TEST BANK For Edmunds' Pharmacology for the
Primary Care Provider, 5th Edition Constance
Which of the following has influenced an emphasis on primary care education in
medical schools? - ANSWER Changes in Medicare reimbursement methods
recommended in 1992
Which of the following statements is true about the prescribing practices of
physicians? - ANSWER The dominant form of drug information used by primary
care physicians continues to be that provided by pharmaceutical companies
As primary care nurse practitioners (NPs) continue to develop their role as
prescribers of medications, it will be important to: - ANSWER learn from the
experiences of physicians and develop expertise based on evidence-based practice.
A primary care NP will begin practicing in a state in which the governor has opted out
of the federal facility reimbursement requirement. The NP should be aware that this
defines how NPs may write prescriptions: - ANSWER as CRNAs without physician
supervision in a hospital setting.
CRNAs in most states: - ANSWER order and administer controlled substances but
do not have full prescriptive authority.
A CNM: - ANSWER has prescriptive authority in all 50 states.
In every state, prescriptive authority for NPs includes the ability to write prescriptions:
- ANSWER for specified classifications of medications.
The current trend toward transitioning NP programs to the doctoral level will mean
that: - ANSWER NPs will be better prepared to meet emerging health care needs of
patients.
An important difference between physician assistants (PAs) and NPs is PAs: -
ANSWER always work under physician supervision.
To increase the likelihood of successful pharmacotherapy, when teaching a patient
about using a medication, the primary care nurse practitioner (NP) should: -
ANSWER encourage the patient to participate in the choice of the medication.
A patient has recurrent symptoms and tells the primary care NP that she can't
remember to take her medication all the time. The NP should: - ANSWER ask her
about her lifestyle, her schedule, and her understanding of her condition.
A primary care NP prepares to teach a patient about the management of a chronic
condition. The patient says, "I don't want to know all of that. Just tell me what to take
,and when." The NP should initially: - ANSWER give the patient basic written
instructions about medications, follow up visits, and symptoms.
A parent brings a child who has moderate-persistent asthma to the clinic and tells
the primary care NP that none of the child's medications are working. The parent
says, "Everybody tells me something different. I don't know what to do." The NP
suspects that the parent is not administering the medications appropriately. The NP
should initially: - ANSWER perform a careful history of the child's symptoms and
the medications that are given.
A primary care NP sees a 5-year-old child who is morbidly obese. The child has an
elevated hemoglobin A1c and increased lipid levels. Both of the child's parents are
overweight but not obese, and they tell the NP that they see nothing wrong with their
child. They both state that it is difficult to refuse their child's requests for soda or ice
cream. The NP should: - ANSWER initiate a dialogue with the parents about the
implications of the child's laboratory values.
A patient bursts into tears when the primary care NP diagnoses diabetes. The NP
should: - ANSWER ask the patient about past experiences with anyone who has
this diagnosis.
A primary care NP writes a prescription for an off-label use for a drug. To help
ensure compliance, the NP should: - ANSWER include information about the off-
label use on the E-script
The primary care nurse practitioner (NP) writes a prescription for an antibiotic using
an electronic drug prescription system. The pharmacist will fill this prescription when:
- ANSWER the electronic prescription is received.
When prescribing a medication for a chronic condition, the primary care NP should
tell the patient: - ANSWER about the frequency of clinic visits necessary for the
number of refills authorized.
The neighbor of a primary care NP asks the NP to write a prescription for an
antibiotic. The NP should tell the neighbor: - ANSWER that it is best if the neighbor
sees a health care provider before obtaining a prescription.
The primary care NP is prescribing a medication for an off-label use. To help prevent
a medication error, the NP should: - ANSWER write "off-label use" on the
prescription and provide a rationale.
The primary care NP sees a patient covered by Medicaid, writes a prescription for a
medication, and is informed by the pharmacist that the medication is "off-formulary."
The NP should: - ANSWER write the prescription for a generic drug if it meets the
patient's needs.
A patient who has asthma and who is known to the primary care NP calls the NP
after hours and asks for a refill of an albuterol metered-dose inhaler. The patient has
not been seen in the clinic for more than a year. The NP should: - ANSWER refill
the drug and tell the patient that an office visit is necessary for further refills.
,A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic
to ask for a refill of the medication. The primary care NP notes that the medication
refill is not due for 2 weeks. The patient tells the NP that the refill is needed because
he is going out of town. The NP should: - ANSWER review the patient's chart to see
if this is a one-time or repeat occurrence.
The primary care nurse practitioner (NP) is using critical thinking skills when: -
ANSWER analyzing current research and synthesizing new approaches to patient
care.
The primary care NP has referred a child who has significant gastrointestinal reflux
disease to a specialist for consideration for a fundoplication and gastrostomy tube
placement. The child's weight is 80% of what is recommended for age, and a recent
swallow study revealed significant risk for aspiration. The child's parents do not want
the procedure. The NP should: - ANSWER initiate a discussion with the parents
about the potential outcomes of each possible action.
The primary care NP prescribes an inhaled corticosteroid for a patient who has
asthma. The third-party payer for this patient denies coverage for the brand that
comes in the specific strength the NP prescribes. The NP should: - ANSWER order
the closest formulary-approved approximation of the drug and monitor effectiveness.
A patient takes a cardiac medication that has a very narrow therapeutic range. The
primary care NP learns that the particular brand the patient is taking is no longer
covered by the patient's medical plan. The NP knows that the bioavailability of the
drug varies from brand to brand. The NP should: - ANSWER contact the insurance
provider to explain why this particular formulation is necessary.
A patient comes to the clinic reporting dizziness and fatigue associated with nausea
and vomiting. The primary care NP suspects anemia and orders a complete blood
count. The patient's hemoglobin is elevated. The NP correctly concludes that the
patient is not anemic. The NP has made an error in: - ANSWER hypothesis
triggering and information processing.
A patient comes to the clinic with a 2-day history of cough and wheezing. The patient
has no previous history of asthma. The patient reports having heartburn for several
months, which has worsened considerably. The primary care NP makes a diagnosis
of asthma and orders oral steroids and inhaled albuterol. The patient's condition
worsens, and a chest radiograph obtained 2 days later shows bilateral infiltrates. The
NP has failed to: - ANSWER confirm the diagnosis.
A patient comes to the clinic and asks the primary care NP about using a newly
developed formulation of the drug the patient has been taking for a year. When
deciding whether or not to prescribe this formulation, the NP should: - ANSWER tell
the patient that when postmarketing data is available, it will be considered.
The primary care NP is reviewing evidence-based recommendations about the off-
label use of a particular drug. Which recommendation should influence the NP's
, decision about prescribing the medication? - ANSWER Data from randomized,
experimental studies
A primary care NP is developing a clinical practice guideline for management of a
patient population in a midsized suburban hospital. The NP should: - ANSWER
review expert opinion and experimental, anecdotal, correlational study data.
A primary care nurse practitioner (NP) prescribes a drug to an 80-year-old African-
American woman. When selecting a drug and determining the correct dose, the NP
should understand that the knowledge of how age, race, and gender may affect drug
excretion is based on an understanding of: - ANSWER pharmacokinetics.
A patient asks the primary care NP which medication to use for mild to moderate
pain. The NP should recommend:
a. APAP.
b. Tylenol.
c. acetaminophen.
d. any over-the-counter pain product. - ANSWER c. acetaminophen.
Rationale: Providers should use generic drug names when prescribing drugs or
recommending them to patients, unless a particular brand is essential for some
reason. Because acetaminophen can have many trade names, it is important for
patients to understand that the drug is the same for all to avoid overdosing on
acetaminophen. APAP is a commonly used abbreviation but should not be used
when recommending the drug to patients.
A patient wants to know why a cheaper version of a drug cannot be used when the
primary care NP writes a prescription for a specific brand name of the drug and
writes, "Dispense as Written." The NP should explain that a different brand of this
drug: - ANSWER may vary in the amount of drug that reaches the site of action in
the body
A primary care NP wishes to order a drug that will be effective immediately after
administration of the drug. Which route should the NP choose? - ANSWER
Sublingual
A patient receives an inhaled corticosteroid to treat asthma. The patient asks the
primary care NP why the drug is given by this route instead of orally. The NP should
explain that the inhaled form: - ANSWER has fewer systemic side effects.
A patient takes an oral medication that causes gastrointestinal upset. The patient
asks the primary care NP why the drug information insert cautions against using
antacids while taking the drug. The NP should explain that the antacid may: -
ANSWER alter drug absorption
A patient will begin taking two drugs that are both protein-bound. The primary care
NP should: - ANSWER monitor drug levels, actions, and side effects.
Primary Care Provider, 5th Edition Constance
Which of the following has influenced an emphasis on primary care education in
medical schools? - ANSWER Changes in Medicare reimbursement methods
recommended in 1992
Which of the following statements is true about the prescribing practices of
physicians? - ANSWER The dominant form of drug information used by primary
care physicians continues to be that provided by pharmaceutical companies
As primary care nurse practitioners (NPs) continue to develop their role as
prescribers of medications, it will be important to: - ANSWER learn from the
experiences of physicians and develop expertise based on evidence-based practice.
A primary care NP will begin practicing in a state in which the governor has opted out
of the federal facility reimbursement requirement. The NP should be aware that this
defines how NPs may write prescriptions: - ANSWER as CRNAs without physician
supervision in a hospital setting.
CRNAs in most states: - ANSWER order and administer controlled substances but
do not have full prescriptive authority.
A CNM: - ANSWER has prescriptive authority in all 50 states.
In every state, prescriptive authority for NPs includes the ability to write prescriptions:
- ANSWER for specified classifications of medications.
The current trend toward transitioning NP programs to the doctoral level will mean
that: - ANSWER NPs will be better prepared to meet emerging health care needs of
patients.
An important difference between physician assistants (PAs) and NPs is PAs: -
ANSWER always work under physician supervision.
To increase the likelihood of successful pharmacotherapy, when teaching a patient
about using a medication, the primary care nurse practitioner (NP) should: -
ANSWER encourage the patient to participate in the choice of the medication.
A patient has recurrent symptoms and tells the primary care NP that she can't
remember to take her medication all the time. The NP should: - ANSWER ask her
about her lifestyle, her schedule, and her understanding of her condition.
A primary care NP prepares to teach a patient about the management of a chronic
condition. The patient says, "I don't want to know all of that. Just tell me what to take
,and when." The NP should initially: - ANSWER give the patient basic written
instructions about medications, follow up visits, and symptoms.
A parent brings a child who has moderate-persistent asthma to the clinic and tells
the primary care NP that none of the child's medications are working. The parent
says, "Everybody tells me something different. I don't know what to do." The NP
suspects that the parent is not administering the medications appropriately. The NP
should initially: - ANSWER perform a careful history of the child's symptoms and
the medications that are given.
A primary care NP sees a 5-year-old child who is morbidly obese. The child has an
elevated hemoglobin A1c and increased lipid levels. Both of the child's parents are
overweight but not obese, and they tell the NP that they see nothing wrong with their
child. They both state that it is difficult to refuse their child's requests for soda or ice
cream. The NP should: - ANSWER initiate a dialogue with the parents about the
implications of the child's laboratory values.
A patient bursts into tears when the primary care NP diagnoses diabetes. The NP
should: - ANSWER ask the patient about past experiences with anyone who has
this diagnosis.
A primary care NP writes a prescription for an off-label use for a drug. To help
ensure compliance, the NP should: - ANSWER include information about the off-
label use on the E-script
The primary care nurse practitioner (NP) writes a prescription for an antibiotic using
an electronic drug prescription system. The pharmacist will fill this prescription when:
- ANSWER the electronic prescription is received.
When prescribing a medication for a chronic condition, the primary care NP should
tell the patient: - ANSWER about the frequency of clinic visits necessary for the
number of refills authorized.
The neighbor of a primary care NP asks the NP to write a prescription for an
antibiotic. The NP should tell the neighbor: - ANSWER that it is best if the neighbor
sees a health care provider before obtaining a prescription.
The primary care NP is prescribing a medication for an off-label use. To help prevent
a medication error, the NP should: - ANSWER write "off-label use" on the
prescription and provide a rationale.
The primary care NP sees a patient covered by Medicaid, writes a prescription for a
medication, and is informed by the pharmacist that the medication is "off-formulary."
The NP should: - ANSWER write the prescription for a generic drug if it meets the
patient's needs.
A patient who has asthma and who is known to the primary care NP calls the NP
after hours and asks for a refill of an albuterol metered-dose inhaler. The patient has
not been seen in the clinic for more than a year. The NP should: - ANSWER refill
the drug and tell the patient that an office visit is necessary for further refills.
,A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic
to ask for a refill of the medication. The primary care NP notes that the medication
refill is not due for 2 weeks. The patient tells the NP that the refill is needed because
he is going out of town. The NP should: - ANSWER review the patient's chart to see
if this is a one-time or repeat occurrence.
The primary care nurse practitioner (NP) is using critical thinking skills when: -
ANSWER analyzing current research and synthesizing new approaches to patient
care.
The primary care NP has referred a child who has significant gastrointestinal reflux
disease to a specialist for consideration for a fundoplication and gastrostomy tube
placement. The child's weight is 80% of what is recommended for age, and a recent
swallow study revealed significant risk for aspiration. The child's parents do not want
the procedure. The NP should: - ANSWER initiate a discussion with the parents
about the potential outcomes of each possible action.
The primary care NP prescribes an inhaled corticosteroid for a patient who has
asthma. The third-party payer for this patient denies coverage for the brand that
comes in the specific strength the NP prescribes. The NP should: - ANSWER order
the closest formulary-approved approximation of the drug and monitor effectiveness.
A patient takes a cardiac medication that has a very narrow therapeutic range. The
primary care NP learns that the particular brand the patient is taking is no longer
covered by the patient's medical plan. The NP knows that the bioavailability of the
drug varies from brand to brand. The NP should: - ANSWER contact the insurance
provider to explain why this particular formulation is necessary.
A patient comes to the clinic reporting dizziness and fatigue associated with nausea
and vomiting. The primary care NP suspects anemia and orders a complete blood
count. The patient's hemoglobin is elevated. The NP correctly concludes that the
patient is not anemic. The NP has made an error in: - ANSWER hypothesis
triggering and information processing.
A patient comes to the clinic with a 2-day history of cough and wheezing. The patient
has no previous history of asthma. The patient reports having heartburn for several
months, which has worsened considerably. The primary care NP makes a diagnosis
of asthma and orders oral steroids and inhaled albuterol. The patient's condition
worsens, and a chest radiograph obtained 2 days later shows bilateral infiltrates. The
NP has failed to: - ANSWER confirm the diagnosis.
A patient comes to the clinic and asks the primary care NP about using a newly
developed formulation of the drug the patient has been taking for a year. When
deciding whether or not to prescribe this formulation, the NP should: - ANSWER tell
the patient that when postmarketing data is available, it will be considered.
The primary care NP is reviewing evidence-based recommendations about the off-
label use of a particular drug. Which recommendation should influence the NP's
, decision about prescribing the medication? - ANSWER Data from randomized,
experimental studies
A primary care NP is developing a clinical practice guideline for management of a
patient population in a midsized suburban hospital. The NP should: - ANSWER
review expert opinion and experimental, anecdotal, correlational study data.
A primary care nurse practitioner (NP) prescribes a drug to an 80-year-old African-
American woman. When selecting a drug and determining the correct dose, the NP
should understand that the knowledge of how age, race, and gender may affect drug
excretion is based on an understanding of: - ANSWER pharmacokinetics.
A patient asks the primary care NP which medication to use for mild to moderate
pain. The NP should recommend:
a. APAP.
b. Tylenol.
c. acetaminophen.
d. any over-the-counter pain product. - ANSWER c. acetaminophen.
Rationale: Providers should use generic drug names when prescribing drugs or
recommending them to patients, unless a particular brand is essential for some
reason. Because acetaminophen can have many trade names, it is important for
patients to understand that the drug is the same for all to avoid overdosing on
acetaminophen. APAP is a commonly used abbreviation but should not be used
when recommending the drug to patients.
A patient wants to know why a cheaper version of a drug cannot be used when the
primary care NP writes a prescription for a specific brand name of the drug and
writes, "Dispense as Written." The NP should explain that a different brand of this
drug: - ANSWER may vary in the amount of drug that reaches the site of action in
the body
A primary care NP wishes to order a drug that will be effective immediately after
administration of the drug. Which route should the NP choose? - ANSWER
Sublingual
A patient receives an inhaled corticosteroid to treat asthma. The patient asks the
primary care NP why the drug is given by this route instead of orally. The NP should
explain that the inhaled form: - ANSWER has fewer systemic side effects.
A patient takes an oral medication that causes gastrointestinal upset. The patient
asks the primary care NP why the drug information insert cautions against using
antacids while taking the drug. The NP should explain that the antacid may: -
ANSWER alter drug absorption
A patient will begin taking two drugs that are both protein-bound. The primary care
NP should: - ANSWER monitor drug levels, actions, and side effects.
