NUR 521 Exam 1 Study Guide part 1
Module 1: Chapters 1-10
Legal Issues:
Why should APRNs have full prescriptive authority?
• To decrease barriers to quality, affordable, and accessible patient care.
• Decrease patient wait times by avoiding having to obtain physician's cosignature.
• Fewer avoidable hospitalizations, readmissions, and ER visits
• Flexibility in healthcare teams
Who would benefit from this?
• Would help address shortages of healthcare providers, especially in underserved
or rural areas.
Controlled Substances Classification:
What is the definition of each schedule? Provide an example drug that fits into each schedule.
1. Schedule I: High potential for abuse, no currently accepted medical use in treatment in
the United States, and not of accepted safely for use under medical supervision.
Examples: Heroin, LSD, MDMA(ecstasy), Marijuana(cannabis).
2. Schedule II: High potential for abuse, currently accepted medical use with severe
restrictions, and the potential for severe psychological or physical dependence. Consists
of certain narcotic, stimulant and depressant drugs.
Examples: Morphine, Dilaudid, Methadone, Demerol, Hydrocodone, Oxycodone,
Methamphetamine, Fentanyl, Cocaine.
3. Schedule III : Potential for abuse is less than schedule I or II, currently accepted medical
use, and moderate to low potential for physical dependence or high psychological
dependence, compounds containing limited quantities of certain narcotic drugs
Examples: Codeine with aspirin or acetaminophen, Ketamine, Anabolic steroids. include
products containing no more than 90 mg of codeine per dosage unit such as Tylenol with
Codeine, buprenorphine (Suboxone®).
4. Schedule IV: Lower potential for abuse than Schedule III, currently accepted medical
use, and limited potential for dependence.
• Examples: Xanax(alprazolam), Ativan(lorazepam), Valium(diazepam), Tramadol. barbital,
phenobarbital, chloral hydtrate, clorazepate (Tranxene), Quazepam (Dormalin).
, 5. Schedule V: lower potential for abuse than schedule IV, currently accepted medical use,
and limited potential for dependence, preparations containing limited quantities of
certain narcotic and stimulant used for diarrhea, cough, and pain.
Examples: buprenorphine and propylhexedrine. Cough preparations with less than
200mg of Codeine per 100ml or 100g, Lomotil(Diphenoxylate/Atropine).
Prescribing Medications:
What Components are necessary when writing a prescription?
• Prescriber name, license number, and contact information
• Prescriber U.S. Drug Enforcement Administration (DEA) number, if applicable
• Patient name and DOB
• Patient allergies
• Name of medication
• Indication
• Strength
• Dose and frequency
• Concentration if a liquid preparation Number of tablets or capsules to dispense.
• Number of refills
• If ok to use generic form of drug
What factors should the APRN consider when prescribing medications?
• Cost-consider changing pharmacies of drug regimen if the patient is having difficulty
affording medications.
• Guidelines for the particular disease or symptom and document the rationale for
deviating from the standard of care.
• Availability-become familiar with the formulary where you are employed.
• Interactions- when adding a new med to a patient's regimen, check for significant
interactions.
• Side effects
• Allergies- critical to determine the reaction type and document in the patient chart. If
the allergy is severe and causes anaphylaxis or swelling to the face, these drugs are
absolutely contraindicated.
• Hepatic and Renal Function- Many drugs are metabolized and eliminated by the liver and
kidneys if impaired can lead to increased adverse effects and possible overdose, refer to
hepatic and renal dosing when indicated.
• Need for monitoring-meds that require therapeutic range.
• Special populations- pregnant/nursing mothers, older adults.
What factors should the APRN consider when refilling medications?
• Is this a newer medication for this patient?
• Am I changing the dose or frequency of the medication?
, • Am I adding new medications to their regimen?
• Is the patient having undesired side effects?
• When do I expect to follow up with this patient?
• If the patient is requesting a refill by telephone, when was the last time I saw this
patient? Do I need to see the patient again before refill?
• Is this a schedule II medication?
**If the answer is yes to any of these questions, consider a shorter time between refills
(1-3 months). Schedule II medications are not eligible for refills and must have a new
prescription each renewal period.
**If the patient is maintained on the current dose of medication for some time and
remains stable, it is likely acceptable to continue to refill that medication for a longer
time period. (6-12 months).
What is the benefit of collaboration during drug selection and prescription writing?
Pharmacists will likely have additional information on formulary or drug interactions as well as
suggestions for adequate medication dosing.
ID specialists can provide guidance on resistance patterns, common local microbial flora, and
correct doses, as well as on duration of treatment for specific infections.
Patient Education:
What information should be included in patient education material?
• Medication name
• Purpose
• Dosing
• Administration
• Adveres Effects
• Storage
• Laboratory testing
• Food or drug interactions
• Duration of therapy
Why is patient education so important?
Education reduces medication errors by empowering patients with accurate information and
clear guidelines.
Ensures the patient understands how to take the medication and the reason they are taking the
medication.
Knowing the generic name empowers each patient to catch medication errors in the event two
different providers prescribe the same medication.
More likely to adhere to testing schedules.
Module 1: Chapters 1-10
Legal Issues:
Why should APRNs have full prescriptive authority?
• To decrease barriers to quality, affordable, and accessible patient care.
• Decrease patient wait times by avoiding having to obtain physician's cosignature.
• Fewer avoidable hospitalizations, readmissions, and ER visits
• Flexibility in healthcare teams
Who would benefit from this?
• Would help address shortages of healthcare providers, especially in underserved
or rural areas.
Controlled Substances Classification:
What is the definition of each schedule? Provide an example drug that fits into each schedule.
1. Schedule I: High potential for abuse, no currently accepted medical use in treatment in
the United States, and not of accepted safely for use under medical supervision.
Examples: Heroin, LSD, MDMA(ecstasy), Marijuana(cannabis).
2. Schedule II: High potential for abuse, currently accepted medical use with severe
restrictions, and the potential for severe psychological or physical dependence. Consists
of certain narcotic, stimulant and depressant drugs.
Examples: Morphine, Dilaudid, Methadone, Demerol, Hydrocodone, Oxycodone,
Methamphetamine, Fentanyl, Cocaine.
3. Schedule III : Potential for abuse is less than schedule I or II, currently accepted medical
use, and moderate to low potential for physical dependence or high psychological
dependence, compounds containing limited quantities of certain narcotic drugs
Examples: Codeine with aspirin or acetaminophen, Ketamine, Anabolic steroids. include
products containing no more than 90 mg of codeine per dosage unit such as Tylenol with
Codeine, buprenorphine (Suboxone®).
4. Schedule IV: Lower potential for abuse than Schedule III, currently accepted medical
use, and limited potential for dependence.
• Examples: Xanax(alprazolam), Ativan(lorazepam), Valium(diazepam), Tramadol. barbital,
phenobarbital, chloral hydtrate, clorazepate (Tranxene), Quazepam (Dormalin).
, 5. Schedule V: lower potential for abuse than schedule IV, currently accepted medical use,
and limited potential for dependence, preparations containing limited quantities of
certain narcotic and stimulant used for diarrhea, cough, and pain.
Examples: buprenorphine and propylhexedrine. Cough preparations with less than
200mg of Codeine per 100ml or 100g, Lomotil(Diphenoxylate/Atropine).
Prescribing Medications:
What Components are necessary when writing a prescription?
• Prescriber name, license number, and contact information
• Prescriber U.S. Drug Enforcement Administration (DEA) number, if applicable
• Patient name and DOB
• Patient allergies
• Name of medication
• Indication
• Strength
• Dose and frequency
• Concentration if a liquid preparation Number of tablets or capsules to dispense.
• Number of refills
• If ok to use generic form of drug
What factors should the APRN consider when prescribing medications?
• Cost-consider changing pharmacies of drug regimen if the patient is having difficulty
affording medications.
• Guidelines for the particular disease or symptom and document the rationale for
deviating from the standard of care.
• Availability-become familiar with the formulary where you are employed.
• Interactions- when adding a new med to a patient's regimen, check for significant
interactions.
• Side effects
• Allergies- critical to determine the reaction type and document in the patient chart. If
the allergy is severe and causes anaphylaxis or swelling to the face, these drugs are
absolutely contraindicated.
• Hepatic and Renal Function- Many drugs are metabolized and eliminated by the liver and
kidneys if impaired can lead to increased adverse effects and possible overdose, refer to
hepatic and renal dosing when indicated.
• Need for monitoring-meds that require therapeutic range.
• Special populations- pregnant/nursing mothers, older adults.
What factors should the APRN consider when refilling medications?
• Is this a newer medication for this patient?
• Am I changing the dose or frequency of the medication?
, • Am I adding new medications to their regimen?
• Is the patient having undesired side effects?
• When do I expect to follow up with this patient?
• If the patient is requesting a refill by telephone, when was the last time I saw this
patient? Do I need to see the patient again before refill?
• Is this a schedule II medication?
**If the answer is yes to any of these questions, consider a shorter time between refills
(1-3 months). Schedule II medications are not eligible for refills and must have a new
prescription each renewal period.
**If the patient is maintained on the current dose of medication for some time and
remains stable, it is likely acceptable to continue to refill that medication for a longer
time period. (6-12 months).
What is the benefit of collaboration during drug selection and prescription writing?
Pharmacists will likely have additional information on formulary or drug interactions as well as
suggestions for adequate medication dosing.
ID specialists can provide guidance on resistance patterns, common local microbial flora, and
correct doses, as well as on duration of treatment for specific infections.
Patient Education:
What information should be included in patient education material?
• Medication name
• Purpose
• Dosing
• Administration
• Adveres Effects
• Storage
• Laboratory testing
• Food or drug interactions
• Duration of therapy
Why is patient education so important?
Education reduces medication errors by empowering patients with accurate information and
clear guidelines.
Ensures the patient understands how to take the medication and the reason they are taking the
medication.
Knowing the generic name empowers each patient to catch medication errors in the event two
different providers prescribe the same medication.
More likely to adhere to testing schedules.
