ADVANCED PHARMACOLOGY TEST BANK ALL n n n n
CHAPTERSQUESTIONS AND ANSWERS WITH
n n n n
RATIONALES n
Chapter 01: Prescriptive Authority and Role Implementation: Tradition vs. Change
n n n n n n n n n
Test Bank
n n
MULTIPLE CHOICE n
1. Which of the following has influenced an emphasis on primary care education in medical
n n n n n n n n n n n n n
schools?
n
a. Changes in Medicare reimbursement n n n
methods recommended in 1992
n n n n
b. Competition from nonphysicians desiring n n n
to meet primary care shortages
n n n n n
c. The need for monopolistic control in the
n n n n n n
marketplace of primary outpatient care
n n n n n
d. The recognition that nonphysicians have
n n n n
variable success providing primary care
n n n n n
ANS: A n
The Physician Payment Review Commission in 1992 directly increased financial
n n n n n n n n n
reimbursement to clinicians who provide primary care. Coupled with a shortage of
n n n n n n n n n n n n
primary care providers, this incentive led medical schools to place greater emphasis on
n n n n n n n n n n n n n
preparing primary care physicians. Competition from nonphysicians increased
n n n n n n n n
coincidentally as professionals from other disciplines stepped up to meet the needs.
n n n n n n n n n n n n
Nonphysicians have had increasing success at providing primary care and have been
n n n n n n n n n n n
shown to be safe and effective.
n n n n n n
DIF: Cognitive Level: Remembering (Knowledge)
n n n REF: 2 n
2. Which of the following statements is true about the prescribing practices of physicians?
n n n n n n n n n n n n
a. Older physicians tend to prescribe more
n n n n n
appropriate medications than younger
n n n n
physicians.
b. Antibiotic medications remain in the top n n n n n
five classifications of medications
n n n n
prescribed.
n
c. Most physicians rely on a ―therapeutic
n n n n n
armamentarium‖ that consists of less than
n n n n n n
100 drug preparations per physician.
n n n n n
d. The dominant form of drug information
n n n n n
used by primary care physicians continues
n n n n n n
to be that provided by pharmaceutical
n n n n n n
companies.
n
, ANS: D n
Even though most physicians claim to place little weight on drug advertisements,
n n n n n n n n n n n
pharmaceutical representatives, and patient preference and state that they rely on
n n n n n n n n n n
academic sources for drug information, a study showed that commercial rather than
n n n n n n n n n n n n
scientific sources of drug information dominated their drug information materials.
n n n n n n n n n n
Younger physicians tend to prescribe fewer and more appropriate drugs. Antibiotics have
n n n n n n n n n n n n
dropped out of the top five classifications of drugs prescribed. Most physicians have a
n n n n n n n n n n n n n n
therapeutic armamentarium of about 144 drugs.
n n n n n n
DIF: Cognitive Level: Remembering (Knowledge) n n n REF: 3 n
3. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of
n n n n n n n n n n n n n
medications, it will be important to:
n n n n n n
a. attain the same level of expertise as
n n n n n n
physicians who currently prescribe
n n n n
medications.
n
b. learn from the experiences of physicians
n n n n n
nand develop expertise based on evidence-
n n n n n
nbased practice. n
c. maintain collaborative and supervisorial n n n
relationships with physicians who will
n n n n n
oversee prescribing practices.
n n n
d. develop relationships with pharmaceutical n n n
representatives to learn about new
n n n n n
medications as they are developed.
n n n n n
ANS: B n
As nonphysicians develop the roles associated with prescriptive authority, it will be
n n n n n n n n n n n
important to learn from the past experiences of physicians and to develop prescribing
n n n n n n n n n n n n n
practices based on evidence-based medicine. It is hoped that all prescribers, including
n n n n n n n n n n n n
physicians and nurse practitioners, will strive to do better than in the past. NPs should
n n n n n n n n n n n n n n n
work toward prescriptive authority and for practice that is not supervised by another
n n n n n n n n n n n n n
professional. Pharmaceutical representatives provide information that carries some bias.
n n n n n n n n n
Academic sources are better.
n n n n
DIF: Cognitive Level: Applying (Application) n n n REF: 4 n
Chapter 02: Historical Review of Prescriptive Authority: The Role of Nurses (NPs,
n n n n n n n n n n n
CNMs, CRNAs, and CNSs) and Physician Assistants
n n n n n n n
Test Bank
n
MULTIPLE CHOICE n
1. A primary care NP will begin practicing in a state in which the governor has opted out of
n n n n n n n n n n n n n n n n n
the federal facility reimbursement requirement. The NP should be aware that this defines
n n n n n n n n n n n n n
how NPs may write prescriptions:
n n n n n
, a. without physician supervision in private
n n n n
practice.
n
b. as CRNAs without physician supervision
n n n n
in a hospital setting.
n n n n
c. in any situation but will not be reimbursed
n n n n n n n
nfor this by government insurers.
n n n n
d. only with physician supervision in both
n n n n n
private practice and a hospital setting.
n n n n n n
ANS: B n
In 2001, the Centers for Medicare and Medicaid Services changed the federal physician
n n n n n n n n n n n n
nsupervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write
n n n n n n n n n n n n n n
nprescriptions and dispense drugs without physician supervision.
n n n n n n
DIF: Cognitive Level: Understanding (Comprehension)
n n n REF: 9 n
2. CRNAs in most states: n n n
a. must have a Drug Enforcement
n n n n
Administration (DEA) number to practice.
n n n n n
b. must have prescriptive authority to
n n n n
practice.
n
c. order and administer controlled substances
n n n n
but do not have full prescriptive authority.
n n n n n n n
d. administer medications, including n n
controlled substances, under direct
n n n n
physician supervision.
n n
ANS: C n
Only five states grant independent prescriptive authority to CRNAs. CRNAs do not
n n n n n n n n n n n
require prescriptive authority because they dispense a drug immediately to a patient and
n n n n n n n n n n n n n
do not prescribe. Without prescriptive authority, they do not need a DEA number.
n n n n n n n n n n n n n
DIF: Cognitive Level: Understanding (Comprehension)
n n n REF: 9 n
3. A CNM:
n
a. may treat only women.
n n n
b. has prescriptive authority in all 50 states.
n n n n n n
c. may administer only drugs used during
n n n n n
labor and delivery.
n n n
d. may practice only in birthing centers and
n n n n n n
home birth settings.
n n n
ANS: B n
, CNMs have prescriptive authority in all 50 states. They may treat partners of women for
n n n n n n n n n n n n n n
sexually transmitted diseases. They have full prescriptive authority and are not limited to
n n n n n n n n n n n n n
drugs used during childbirth. They practice in many other types of settings.
n n n n n n n n n n n n
DIF: n n Cognitive Level: Remembering (Knowledge) n n n REF: 9 n
4. In every state, prescriptive authority for NPs includes the ability to write prescriptions:
n n n n n n n n n n n n
a. for controlled substances.
n n
b. for specified classifications of
n n n
medications.
n
c. without physician-mandated involvement. n n
d. with full, independent prescriptive
n n n
authority.
n
ANS: B n
All states now have some degree of prescriptive authority granted to NPs, but not all
n n n n n n n n n n n n n n
states allow authority to prescribe controlled substances. Many states still require some
n n n n n n n n n n n n
degree of physician involvement with certain types of drugs.
n n n n n n n n n
DIF: Cognitive Level: Understanding (Comprehension)
n n n REF: 12 n
5. The current trend toward transitioning NP programs to the doctoral level will mean that:
n n n n n n n n n n n n n
a. NPs licensed in one state may practice in
n n n n n n n
other states.
n n
b. full prescriptive authority will be granted
n n n n n
to all NPs with doctoral degrees.
n n n n n n
c. NPs will be better prepared to meet
n n n n n n
emerging health care needs of patients.
n n n n n n
d. requirements for physician supervision of n n n n
NPs will be removed in all states.
n n n n n n n
ANS: C n
The American Association of Colleges of Nursing has recommended transitioning
n n n n n n n n n
graduate level NP programs to the doctoral level as a response to changes in health care
n n n n n n n n n n n n n n n n
delivery and emerging health care needs. NPs with doctoral degrees will not necessarily
n n n n n n n n n n n n n
have full prescriptive authority or be freed from requirements about physician
n n n n n n n n n n n
supervision because those are subject to individual state laws. NPs will still be required to
n n n n n n n n n n n n n n n
meet licensure requirements of each state.
n n n n n n
DIF: Cognitive Level: Understanding (Comprehension)
n n n REF: 12 n
6. An important difference between physician assistants (PAs) and NPs is PAs:
n n n n n n n n n n
a. always work under physician supervision.n n n n
b. are not required to follow drug treatment
n n n n n n
CHAPTERSQUESTIONS AND ANSWERS WITH
n n n n
RATIONALES n
Chapter 01: Prescriptive Authority and Role Implementation: Tradition vs. Change
n n n n n n n n n
Test Bank
n n
MULTIPLE CHOICE n
1. Which of the following has influenced an emphasis on primary care education in medical
n n n n n n n n n n n n n
schools?
n
a. Changes in Medicare reimbursement n n n
methods recommended in 1992
n n n n
b. Competition from nonphysicians desiring n n n
to meet primary care shortages
n n n n n
c. The need for monopolistic control in the
n n n n n n
marketplace of primary outpatient care
n n n n n
d. The recognition that nonphysicians have
n n n n
variable success providing primary care
n n n n n
ANS: A n
The Physician Payment Review Commission in 1992 directly increased financial
n n n n n n n n n
reimbursement to clinicians who provide primary care. Coupled with a shortage of
n n n n n n n n n n n n
primary care providers, this incentive led medical schools to place greater emphasis on
n n n n n n n n n n n n n
preparing primary care physicians. Competition from nonphysicians increased
n n n n n n n n
coincidentally as professionals from other disciplines stepped up to meet the needs.
n n n n n n n n n n n n
Nonphysicians have had increasing success at providing primary care and have been
n n n n n n n n n n n
shown to be safe and effective.
n n n n n n
DIF: Cognitive Level: Remembering (Knowledge)
n n n REF: 2 n
2. Which of the following statements is true about the prescribing practices of physicians?
n n n n n n n n n n n n
a. Older physicians tend to prescribe more
n n n n n
appropriate medications than younger
n n n n
physicians.
b. Antibiotic medications remain in the top n n n n n
five classifications of medications
n n n n
prescribed.
n
c. Most physicians rely on a ―therapeutic
n n n n n
armamentarium‖ that consists of less than
n n n n n n
100 drug preparations per physician.
n n n n n
d. The dominant form of drug information
n n n n n
used by primary care physicians continues
n n n n n n
to be that provided by pharmaceutical
n n n n n n
companies.
n
, ANS: D n
Even though most physicians claim to place little weight on drug advertisements,
n n n n n n n n n n n
pharmaceutical representatives, and patient preference and state that they rely on
n n n n n n n n n n
academic sources for drug information, a study showed that commercial rather than
n n n n n n n n n n n n
scientific sources of drug information dominated their drug information materials.
n n n n n n n n n n
Younger physicians tend to prescribe fewer and more appropriate drugs. Antibiotics have
n n n n n n n n n n n n
dropped out of the top five classifications of drugs prescribed. Most physicians have a
n n n n n n n n n n n n n n
therapeutic armamentarium of about 144 drugs.
n n n n n n
DIF: Cognitive Level: Remembering (Knowledge) n n n REF: 3 n
3. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of
n n n n n n n n n n n n n
medications, it will be important to:
n n n n n n
a. attain the same level of expertise as
n n n n n n
physicians who currently prescribe
n n n n
medications.
n
b. learn from the experiences of physicians
n n n n n
nand develop expertise based on evidence-
n n n n n
nbased practice. n
c. maintain collaborative and supervisorial n n n
relationships with physicians who will
n n n n n
oversee prescribing practices.
n n n
d. develop relationships with pharmaceutical n n n
representatives to learn about new
n n n n n
medications as they are developed.
n n n n n
ANS: B n
As nonphysicians develop the roles associated with prescriptive authority, it will be
n n n n n n n n n n n
important to learn from the past experiences of physicians and to develop prescribing
n n n n n n n n n n n n n
practices based on evidence-based medicine. It is hoped that all prescribers, including
n n n n n n n n n n n n
physicians and nurse practitioners, will strive to do better than in the past. NPs should
n n n n n n n n n n n n n n n
work toward prescriptive authority and for practice that is not supervised by another
n n n n n n n n n n n n n
professional. Pharmaceutical representatives provide information that carries some bias.
n n n n n n n n n
Academic sources are better.
n n n n
DIF: Cognitive Level: Applying (Application) n n n REF: 4 n
Chapter 02: Historical Review of Prescriptive Authority: The Role of Nurses (NPs,
n n n n n n n n n n n
CNMs, CRNAs, and CNSs) and Physician Assistants
n n n n n n n
Test Bank
n
MULTIPLE CHOICE n
1. A primary care NP will begin practicing in a state in which the governor has opted out of
n n n n n n n n n n n n n n n n n
the federal facility reimbursement requirement. The NP should be aware that this defines
n n n n n n n n n n n n n
how NPs may write prescriptions:
n n n n n
, a. without physician supervision in private
n n n n
practice.
n
b. as CRNAs without physician supervision
n n n n
in a hospital setting.
n n n n
c. in any situation but will not be reimbursed
n n n n n n n
nfor this by government insurers.
n n n n
d. only with physician supervision in both
n n n n n
private practice and a hospital setting.
n n n n n n
ANS: B n
In 2001, the Centers for Medicare and Medicaid Services changed the federal physician
n n n n n n n n n n n n
nsupervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write
n n n n n n n n n n n n n n
nprescriptions and dispense drugs without physician supervision.
n n n n n n
DIF: Cognitive Level: Understanding (Comprehension)
n n n REF: 9 n
2. CRNAs in most states: n n n
a. must have a Drug Enforcement
n n n n
Administration (DEA) number to practice.
n n n n n
b. must have prescriptive authority to
n n n n
practice.
n
c. order and administer controlled substances
n n n n
but do not have full prescriptive authority.
n n n n n n n
d. administer medications, including n n
controlled substances, under direct
n n n n
physician supervision.
n n
ANS: C n
Only five states grant independent prescriptive authority to CRNAs. CRNAs do not
n n n n n n n n n n n
require prescriptive authority because they dispense a drug immediately to a patient and
n n n n n n n n n n n n n
do not prescribe. Without prescriptive authority, they do not need a DEA number.
n n n n n n n n n n n n n
DIF: Cognitive Level: Understanding (Comprehension)
n n n REF: 9 n
3. A CNM:
n
a. may treat only women.
n n n
b. has prescriptive authority in all 50 states.
n n n n n n
c. may administer only drugs used during
n n n n n
labor and delivery.
n n n
d. may practice only in birthing centers and
n n n n n n
home birth settings.
n n n
ANS: B n
, CNMs have prescriptive authority in all 50 states. They may treat partners of women for
n n n n n n n n n n n n n n
sexually transmitted diseases. They have full prescriptive authority and are not limited to
n n n n n n n n n n n n n
drugs used during childbirth. They practice in many other types of settings.
n n n n n n n n n n n n
DIF: n n Cognitive Level: Remembering (Knowledge) n n n REF: 9 n
4. In every state, prescriptive authority for NPs includes the ability to write prescriptions:
n n n n n n n n n n n n
a. for controlled substances.
n n
b. for specified classifications of
n n n
medications.
n
c. without physician-mandated involvement. n n
d. with full, independent prescriptive
n n n
authority.
n
ANS: B n
All states now have some degree of prescriptive authority granted to NPs, but not all
n n n n n n n n n n n n n n
states allow authority to prescribe controlled substances. Many states still require some
n n n n n n n n n n n n
degree of physician involvement with certain types of drugs.
n n n n n n n n n
DIF: Cognitive Level: Understanding (Comprehension)
n n n REF: 12 n
5. The current trend toward transitioning NP programs to the doctoral level will mean that:
n n n n n n n n n n n n n
a. NPs licensed in one state may practice in
n n n n n n n
other states.
n n
b. full prescriptive authority will be granted
n n n n n
to all NPs with doctoral degrees.
n n n n n n
c. NPs will be better prepared to meet
n n n n n n
emerging health care needs of patients.
n n n n n n
d. requirements for physician supervision of n n n n
NPs will be removed in all states.
n n n n n n n
ANS: C n
The American Association of Colleges of Nursing has recommended transitioning
n n n n n n n n n
graduate level NP programs to the doctoral level as a response to changes in health care
n n n n n n n n n n n n n n n n
delivery and emerging health care needs. NPs with doctoral degrees will not necessarily
n n n n n n n n n n n n n
have full prescriptive authority or be freed from requirements about physician
n n n n n n n n n n n
supervision because those are subject to individual state laws. NPs will still be required to
n n n n n n n n n n n n n n n
meet licensure requirements of each state.
n n n n n n
DIF: Cognitive Level: Understanding (Comprehension)
n n n REF: 12 n
6. An important difference between physician assistants (PAs) and NPs is PAs:
n n n n n n n n n n
a. always work under physician supervision.n n n n
b. are not required to follow drug treatment
n n n n n n
