1. Question :A patient’s nutritional intake and lab work reflect hypoalbuminemia. This is critical to prescribing because:
Distribution of drugs to target tissue may be affected
The solubility of the drug will not match the site of absorption
There will be less free drug available to generate an effect
Drugs bound to albumin are readily excreted by the kidney
Question 2. Drugs that have a significant first-pass effect:
Must be given by the enteral (oral) route only
Bypass the hepatic circulation
Are rapidly metabolized by the liver and may have little if any desired action
Are converted by the liver to more active and fat-soluble forms
Question 3. An advantage of prescribing a sublingual medication is that the medication is:
Question 4. Which one of the following statements about bioavailability is true?
Bioavailability issues are especially important for drugs with narrow therapeutic ranges or sustained release mechanisms.
All brands of a drug have the same bioavailability.
Drugs that are administered more than once a day have greater bioavailability than drugs given once daily.
Combining an active drug with an inert substance does not affect bioavailability.
Question 5. The route of excretion of a volatile drug will likely be:
The bile and feces
Question 6. The time required for the amount of drug in the body to decrease by 50% is called:
Phase II metabolism
Reduced bioavailability time
Question 7. The elderly are at high risk of ADRs due to:
Having greater muscle mass than younger adults, leading to higher volume of distribution
The extensive studies that have been conducted on drug safety in this age group
The blood-brain barrier being less permeable, requiring higher doses to achieve therapeutic effect
Age-related decrease in renal function
Question 8. Patient education regarding prescribed medication includes:
Instructions written at the high school reading level
Discussion of expected ADRs
How to store leftover medication such as antibiotics
Verbal instructions always in English
Question 9. Pharmacokinetic factors that affect prescribing include:
Minimum effective concentration
Ease of titration
Question 10. Drugs that use CYP3A4 isoenzymes for metabolism may:
Induce the metabolism of another drug
Inhibit the metabolism of another drug
Both A and B
Neither A nor B
Question 11.Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that:
Has a short half-life so that missing one dose has limited effect
Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down
Has a tolerability profile with less of the adverse effects that are considered “irritating,” such as nausea and dizziness
Must be taken no more than twice a day
Question 12. A patient may develop neutropenia from using topical Silvadene for burns. Neutropenia is:
A cytotoxic hypersensitivity reaction
An immune complex hypersensitivity
An immediate hypersensitivity reaction
A delayed hypersensitivity reaction
Question 13. Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen?
Complexity of the drug regimen
Patient’s perception of the potential adverse effects of the drugs
Both A and B
Neither A nor B
Question 14. The first step in the prescribing process according to the World Health Organization is:
Choosing the treatment
Educating the patient about the medication
Diagnosing the patient’s problem
Starting the treatment
Question 15. When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare-ups. This is an example of:
His appropriately only telling you about his regularly prescribed medications
His hiding information regarding his inappropriate use of aspirin from you
A common misconception that intermittently taken OTC medications are not an important part of his drug history
A common misuse of OTC aspirin
Question 16. Herbs and supplements are tested for safety by the FDA.
Question 17. The role of the nurse practitioner in the use of herbal medication is to:
Maintain competence in the prescribing of common herbal remedies.
Recommend common OTC herbs to patients.
Educate patients and guide them to appropriate sources of care.
Encourage patients to not use herbal therapy due to the documented dangers.
Question 18. Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
Toxic levels of warfarin building up
Decreased response to warfarin
Increased risk for significant drug interactions with warfarin
Less risk of drug interactions with warfarin
Question 19. Common OTC pain relievers such as acetaminophen or ibuprofen:
Are always safer for the patient than prescription pain medication
Are harmful if taken in higher-than-recommended amounts
Have minimal interaction with prescription medications
Should never be given to children unless recommended by their provider
Question 20. Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:
With a longer half-life so that missed doses produce a longer taper on the drug curve
In oral formulations that are more easily taken
That do not require frequent monitoring
Combined with patient education about the need to adhere even when symptoms are absent
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