LEHNE'S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS 3RD EDITION: COMPREHENSIVE
EXAMINATION BANK AND STUDY GUIDE
SECTION 1: PRESCRIPTIVE AUTHORITY AND REGULATORY ISSUES
1. An APRN works in a cardiology clinic under a collaborative agreement with a supervising
physician. State law does not mandate physician oversight but requires a collaborative
agreement for prescriptive authority. How would this APRN's prescriptive authority be
described?
A. Full authority
B. Independent authority
C. Restricted authority
D. Limited authority
Correct Answer: C
,Rationale: Restricted prescriptive authority requires APRNs to have a collaborative practice
agreement or supervisory relationship with a physician to prescribe, particularly for
controlled substances. Independent authority means no such oversight is required. Full
authority implies no restrictions on drug types. Limited authority typically involves
additional restrictions beyond a collaborative agreement .
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 assistants are being utilized less often
D. APRN education is more complex than education for physicians
Correct Answer: A
Rationale: 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 .
3. Which federal agency is responsible for determining a drug's schedule under the
Controlled Substances Act?
A. Food and Drug Administration (FDA)
B. Drug Enforcement Administration (DEA)
C. Centers for Medicare & Medicaid Services (CMS)
D. Environmental Protection Agency (EPA)
,Correct Answer: B
Rationale: The DEA is responsible for enforcing the Controlled Substances Act and
determining drug schedules. The FDA approves drugs for safety and efficacy. CMS
administers Medicare/Medicaid. The EPA deals with environmental issues .
4. A patient with chronic pain has been prescribed a Schedule II opioid. Which prescription
requirement applies?
A. The prescription may be called in and refilled up to 5 times
B. The prescription must be written and cannot be refilled
C. The prescription is valid for 12 months
D. The prescription can be refilled indefinitely
Correct Answer: B
Rationale: Schedule II prescriptions must be written (not called in except in emergencies)
and cannot be refilled. They are valid for 6 months. Schedule III-V drugs may be refilled up
to 5 times within 6 months .
5. A patient is taking a drug with a "black box warning." The APRN should understand that
this warning indicates:
A. The drug is generic and less effective
B. The drug has the highest level of safety concern requiring risk mitigation
C. The drug is not approved for use in the United States
D. The drug is safe for use in all populations
, Correct Answer: B
Rationale: A black box warning is the FDA's strongest warning for drugs with serious safety
risks. It requires risk mitigation strategies and patient/provider education. Generic status
and U.S. approval are not related to black box warnings .
6. Off-label prescribing refers to:
A. Prescribing a medication for an indication not approved by the FDA
B. Prescribing an illegal substance
C. Prescribing a medication outside of the prescriber's license
D. Prescribing a medication without a DEA number
Correct Answer: A
Rationale: Off-label prescribing is legal and common in clinical practice (e.g., gabapentin
for neuropathic pain, beta-blockers for anxiety). However, the prescriber assumes
responsibility for off-label use .
7. 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
ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS 3RD EDITION: COMPREHENSIVE
EXAMINATION BANK AND STUDY GUIDE
SECTION 1: PRESCRIPTIVE AUTHORITY AND REGULATORY ISSUES
1. An APRN works in a cardiology clinic under a collaborative agreement with a supervising
physician. State law does not mandate physician oversight but requires a collaborative
agreement for prescriptive authority. How would this APRN's prescriptive authority be
described?
A. Full authority
B. Independent authority
C. Restricted authority
D. Limited authority
Correct Answer: C
,Rationale: Restricted prescriptive authority requires APRNs to have a collaborative practice
agreement or supervisory relationship with a physician to prescribe, particularly for
controlled substances. Independent authority means no such oversight is required. Full
authority implies no restrictions on drug types. Limited authority typically involves
additional restrictions beyond a collaborative agreement .
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 assistants are being utilized less often
D. APRN education is more complex than education for physicians
Correct Answer: A
Rationale: 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 .
3. Which federal agency is responsible for determining a drug's schedule under the
Controlled Substances Act?
A. Food and Drug Administration (FDA)
B. Drug Enforcement Administration (DEA)
C. Centers for Medicare & Medicaid Services (CMS)
D. Environmental Protection Agency (EPA)
,Correct Answer: B
Rationale: The DEA is responsible for enforcing the Controlled Substances Act and
determining drug schedules. The FDA approves drugs for safety and efficacy. CMS
administers Medicare/Medicaid. The EPA deals with environmental issues .
4. A patient with chronic pain has been prescribed a Schedule II opioid. Which prescription
requirement applies?
A. The prescription may be called in and refilled up to 5 times
B. The prescription must be written and cannot be refilled
C. The prescription is valid for 12 months
D. The prescription can be refilled indefinitely
Correct Answer: B
Rationale: Schedule II prescriptions must be written (not called in except in emergencies)
and cannot be refilled. They are valid for 6 months. Schedule III-V drugs may be refilled up
to 5 times within 6 months .
5. A patient is taking a drug with a "black box warning." The APRN should understand that
this warning indicates:
A. The drug is generic and less effective
B. The drug has the highest level of safety concern requiring risk mitigation
C. The drug is not approved for use in the United States
D. The drug is safe for use in all populations
, Correct Answer: B
Rationale: A black box warning is the FDA's strongest warning for drugs with serious safety
risks. It requires risk mitigation strategies and patient/provider education. Generic status
and U.S. approval are not related to black box warnings .
6. Off-label prescribing refers to:
A. Prescribing a medication for an indication not approved by the FDA
B. Prescribing an illegal substance
C. Prescribing a medication outside of the prescriber's license
D. Prescribing a medication without a DEA number
Correct Answer: A
Rationale: Off-label prescribing is legal and common in clinical practice (e.g., gabapentin
for neuropathic pain, beta-blockers for anxiety). However, the prescriber assumes
responsibility for off-label use .
7. 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
