Deck 23: Pharmacogenomics

Question 1

A client had pharmacogenetic testing (PGx)two years ago,but the prescriber has ordered another test prior to starting the client on tamoxifen.How should the nurse explain the need for this second test?

A)"Your first test was not normal."
B)"The testing you had last time must have been inconclusive."
C)"Your last test was not specific for tamoxifen."
D)"Your last test shows you have wild-type genes."

Answer 1

"Your last test was not specific for tamoxifen."

Question 2

A client who has been taking warfarin for three days is bleeding.The nurse notifies the physician,who says,"I thought his genetic testing indicated he would metabolize warfarin normally." How should the nurse respond?

A)"I am looking for that result on the medical record."
B)"Do you think the test was accurate?"
C)"The results of the test do not replace the need for me to monitor the client."
D)"Did we dose the drug correctly according to the test results?"

Answer 2

"The results of the test do not replace the need for me to monitor the client."

Question 3

A client was prescribed warfarin starting last week.The genetic testing results returned today indicate the client is a CYP2C9 poor metabolizer.What therapy changes may be indicated?

A)The client is likely to need a higher-than-standard dose of warfarin.
B)The medication should be discontinued.
C)The client's status and INR lab results should be monitored very closely.
D)The client's dose should be lowered.

Answer 3

The client's status and INR lab results should be monitored very closely.

Question 4

Which client question reveals a primary ethical issue associated with pharmacogenomic testing?

A)"How is this test done?"
B)"Who pays for this testing?"
C)"Who has access to the results of this test?"
D)"What happens to the sample after it has been tested?"

Question 5

Which way of encouraging use of pharmacogenetic (PGx)information as it applies to prescribing medications should the nurse avoid?

A)Support efforts to make the use of this information mandatory.
B)Become involved in educating prescribers about PGx.
C)Encourage the use of electronic health records that flag PGx results when specific drugs are prescribed.
D)Support efforts to develop and distribute templates or flow sheets that would assist prescribers in making prescribing decisions.

Question 6

A client is having genetic testing done before being prescribed a medication.How should the nurse explain the rationale for the test?

A)"This test can warn us that you may be allergic to this medication."
B)"The test results will help us decide the best dose of the medication for you."
C)"The test will help us minimize the adverse effects you experience from the medication."
D)"The test results will help us decide which medication from the drug class will be most effective for you."
E)"This testing will help us choose the least expensive medication for you."

Question 7

The nurse is discussing the current use of genetic testing and tamoxifen with a client who has breast cancer.Which information should the nurse include in this discussion?

A)The United States Agency of Healthcare Research and Quality recommends genetic testing for clients starting tamoxifen.
B)Insurance providers in the United States do not support the use of CYP2D6 testing prior to prescribing tamoxifen.
C)Dutch researchers support CYP2D6 testing prior to prescribing tamoxifen.
D)Some European groups recommend using medications other than tamoxifen for women whose CYP2D6 testing reveals intermediate metabolizer status.
E)Recommendations from across the globe vary as to the benefit of genetic testing prior to prescribing tamoxifen.

Question 8

Which statement by a newly licensed nurse would indicate to the nurse manager a need for additional information about pharmacogenetics and pharmacogenomics?

A)"Pharmacogenomics focuses on how an individual's genetic makeup will alter their response to medications."
B)"To understand how multiple genes affect medication use in a given population,I should look for pharmacogenomic studies."
C)"Pharmacogenomics is more comprehensive than is pharmacogenetics."
D)"Pharmacogenetic studies have produced information on how single gene alterations change medication efficacy."

Question 9

The prescriber who follows the latest research regarding dosing of warfarin would consider which information prior to writing a prescription?

A)Client's alcohol consumption
B)Amount of green,leafy vegetables the client consumes
C)CYP2D6 status
D)CYP2C9 status
E)VKORC1 status

Question 10

The nurse is evaluating the appropriateness of an informed consent used prior to genetic testing.What information should the nurse be certain is included in this form?

A)Why the test is being performed
B)How much the test is expected to cost
C)How the results of the test are expected to be used
D)The limitations of the test
E)Where the blood for the test will be drawn

Question 11

The nurse will be responsible for the compilation,analysis,and reporting of large amounts of pharmacogenomic data generated by a research study.The nurse should be aware of which considerations?

A)It is important to adhere to the written analysis plan.
B)Procedures should be varied according to the needs of the researcher inputting data.
C)The steps of data analysis must be documented.
D)The team working with data should be aware of and look for common errors of input and analysis.
E)Regular validation testing should occur.

Question 12

A client asks the nurse how something as small as a gene can change the way a medication works.Which responses would be most accurate?

A)"A change in a gene can make enzymes function poorly."
B)"Changes in a gene can result in the absence of the enzymes needed for the drug to work correctly."
C)"A genetic alteration can make enzymes work too much,which changes the way the drug works."
D)"Genetic changes can make enzymes that will work only on specific medications."
E)"Changes in a gene can result in enzymes that cause rapid fatal results in the presence of some medications."

Question 13

A prescriber is considering pharmacogenetic testing (PGx)for a medication even though no alternative therapy exists.What issues should the nurse discuss with the prescriber?

A)If the test reveals the client to be a nonresponder,is it ethical to prescribe the medication anyway?
B)If the test inaccurately categorizes the client as a nonresponder and the medication is not prescribed,what are the implications?
C)If the client is sensitive to the drug and will experience adverse effects,should dosing be decreased?
D)If the client is a nonresponder to the medication,should that information be revealed to the client?
E)If the client is prescribed this medication,what follow-up schedule is necessary?

Question 14

The benefits of pharmacogenetics (PGx)are documented.Which reasons would the nurse list to explain why it is not more common in bedside practice?

A)There are not enough laboratories prepared to offer these services.
B)Many prescribers are not aware of the PGx testing that is available.
C)Many prescribers are not aware of which PGx tests are applicable to which drugs.
D)In most cases,patients do not want any kind of genetic testing.
E)There is no simple,universal method of determining how to use the information from testing to modify prescribing habits.

Question 15

A client with breast cancer has had genetic testing that shows she is a CYP2D6 ultra-rapid metabolizer.How would the nurse explain this result?

A)"You do not have the functional enzyme to break down tamoxifen."
B)"Your ability to break tamoxifen down to active metabolites is normal."
C)"Your body will break down tamoxifen to its active metabolites very quickly,which increases your ability to fight your cancer."
D)"You will break tamoxifen down so quickly that it will be metabolized out of your system before it can work on cancer cells."