NUR 600: ADVANCED CLINICAL PHARMACOLOGY: EXAM 1
QUESTIONS WITH ACCURATE SOLUTIONS
1) Sadie is a 90-year-old patient who requires a new prescription. What changes in
drug distribution with aging would influence prescribing for Sadie?
A) Increased volume of distribution
B) Decreased lipid solubility
C) Decreased plasma proteins
D) Increased muscle to fat ratio -- Correct Answer ✔✔ C.
Decreased plasma proteins
2) Glen is an 82 year old who needs to be prescribed a new drug. What changes in
elimination should be taken into consideration when prescribing for Glen?
A) Increased GFR will require higher doses of some renally excreted
drugs
B) Decreased tubular secretion of medication will require dosage
adjustments
C) Thin skin will cause increased elimination via sweat
D) Decreased lung capacity will lead to measurable decreases in lung
excretion of drugs -- Correct Answer ✔✔ B. Decreased tubular
secretion of medication will require dosage adjustments
3) A medication review of an elderly person's medications involves:
, A) Asking the patient to bring a list of current prescription
medications to the visit
B) Having the patient bring all of their prescription, over-the-
counter, and herbal medication to the visit
C) Asking what other providers are writing prescriptions for them
D) All of the above -- Correct Answer ✔✔ D. All of the above
4) Steps to avoid polypharmacy include:
A) Prescribing two or fewer drugs from each drug class
B) Reviewing a complete drug history every 12 to 18 months
C) Encouraging the elderly patient to coordinate their care with all
of their providers
D) Evaluating for duplications in drug therapy and discontinuing any
duplications -- Correct Answer ✔✔ D. Evaluating for
duplications in drug therapy and discontinuing any duplications
5) Robert is a 72 year old who has hypertension and angina. He is at risk for
common medication practices seen in the elderly including:
A) Use of another person's medications
B) Hoarding medications
C) Changing his medication regimen without telling his provider
D) All of the above -- Correct Answer ✔✔ D. All of the above
6) To improve positive outcomes when prescribing for the elderly the nurse
practitioner should:
A) Assess cognitive functioning in the elder
B) Encourage the patient to take a weekly "drug holiday" to keep
drug costs down
C) Encourage the patient to cut drugs in half with a knife to lower
costs
D) All of the above -- Correct Answer ✔✔ A. Assess cognitive
functioning in the elder
7) When an elderly diabetic patient is constipated the best treatment options
include:
, A) Mineral oil
B) Bulk-forming laxatives such as psyllium
C) Stimulant laxatives such as senna
D) Stool softeners such as docusate -- Correct Answer ✔✔ D.
Stool softeners such as docusate
8) Delta is an 88 year old who has mild low back pain. What guidelines should be
followed when prescribing pain management for Delta?
A) Keep the dose of oxycodone low to prevent development of
tolerance
B) Acetaminophen is the first-line drug of choice
C) Avoid prescribing NSAIDs
D) Add in a short-acting benzodiazepine for a synergistic effect on
pain -- Correct Answer ✔✔ B. Acetaminophen is the first-line
drug of choice
9) Robert is complaining of poor sleep. Medications that may contribute to sleep
problems in the elderly include:
A) Diuretics
B) Trazodone
C) Clonazepam
D) Levodopa -- Correct Answer ✔✔ A. Diuretics
10) Different areas of the brain are involved in specific aspects of pain. The reticular
and limbic systems in the brain influence:
A) The sensory aspects of pain
B) The discriminative aspects of pain
C) The motivational aspects of pain
D) The cognitive aspects of pain -- Correct Answer ✔✔ C. The
motivational aspects of pain
11) Patients need to be questioned about all pain sites because:
A) Patients tend to report the most severe or important in their
perception
B) Pain tolerance generally decreases with repeated exposure
, C) The reported pain site is usually the most important to treat
D) Pain may be referred from a different site to the one reported --
Correct Answer ✔✔ A. Patients tend to report the most severe
or important in their perception
12) The chemicals that promote the spread of pain locally include:
A) Serotonin
B) Norepinephrine
C) Enkephalin
D) Neurokinin A -- Correct Answer ✔✔ D. Neurokinin A
13) Narcotics are exogenous opiates. They act by:
A) Inhibiting pain transmission in the spinal cord
B) Attaching to receptors in the afferent neuron to inhibit the
release of substance P
C) Blocking neurotransmitters in the midbrain
D) Increasing beta-lipoprotein excretion from the pituitary --
Correct Answer ✔✔ B. Attaching to receptors in the afferent
neuron to inhibit the release of substance P
14) Age is a factor in different responses to pain. Which of the following age-related
statements about pain is NOT true?
A) Preterm and newborn infants do not yet have functional pain
pathways.
B) Painful experiences and prolonged exposure to analgesic drugs
during pregnancy may permanently alter neuronal organization in
the child.
C) Increases in pain threshold in older adults may be related to
peripheral neuropathies and changes in skin thickness
D) Decreases in pain tolerance are evident in older adults --
Correct Answer ✔✔ A. Preterm and newborn infants do not yet
have functional pain pathways.
15) Which of the following statements is true about acute pain?
QUESTIONS WITH ACCURATE SOLUTIONS
1) Sadie is a 90-year-old patient who requires a new prescription. What changes in
drug distribution with aging would influence prescribing for Sadie?
A) Increased volume of distribution
B) Decreased lipid solubility
C) Decreased plasma proteins
D) Increased muscle to fat ratio -- Correct Answer ✔✔ C.
Decreased plasma proteins
2) Glen is an 82 year old who needs to be prescribed a new drug. What changes in
elimination should be taken into consideration when prescribing for Glen?
A) Increased GFR will require higher doses of some renally excreted
drugs
B) Decreased tubular secretion of medication will require dosage
adjustments
C) Thin skin will cause increased elimination via sweat
D) Decreased lung capacity will lead to measurable decreases in lung
excretion of drugs -- Correct Answer ✔✔ B. Decreased tubular
secretion of medication will require dosage adjustments
3) A medication review of an elderly person's medications involves:
, A) Asking the patient to bring a list of current prescription
medications to the visit
B) Having the patient bring all of their prescription, over-the-
counter, and herbal medication to the visit
C) Asking what other providers are writing prescriptions for them
D) All of the above -- Correct Answer ✔✔ D. All of the above
4) Steps to avoid polypharmacy include:
A) Prescribing two or fewer drugs from each drug class
B) Reviewing a complete drug history every 12 to 18 months
C) Encouraging the elderly patient to coordinate their care with all
of their providers
D) Evaluating for duplications in drug therapy and discontinuing any
duplications -- Correct Answer ✔✔ D. Evaluating for
duplications in drug therapy and discontinuing any duplications
5) Robert is a 72 year old who has hypertension and angina. He is at risk for
common medication practices seen in the elderly including:
A) Use of another person's medications
B) Hoarding medications
C) Changing his medication regimen without telling his provider
D) All of the above -- Correct Answer ✔✔ D. All of the above
6) To improve positive outcomes when prescribing for the elderly the nurse
practitioner should:
A) Assess cognitive functioning in the elder
B) Encourage the patient to take a weekly "drug holiday" to keep
drug costs down
C) Encourage the patient to cut drugs in half with a knife to lower
costs
D) All of the above -- Correct Answer ✔✔ A. Assess cognitive
functioning in the elder
7) When an elderly diabetic patient is constipated the best treatment options
include:
, A) Mineral oil
B) Bulk-forming laxatives such as psyllium
C) Stimulant laxatives such as senna
D) Stool softeners such as docusate -- Correct Answer ✔✔ D.
Stool softeners such as docusate
8) Delta is an 88 year old who has mild low back pain. What guidelines should be
followed when prescribing pain management for Delta?
A) Keep the dose of oxycodone low to prevent development of
tolerance
B) Acetaminophen is the first-line drug of choice
C) Avoid prescribing NSAIDs
D) Add in a short-acting benzodiazepine for a synergistic effect on
pain -- Correct Answer ✔✔ B. Acetaminophen is the first-line
drug of choice
9) Robert is complaining of poor sleep. Medications that may contribute to sleep
problems in the elderly include:
A) Diuretics
B) Trazodone
C) Clonazepam
D) Levodopa -- Correct Answer ✔✔ A. Diuretics
10) Different areas of the brain are involved in specific aspects of pain. The reticular
and limbic systems in the brain influence:
A) The sensory aspects of pain
B) The discriminative aspects of pain
C) The motivational aspects of pain
D) The cognitive aspects of pain -- Correct Answer ✔✔ C. The
motivational aspects of pain
11) Patients need to be questioned about all pain sites because:
A) Patients tend to report the most severe or important in their
perception
B) Pain tolerance generally decreases with repeated exposure
, C) The reported pain site is usually the most important to treat
D) Pain may be referred from a different site to the one reported --
Correct Answer ✔✔ A. Patients tend to report the most severe
or important in their perception
12) The chemicals that promote the spread of pain locally include:
A) Serotonin
B) Norepinephrine
C) Enkephalin
D) Neurokinin A -- Correct Answer ✔✔ D. Neurokinin A
13) Narcotics are exogenous opiates. They act by:
A) Inhibiting pain transmission in the spinal cord
B) Attaching to receptors in the afferent neuron to inhibit the
release of substance P
C) Blocking neurotransmitters in the midbrain
D) Increasing beta-lipoprotein excretion from the pituitary --
Correct Answer ✔✔ B. Attaching to receptors in the afferent
neuron to inhibit the release of substance P
14) Age is a factor in different responses to pain. Which of the following age-related
statements about pain is NOT true?
A) Preterm and newborn infants do not yet have functional pain
pathways.
B) Painful experiences and prolonged exposure to analgesic drugs
during pregnancy may permanently alter neuronal organization in
the child.
C) Increases in pain threshold in older adults may be related to
peripheral neuropathies and changes in skin thickness
D) Decreases in pain tolerance are evident in older adults --
Correct Answer ✔✔ A. Preterm and newborn infants do not yet
have functional pain pathways.
15) Which of the following statements is true about acute pain?
