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. 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: Absorbed rapidly Excreted rapidly Metabolized minimally Distributed equally 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 kidneys The lungs The bile and feces The skin Question 6. The time required for the amount of drug in the body to decrease by 50% is called: Steady state Half-life 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: Therapeutic index Minimum effective concentration Bioavailability 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. True False 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 ]]>