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Rosenthal: Lehne’s Pharmacotherapeutics for Advanced Practice Nurses andPhysician Assistants, 2nd Edition
Unit 01: Introduction
Case Study
Mr. G, PA is recent graduate of a master’s degree PA program. His program has prepared him in
prescribing using rational drug selection. He feels confident that he can promote positive
outcomes when prescribing. He is exploring licensure in a variety of states.
1. Several factors influence PA or APRN prescribing authority. Prescribing authority is
a. determined by state law.
b. the same for PAs and APRNs.
c. is the same in all states.
d. regulated by the federal government.
2. While rational drug selection is based on the individual patient the aspect of rational drug
selection addressing disease-specific information by a national medical or nursing organization is
a. a guideline.
b. cost.
c. availability.
d. patient hepatic and renal function.
3. One aspect of promotion of positive outcomes is medication education. Identify the incorrect
statement.
a. Teach the patient purpose of the drug.
b. Teach the patient brand or generic name.
c. Teach the patient the dosing schedule.
d. Teach the patient about adverse reactions.
Unit 02: Basic Principles of Pharmacology
Case Study
The prescriber uses knowledge of pharmacokinetics, pharmacodynamics, and drug interactions
to prescribe. This knowledge assists the prescriber in reducing adverse drug reactions and
medication errors. For Mary, an 89-year-old, Asian female who weighs 110 pounds and is 65
inches tall, several key points must be considered when prescribing.
1. Identify the most concerning points for Mary’s drug metabolism.
,a. Potential for impaired renal and hepatic function due to age, body weight and composition,
and female.
b. Body weight and composition, race, potential for tolerance.
c. First pass effect, body weight and composition, and race.
d. Female, body weight and composition, decreased therapeutic action.
2. To reduce the risk of adverse drug reactions for Mary, the prescriber should
a. avoid medications with a boxed warning.
b. evaluate the risk versus benefit of specific medications with monitoring of complete blood
count and complete metabolic panel for every visit.
c. provide patient education regarding potential adverse drug reactions with instructions for
follow-up.
d. trust that Mary knows her own body and will know if anything changes.
3. Which statement about race as a factor for medication prescribing is most accurate?
a. Race has not been helpful in determining individual drug responses.
b. Individual drug responses based on race are well defined.
c. Specific genetic testing based on a risk factor or specific genetic variation is not helpful in
prescribing.
d. Genetic testing across ethnic groups has defined treatment for a variety of disease processes.
4. Pharmacogenomics (Select all that apply.)
a. has limited usefulness in prescribing to individuals.
b. can offer the prescriber insight into expected responses to specific medications.
c. does not identify paths of altered metabolism.
d. provides exact recommendations for drug therapy for prescribers.
Unit 03: Drug Therapy Across the Life Span
Case Study
The advanced practice prescriber must be aware of variations in prescription therapy based on
age, pregnancy, and breastfeeding. Each of these may require alteration in prescribing decisions.
Awareness of these variations may reduce the risk of adverse drug reactions.
1. Britney, a 22-year-old African-American female, is 16 weeks pregnant. She has a preexisting
diagnosis of asthma. The advanced practice prescriber knows that
a. her pregnancy has no effect on her asthma.
b. her asthma increases her risk for fetal death.
c. her asthma medications must be discontinued due to risk to the fetus.
d. her asthma medications may be less effective due to pregnancy.
, 2. When prescribing for Britney, the advanced practice prescriber should consider
a. that any medication Britney receives will cross the placental barrier to the fetus.
b. that medications will be stopped by the placental barrier preventing transmission to the fetus.
c. lipid soluble medications have limited transmission across the placental barrier.
d. protein-bound medications are readily transmitted across the placental barrier.
3. Anisha is a 6-month-old infant. She was full term at delivery with no postdelivery
complications. If considering prescribing for her, the prescriber knows
a. drug sensitivity in the infant is related to immature organ systems.
b. renal and hepatic systems are fully developed in utero.
c. prescriptions are based solely on age.
d. gastric emptying is similar to adults at birth.
4. Promoting adherence to medications can be achieved by
a. providing verbal instructions only.
b. selected medications that must be delivered several times a day.
c. trusting the pharmacist will provide flavorings and medication education.
d. medication education regarding dosage, quantity, timing, and duration of treatment.
5. The prescriber may provide care to patients at the end of their life. The prescriber knows
a. medications for treatment of illness remains the same throughout end of life care.
b. medications for treatment of illness may be discontinued while medications for comfort are
added.
c. treatment of symptoms such as constipation and excess secretions are best managed with over-
the-counter medications.
d. sedatives and opiates are always inappropriate in the elderly.
Unit 04: Peripheral Nervous System Drugs
Case Study
Jackie is a 55-year-old nurse who works on the Medical-Surgical floor of the local hospital. She
is experiencing symptoms of overactive bladder (OAB) with frequency and urge incontinence. A
urinalysis is negative for infection, protein, or glucose. She has no known drug allergies. Past
medical history includes hypertension. Current medication is Losartan 50 mg daily. She denies
use of over-the-counter medications or supplements.
1. When selecting treatment for Jackie the advanced practice provider knows the treatments for
OAB are classified as
a. muscarinic agonists.
b. muscarinic antagonists.
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