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Test Bank - Lehnes Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants, 2nd Edition (Rosenthal, 2021), Unit 1-21 | All Chapters

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  • July 10, 2023
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  • 2nd edition
  • rosenthal
  • 2021
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  • advanced practice nurses and physician assistants

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TEST BANK
Lehne’s Pharmacotherapeutics for Advanced Practice Nurses
and Physician Assistants

Laura D. Rosenthal, and Jacqueline Rosenjack Burchum
2nd Edition

,Table of Contents

Unit 01 Introduction 1
Unit 02 Basic Principles of Pharmacology 6
Unit 03 Drug Therapy Across the Life Span 15
Unit 04 Peripheral Nervous System Drugs 22
Unit 05 Central Nervous System Drugs 31
Unit 06 Drugs for Pain 38
Unit 07 Psychotherapeutic Drugs 43
Unit 08 Substance Use Disorders 51
Unit 09 Drugs That Affect the Heart, Blood Vessels, Blood, and Blood Volume 59
Unit 10 Drugs for Endocrine Disorders 68
Unit 11 Women’s Health 73
Unit 12 Men’s Health 78
Unit 13 Antiinflammatory, Antiallergic, and Immunologic Drugs 83
Unit 14 Drugs for Bone and Joint Disorders 91
Unit 15 Respiratory Tract Drugs 97
Unit 16 Gastrointestinal Drugs 102
Unit 17 Nutrition and Complimentary Therapies 110
Unit 18 Therapy of Infectious and Parasitic Diseases 116
Unit 19 Cancer Therapy 140
Unit 20 Drugs for Eyes, Ears, and Skin 145
Unit 21 Drugs Therapy in Acute Care 152

,______________________________________________________________________________________________
Test Bank - Lehne’s Pharmacotherapeutics for Advanced Practice Nurses & Physician Assistants, 2e (Rosenthal, 2021)

Unit 01: Introduction
Rosenthal: 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 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.
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 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.

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
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.
WWW.TBSM.WS
c. Auscultate the patient's lung sounds and obtain other relevant vital signs.
d. Decrease the dosage to reduce side effects.
ANS: C
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 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 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
would be most concerning to the provider?
a. The patient had a recent yeast infection.
b. There is a family history of cervical cancer.
c. The patient drinks two glasses of wine every night.
d. The patient is unemployed.
ANS: C




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Test Bank - Lehne’s Pharmacotherapeutics for Advanced Practice Nurses & Physician Assistants, 2e (Rosenthal, 2021)

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.
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
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
ANS: A
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
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
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 medicationWWW.TBSM.WS
for migraine management.
d. Suggest biofeedback as an adjunct to drug therapy.
ANS: A
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 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 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 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
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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Test Bank - Lehne’s Pharmacotherapeutics for Advanced Practice Nurses & Physician Assistants, 2e (Rosenthal, 2021)

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?
a. Evaluate preadministration blood work.
b. Prescribe the lithium to be taken at regular intervals.
c. Order periodic laboratory testing.
d. Assess the patient for signs and symptoms of lithium toxicity.
ANS: C
Therapeutic serum levels are determined through periodic laboratory testing.
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,
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.

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.
WWW.TBSM.WS
b. Enrollment in medical schools is predicted to decrease.
c. Enrollment in both APRN and PA programs has increased.
d. Physician practices have become so large, quality care is in jeopardy.
ANS: A
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
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. 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
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.
c. Prescribe an antihistamine for the itching.
d. Flag all medical records with an “Allergic to Penicillin” notice.
ANS: B



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Test Bank - Lehne’s Pharmacotherapeutics for Advanced Practice Nurses & Physician Assistants, 2e (Rosenthal, 2021)

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?
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
d. Assuring that the medication prescription will be covered by the patient’s
insurance
ANS: C
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 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?
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 WWW.TBSM.WS
to take the pill every other day; so, I’ve missed several
doses.”
d. “I have a very intense, fast paced job; it’s hard to make time to take the medication
like I should.”
ANS: B
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
time. Medication costs, forgetfulness, and lack of planning are suggested by the other
options.

MULTIPLE RESPONSE

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.
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.
e. Pharmacy can alter prescriptions when necessary to prevent patient harm.
ANS: B, C, D




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Test Bank - Lehne’s Pharmacotherapeutics for Advanced Practice Nurses & Physician Assistants, 2e (Rosenthal, 2021)

Providers should collaborate with pharmacists because they will likely have additional
information on formulary, drug interactions, and suggestions for adequate medication
dosing. Dietitians can make food recommendations to treat the patient’s condition. The
pharmacist can contact the prescriber about questionable prescriptions, but cannot alter the
prescription without notification of and approval by the provider.

2. Which statements made by the prescriber demonstrate an understanding of effective
medication education? (Select all that apply.)
a. “This medication needs to be stored in the refrigerator.”
b. “Take 3 tablets daily: 1 with breakfast, 1 with lunch, and one with dinner.”
c. “You need to take the medication as we discussed until all the tablets are gone.”
d. “Call the office immediately if you begin experiencing any itching, headache, or
difficulty breathing.”
e. “When you call about a medication refill, be sure to let the pharmacist know you
are talking about your heart pill.”
ANS: A, B, C, D
There are basic components that should be included when teaching about any new
medication. They are (1) medication name, (2) purpose, (3) dosing regimen, (4)
administration, (5) adverse effects, (6) any special storage needs, (7) associated laboratory
testing, (8) food or drug interactions, and (9) duration of therapy. The statement suggesting
referring to the medication as “your heart pill” is inappropriate since being familiar with the
drug’s name is important in avoiding medication errors.

3. The patient who has been prescribed lithium for a diagnosis of bipolar disorder asks why
blood tests are required on a regular basis. Which provider responses demonstrate an
understanding of why the patientWWW.TBSM.WS
requires a variety of laboratory tests? (Select all that
apply.)
a. “We need to monitor how your thyroid is functioning.”
b. “We need to monitor kidney function while you are on this drug.”
c. This medication can cause you to lose sodium, so we need to measure sodium
levels.”
d. “Your liver can be damaged by lithium; regular testing helps us monitor for that.”
e. “Lithium can cause you to lose potassium; so, we regularly monitor your blood
potassium level.”
ANS: A, B, C
Lithium therapy can affect thyroid and renal function as well as deplete sodium levels.
Regular laboratory testing is needed to monitor sodium levels and thyroid and renal function
and so allows for modification of the lithium dose as needed. Lithium is not associated with
altered liver function or potassium depletion.




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,______________________________________________________________________________________________
Test Bank - Lehne’s Pharmacotherapeutics for Advanced Practice Nurses & Physician Assistants, 2e (Rosenthal, 2021)

Unit 02: Basic Principles of Pharmacology
Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician
Assistants, 2nd Edition


MULTIPLE CHOICE

1. When prescribing lovastatin, what will a provider advise to decrease the risk of developing
muscle toxicity?
a. Avoid exercise for 2 hours after administration.
b. Substitute grapefruit juice with orange juice.
c. Monitor aspartate aminotransferase (AST) and alanine aminotransferase (ALT).
d. Take the medication with an NSAID or other anti-inflammatory drug.
ANS: B
Grapefruit juice can inhibit the metabolism of certain drugs including statins like lovastatin.
The juice raises drug levels decreasing the intestinal metabolism of the drug resulting in
increased drug levels which increases the risk for adverse effects such as muscle toxicity.
Taking the drug with an anti-inflammatory drug and avoiding exercise after administration
are not supported by science. Monitoring AST and ALT detects liver toxicity, not muscle
toxicity.

2. When prescribing drugs with a narrow therapeutic index, what intervention does the
provider take to decrease risk to the patient?
a. Schedule drug administration intervals that exceed the drug’s half-life.
b. Order the medication to be administered by the intravenous route.
c. Monitor the patient’s plasma WWW.TBSM.WS
drug levels at regular intervals.
d. Teach the patient that optimal outcomes will require adherence to the medication
regimen.
ANS: C
A drug with a narrow therapeutic range or index is more difficult to administer safely,
because the difference between the minimum effective concentration and the toxic
concentration is small. Patients taking these medications must have their plasma drug levels
monitored closely to ensure that they are getting an effective dose that is not toxic.
Administering medications at longer intervals risks increased periods of subtherapeutic
levels. Drugs that have a narrow therapeutic range may be given by any route; intravenous
administration is not preferable and in most cases will not be feasible. Medication regimen
adherence is necessary; however, due to individual variation, for drugs with a narrow
therapeutic range, what is an effective dose for one patient may be a lethal dose for another.
For this reason, monitoring drug levels remains the primary method for decreasing risk.

3. A patient reports that a medication no longer effectively alleviates symptoms. What process
informs the provider’s response to the patient’s concerns?
a. Endogenous antagonists compete with the drug for receptor sites.
b. Decreased selectivity for receptors results in a variety of effects.
c. Desensitization of receptor sites results from continual exposure to the drug.
d. Additional receptor sites are synthesized in response to the medication.
ANS: C



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Test Bank - Lehne’s Pharmacotherapeutics for Advanced Practice Nurses & Physician Assistants, 2e (Rosenthal, 2021)

Continual exposure to an agonist would cause the cell to become less responsive or
desensitized. The body does not produce antagonists as a response to a medication.
Medication tolerance is not related to receptor selectivity. Medications do not cause more
receptors to be produced.

4. A patient reports that Brand X tablets work faster than Brand Y tablets of the same amount
of the same drug. Which statement informs the prescriber’s response when explaining this
phenomenon to the patient?
a. Advertising by pharmaceutical companies can enhance patient expectations of one
brand over another, leading to a placebo effect.
b. Because the drug preparations are chemically equivalent, the actions of the two
brands must be identical.
c. Inactive ingredients used in composition can result in differing rates of dissolution,
which can alter the drug’s onset of action.
d. The bioavailability of a drug is determined by the amount of the drug in each dose.
ANS: C
Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of
the same chemical compound), they can have different effects in the body if they differ in
bioavailability. Tablets made by different manufacturers contain different binders and
fillers, which disintegrate and dissolve at different rates and affect the bioavailability of the
drug.

5. A patient receiving intravenous gentamicin has a toxic serum drug level. The prescriber
confirms that the dosing is correct. Which possible cause of this situation will the provider
explore?
a. Whether a loading dose wasWWW.TBSM.WS
administered
b. If the drug was completely dissolved in the IV solution
c. Whether patient is taking a medication that binds to serum albumin
d. If the ordered dose frequency is longer than the gentamicin half-life
ANS: C
Gentamicin binds to albumin, but only weakly, and in the presence of another drug that
binds to albumin, it can rise to toxic levels in blood serum. A loading dose increases the
initial amount of a drug and is used to bring drug levels to the desired plateau more quickly.
A drug that is not completely dissolved carries a risk of causing embolism but this addresses
a different concern. A drug given at a frequency longer than the drug half-life will likely be
at subtherapeutic levels and not at toxic levels.

6. A patient takes a drug that is metabolized by CYP3A4 isoenzymes. If a CYP3A4 inducing
drug is prescribed, what drug adjustment may be necessary to maintain a therapeutic level of
CYP3A4 substrate?
a. Increase dosage of the CYP3A4 inducer.
b. Decrease dosage of the CYP3A4 inducer.
c. Increase dosage of the CYP3A4 substrate.
d. Decrease dosage of the CYP3A4 substrate.
ANS: C




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Test Bank - Lehne’s Pharmacotherapeutics for Advanced Practice Nurses & Physician Assistants, 2e (Rosenthal, 2021)

A drug that acts as an inducing agent for an enzyme system increases the metabolism of
drugs metabolized by that enzyme system, thereby lowering the level of those drugs in the
body and requiring higher doses to maintain drug effectiveness. Although decreasing the
dosage of the drug that induces metabolism may seem reasonable at first glance, this may
decrease the therapeutic level of the drug making it ineffective in treating the condition for
which it was prescribed.

7. The provider prescribes hydrocodone with acetaminophen for a patient’s postsurgical pain.
What instruction will the prescriber include regarding alcohol intake?
a. “If you plan to drink alcohol, I will write an order for acetaminophen without
hydrocodone for your pain.”
b. “I’d suggest that you substitute ibuprofen for pain on days when you plan to drink
alcohol.”
c. “You should avoid drinking alcohol while you are taking the pain medication I’ve
ordered.”
d. “You should limit your alcohol intake to no more than two servings of alcohol
daily while on the pain medication.”
ANS: C
Combining a hepatotoxic drug with other hepatotoxic agents increases the risk of
hepatotoxicity. When even therapeutic doses of acetaminophen are taken with alcohol, the
acetaminophen can cause liver damage. Patients should be cautioned not to drink alcohol;
even two drinks with acetaminophen can produce this effect. Hydrocodone does not
contribute to hepatotoxicity. Ibuprofen is not indicated for postoperative pain unless the pain
is mild. Limiting alcohol intake to two servings per day still increases the risk of
hepatotoxicity.
WWW.TBSM.WS
8. Which order for furosemide is written appropriately by the prescriber?
a. Furosemide [Lasix] 20 mg PO QD
b. Furosemide [Lasix] 20 mg PO qd
c. Furosemide [Lasix] 20 mg daily
d. Furosemide [Lasix] 20 mg PO daily
ANS: D
The correct answer is a complete order; it contains the medication, dose, route, and time.
“QD” and “qd” are no longer accepted abbreviations; it should be written out as “daily” or
“every day.” The order of “20 mg daily” does not specify the route to be used.

9. A drug can cause symptoms that resemble those of Parkinson disease. What action should
the prescriber take to minimize the potential patient risk?
a. Explain that these are teratogenic effects that must be reported immediately.
b. Thoroughly educate the patient about recognizing such symptoms and the need to
notify the office immediately.
c. Order an evaluation of the patient’s genetic predisposition to these effects.
d. Educate the patient about these symptoms and provide reassurance that the
condition is expected.
ANS: B




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