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Lehnes Pharmacotherapeutics for Advanced Practice Nurses
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- Pharmacotherapeutics
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Unit 01: IntroductionRosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician
Assistants, 2nd Edition
MULTIPLE CHOICE
1. A patient diagnosed with chronic pain calls to request an oxycodone (Oxycontin) refill. Which
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action should the prescriber take initially?
a. Fax the renewal order to the pharmacy.
b. Arrange to schedule an appointment with the patient.
c. Verify the patient’s adherence to the prescribed drug regimen.
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d. Determine the patient’s current medication dosage and pain level.
ANS: B
Schedule II medications are not eligible for refills, and prescriptions must be handwritten. It is
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important to verify the patient’s adherence to the drug regimen and determine the current
dosage of medication and pain level; however, this can be accomplished by scheduling an
appointment and evaluating the patient in person.
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2. A metered-dose albuterol inhaler is prescribed for asthma management. The patient reports
feeling jittery sometimes when taking the medication, and does not feel that the medication is
always effective. Which action will the provider take to best minimize patient risks and
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maximize medication effectiveness?
a. Ask the patient to demonstrate use of the inhaler and assess effectiveness.
b. Assess the patient’s exposure to first- and second-hand tobacco smoke.
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c. Auscultate the patient's lung sounds and obtain other relevant vital signs.
d. Decrease the dosage to reduce side effects.
ANS: C
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Assessing and evaluating lung sounds as well as other vital signs helps determine the patient's
physical response to the medication and allows comparison to the patient's baseline vital
signs. Asking the patient to demonstrate inhaler use helps to evaluate the patient’s ability to
administer the medication properly and is part of an effective evaluation, but is not a priority
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intervention based on the patient’s current report. Assessing tobacco smoke exposure helps
determine whether nondrug therapies, such as smoke avoidance, can be used as an adjunct to
drug therapy, but does not relate to the patient’s current problem. Rewriting the prescription to
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decrease the dosage may address the degree of jitteriness experienced, but does not address
the patient’s concern that the drug is not always effective.
3. A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding
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would be most concerning to the provider?
a. The patient had a recent yeast infection.
b. There is a family history of cervical cancer.
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c. The patient drinks two glasses of wine every night.
d. The patient is unemployed.
ANS: C
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, Patients taking metronidazole should be educated not to drink alcohol to prevent a
disulfiram-like reaction. It would be concerning that the patient drinks wine daily. History of a
yeast infection may indicate increased risk for recurrence with administration of an
antimicrobial. A family history of cervical cancer is not related to administration of
metronidazole. Unemployment can indicate lack of insurance coverage, which may limit the
patient’s ability to purchase medications; however, generic metronidazole is one of the less
expensive medications.
4. The provider prepares a patient with newly diagnosed type 1 diabetes for hospital discharge.
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Which action by the provider will best support the patient’s ability to effectively manage
medication therapy?
a. Asking the patient to demonstrate how to measure and administer insulin
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b. Discussing methods of storing insulin and discarding syringes
c. Giving information about how diet and exercise affect insulin requirements
d. Teaching the patient about the long-term consequences of poor diabetes control
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Because insulin must be given correctly to control symptoms and prevent an overdose, it is
most important for the patient to know how to measure and administer it. Asking for a
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demonstration of technique is the best way to determine whether the patient has understood
the teaching. The other teaching points are important as well, but they are not as critical.
5. A patient reports that a medication prescribed for recurrent migraine headaches is not
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working. Which action is the prescriber’s priority when addressing the patient's concern?
a. Ask the patient about the number and frequency of tablets taken.
b. Assess the patient’s headache pain on a scale from 1 to 10.
c. Prescribe a new medication for migraine management.
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d. Suggest biofeedback as an adjunct to drug therapy.
ANS: A
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When evaluating the effectiveness of a drug, it is important to determine how often the patient
is using the drug. Asking the patient to identify how many tablets are taken and how often
helps the provider determine effective dosages and adherence to the medication regimen. The
patient has already stated that the medication is not working; the actual level of pain may
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determine the degree to which it is not working, but it does not help the provider to determine
why it is not working. The assessment process should gather as much information about
compliance, symptoms, and drug effectiveness as possible before enacting a change in
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treatment. Biofeedback may be an effective adjunct to treatment, but it should not be
recommended without complete information about drug effectiveness.
6. The drug manual states that older adult patients are at increased risk for hepatotoxicity. Which
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action is most important when prescribing this medication to an 80-year-old patient?
a. Obtaining baseline liver function studies
b. Ensuring that the drug is taken in the correct dose at the correct time
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c. Discontinuing the order; the drug is contraindicated for this patient
d. Giving the medication intravenously to avoid first pass metabolism
ANS: A
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, The drug manual indicates that this drug increases risk of hepatotoxicity for elderly patients.
Getting information about liver function before giving the drug establishes baseline data that
can be compared with posttreatment data to determine whether the drug is affecting the liver.
Taking the correct dose at the correct interval may minimize risk, but without baseline
information, the effects cannot be determined. Drugs are not routinely contraindicated for an
increased risk of adverse effects.
7. A patient with bipolar disorder is prescribed daily lithium. Which action is most important for
the provider to take in order to determine if the therapeutic level is maintained?
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a. Evaluate preadministration blood work.
b. Prescribe the lithium to be taken at regular intervals.
c. Order periodic laboratory testing.
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d. Assess the patient for signs and symptoms of lithium toxicity.
ANS: C
Therapeutic serum levels are determined through periodic laboratory testing.
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Preadministration blood work may be necessary to obtain baseline status prior to initiating
treatment, but it will not determine therapeutic levels. Scheduling medication administration
at regular intervals will help to ensure medication is absorbed and metabolized predictably,
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but it will not determine therapeutic blood levels. Assessing the patient for signs and
symptoms of toxicity will help to determine if the therapeutic level has been exceeded, not
maintained.
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8. Which factor best supports an increase for full prescriptive authority for both advanced
practice registered nurses (APRNs) and physician assistants (PAs)?
a. More patients will have access to health care.
b. Enrollment in medical schools is predicted to decrease.
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c. Enrollment in both APRN and PA programs has increased.
d. Physician practices have become so large, quality care is in jeopardy.
ANS: A
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Implementation of the Affordable Care Act has increased the number of individuals with
health care coverage, and thus the number who have access to health care services. The
increase in the number of patients creates the need for more providers with prescriptive
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authority. APRNs and physical assistants can fill this practice gap. Enrollment in medical
school has increased in recent years and shows no indication of decline. While some medical
practices have increased in patient volume, there is no reason to believe care has suffered.
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While enrollment for both APRN and PA education has increased, that is not the primary
factor associated with the need for increased prescriptive authority for these providers.
9. A pediatric patient prescribed ampicillin for streptococcal pharyngitis reports new onset of a
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pruritic, dull red, maculopapular rash on the chest and neck. Which action is most important
for the provider to take to minimize this patient’s risk for injury?
a. Prescribe azithromycin to replace the ampicillin.
b. Discontinue the ampicillin.
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c. Prescribe an antihistamine for the itching.
d. Flag all medical records with an “Allergic to Penicillin” notice.
ANS: B
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, The priority action is to discontinue the medication to prevent a potential worsening of the
patient’s symptoms. A different prescription may be indicated depending on the length of
treatment. An antihistamine may be administered for pruritis. Rashes are a common side
effect of ampicillin. Pruritic maculopapular rashes such as the one described occur in 5% to
10% of children taking ampicillin, especially in the presence of viral infections. They do not
contraindicate future administration of penicillin antibiotics.
10. Which prescriber action will have the greatest impact on the patient’s commitment to
adherence to any type of medication therapy?
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a. Prescribing the medication in oral form whenever possible
b. Scheduling once a day administration
c. Providing medication education that the patient can easily understand
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d. Assuring that the medication prescription will be covered by the patient’s
insurance
ANS: C
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No other provider action assures the patient’s commitment to adhere to a medication plan
more than effective medication education provided in a concise, understandable form. It is not
always possible or appropriate to prescribe an oral form. While medication costs can present a
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barrier to compliance, insurance coverage is but one factor affecting costs.
11. Which patient statement suggests to the provider that the patient’s nonadherence with their
medication plan is related to dissatisfaction with the therapy?
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a. “This medication is too expensive; I can’t afford it any longer.”
b. “I’ve been taking this medication for well over a week and I lost only a half a
pound.”
c. “It’s too hard to remember to take the pill every other day; so, I’ve missed several
doses.” abirb.com/test
d. “I have a very intense, fast paced job; it’s hard to make time to take the medication
like I should.”
ANS: B
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Dissatisfaction with drug therapy can take the form of a patient’s unrealistic expectation of
desired results such as in the case of significant weight loss in a relatively short period of
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time. Medication costs, forgetfulness, and lack of planning are suggested by the other options.
MULTIPLE RESPONSE
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1. How can the prescriber’s regular collaboration with a pharmacist improve positive outcomes
for patients? (Select all that apply.)
a. Pharmacists can suggest foods that will help with the medications' absorption.
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b. Pharmacists have additional information on drug interactions.
c. The pharmacist can suggest adequate medication dosing.
d. Pharmacists have firsthand knowledge of the facility formulary.
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e. Pharmacy can alter prescriptions when necessary to prevent patient harm.
ANS: B, C, D
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