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Clinical Drug Testing in Primary Care

Chapter 1 - Introduction

1. Drug tests target only specific drugs or drug classes and can detect substances only when they are present above predetermined thresholds.

A. True B. False

2. When combined with a patient's history, collateral information from a spouse or other family member, questionnaires, biological markers, and clinical judgement, drug testing provides information that:

A. Prevents dangerous medication interactions during surgery or other medical procedures. B. Identifies women who are pregnant, or who want to become pregnant, and are using drugs or alcohol. C. Identifies a relapse to substance use. D. All of the above.

3. Substance dependence refers to a maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.

A. True B. False

4. The Federal mandatory guidelines recommend that the initial screening test identify the presence of all of the following commonly abused drugs or their metabolites, except for:

A. Amphetamines B. MDMA C. Cocaine metabolites D. Marijuana metabolites

5. Drug testing in SUD treatment is:

A. Part of the initial assessment of a patient being evaluated for a diagnosis of an SUD. B. A way to monitor the patient's use of illicit substances or adherence to pharmacotherapy treatment for SUDs. C. A way to assess the efficacy of the treatment plan. D. All of the above.

Chapter 2 - Terminology and Essential Concepts in Drug Testing

6. Screening tests do all of the following, except:

A. Indicate the presence or absence of a substance or its metabolite. B. Indicate the presence of a cross-reacting, chemically similar substance. C. Measure the quantity of the drug or alcohol or its metabolite present in the specimen. D. Screening tests do all of the above.

7. Screening POCT immunoassay testing devices are available for all of the following, except:

A. Urine. B. Oral fluids. C. Blood. D. Screening POCT immunoassay testing devices are available for all of the above.

8. Confirmatory tests usually:

A. Provide quantitative concentrations of specific substances or their metabolites in the specimen. B. Have high specificity and sensitivity. C. Can identify specific drugs within drug classes. D. All of the above.

9. Even if the patient or a family member affirms that drug use occurred, a confirmation drug test is required.

A. True B. False

10. All of the following are the most common technologies used to perform the confirmatory tests, except for:

A. Immunoassay testing B. Gas chromatography / mass spectrometry C. Liquid chromatography / mass spectrometry D. Tandem mass spectrometry

11. If the test incorrectly detects the presence of the drug when none is present, it is known as a:

A. True positive B. False positive C. True negative D. False negative

12. The window of detection depends on:

A. Chemical properties of the substances for which the test is being performed. B. Individual metabolism rates and excretion routes. C. The individual's health, diet, weight, gender, fluid intake, and pharmacogenomic profile. D. All of the above.

13. Drug metabolites usually remain in the body longer than do the parent drugs.

A. True B. False

14. Which of the following is most likely to contain the drug's metabolites, rather than the parent drug?

A. Blood B. Oral fluid C. Urine D. All of the above

15. The Federal cutoff concentrations should also be used for clinical use.

A. True B. False

16. Substances other than the drug to be detected may also cross-react with the antibody and produce a false-positive result.

A. True B. False

17. The drug test panels are designed to:

A. Monitor adherence to pain treatment plans. B. Detect use of nonprescribed pain medications. C. Screen for use of illicit drugs. D. All of the above.

18. It is just as important to know what a urine drug screen will not detect as it is to know what it will detect.

A. True B. False

19. Which of the following is the most widely used test matrix?

A. Urine B. Blood C. Oral fluid D. Hair

20. No one adulterant, with the exception of strong acids, bases, oxidizers, and reducing agents, can mask the presence of all drugs.

A. True B. False

21. Specimen adulteration should be suspected if the pH level of urine is:

A. Less than 4.5 or greater than 11.0. B. Less than 3.0 or greater than 11.0. C. Less than 4.5 or greater than 9.0. D. Less than 3.0 or greater than 9.0.

Chapter 3 - Preparing for Drug Testing

22. Which matrix has the longest window of detection?

A. Meconium B. Hair C. Sweat D. Blood

23. Drugs may be incorporated into hair from external sources, such as mechanical contact between the hair and the drug.

A. True B. False

24. Use of commercial adulterants or mouthwashes do not interfere with the immunoassay of oral fluid specimens if the products are used more than _____ before specimen collection.

A. 2 hours B. 60 minutes C. 30 minutes D. 5 minutes

25. Drug testing of oral fluids detects drug use during the previous _____, regardless of the route of administration.

A. 4 - 12 hours B. 12 - 24 hours C. 24 - 48 hours D. 12 - 48 hours

26. The sweat patch should be worn for at least _____, but no longer than 7 days.

A. 12 hours B. 48 hours C. 3 days D. 5 days

27. Which of the following is not proper procedure for applying the sweat patch?

A. The skin should be thoroughly cleaned with soap and water. B. The skin should be swabbed well with alcohol. C. The patch should be applied to the skin by the patient. D. All of the above are proper procedures for applying the patch.

28. In general, blood has a longer detection period than urine.

A. True B. False

29. Drug metabolites can be detected in the hair shaft approximately _____ days after drug ingestion.

A. 2 - 3 B. 7 - 10 C. 10 - 14 D. 14 - 21

30. Hair testing appears to be most reliable for detecting:

A. Prior frequent, heavy use of cocaine, opioids, amphetamine, PCP, and Ecstasy. B. Very recent use of cocaine, opioids, amphetamine, PCP, and Ecstasy. C. Occasional use of cocaine, opioids, amphetamine, PCP, and Ecstasy. D. All of the above.

31. Hair analysis can often distinguish between heroin and morphine use.

A. True B. False

32. Hair testing for alcohol is inappropriate, as alcohol does not incorporate into hair.

A. True B. False

33. Studies have shown that concentrations of drugs in hair can be affected by variations in:

A. Melanin content B. Hygiene C. Cosmetic hair treatments D. All of the above

34. Alcohol will be detectable in breath as long as it is present in blood.

A. True B. False

35. Research shows that meconium provides a record of neonate exposure and maternal substance use during which trimester of gestation?

A. The third trimester B. The second trimester C. The first trimester D. The entire gestational period

36. Collection of a meconium specimen must be made before the neonate passes the first formed stool, which generally occurs within 7 days for full-term babies.

A. True B. False

37. Which of the following is not an advantage of laboratory tests over POCTs?

A. Laboratory tests generally have a higher degree of precision. B. Laboratory tests have faster turnaround time. C. Laboratory tests can provide information on specific drugs used. D. Laboratory tests may offer quantitation of drugs and/or metabolites.

38. The FDA has approved POCT devices for testing all of the following, except:

A. Blood B. Urine C. Breath D. Oral fluid

39. The principle advantage of POCTs is that the results are available in approximately 60 minutes.

A. True B. False

40. Most studies suggest that POCTs are a reliable method to screen for drugs of abuse and that the results are comparable to those from automated immunoassays and GC/MS.

A. True B. False

41. POCT devices provide presumptive results only and a sample needs to be sent for confirmatory testing at a laboratory.

A. True B. False

Chapter 4 - Drug Testing in Primary Care

42. Current clinical guidelines recommend the use of drug tests for pain management with opioids to help:

A. Guide decisions about prescribing scheduled medications. B. Revise treatment regimens. C. Decide when to initiate or refer for substance abuse treatment. D. All of the above.

43. Patients may not disclose which of the following?

A. All the medications prescribed by other providers or over-the-counter medications and herbal products. B. That they take medications prescribed for other people. C. If they have stopped taking their medications. D. All of the above.

44. SUD screening and assessment of a pregnant woman can identify an SUD early enough for intervention and for preventing, minimizing, or at the very least preparing for serious problems for the fetus or neonate.

A. True B. False

45. Women have the right to refuse drug testing, however, if drug abuse is suspected that is contributing to child abuse, report to child protective services is necessary.

A. True B. False

46. Which of the following may suggest current or past alcohol misuse or dependence?

A. Liver enzyme abnormalities B. Hepatitis B antibodies C. Hepatitis C antibodies D. All of the above

47. Prior to testing, which of the following should be explained to the patient?

A. The reason for performing drug testing. B. Use of the test results. C. The drug tests and the results will become part of the patient's record. D. All of the above.

48. Explicit consent from the patient for drug testing is required in primary care settings.

A. True B. False

49. Product inserts should be the basis for written protocols and used as directions when collecting and testing specimens and reporting results.

A. True B. False

50. A drug test result can reveal:

A. That a specimen is negative, positive, adulterated, substituted, or dilute. B. The amount of drug ingested by the patient, and whether a therapeutic level has been achieved. C. The patient's level of intoxication, impairment, or severity of abuse. D. A diagnosis of an SUD.

51. If the second specimen using the same or a different matrix is negative, it refutes the scientific validity of the first test.

A. True B. False

52. An invalid laboratory test result for urine can be caused by which of the following factors?

A. A physiological inconsistency between the patient's urine creatinine and specific gravity. B. The possible presence of chromium (VI). C. The possible presence of surfactant. D. All of the above.

53. An invalid test result is definitive proof of specimen tampering.

A. True B. False

54. For patients receiving medications, particularly opioids, with abuse potential, drug tests can be done:

A. Randomly. B. Before providing prescription refills. C. If the patient exhibits aberrant behavior. D. Any of the above.

Chapter 5 - Urine Drug Testing for Specific Substances

55. All of the following methods of drug use are detectable in urine samples almost immediately, except for:

A. When smoked. B. When taken orally. C. When injected. D. All of the above are immediately detectable in urine samples.

56. Most substances of abuse are detectable in urine for approximately:

A. 24 hours B. 2 - 4 days C. 3 - 5 days D. 7 - 10 days

57. The urine specimen temperature should be recorded within _____ of collection and the temperature should be between 90 degrees Fahrenheit and 100 degrees Fahrenheit.

A. 10 minutes B. 8 minutes C. 4 minutes D. 1 minute

58. Pyridinium chlorochromate (PCC) is an oxidizing agent that can affect test results for:

A. Morphine B. Cocaine metabolites C. Amphetamine D. All of the above

59. Which of the following may be a reason for a diluted urine sample other than tampering?

A. If the patient is taking a diuretic. B. If the patient is eating a strict vegetarian diet. C. If the patient is maintaining a high state of hydration. D. All of the above.

60. Urine drug tests for alcohol indicate recent ingestion and can identify long-term abuse.

A. True B. False

61. Adderall is an amphetamine and will result in a positive test for amphetamine.

A. True B. False

62. The approximate window of detection for a single use of marijuana is:

A. Up to 3 days B. Up to 4 days C. Up to 10 days D. 30 - 36 days

63. THC metabolites have been detected in urine specimens after a person has ingested which of the following legal food products?

A. Hemp seed oil B. Hemp seed flour C. Hemp seed liquor D. All of the above

64. The original employment-related and clinical cutoff concentration for morphine and codeine was increased from 300 ng/mL to 2,000 ng/mL to avoid positive test results from poppy seed consumption, often cited as the "poppy seed defense."

A. True B. False

65. Collection of a specimen for inhalants requires that the specimen be appropriately and rapidly sealed to ensure that the volatile inhalants are not lost.

A. True B. False


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