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Test bank pharmaco.docx NURSING NGR 5035 Chapter 6-10

Test bank NURSING NGR 5035 Chapter 6-10 Chapter 6: Factors that Foster Positive Outcomes Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A comprehensive assessment of a patient should be holistic when trying to determine competence in drug administration. Which of the following factors would the NP omit from this type of assessment? A. Financial status B. Mobility C. Social support D. Sexual practices ____ 2. Elena Vasquez’ primary language is Spanish and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed? A. Use correct medical terminology since Spanish has a Latin base B. Use a family member who speaks more English to act as interpreter C. Use a professional interpreter or a reliable staff member who can interpret D. Use careful, detailed explanations ____ 3. Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug? A. Stand facing him and speak slowly and clearly B. Speak in low tones or find a provider who has a lower voice C. Write down the instructions as well as speaking them D. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds ____ 4. Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen? A. Complexity of the drug regimen B. Patient perception of the potential adverse effects of the drugs C. Both A and B D. Neither A nor B ____ 5. The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which of the following system variables creates such a barrier? A. Increasing copayments for care B. Unrestricted formularies for drugs including brand names C. Increasing the number of people who have access to care D. Treating a wider range of disorders ____ 6. Adverse drug reactions and patients’ perceptions of them are likely to produce non-adherence. Which of the following ADRs are least likely to produce non-adherence? A. Severe hypotension and anaphylaxis B. Constipation and diarrhea C. Headache and dizziness D. Nausea and vomiting ____ 7. Ralph’s blood pressure remains elevated despite increased doses of his drug. The NP is concerned that he might not be adhering to his treatment regimen. Which of the following events would suggest that he might not be adherent? A. Ralph states that he always takes the drug “when I feel my pressure is going up.” B. Ralph contacts his NP to discuss the need to increase the dose. C. Ralph consistently keeps his follow-up appointments to check his blood pressure. D. All of the above show that he is adherent to the drug regimen. ____ 8. Non-adherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of non-adherence to these drugs is to prescribe a drug that: A. Has a short half-life so that missing one dose has limited effect B. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down. C. Has a tolerability profile with less of the adverse effects that are considered “irritating,” such as nausea and dizziness. D. Must be taken no more than twice a day. ____ 9. Factors in chronic conditions that contribute to non-adherence include: A. The complexity of the treatment regimen B. The length of time over which it must be taken C. Breaks in the usual daily routine, such as vacations and weekends D. All of the above ____ 10. While patient education about their drugs is important, information alone does not necessarily lead to adherence to a drug regimen. Patients report greater adherence when: A. The provider spent a lot of time discussing the drugs with them B. Their concerns and specific area of knowledge deficit were addressed C. They were given written material, such as pamphlets, about the drugs D. The provider used appropriate medical and pharmacologic terms ____ 11. Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs: A. With a longer half-life so that missed doses produce a longer taper on the drug curve B. In oral formulations that are more easily taken C. That do not require frequent monitoring D. Combined with patient education about the need to adhere even when symptoms are absent ____ 12. Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less likely the patient will adhere to it. Which of the following interventions will NOT improve adherence? A. Have the patient purchase a pill container with compartments for daily or multiple times per day dosing. B. Match the clinic appointment to the next time the drug is to be refilled. C. Write prescriptions for new drugs with shorter times between refills. D. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug. ____ 13. Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include: A. Older adults and those on fixed incomes B. Patients with chronic illnesses C. Patients with copayments for drugs on their insurance D. Patients on public assistance ____ 14. Providers have a responsibility for determining the best plan of care, but patients also have responsibilities. Patients the provider can be assured will carry through on these responsibilities include those who: A. Are well-educated and affluent B. Have chronic conditions C. Self-monitor drug effects on their symptoms D. None of the above guarantee adherence ____ 15. Monitoring adherence can take several forms, including: A. Patient reports from data in a drug diary B. Pill counts C. Lab reports and other diagnostic markers D. All of the above Chapter 7: Cultural and Ethnic Influences in Pharmacotherapeutics Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Cultural factors that must be taken into account when prescribing include(s): A. Who is the decision maker in the family regarding health-care decisions B. The patient’s view of health and illness C. Attitudes regarding the use of drugs to treat illness D. All of the above ____ 2. Ethnic differences have been found in drug: A. Absorption B. Hepatic metabolism C. Filtration at the glomerulus D. Passive tubular reabsorption ____ 3. The National Standards of Culturally and Linguistically Appropriate Services (CLAS) are required to be implemented in all: A. Hospitals B. Clinics that serve the poor C. Organizations that receive federal funds D. Clinics that serve ethnic minorities ____ 4. According to the National Standards of Culturally and Linguistically Appropriate Services (CLAS), interpreters for health care: A. May be a bilingual family member B. May be a bilingual nurse or other health-care provider C. Must be a professionally trained medical interpreter D. Must be an employee of the organization ____ 5. According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to: A. The belief among African Americans that prayer is more powerful than drugs B. Poor compliance on the part of the African-American patient C. The genetic predisposition for illness found among African Americans D. Discrimination, cultural barriers, and lack of access to health care ____ 6. The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are: A. Increased CYP 2D6 activity, leading to rapid metabolism of some drugs B. Largely unknown due to lack of studies of this population C. Rapid metabolism of alcohol, leading to increased tolerance D. Decreased elimination of opioids, leading to increased risk for addiction ____ 7. Pharmacokinetics among Asians are universal to all the Asian ethnic groups. A. True B. False ____ 8. Alterations in drug metabolism among Asians may lead to: A. Slower metabolism of antidepressants, requiring lower doses B. Faster metabolism of neuroleptics, requiring higher doses C. Altered metabolism of omeprazole, requiring higher doses D. Slower metabolism of alcohol, requiring higher doses ____ 9. Asians from Eastern Asia are known to be fast acetylators. Fast acetylators: A. Require acetylization in order to metabolize drugs B. Are unable to tolerate higher doses of some drugs that require acetylization C. May have a toxic reaction to drugs that require acetylization D. Require higher doses of drugs metabolized by acetylization to achieve efficacy ____ 10. Hispanic native healers (curanderas): A. Are not heavily utilized by Hispanics who immigrate to the United States B. Use herbs and teas in their treatment of illness C. Provide unsafe advice to Hispanics and should not be trusted D. Need to be licensed in their home country in order to practice in the United States Chapter 8: Pharmacogenomics Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Genetic polymorphisms account for differences in metabolism, including: A. Poor metabolizers (PMs) who lack a working enzyme B. Intermediate metabolizers (IMs) who have one working, wild-type allele and one mutant allele C. Extensive metabolizers (EMs), with two normally functioning alleles D. All of the above ____ 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 SSRIs C. Decreased conversion of codeine to morphine by CYP 2D6 D. The need for lowered dosages of drugs, such as beta blockers ____ 3. Rifampin is a nonspecific CYP450 inducer that may: A. Lead to toxic levels of rifampin and must be monitored closely B. Cause toxic levels of drugs, such as oral contraceptives, when co-administered C. Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure D. Cause nonspecific changes in drug metabolism ____ 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 co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination D. Increased levels of a co-administered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination ____ 5. Warfarin resistance may be seen in patients with VCORC1 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 ____ 6. Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin. A. True B. False ____ 7. Pharmacogenetic testing is required by the Food and Drug Administration (FDA) prior to prescribing: A. Erythromycin B. Digoxin C. Cetuximab D. Rifampin ____ 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 HLA-B*1502 allele D. Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine ____ 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 ____ 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 ____ 11. Ultra-rapid metabolizers of drugs may have: 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 accumulation of prodrug ____ 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 Chapter 9: Nutritional Supplements and Nutraceuticals Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The most frequent type of drug-food interaction is: A. Food causing increased therapeutic drug levels B. Food affecting the metabolism of the drug C. Food altering the volume of distribution of drugs D. Food affecting the gastrointestinal absorption of drugs ____ 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 ____ 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 ____ 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 ____ 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 ____ 6. A low-carbohydrate, high-protein diet may: A. Increase drug-metabolizing enzymes B. Decrease drug absorption from the GI tract C. Alter drug binding to plasma proteins D. Enhance drug elimination ____ 7. Grapefruit juice contains furanocoumarins that have been found to: A. Alter absorption of drugs through competition for binding sites B. Inhibit CYP 3A4, 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 ____ 8. Cruciferous vegetables may alter drug pharmacokinetics by: A. Enhancing absorption of weakly acidic drugs B. Altering CYP 3A4 activity, leading to elevated levels of drugs, such as the statins C. Inducing CYP 1A2, possibly leading to therapeutic failure of drugs metabolized by CYP 1A2 D. Decreasing first pass metabolism of drugs ____ 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 ____ 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 ____ 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. Chelation of the folic acid into inactive ingredients ____ 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: A. Spinach B. Milk C. Romaine lettuce D. Cauliflower ____ 13. The American Dietetic Association (ADA) 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. 1000 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 ____ 14. The American Dietetic Association (ADA) recommends pregnant women take a supplement including: A. 1000 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 ____ 15. The American Heart Association (AHA) and the ADA recommend a minimum daily fiber intake of ____ for cardiovascular health: A. 10 mg/day B. 15 mg/day C. 20 mg/day D. 25 mg/day ____ 16. Which of the following vitamin or mineral supplements may by teratogenic if a pregnant woman takes more than the recommended amount? A. Iron B. Vitamin A C. Vitamin B6 D. Vitamin C ____ 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 ____ 18. Isoniazid (INH) may induce a deficiency of which vitamin? A. Vitamin B6 B. Vitamin C C. Vitamin D D. Vitamin E ____ 19. Pregnant patients who are taking isoniazid (INH) should take 25 mg/day of vitamin B6 (pyridoxine) to prevent: A. Beriberi B. Peripheral neuropathy C. Rickets D. Megaloblastic anemia ____ 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 ____ 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. 1000 mg/day D. 35 mg/day more than nonsmokers ____ 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 ____ 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 ____ 24. Newborns are at risk for early vitamin K deficiency bleeding and the American Academy of Pediatrics recommends that all newborns receive: A. 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 ____ 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 ____ 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 ____ 27. According to the 2003–2006 NHANES study of dietary intake, the group at highest risk for inadequate calcium intake was: A. Elderly (over age 60 years) B. Teenage females C. Teenage males D. Preschoolers ____ 28. Patients with iron deficiency will develop: A. Hemolytic anemia B. Megaloblastic anemia C. Macrocytic-hypochromic anemia D. Microcytic-hypochromic anemia ____ 29. There is evidence that dietary supplementation or adequate intake of fish oils and omega-3 fatty acids have well documented: A. Concern for developing cardiac dysrhythmias B. Anti-inflammatory effects C. Total cholesterol-lowering effects D. Effects on fasting blood sugar ____ 30. There is enough preliminary evidence to recommend that children with autism receive which supplemental nutrient? A. Vitamin B1 (thiamine) B. Vitamin B2 (riboflavin) C. Calcium D. Omega-3 fatty acids ____ 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 ____ 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 ____ 33. Probiotics are recommended to be co-administered when ____ are prescribed: A. Antacids B. Antihypertensives C. Antidiarrheals D. Antibiotics ____ 34. It is reasonable to add ____ to a Helicobacter pylori treatment regimen to improve eradication rates of H. pylori. A. Probiotics B. Omega-3 fatty acids C. Plant sterols D. Fiber Chapter 10: Herbal and Complementary Medicine Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. A good history of herb and supplement use is critical before prescribing because approximately ____ of patients in the United States are using herbal products. A. 10% B. 5% C. 38% D. 70% ____ 2. A potential harmful effect to patients who take some herbal medication is: A. Constipation B. Lead poisoning C. Diarrhea D. Life-threatening rash ____ 3. A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat Type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains: 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 ____ 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 which are yang in nature B. Herbs that are yin in nature C. Ginger D. Golden seal ____ 5. According to Traditional Chinese Medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient’s illness will: A. Get worse B. Get better C. Not be adequately treated D. Need additional herbs to treat the yang ____ 6. In Ayurvedic medicine treatment is based on the patient’s dominant dosha, which is referred to as the person’s: A. Vata B. Pitta C. Kapha D. Prakriti ____ 7. Herbs and supplements are regulated by the Food and Drug Administration. A. True B. False ____ 8. When melatonin is used to induce sleep, the recommendation is 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 three nights a week D. Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep ____ 9. Valerian tea causes relaxation and can be used to help a patient fall asleep. Overdosage of valerian (more than 2.5 gm/dose) may lead to: A. Cardiac disturbances B. Central nervous system depression C. Respiratory depression D. Skin rashes ____ 10. The standard dosage of St John’s Wort for the treatment of mild depression is: A. 300 mg daily B. 100 mg three times a day C. 300 mg three times a day D. 600 mg three times a day ____ 11. Patients need to be instructed regarding the drug interactions with St John’s Wort, including: A. MAO inhibitors (MAOIs) B. Serotonin reuptake inhibitors (SSRIs) C. Over-the-counter (OTC) cough and cold medications D. All of the above ____ 12. Ginseng, which is taken to assist with memory, may potentiate: A. Aricept B. Insulin C. Digoxin D. Propranolol ____ 13. Licorice root is a common treatment for dyspepsia. Drug interactions with licorice include: A. Antihypertensives, diuretics, and digoxin B. Antidiarrheals, antihistamines, and omeprazole C. Penicillin antibiotic class and benzodiazepines D. None of the above ____ 14. Patients should be warned about the overuse of topical wintergreen oil to treat muscle strains, as overapplication can lead to: A. Respiratory depression B. Cardiac disturbance C. Salicylates poisoning D. Life-threatening rashes ____ 15. The role of the NP in the use of 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

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