Question 1

Patients with pernicious anemia require treatment with:

Accepted Answer

A)  Iron 
B)  Folic acid 
C)  Epogen alpha 
D)  Vitamin B12 
A)  Iron 
B)  Folic acid 
C)  Epogen alpha 
D)  Vitamin B12 D

Question 2

For patients taking warfarin, INRs are best drawn:

Accepted Answer

A)  Monthly throughout therapy 
B)  Three times a week throughout therapy 
C)  Two hours after the last dose of warfarin to get an accurate peak level 
D)  In the morning if the patient takes their warfarin at night 
A)  Monthly throughout therapy 
B)  Three times a week throughout therapy 
C)  Two hours after the last dose of warfarin to get an accurate peak level 
D)  In the morning if the patient takes their warfarin at night D

Question 3

Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to:

Accepted Answer

A)  Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case. 
B)  Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. 
C)  Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission. 
D)  Draw anticoagulation studies to make sure she does not have dangerously high bleeding times. 
A)  Contact the hospitalist as this is not the normal guideline for prescribing these two medications and she may have had a more complicated case. 
B)  Explain that warfarin is often started while a patient is still on heparin because warfarin takes a few days to reach effectiveness. 
C)  Encourage the patient to contact the Customer Service department at the hospital as this was most likely a medication error during her admission. 
D)  Draw anticoagulation studies to make sure she does not have dangerously high bleeding times. B

Question 4

Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended?

Accepted Answer

A)  He has arthritis and this will help with the inflammation and pain. 
B)  Aspirin has anti-platelet activity and prevents clots that cause heart attacks. 
C)  Aspirin acidifies the urine and he needs this for prostrate health. 
D)  He has a history of GI bleed, and one aspirin a day is a safe dosage. 
A)  He has arthritis and this will help with the inflammation and pain. 
B)  Aspirin has anti-platelet activity and prevents clots that cause heart attacks. 
C)  Aspirin acidifies the urine and he needs this for prostrate health. 
D)  He has a history of GI bleed, and one aspirin a day is a safe dosage.

Question 5

Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is:

Accepted Answer

A)  Ibuprofen 400 mg three times a day 
B)  Acetaminophen, not to exceed 4 grams per day 
C)  Prescribe acetaminophen with codeine 
D)  Aspirin 640 mg three times a day 
A)  Ibuprofen 400 mg three times a day 
B)  Acetaminophen, not to exceed 4 grams per day 
C)  Prescribe acetaminophen with codeine 
D)  Aspirin 640 mg three times a day

Question 6

Monitoring for a patient being prescribed iron for iron deficiency anemia includes:

Accepted Answer

A)  Reticulocyte count 1 week after therapy is started 
B)  Complete blood count every 2 weeks throughout therapy 
C)  Hemoglobin level at 1 week of therapy 
D)  INR weekly throughout therapy 
A)  Reticulocyte count 1 week after therapy is started 
B)  Complete blood count every 2 weeks throughout therapy 
C)  Hemoglobin level at 1 week of therapy 
D)  INR weekly throughout therapy

Question 7

The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that:

Accepted Answer

A)  ESAs no longer be prescribed to patients with chronic renal failure 
B)  The risk of tumor development be explained to cancer patients on ESA therapy 
C)  Patients should no longer receive ESA therapy to prepare for allogenic transfusions 
D)  ESAs be prescribed only to patients younger than age 60 years 
A)  ESAs no longer be prescribed to patients with chronic renal failure 
B)  The risk of tumor development be explained to cancer patients on ESA therapy 
C)  Patients should no longer receive ESA therapy to prepare for allogenic transfusions 
D)  ESAs be prescribed only to patients younger than age 60 years

Question 8

Patients receiving heparin therapy require monitoring of:

Accepted Answer

A)  Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy 
B)  Electrolytes for elevated potassium levels in the first 24 hours of therapy 
C)  INR throughout therapy to stay within the range of 2.0 
D)  Blood pressure for hypertension that may occur in the first 2 days of treatment 
A)  Platelets every 2 to 3 days for thrombocytopenia that may occur on day 4 of therapy 
B)  Electrolytes for elevated potassium levels in the first 24 hours of therapy 
C)  INR throughout therapy to stay within the range of 2.0 
D)  Blood pressure for hypertension that may occur in the first 2 days of treatment

Question 9

Patient education when prescribing clopidogrel includes:

Accepted Answer

A)  Do not take any herbal products without discussing it with the provider. 
B)  Monitor urine output closely and contact the provider if it decreases. 
C)  Clopidogrel can be constipating, use a stool softener if needed. 
D)  The patient will need regular anticoagulant studies while on clopidogrel. 
A)  Do not take any herbal products without discussing it with the provider. 
B)  Monitor urine output closely and contact the provider if it decreases. 
C)  Clopidogrel can be constipating, use a stool softener if needed. 
D)  The patient will need regular anticoagulant studies while on clopidogrel.

Question 10

Education of patients who are taking warfarin includes discussing their diet. Instructions include:

Accepted Answer

A)  Avoiding all vitamin K-containing foods 
B)  Avoiding high-vitamin K-containing foods 
C)  Increasing intake of iron-containing foods 
D)  Making sure they eat 35 grams of fiber daily 
A)  Avoiding all vitamin K-containing foods 
B)  Avoiding high-vitamin K-containing foods 
C)  Increasing intake of iron-containing foods 
D)  Making sure they eat 35 grams of fiber daily

Question 11

Patient education regarding taking iron replacements includes:

Accepted Answer

A)  Doubling the dose if they miss a dose to maintain therapeutic levels 
B)  Taking the iron with milk or crackers if it upsets their stomach 
C)  Iron is best taken on an empty stomach with juice 
D)  Antacids such as Tums may help the upset stomach caused by iron therapy 
A)  Doubling the dose if they miss a dose to maintain therapeutic levels 
B)  Taking the iron with milk or crackers if it upsets their stomach 
C)  Iron is best taken on an empty stomach with juice 
D)  Antacids such as Tums may help the upset stomach caused by iron therapy

Question 12

The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients?

Accepted Answer

A)  Pregnant women 
B)  Elderly men 
C)  Overweight or obese patients 
D)  Patients with multiple comorbidities 
A)  Pregnant women 
B)  Elderly men 
C)  Overweight or obese patients 
D)  Patients with multiple comorbidities

Question 13

The safest drug to use to treat pregnant women who require anticoagulant therapy is:

Accepted Answer

A)  Low-molecular-weight heparin 
B)  Warfarin 
C)  Aspirin 
D)  Heparin 
A)  Low-molecular-weight heparin 
B)  Warfarin 
C)  Aspirin 
D)  Heparin

Question 14

Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed:

Accepted Answer

A)  Folic acid to prevent megaloblastic anemia 
B)  Iron, to start when the epogen starts 
C)  An antihypertensive to counter the adverse effects of epogen 
D)  Vitamin B12 to prevent pernicious anemia 
A)  Folic acid to prevent megaloblastic anemia 
B)  Iron, to start when the epogen starts 
C)  An antihypertensive to counter the adverse effects of epogen 
D)  Vitamin B12 to prevent pernicious anemia

Question 15

The routine monitoring recommended for low molecular weight heparin is:

Accepted Answer

A)  INR every 2 days until stable, then weekly 
B)  aPTT every week while on therapy 
C)  Factor Xa levels if the patient is pregnant 
D)  White blood cell count every 2 weeks 
A)  INR every 2 days until stable, then weekly 
B)  aPTT every week while on therapy 
C)  Factor Xa levels if the patient is pregnant 
D)  White blood cell count every 2 weeks

Question 16

When writing a prescription for warfarin it is common to write _________ on the prescription.

Accepted Answer

A)  OK to substitute for generic 
B)  The brand name of warfarin and Do Not Substitute 
C)  PRN refills 
D)  Refills for 1 year 
A)  OK to substitute for generic 
B)  The brand name of warfarin and Do Not Substitute 
C)  PRN refills 
D)  Refills for 1 year

Question 17

Patients who are being treated with epoetin alfa need to be monitored for the development of:

Accepted Answer

A)  Thrombocytopenia 
B)  Neutropenia 
C)  Hypertension 
D)  Gout 
A)  Thrombocytopenia 
B)  Neutropenia 
C)  Hypertension 
D)  Gout

Question 18

The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is:

Accepted Answer

A)  Hematocrit levels start to rise 
B)  Hemoglobin levels return to normal 
C)  Reticulocyte count begins to rise 
D)  Vitamin B12 levels return to normal 
A)  Hematocrit levels start to rise 
B)  Hemoglobin levels return to normal 
C)  Reticulocyte count begins to rise 
D)  Vitamin B12 levels return to normal

Question 19

Cecil and his wife are traveling to Southeast Asia on vacation and he has come into the clinic to review his medications. He is healthy with only mild hypertension that is well controlled. He asks about getting "a shot" to prevent blood clots like his friend Ralph did before international travel. The correct respond would be:

Accepted Answer

A)  Administer one dose of low-molecular weight heparin 24 hours before travel. 
B)  Prescribe one dose of warfarin to be taken the day of travel. 
C)  Consult with a hematologist regarding a treatment plan for Cecil. 
D)  Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling. 
A)  Administer one dose of low-molecular weight heparin 24 hours before travel. 
B)  Prescribe one dose of warfarin to be taken the day of travel. 
C)  Consult with a hematologist regarding a treatment plan for Cecil. 
D)  Explain that Cecil is not at high risk of a blood clot and provide education about how to prevent blood clots while traveling.

Question 20

When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in:

Accepted Answer

A)  6 weeks if they are a cancer patient 
B)  1 week if they have chronic renal failure 
C)  2 weeks if they are taking it for allogenic transfusion 
D)  Each week throughout therapy 
A)  6 weeks if they are a cancer patient 
B)  1 week if they have chronic renal failure 
C)  2 weeks if they are taking it for allogenic transfusion 
D)  Each week throughout therapy

Exam 18: Drugs Affecting the Hematopoietic System

Patients with pernicious anemia require treatment with:

For patients taking warfarin, INRs are best drawn:

Juanita had a deep vein thrombosis (DVT) and was on heparin in the hospital and was discharged on warfarin. She asks her primary care provider NP why she was getting both medications while in the hospital. The best response is to:

Robert, age 51 years, has been told by his primary care provider (PCP) to take an aspirin a day. Why would this be recommended?

Kenneth is taking warfarin and is asking about what he can take for minor aches and pains. The best recommendation is:

Monitoring for a patient being prescribed iron for iron deficiency anemia includes:

The FDA issued a safety announcement regarding the use of erythropoiesis-stimulating agents (ESAs) in 2010 with the recommendation that:

Patients receiving heparin therapy require monitoring of:

Patient education when prescribing clopidogrel includes:

Education of patients who are taking warfarin includes discussing their diet. Instructions include:

Patient education regarding taking iron replacements includes:

The average starting dose of warfarin is 5 mg daily. Higher doses of 7.5 mg daily should be considered in which patients?

The safest drug to use to treat pregnant women who require anticoagulant therapy is:

Jim is having a hip replacement surgery and would like to self-donate blood for the surgery. In addition to being prescribed epogen alpha he should also be prescribed:

The routine monitoring recommended for low molecular weight heparin is:

When writing a prescription for warfarin it is common to write _________ on the prescription.

Patients who are being treated with epoetin alfa need to be monitored for the development of:

The first laboratory value indication that vitamin B12 therapy is adequately treating pernicious anemia is:

When patients are started on darbepoetin alfa (Aranesp) they need monitoring of their blood counts to determine a dosage adjustment in:

The Role of the Nurse Practitioner

Review of Basic Principles of Pharmacology

Rational Drug Selection

Legal and Professional Issues in Prescribing

Adverse Drug Reactions

Factors That Foster Positive Outcomes

Cultural and Ethnic Influences in Pharmacotherapeutics

An Introduction to Pharmacogenomics

Nutrition and Nutraceuticals

Herbal Therapy and Nutritional Supplements

Information Technology and Pharmacotherapeutics

Pharmacoeconomics

Over-The-Counter Medications

Drugs Affecting the Autonomic Nervous System

Drugs Affecting the Central Nervous System

Drugs Affecting the Cardiovascular and Renal Systems

Drugs Affecting the Respiratory System

Drugs Affecting the Immune System

Drugs Affecting the Gastrointestinal System

Drugs Affecting the Endocrine System

Drugs Affecting the Reproductive System

Drugs Affecting the Integumentary System

Drugs Used in Treating Infectious Diseases

Drugs Used in Treating Inflammatory Processes

Drugs Used in Treating Eye and Ear Disorders

Anemia

Chronic Stable Angina and Low-Risk Unstable Angina

Anxiety and Depression

Asthma and Chronic Obstructive Pulmonary Disease

Contraception

Dermatologic Conditions

Diabetes Mellitus

Gastroesophageal Reflux and Peptic Ulcer Disease

Headaches

Heart Failure

Human Immunodeficiency Virus Disease and Acquired Immunodeficiency Syndrome

Hormone Replacement Therapy and Osteoporosis

Hyperlipidemia

Hypertension

Hyperthyroidism and Hypothyroidism

Pneumonia

Smoking Cessation

Sexually Transmitted Infections and Vaginitis

Tuberculosis

Upper Respiratory Infections, Otitis Media, and Otitis Externa

Urinary Tract Infections

Women As Patients

Men As Patients

Children As Patients

Geriatric Patients

Pain Management: Acute and Chronic Pain

Filters

The first laboratory value indication that vitamin B₁₂therapy is adequately treating pernicious anemia is: