Chapter 2. Review of Basic Principles of Pharmacology

1. Question: A patient’s nutritional intake and laboratory results reflect hypo albuminemia. This is critical to prescribing because:
2. Question: Drugs that have a significant first-pass effect:
3. Question: Medroxy progesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir
4. Question: The route of excretion of a volatile drug will likely be the: Medroxy progesterone (Depo Provera) is prescribed intramuscularly (IM) to create a storage reservoir
5. Question: The NP chooses to give cephalexin every 8 hours based on knowledge of the drug’s:
6. Question: Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:
7. Question: The point in time on the drug concentration curve that indicates the first sign of a therapeutic effect is the:
8. Question: Phenytoin requires that a trough level be drawn. Peak and trough levels are done:
9. Question: A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the:
10. Question: Drugs that are receptor agonists may demonstrate what property?
11. Question: Drugs that are receptor antagonists, such as beta blockers, may cause:
12. Question: Factors that affect gastric drug absorption include:
13. Question: Drugs administered via IV:
14. Question: When a medication is added to a regimen for a synergistic effect, the combined effect of the drugs is:
15. Question: Which of the following statements about bioavailability is true?
16. Question: Which of the following statements about the major distribution barriers (blood-brain or fetal- placental) is true?
17. Question: 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:

18. Question: Once they have been metabolized by the liver, the metabolites may be:
19. Question: 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:
20. Question: Steady state is:
21. Question: Two different pain medications are given together for pain relief. The drug—drug interaction
22. Question: Actions taken to reduce drug—drug interaction problems include all of the following EXCEPT:
23. Question: Phase I oxidative-reductive processes of drug metabolism require certain nutritional elements. Which of the following would reduce or inhibit this process?
24. Question: The time required for the amount of drug in the body to decrease by 50% is called:
25. Question: An agonist activates a receptor and stimulates a response. When given frequently over time, the body may:
26. Question: Drug antagonism is best defined as an effect of a drug that:
27. Question: Instructions to a client regarding self-administration of oral enteric-coated tablets should include which of the following statements?
28. Question: The major reason for not crushing a sustained-release capsule is that, if crushed, the coated beads of the drugs could possibly result in:
29. Question: Which of the following substances is the most likely to be absorbed in the intestines rather than in the stomach?
30. Question: Which of the following variables is a factor in drug absorption?
31. Question: An advantage of prescribing a sublingual medication is that the medication is:
32. Question: Drugs that use CYP 3A4 isoenzymes for metabolism may:
33. Question: Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
34. Question: Upregulation or hypersensitization may lead to:

Chapter 7. Cultural and Ethnic Influences in Pharmacotherapeutics

1. Question: Cultural factors that must be taken into account when prescribing include(s):
2. Question: Ethnic differences have been found in drug:
3. Question: The National Standards of Culturally and Linguistically Appropriate Services are required to be implemented in all:
4. Question: According to the National Standards of Culturally and Linguistically Appropriate Services, an interpreter for health care:
5. Question: According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:
6. Question: The racial difference in drug pharmacokinetics seen in American Indian or Alaskan Natives are:
7. Question: Pharmacokinetics among Asians are universal to all the Asian ethnic groups.
8. Question: Alterations in drug metabolism among Asians may lead to:
9. Question: Asians from Eastern Asia are known to be fast acetylators. Fast acetylators:
10. Question: Hispanic native healers (curanderas):

Chapter 8. An Introduction to Pharmacogenomics

1. Question: Genetic polymorphisms account for differences in metabolism, including:
2. Question: Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:
3. Question: Rifampin is a nonspecific CYP450 inducer that may:
4. Question: Inhibition of P-glycoprotein by a drug such as quinidine may lead to:
5. Question: Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:
6. Question: Genetic testing for VCORC1 mutation to assess potential warfarin resistance is required prior to prescribing warfarin.
7. Question: Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:
8. Question: 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:
9. Question: A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:
10. Question: Patients who have a poor metabolism phenotype will have:
11. Question: Ultra-rapid metabolizers of drugs may have:
12. Question: A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:

Chapter 1. The Role of the Nurse Practitioner

1. Question: Nurse practitioner prescriptive authority is regulated by:
2. Question: The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include:
3. Question: Clinical judgment in prescribing includes:
4. Question: Criteria for choosing an effective drug for a disorder include:
5. Question: Nurse practitioner practice may thrive under health-care reform because of:

Chapter 4. Legal and Professional Issues in Prescribing

1. Question: The U.S. Food and Drug Administration regulates:
2. Question: The U.S. Food and Drug Administration approval is required for:
3. Question: An Investigational New Drug is filed with the U.S. Food and Drug Administration:
4. Question: Phase IV clinical trials in the United States are also known as:
5. Question: Off-label prescribing is:
6. Question: The U.S. Drug Enforcement Administration:
7. Question: Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration:
8. Question: Precautions that should be taken when prescribing controlled substances include:
9. Question: Strategies prescribers can use to prevent misuse of controlled prescription drugs include:
10. Question: Behaviors predictive of addiction to controlled substances include:
11. Question: Medication agreements or “Pain Medication Contracts” are recommended to be used:
12. Question: A prescription needs to be written for:

Chapter 13. Over-the-Counter Medications

1. Question: Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must:
2. Question: In the United States, over-the-counter drugs are regulated by:
3. Question: As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to:
4. Question: New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do.
5. Question: The ailment that generates the greatest over-the-counter annual drug sales is:
6. Question: Common over-the-counter pain relievers such as acetaminophen or ibuprofen:
7. Question: 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:
8. Question: The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:
9. Question: When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:

Chapter 25. Drugs Used in Treating Inflammatory Processes

1. Question: Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry?
2. Question: Patient education when prescribing colchicine includes:
3. Question: Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:
4. Question: Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes:
5. Question: Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for:
6. Question: Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for:
7. Question: Daniel 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?
8. Question: Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co- treatment with which medications to prevent further adverse effects?
9. Question: Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of:
10. Question: Patients who are on chronic long-term corticosteroid therapy need education regarding:
11. Question: All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding:
12. Question: Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes:
13. Question: When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs:
14. Question: Josefina is a 2-year-old child with acute otitis media and an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen?
15. Question: Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?
16. Question: The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is:
17. Question: Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is:
18. Question: Monitoring a patient on a high-dose aspirin level includes:
19. Question: Patients who are on long-term aspirin therapy should have annually.

Chapter 52. Pain Management: Acute and Chronic Pain

1. Question: Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the:
2. Question: Patients need to be questioned about all pain sites because:
3. Question: The chemicals that promote the spread of pain locally include:
4. Question: Narcotics are exogenous opiates. They act by:
5. Question: Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true?
6. Question: Which of the following statements is true about acute pain?
7. Question: One of the main drug classes used to treat acute pain is NSAIDs. They are used because:
8. Question: Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?
9. Question: 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?
10. Question: The goal of treatment of acute pain is:
11. Question: Which of the following statements is true about age and pain?
12. Question: Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to:
13. Question: Pathological similarities and differences between acute pain and chronic pain include:
14. Question: A treatment plan for management of chronic pain should include:
15. Question: Chronic pain is a complex problem. Some specific strategies to deal with it include:
16. Question: Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?
17. Question: The Pain Management Contract is appropriate for:

Chapter 14. Drugs Affecting the Autonomic Nervous System

1. Question: 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:
2. Question: To reduce potential adverse effects, patients taking a peripherally acting alpha₁ antagonist should do all of the following EXCEPT:
3. Question: John has clonidine, a centrally acting adrenergic blocker, prescribed for his hypertension. He should
4. Question: Clonidine has several off-label uses, including:
5. Question: Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:
6. Question: Which of the following adverse effects are less likely in a beta₁-selective blocker?
7. Question: 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?
8. Question: Beta blockers are the drugs of choice for exertional angina because they:
9. Question: Adherence to beta blocker therapy may be affected by their:
10. Question: Beta blockers have favorable effects on survival and disease progression in heart failure. Treatment should be initiated when the:
11. Question: Abrupt withdrawal of beta blockers can be life threatening. Patients at highest risk for serious consequences of rapid withdrawal are those with:
12. Question: To prevent life-threatening events from rapid withdrawal of a beta blocker:
13. Question: Beta blockers are prescribed for diabetics with caution because of their ability to produce hypoglycemia and block the common symptoms of it. 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?
14. Question: Combined alpha-beta antagonists are used to reduce the progression of heart failure because they:
15. Question: Carvedilol is heavily metabolized by CYP2D6 and 2C9, resulting in drug interactions with which of the following drug classes?
16. Question: Alpha-beta blockers are especially effective to treat hypertension for which ethnic group?
17. Question: Bethanechol:
18. Question: Clinical dosing of Bethanechol:
19. Question: Patients who need to remain alert are taught to avoid which drug due to its antimuscarinic effects?
20. Question: Anticholinesterase inhibitors are used to treat:
21. Question: Which of the following drugs used to treat Alzheimer’s disease is not an anticholinergic?
22. Question: Taking which drug with food maximizes it bioavailability?
23. Question: Which of the following drugs should be used only when clearly needed in pregnant and breastfeeding women?
24. Question: There is a narrow margin between first appearance of adverse reaction to AChE inhibitors and serious toxic effects. Adverse reactions that require immediate action include:
25. Question: Adherence is improved when a drug can be given once daily. Which of the following drugs can be given once daily?
26. Question: Nicotine has a variety of effects on nicotinic receptors throughout the body. Which of the following is NOT an effect of nicotine?
27. Question: Nicotine gum products are:
28. Question: Nicotine replacement therapy (NRT):
29. Question: Success rates for smoking cessation using NRT:
30. Question: Cholinergic blockers are used to:
31. Question: Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?
32. Question: Scopolamine can be used to prevent the nausea and vomiting associated with motion sickness. The patient is taught to:
33. Question: 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:
34. Question: You are treating a patient with a diagnosis of Alzheimer’s disease. The patient’s wife mentions difficulty with transportation to the clinic. Which medication is the best choice?
35. Question: A patient presents with a complaint of dark stools and epigastric pain described as gnawing and burning. Which of the medications is the most likely cause?
36. Question: 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?
37. Question: Activation of central alpha₂ receptors results in inhibition of cardioacceleration and ___________

centers in the brain.

Chapter 15. Drugs Affecting the Central Nervous System

1. Question: Sarah, a 42-year-old female, requests a prescription for an anorexiant to treat her obesity. A trial of phentermine is prescribed. Prescribing precautions include:
2. Question: Before prescribing phentermine to Sarah, 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:
3. Question: Antonia is a 3-year-old child who has a history of status epilepticus. Along with her routine antiseizure medication, she should also have a home prescription for to be used for an episode of status epilepticus.
4. Question: Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing: 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 include:
5. Question: Carbamazepine has a Black Box Warning due to life-threatening:
6. Question: Long-term monitoring of patients who are taking carbamazepine includes:
7. Question: Six-year-old Lucy has recently been started on ethosuximide (Zarontin) for seizures. She should be monitored for:
8. Question: Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be:
9. Question: Selma, who is overweight, recently started taking topiramate for seizures and at her follow- up visit you note she has lost 3 kg. The appropriate action would be:
10. Question: Monitoring of a patient on gabapentin to treat seizures includes:
11. Question: Scott’s seizures are well controlled on topiramate and he wants to start playing baseball. Education for Scott regarding his topiramate includes:
12. Question: Cara is taking levetiracetam (Keppra) to treat seizures. Routine education for levetiracetam

includes reminding her:

13. Question: Levetiracetam has known drug interactions with:
14. Question: Zainab is taking lamotrigine (Lamictal) and presents to the clinic with fever and lymphadenopathy. Initial evaluation and treatment includes:
15. Question: Samantha is taking lamotrigine (Lamictal) for her seizures and requests a prescription for combined oral contraceptives (COCs), which interact with lamotrigine and may cause:
16. Question: The tricyclic antidepressants should be prescribed cautiously in patients with:
17. Question: A 66-year-old male was prescribed phenelzine (Nardil) while in an acute psychiatric unit for recalcitrant depression. The NP managing his primary health care needs to understand the following regarding phenelzine and other monoamine oxidase inhibitors (MAOIs):
18. Question: Taylor is a 10-year-old child diagnosed with major depression. The appropriate first-line antidepressant for children is:
19. Question: Suzanne is started on paroxetine (Paxil), a selective serotonin reuptake inhibitor (SSRI), for depression. Education regarding her antidepressant includes:
20. Question: Cecilia presents with depression associated with complaints of fatigue, sleeping all the time, and lack of motivation. An appropriate initial antidepressant for her would be:
21. Question: Jake, a 45-year-old patient with schizophrenia, was recently hospitalized for acute psychosis due to medication noncompliance. He was treated with IM long-acting haloperidol. Besides monitoring his schizophrenia symptoms, the patient should be assessed by his primary care provider:
22. Question: Anticholinergic agents, such as benztropine (Cogentin), may be given with a phenothiazine to:
23. Question: Patients who are prescribed olanzapine (Zyprexa) should be monitored for: A 19-year-old male was started on risperidone. Monitoring for risperidone includes observing for common side effects, including:
24. Question: 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 rapidly developing dependence is:
25. Question: A patient with anxiety and depression may respond to:
26. Question: When prescribing temazepam (Restoril) for insomnia, patient education includes:
27. Question: Patients should be instructed regarding the rapid onset of zolpidem (Ambien) because:
28. Question: 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:
29. Question: Tom is taking lithium for bipolar disorder. He should be taught to:
30. Question: Cynthia is taking valproate (Depakote) for seizures and would like to get pregnant. What advice would you give her?
31. Question: When prescribing an opioid analgesic such as acetaminophen and codeine (Tylenol #3),

instructions to the patient should include:

32. Question: Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be:
33. Question: Kasey fractured his ankle in two places and is asking for medication for his pain. The appropriate first-line medication would be:
34. Question: Jack, age 8, 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:
35. Question: Monitoring for a child on methylphenidate for attention deficit hyperactivity disorder (ADHD) includes:
36. Question: When prescribing Adderall (amphetamine and dextroamphetamine) to adults with ADHD the nurse practitioner will need to monitor:

Chapter 29. Anxiety and Depression

1. Question: Common mistakes practitioners make in treating anxiety disorders include:
2. Question: An appropriate first-line drug to try for mild to moderate generalized anxiety disorder would be:
3. Question: An appropriate drug to initially treat panic disorder is:
4. Question: Prior to starting antidepressants, patients should have laboratory testing to rule out:
5. Question: David is a 34-year-old patient who is starting on paroxetine (Paxil) for depression. David’s education regarding his medication would include:
6. Question: Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:
7. Question: An appropriate drug for the treatment of depression with anxiety would be:
8. Question: An appropriate first-line drug for the treatment of depression with fatigue and low energy would be:
9. Question: The laboratory monitoring required when a patient is on a selective serotonin reuptake inhibitor is:
10. Question: Jaycee has been on escitalopram (Lexapro) for a year and is willing to try tapering off of the selective serotonin reuptake inhibitor. What is the initial dosage adjustment when starting a taper off antidepressants?
11. Question: The longer-term Xanax patient comes in and states they need a higher dose of the medication. They deny any additional, new, or accelerating triggers of their anxiety. What is the probable reason?
12. Question: What “onset of action” symptoms should be reviewed with patients who have been newly prescribed a selective serotonin reuptake inhibitor?
13. Question: Which of the following should not be taken with a selective serotonin reuptake inhibitor?
14. Question: Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)?
15. Question: The patient shares with the provider that he is taking his Prozac at night before going to bed. What is the best response?