Chapter 8 - Pharmacology for the Primary Care Provider - Test Bank

Chapter 08: Complementary and Alternative Therapies Test Bank MULTIPLE CHOICE 1. A patient with chronic back pain that is unrelieved by prescription analgesic medications asks a primary care nurse practitioner (NP) about acupuncture treatments. The NP should tell this patient: a. biofield therapy has been shown to be more effective than acupuncture. b. creatine has been shown to be an effective herbal choice to treat back pain. c. there is no valid research documenting the efficacy of this treatment for pain. d. most studies that show benefits of alternative therapies are based on observation. ANS: D Current literature does not allow definitive conclusions to be drawn regarding the use of complementary and alternative medicine (CAM) because much of what appears in the literature continues to be based on observational reports and small studies. Biofield therapy has not been shown to be more effective than acupuncture. Creatine is used to increase muscle mass. DIF: Cognitive Level: Applying (Application) REF: 93 2. A primary care NP is aware that many patients in the community use herbal remedies to treat various conditions. The NP understands the importance of: a. learning about the actions, uses, doses, and toxicities of these agents. b. prescribing these agents when possible to ensure safe dosing. c. counseling patients to stop using herbal products to avoid toxic side effects. d. teaching patients that these products are unregulated and unsafe to use. ANS: A It is important for primary care providers to be familiar with these products and their ingredients so that they can help patients choose the safest product for their ailments. Because there are few evidence-based recommendations for the use of these products, NPs should not prescribe them. Counseling patients to stop using the products would probably not be effective; it is more important to know about the products to assist patients in decision making. Although it is true that the products are not directly regulated by the Food and Drug Administration (FDA), there are agencies that maintain safety of the products. DIF: Cognitive Level: Applying (Application) REF: 94 3. A patient has been using an herbal supplement for 2 years that the primary care NP knows may have toxic side effects. The NP should: a. tell the patient to stop taking the supplement immediately. b. inform the patient of the risks of toxic side effects with this supplement. c. refer the patient to a CAM provider who can manage this patient?s therapy. d. prescribe another herbal drug that has fewer adverse effects than the one the patient is taking. ANS: B It is important for primary care NPs to inform patients of any known risks associated with herbal supplements. Asking the patient to stop an herbal remedy immediately when the patient has been using it for 2 years would probably be met with resistance. The NP should realize that referral to a CAM provider can incur legal liabilities if the CAM provider does not have proper competencies and licensure. Likewise, unless there is evidence-based documentation about the safety and efficacy of a product, the NP should not prescribe these therapies. DIF: Cognitive Level: Applying (Application) REF: 94 4. A patient asks a primary care NP why herbal supplements are not regulated by the FDA. The nurse practitioner should tell the patient these products are not regulated by the FDA because they are: a. natural, plant-based products and not man-made. b. not marketed as products that can treat or cure disease. c. regulated by the Dietary Supplement Health and Education Act. d. covered by the Hatch-Richardson Bill of 1992, which allows them to make health claims without FDA approval. ANS: B A manufacturer must comply with the rigorous standards of safety and efficacy set forth by the FDA only when the claim is made that a product can be used to treat or cure an illness or disease. The Hatch-Richardson Bill of 1992 defines herbal supplements as different from a food additive or drug. The Dietary Supplement Health and Education Act allows claims to be made as long as they are substantiated with evidence. DIF: Cognitive Level: Understanding (Comprehension) REF: 95 5. A patient is diagnosed with lupus and reports occasional use of herbal supplements. The primary care NP should caution this patient to avoid: a. ginseng. b. echinacea. c. ginkgo biloba. d. St. John?s wort. ANS: B Patients with lupus who take echinacea may experience an increase in symptoms, even if the patient is taking immunosuppressants. DIF: Cognitive Level: Understanding (Comprehension) REF: 98 6. A patient who takes warfarin (Coumadin) experiences excessive bleeding, even though serum drug levels are normal. The primary care NP should question this patient about the use of: a. feverfew. b. echinacea. c. green tea. d. ginkgo biloba. ANS: D Ginkgo biloba decreases blood viscosity and can enhance the effects of warfarin. Feverfew, echinacea, and green tea do not have this effect. DIF: Cognitive Level: Applying (Application) REF: 99 7. A patient develops hepatotoxicity from chronic acetaminophen use. The primary care NP may recommend: a. milk thistle. b. chondroitin. c. coenzyme Q. d. glucosamine. ANS: A Milk thistle has been shown to protect the liver after exposure to hepatotoxins such as acetaminophen, ethanol, and halothane. The other supplements listed do not have this effect. DIF: Cognitive Level: Understanding (Comprehension) REF: 100