf D. Those who are under 60 years of age ANS: B

PTS: 1

10. Monitoring of male patients who are using PDE-5 inhibitors includes: A. Serum fasting glucose levels B. Cholesterol and lipid levels C. Blood pressure D. Complete blood count ANS: C

PTS: 1

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Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 55. Pediatric Patients MULTIPLE CHOICE 1. The Pediatric Research Equity Act says that: A. All children must be given equal access to drug research trials.

B. Children must be included in the planning phase of new drug development.

C. Children of multiple ethnic groups must be included in pediatric drug trials.

D. All applications for new active ingredients, new indications, new dosage forms, or

new routes of administration require pediatric studies.

ANS: D

PTS: 1

2. The Best Pharmaceuticals for Children Act: A. Includes a pediatric exclusivity rule that extends the patent on drugs studied in

children B. Establishes a committee that writes guidelines for pediatric prescribing C. Provides funding for new drug development aimed at children D. Encourages manufacturers to specifically develop pediatric formulations ANS: A

PTS: 1

3. The developmental variation in phase I enzymes has what impact on pediatric prescribing?

A. None, phase I enzymes are stable throughout childhood.

B. Children should always be prescribed lower than adult doses per weight due to low

enzyme activity until puberty.

C. Children should always be prescribed higher than adult doses per weight due to high enzyme activity.

D. Prescribing dosages will vary based on the developmental activity of each enzyme, at times requiring lower than adult doses and at other times higher than adult doses based on the age of the child.

ANS: D

PTS: 1

4. Developmental variation in renal function has what impact on prescribing for infants and

children?

A. Lower doses of renally excreted drugs may be prescribed to infants younger than 6 months.

B. Higher doses of water-soluble drugs may need to be prescribed because of increased renal excretion.

C. Renal excretion rates have no impact on prescribing.

D. Parents need to be instructed on whether drugs are renally excreted or not.

ANS: A

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5. Topical corticosteroids are prescribed cautiously in young children because: A. They may cause an intense hypersensitivity reaction.

1 Ch55

Woo Pharmacotherapeutics for APN Prescribers, 6e B. There may be hypothalamic-pituitary-adrenal axis suppression.

C. Corticosteroids are less effective in young children.

D. Young children may accumulate corticosteroids, leading to toxic levels.

ANS: B

PTS: 1

6. A woman who is breastfeeding her 2-month-old child has an infection that requires an

antibiotic. What drug factors influence the effect of the drug on the infant?

A. Maternal drug levels B. Half-life C. Lipid-solubility D. All of the above ANS: D

PTS: 1

7. Drugs that are absolutely contraindicated in lactating women include: A. Selective serotonin reuptake inhibitors B. Antiepileptic drugs such as carbamazepine C. Antineoplastic drugs such as methotrexate D. All of the above ANS: C

PTS: 1

8. Education of parents regarding administering oral antibiotics to a 4-month-old infant with

otitis media includes: A. Administering an oral drug using a medication syringe B. Mixing the medication with a couple of ounces of formula and putting it in a bottle C. Discontinuing the antibiotic if diarrhea occurs D. Calling for an antibiotic change if the infant chokes and sputters during administration ANS: A

PTS: 1

9. To increase adherence in pediatric patients a prescription medication should: A. Have a short half-life B. Be the best tasting of the effective drugs C. Be the least concentrated form of the medication D. Be administered three or four times a day ANS: B

PTS: 1

10. Treatment for fever in a 5-month-old infant may include: A. “Baby” aspirin B. Acetaminophen suppository C. Ibuprofen suppository D. Alternating acetaminophen and ibuprofen ANS: B

PTS: 1

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1 Ch56

Chapter 56. Transgendered Clients as Patients MULTIPLE CHOICE 1. The goals of treatment in treating transfeminine adults include: A. Lowering serum estradiol levels B. Suppressing testosterone levels C. Raising vocal pitch to feminine levels D. Decreasing male pattern facial and body hair ANS: B

PTS: 1

2. Permanent effects of estrogen therapy in transfeminine adults include: A. Breast development B. Decrease in muscle mass C. Decreased libido D. Softening of the skin ANS: A

PTS: 1

3. The estrogen formulation that most reliably leads to physiological target levels of estrogen is: A. Patch B. Spray C. Topical cream D. Intramuscular (IM) injection ANS: D

PTS: 1

4. Spironolactone is used in gender-affirming therapy: A. As a potassium-sparing diuretic to prevent hypertension B. As a way to treat hypertension associated with estrogen therapy C. As an antiandrogen and to suppress testosterone synthesis D. As a way to prevent male-pattern body hair growth ANS: C

PTS: 1

5. The mainstay of gender-affirming therapy in transmasculine adults is: A. Testosterone B. Spironolactone C. Bicalutamide D. Finasteride ANS: A

PTS: 1

6. When prescribing testosterone for gender-affirming therapy in transmasculine adults the

provider needs to educate the patient regarding the following adverse effects: A. Erythrocytosis leading to thrombosis B. Increased risk for ovarian cancer

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C. Significant increase in low-density lipoproteins (LDL) D. Increased breast size ANS: A

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7. Testosterone may exacerbate the following in transmasculine adults: A. Migraines B. Dysmenorrhea C. Constipation D. Prostatitis ANS: A

PTS: 1

8. Contraception options for a transmasculine adult include: A. Combined oral contraceptive pills B. Levonorgestrel intrauterine (IUD) C. NuvaRing vaginal ring D. Vasectomy ANS: B

PTS: 1

9. Advantages of treating adolescents with gender affirming therapy include: A. Higher levels of testosterone are achieved in transfeminine adolescents.

B. Puberty can be delayed allowing time for exploration of gender identity.

C. If started by Tanner stage 3, secondary sex characteristics can be reversed.

D. Fertility is preserved if treatment is started early.

ANS: B

PTS: 1

10. Monitoring of transgender adolescents on gonadotropin-releasing hormone (GnRH) agonists

to delay puberty includes: A. Height and weight B. Hair growth patterns C. Erections D. All of the above ANS: D

PTS: 1

Woo Pharmacotherapeutics for APN Prescribers, 6e

Chapter 57. Geriatric Patients MULTIPLE CHOICE 1. Principles of prescribing for older adults include: A. Avoiding prescribing any newer high-cost medications B. Starting at a low dose and increasing the dose slowly C. Keeping the total dose at a lower therapeutic range D. All of the above ANS: B

PTS: 1

2. Sadie is a 90-year-old patient who requires a new prescription. What changes in drug

distribution with aging would influence prescribing for Sadie?

A. Increased volume of distribution B. Decreased lipid solubility C. Decreased plasma proteins D. Increased muscle-to-fat ratio ANS: C

PTS: 1

3. Glen is an 82-year-old patient who needs to be prescribed a new drug. What changes in

elimination should be taken into consideration when prescribing for Glen?

A. Increased glomerular filtration rate (GFR) will require higher doses of some renally excreted drugs.

B. Decreased tubular secretion of medication will require dosage adjustments.

C. Thin skin will cause increased elimination via sweat.

D. Decreased lung capacity will lead to measurable decreases in lung excretion of drugs.

ANS: B

PTS: 1

4. A medication review of an elderly person’s medications involves: A. Asking the patient to bring a list of current prescription medications to the visit B. Having the patient bring all of their prescription, over-the-counter, and herbal

medications to the visit C. Asking what other providers are writing prescriptions for them D. All of the above ANS: D

PTS: 1

5. Steps to avoid polypharmacy include: A. Prescribing two or fewer drugs from each drug class B. Reviewing a complete drug history every 12 to 18 months C. Encouraging the elderly patient to coordinate their care with all of their providers D. Evaluating for duplications in drug therapy and discontinuing any duplications

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Woo Pharmacotherapeutics for APN Prescribers, 6e ANS: D

2 Ch57

PTS: 1

6. Robert is a 72-year-old patient who has hypertension and angina. He is at risk for common

medication practices seen in the elderly including: A. Using another person’s medications B. Hoarding medications C. Changing his medication regimen without telling his provider D. All of the above ANS: D

PTS: 1

7. To improve positive outcomes when prescribing for the elderly the nurse practitioner should: A. Assess cognitive functioning B. Encourage the patient to take a weekly “drug holiday” to keep drug costs down C. Encourage the patient to cut drugs in half with a knife to lower costs D. All of the above ANS: A

PTS: 1

8. Delta is an 88-year-old patient who has mild low-back pain. What guidelines should be

followed when prescribing pain management for Delta?

A. The dose of oxycodone should be kept low to prevent development of tolerance.

B. Acetaminophen is the first-line drug of choice.

C. Nonsteroidal anti-inflammatory drugs (NSAIDs) should not be prescribed.

D. A short-acting benzodiazepine should be added for a synergistic effect on pain.

ANS: B

PTS: 1

9. Robert is complaining of poor sleep. Medications that may contribute to sleep problems in the

elderly include: A. Diuretics B. Trazodone C. Clonazepam D. Levodopa ANS: A

PTS: 1

10. In geriatric patients, the percentage of body fat is increased. What are the pharmacologic

implications of this physiologic change?

A. A lipid-soluble medication will be eliminated more quickly and will not work as well.

B. A lipid-soluble medication will accumulate in fat tissue and its duration of action may be prolonged.

C. Absorption of lipid-soluble drugs is impaired in older adults.

D. The bioavailability of the lipid-soluble drug is increased in older adults.

ANS: B

PTS: 1

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11. All of the following statements about the Beers list are true except: A. It is a list of medications or medication classes that should generally be avoided in

persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available.

B. It is derived from the expert opinion of one geriatrician and is not evidence based.

C. These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities.

D. These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration.

ANS: B

PTS: 1

12. You are reviewing the data from several meta-analyses that addressed the most common

causes of adverse drug reactions in the older adult. A decrease in which of the following is the most common cause of adverse drug reactions in older adults?

A. Body fat content B. Liver function C. Renal function/clearance D. Plasma albumin levels ANS: C

PTS: 1

13. Which of the following is not consistent with the rules for geriatric prescribing?

A. Half-life will be longer in older adults.

B. Steady state is reached more quickly in the older adult.

C. The number of drugs in the patient's regimen should be reduced whenever

possible.

D. Adverse drug responses present atypically in the older adult.

ANS: B

PTS: 1

14. Timely posthospitalization medication reconciliation helps clarify: A. Which medications stopped in the acute setting require return to use B. Evaluation of new side effects associated with dose changes or new prescriptions C. Which medications require more patient education D. All of the above ANS: D

PTS: 1

15. Specialty consultation summaries need to be reviewed for: A. Altered dosing of current medications B. Recommendations for interventions that will require medication regimen changes C. Interventions that will conflict with another specialty plan D. All of the above ANS: D

PTS: 1

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16. Patients who plan to retire to warm, sunny climates are at risk for which adverse reaction not

typical in cooler, cloudier climates?

A. Over hydration B. Increased risk of falls C. Photodermatitis D. Failing thyroids ANS: C

PTS: 1

17. Topical medication efficacy may be impacted by which common aging change?

A. Decreased peripheral vascular flows B. Increased ratio of water to fat in the skin C. Dropping renal clearance D. Loss of vellus hair ANS: A

PTS: 1