NR 565 MIDTERM EXAM COMPREHENSIVE
STUDY GUIDE 2026 ADVANCED HEALTH
ASSESSMENT AND DIAGNOSTIC REASONING
PRINCIPLES
◉ benefits of full practice authority.
Answer: Nurse practitioners have the autonomy to evaluate patients,
diagnose, order and interpret tests, initiate and manage treatments
and prescribe medications, including controlled substances without
physician oversight
◉ promoting positive outcomes through prudent prescribing
practices.
Answer: Administering medications and prescribing medications
are two distinct processes. Prescription writing requires prudent
and deliberate decision-making processes to maintain patient safety
and reduce liability, including:
*documentation of a provider-patient relationship for the recipient
of the prescribed medications
*documentation of a thorough history and physical examination for
the recipient
,*documentation of discussions regarding risk factors, side effects, or
therapy options
*documentation of drug monitoring or titration plan, if applicable
*documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
Rational drug selection requires a logical approach that includes the
formulation of a diagnosis based on clinical reasoning and the
selection and monitoring of the most appropriate pharmacological
treatment
Considerations include: Cost, guidelines, availability, interactions,
side effects, allergies, hepatic/renal functions, need for monitoring,
& special populations
◉ Beer's Criteria.
Answer: identifies drugs with a high likelihood of causing adverse
effects in older adults. Accordingly, drugs on this list should
generally be avoided in adults older than 65 years except when the
benefits are significantly greater than the risks.
,◉ Pharmacodynamics.
Answer: the study of the biochemical and physiologic effects of
drugs on the body and the molecular mechanisms by which those
effects are produced
◉ Pharmacokinetics.
Answer: the study of drug movement throughout the body
◉ Pharmacogenomics.
Answer: the study of how genes affect a person's response to drugs.
The purpose of this is to combine the sciences of genomics and
pharmacology to provide individualized, targeted, safe drug
therapies to patients
◉ CYP450 inducers.
Answer: Inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme
synthesis. This action leads to additional sites available for
biotransformation. The increased number of sites enhances
medication metabolism, decreasing the concentration of the "parent
drug" while increasing metabolite production.
Inducers = Increase medication metabolism
, (Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin,
Phenobarbital, Sulfonylureas)
◉ CYP450 inhibitors.
Answer: Inhibitors are medications that inhibit the metabolic
activity of one or more of the CYP450 enzymes. Medications that
inhibit an enzyme potentially slows that enzyme's activity or blocks
the activity required for the metabolism of other medications,
thereby increasing the levels of medications dependent on that
particular enzyme for biotransformation. Inhibitors = decrease
medication metabolism (Valproate, Isoniazid, Sulfonamides,
Amiodarone, Chloramphenicol, Ketoconazole, Grapefruit Juice,
Quinidine)
◉ cultural influences in prescribing.
Answer: The greatest concern surrounding race-based therapy has
to do with genetic variability. We know there is great diversity
within and among racial groups; therefore, a "one fits all" approach
based on race is unwise. Still, we can use known associations to
guide choices. For example, differences in metabolism between
people with East Asian and European heritage are common. The
provider can use this knowledge to guide initial dosing (with
adjustment, as indicated based on response) if genetic testing is not
feasible or warranted
◉ Polypharmacy: Definition, challenges, and outcomes.
STUDY GUIDE 2026 ADVANCED HEALTH
ASSESSMENT AND DIAGNOSTIC REASONING
PRINCIPLES
◉ benefits of full practice authority.
Answer: Nurse practitioners have the autonomy to evaluate patients,
diagnose, order and interpret tests, initiate and manage treatments
and prescribe medications, including controlled substances without
physician oversight
◉ promoting positive outcomes through prudent prescribing
practices.
Answer: Administering medications and prescribing medications
are two distinct processes. Prescription writing requires prudent
and deliberate decision-making processes to maintain patient safety
and reduce liability, including:
*documentation of a provider-patient relationship for the recipient
of the prescribed medications
*documentation of a thorough history and physical examination for
the recipient
,*documentation of discussions regarding risk factors, side effects, or
therapy options
*documentation of drug monitoring or titration plan, if applicable
*documentation of consultations, if any
avoidance of prescribing medications for self, family, or friends
Rational drug selection requires a logical approach that includes the
formulation of a diagnosis based on clinical reasoning and the
selection and monitoring of the most appropriate pharmacological
treatment
Considerations include: Cost, guidelines, availability, interactions,
side effects, allergies, hepatic/renal functions, need for monitoring,
& special populations
◉ Beer's Criteria.
Answer: identifies drugs with a high likelihood of causing adverse
effects in older adults. Accordingly, drugs on this list should
generally be avoided in adults older than 65 years except when the
benefits are significantly greater than the risks.
,◉ Pharmacodynamics.
Answer: the study of the biochemical and physiologic effects of
drugs on the body and the molecular mechanisms by which those
effects are produced
◉ Pharmacokinetics.
Answer: the study of drug movement throughout the body
◉ Pharmacogenomics.
Answer: the study of how genes affect a person's response to drugs.
The purpose of this is to combine the sciences of genomics and
pharmacology to provide individualized, targeted, safe drug
therapies to patients
◉ CYP450 inducers.
Answer: Inducers are xenobiotics (medications and environmental
agents) that elevate CYP450 enzyme activity by increasing enzyme
synthesis. This action leads to additional sites available for
biotransformation. The increased number of sites enhances
medication metabolism, decreasing the concentration of the "parent
drug" while increasing metabolite production.
Inducers = Increase medication metabolism
, (Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin,
Phenobarbital, Sulfonylureas)
◉ CYP450 inhibitors.
Answer: Inhibitors are medications that inhibit the metabolic
activity of one or more of the CYP450 enzymes. Medications that
inhibit an enzyme potentially slows that enzyme's activity or blocks
the activity required for the metabolism of other medications,
thereby increasing the levels of medications dependent on that
particular enzyme for biotransformation. Inhibitors = decrease
medication metabolism (Valproate, Isoniazid, Sulfonamides,
Amiodarone, Chloramphenicol, Ketoconazole, Grapefruit Juice,
Quinidine)
◉ cultural influences in prescribing.
Answer: The greatest concern surrounding race-based therapy has
to do with genetic variability. We know there is great diversity
within and among racial groups; therefore, a "one fits all" approach
based on race is unwise. Still, we can use known associations to
guide choices. For example, differences in metabolism between
people with East Asian and European heritage are common. The
provider can use this knowledge to guide initial dosing (with
adjustment, as indicated based on response) if genetic testing is not
feasible or warranted
◉ Polypharmacy: Definition, challenges, and outcomes.
