Test Bank Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants Rosenthal

Chapter 1: Prescriptive Authority

Test Bank

Multiple Choice

1. An APRN works in a urology clinic under the supervision of a physician who does not restrict

the types of medications the APRN is allowed to prescribe. State law does not require the

APRN to practice under physician supervision. How would the APRN’s prescriptive authority

be described?

a. Full authority

b. Independent

c. Without limitation

d. Limited authority

ANS: B

The APRN has independent prescriptive authority because the regulating body does not require

that the APRN work under physician supervision. Full prescriptive authority gives the provider

the right to prescribe independently and without limitation. Limited authority places restrictions

on the types of drugs that can be prescribed.DIF: Cognitive Level: ComprehensionREF: p. 1TOP:

Nursing Process: I MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic

and Parenteral Therapies

2. Which factors increase the need for APRNs to have full prescriptive authority?

a. More patients will have access to health care.

b. Enrollment in medical schools is predicted to decrease.

c. Physician’s assistants are being utilized less often.

d. APRN education is more complex than education for physicians.

ANS: A

Implementation of the Affordable Care Act has increased the number of individuals with health

care coverage, and thus the number who have access to health care services. The increase in the

number of patients creates the need for more providers with prescriptive authority. APRNs can fill

this practice gap.DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process:

Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and

Parenteral Therapies

3. Which factors could be attributed to limited prescriptive authority for APRNs?

Select all that apply.

a. Inaccessibility of patient care

b. Higher health care costs

c. Higher quality medical treatment

d. Improved collaborative care

e. Enhanced health literacy

ANS: A , B

Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible

patient care. It may also lead to poor collaboration among providers and higher health care costs.

It would not directly impact patient’s health literacy.DIF: Cognitive Level: ComprehensionREF:

p. 2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic

Integrity: Pharmacologic and Parenteral Therapies

4. Which aspects support the APRN’s provision for full prescriptive authority?

Select all that apply.

a. Clinical education includes prescription of medications and disease processes.

b. Federal regulations support the provision of full authority for APRNs.

c. National examinations provide validation of the APRN’s ability to provide safe care.

d. Licensure ensures compliance with health care and safety standards.

e. Limiting provision can decrease health care affordability.

ANS: A , C , D

APRNs are educated to practice and prescribe independently without supervision. National

examinations validate the ability to provide safe and competent care. Licensure ensures

compliance with standards to promote public health and safety. Limited prescriptive authority

creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level:

ComprehensionREF: pp. 1-2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs

Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

5. Which aspects support the APRN’s provision for full prescriptive authority?

Select all that apply.

a. Clinical education includes prescription of medications and disease processes.

b. Federal regulations support the provision of full authority for APRNs.

c. National examinations provide validation of the APRN’s ability to provide safe care.

d. Licensure ensures compliance with health care and safety standards.

ANS: A , C , D

APRNs are educated to practice and prescribe independently without supervision. National

examinations validate the ability to provide safe and competent care. Licensure ensures

compliance with standards to promote public health and safety. Limited prescriptive authority

creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level:

ComprehensionREF:  pp.  1-2TOP:  Nursing  Process:  Implementation MSC: NCLEX Client

Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

6. A family nurse practitioner practicing in Maine is hired at a practice across state lines in

Virginia. Which aspect of practice may change for the APRN?

a. The APRN will have less prescriptive authority in the new position.

b. The APRN will have more prescriptive authority in the new position.

c. The APRN will have equal prescriptive authority in the new position.

d. The APRN’s authority will depend on federal regulations.

ANS: A

Virginia allows limited prescriptive authority, while Maine gives full authority to certified nurse

practitioners. The federal government does not regulate prescriptive authority.DIF: Cognitive

Level: ComprehensionREF: p. 3TOP: Nursing Process: Implementation MSC: NCLEX Client

Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers,

 Ed.

Chapter 2: Rational Drug Selection and Prescription Writing

Test Bank

Multiple Choice

2nd

7. How can collaboration with a pharmacist improve positive outcomes for patients?

Select all that apply.

a. Pharmacists can suggest foods that will help with the patient’s condition.

b. Pharmacists have additional information on drug interactions.

c. The pharmacist can suggest adequate medication dosing.

d. Pharmacists have firsthand knowledge of the facility formulary.

e. Pharmacy can alter prescriptions when necessary to prevent patient harm.

ANS: B , C , D

Providers should collaborate with pharmacists because they will likely have additional information

on formulary, drug interactions, and suggestions for adequate medication dosing. Dietitians can

make foods recommendations to treat the patient’s condition. The pharmacist can contact the

prescriber about questionable prescriptions, but cannot alter the prescription without notification

of and approval by the provider.DIF: Cognitive Level: ComprehensionREF: p. 9TOP: Nursing

Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of

Risk Potential

8. A patient presents with delirium tremens requiring Ativan administration. The provider of care

is not in the facility. Which action by the nurse is most appropriate?

a. Obtain a telephone order.

b. Contact the on-call hospitalist.

c. Obtain an order from the charge nurse.

d. Wait for a written Ativan order.

ANS: A

In an emergency situation, such as delirium tremens with seizure activity, it is acceptable to provide

a telephone order. Contacting the on-call hospitalist or waiting for a written order would take more

time than available for a patient with high seizure risk. Writing an order is outside the scope of

practice for the charge nurse.DIF: Cognitive Level: ApplicationREF: p. 7TOP: Nursing Process:

Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk

Potential

9. A patient with chronic pain calls the provider’s office to request a refill on their oxycontin.

Which action is most appropriate?

a. Fax an order to the pharmacy.

b. Schedule an appointment with the patient.

c. Verify the patient’s adherence to drug regimen.

d. Determine the patient’s current medication dosage.

ANS:  B

Schedule II medications are not eligible for refills, and prescriptions must be handwritten. It is

important to verify the patient’s adherence to the drug regimen and determine the current dosage

of medication; however, this can be accomplished by scheduling an appointment and evaluating

the patient in person.DIF: Cognitive Level: ApplicationREF: p. 8TOP: Nursing Process:

Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk

Potential

10. A patient prescribed amoxicillin for streptococcal pharyngitis reports new onset of a flat, itchy

red rash on the chest and neck. Which action is most important?

a. Provide a different prescription.

b. Discontinue the medication.

c. Prescribe an antihistamine cream.

d. Assess for respiratory compromise.

ANS: B

The priority action is to discontinue the medication to prevent worsening of the patient’s

symptoms. A different prescription would be provided, topical antihistamine may be administered,

and the patient would be assessed for respiratory involvement, but these actions would not be