NURS 565 WEEK 2 STUDY GUIDE EXAM 2026

NURS 565 WEEK 2 STUDY GUIDE EXAM 2026 Nurse practitioner prescriptive authority is regulated by: - -The State Board of Nursing The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include: - -Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care. Clinical judgment in prescribing includes: - -Factoring in the cost to the patient of the medication prescribed Criteria for choosing an effective drug for a disorder include: - -Consulting nationally recognized guidelines for disease management Nurse practitioner practice may thrive under health-care reform because of: - -The demonstrated ability of nurse practitioners to control costs and improve patient outcomes The U.S. Food and Drug Administration regulates: - -The official labeling for all prescription and over-the-counter drugs The U.S. Food and Drug Administration approval is required for: - -Medical devices, including artificial joints An Investigational New Drug is filed with the U.S. Food and Drug Administration: - -Prior to human testing of any new drug entity Phase IV clinical trials in the United States are also known as: - -Postmarketing research Off-label prescribing is: - -Legal if there is scientific evidence for the use The U.S. Drug Enforcement Administration: - -Registers manufacturers and prescribers of controlled substances Drugs that are designated Schedule II by the U.S. Drug Enforcement Administration: - May not be refilled; a new prescription must be written NURS 565 NURS 565 Precautions that should be taken when prescribing controlled substances include: - Using tamper-proof paper for all prescriptions written for controlled drugs Strategies prescribers can use to prevent misuse of controlled prescription drugs include: - -Use of chemical dependency screening tools Firm limit-setting regarding prescribing controlled substances Practicing "just say no" to deal with patients who are pushing the provider to prescribe controlled substances Behaviors predictive of addiction to controlled substances include: - -Stealing or borrowing another patient's drugs Medication agreements or "Pain Medication Contracts" are recommended to be used: - -Universally for all prescribing for chronic pain A prescription needs to be written for: - - Legend drugs Most controlled drugs Medical devices Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must: - -Be safe and labeled for appropriate use Have a low potential for abuse or misuse Be taken for a condition the patient can reliably self-diagnose In the United States, over-the-counter drugs are regulated by: - -The U.S. Food and Drug Administration Center for Drug Evaluation and Research As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to: - -Continue to make large profits from their blockbuster brand-name drug New over-the-counter drug ingredients must undergo the U.S. Food and Drug Administration New Drug Application process, just as prescription drugs do. 1. True 2.False - -True The ailment that generates the greatest over-the-counter annual drug sales is: - -Cough and colds NURS 565 NURS 565 When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of: - -A common misconception that intermittently taken over-the counter medications are not an important part of his drug history Common over-the-counter pain relievers such as acetaminophen or ibuprofen: - -Are harmful if taken in higher than recommended amounts The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act: - -Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient: - -Not to take antacids while on these medications, as the antacid decreases absorption Henry presents to clinic with a significantly swollen, painful great toe and is diagnosed with gout. Of the following, which would be the best treatment for Henry? - -Low-dose colchicine Patient education when prescribing colchicine includes: - -Colchicine always causes some degree of diarrhea. Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes: - -BUN, creatinine, and creatinine clearance Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes: - -Gout may worsen with therapy. Sallie has been taking 10 mg per day of prednisone for the past 6 months. She should be assessed for: - -Osteoporosis Patients whose total dose of prednisone will exceed 1 gram will most likely need a second prescription for: - -Omeprazole, a proton pump inhibitor to prevent peptic ulcer disease Daniel has been on 60 mg of prednisone for 10 days to treat a severe asthma exacerbation. It is time to discontinue the prednisone. How is prednisone discontinued? - -Develop a tapering schedule to slowly wean Daniel off the prednisone. Patients with rheumatoid arthritis who are on chronic low-dose prednisone will need co treatment with which medications to prevent further adverse effects? - -A bisphosphonate Calcium supplementation Vitamin D NURS 565 NURS 565 Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of: - -Serum glucose Patients who are on chronic long-term corticosteroid therapy need education regarding: - -Reporting black tarry stools or abdominal pain All nonsteroidal anti-inflammatory drugs (NSAIDS) have an FDA Black Box Warning regarding: - -Potential for causing life-threatening GI bleeds Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes: - -He should not take any other acetaminophen-containing medications. When prescribing NSAIDS, a complete drug history should be conducted as NSAIDs interact with these drugs: - -Warfarin, an anticoagulant Josefina is a 2-year-old child with acute otitis media and an upper respiratory infection. Along with an antibiotic she receives a recommendation to treat the ear pain with ibuprofen. What education would her parent need regarding ibuprofen? - -Josefina needs to be well-hydrated while taking ibuprofen. Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to "get going" each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry? - -Add an H2 blocker such as ranitidine to his therapy. The trial period to determine effective anti-inflammatory activity when starting a patient on aspirin for rheumatoid arthritis is: - -4 to 6 days Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is: - -Tinnitus Monitoring a patient on a high-dose aspirin level includes: - -Salicylate level Complete blood count Urine pH Patients who are on long-term aspirin therapy should have ______ annually. - Complete blood count Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the: - -Motivational aspects of pain Patients need to be questioned about all pain sites because: - -Patients tend to report the most severe or important in their perception. NURS 565 NURS 565 The chemicals that promote the spread of pain locally include: - -Neurokinin A Narcotics are exogenous opiates. They act by: - -Attaching receptors in the afferent neuron to inhibit the release of substance P Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true? 1. Preterm and newborn infants do not yet have functional pain pathways. 2. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child. 3. Increases in the pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness. 4. Decreases in pain tolerance are evident in older adults. - -1. Preterm and newborn infants do not yet have functional pain pathways. Which of the following statements is true about acute pain? - -Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site. One of the main drug classes used to treat acute pain is NSAIDs. They are used because: - -Inflammation is a common cause of acute pain. Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs? - -Opiates stimulate only mu receptors for the control of pain. If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use? - -Non-opiate, increased dose of non-opiate, opiate The goal of treatment of acute pain is: - -Reduction or elimination of pain with minimum adverse reactions Which of the following statements is true about age and pain? - -Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs. Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to: - -Determine if the diagnosis of source of pain is correct Determine if the current regimen is adequate or different combinations of drugs and non-drug therapy are required Determine if the patient is willing and able to be an active participant in his or her pain management NURS 565 NURS 565 Pathological similarities and differences between acute pain and chronic pain include: - -Chronic pain has a predominance of C-neuron stimulation. A treatment plan for management of chronic pain should include: - -Negotiation with the patient to set personal goals for pain management Discussion of ways to improve sleep and stress An exercise program to improve function and fitness Chronic pain is a complex problem. Some specific strategies to deal with it include: - Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a "red flag" about potential chemical dependency? - Multiple times when prescriptions are lost with requests to refill The Pain Management Contract is appropriate for: - -Patients with chronic pain who will require long-term use of opiates Guiding principles for prescribers - - 1. Be clear about the reasons for prescribing 2. Take into account the patient's medication history before prescribing 3. Take into account other factors that might alter the benefits and risks of treatment 4. Take into account the patient's ideas, concerns, and expectations 5. Select effective, safe, and cost effective medicines individualised for the patient 6. Adhere to national guidelines and local formularies where appropriate 7. Write unambiguous legal prescriptions using the correct documentation 8. Monitor the beneficial and adverse effects of medicines 9. Communicate and document prescribing decisions and the reasons for them 10. Prescribe within the limitations of your knowledge, skills and experience Examples of pure opioid agonists - -Examples of full agonists are heroin, oxycodone, methadone, hydrocodone, morphine, opium and others. What is used to calculate a patient's overdose risk? - -Dosages at or above 50 MME/day increase risks for overdose by at least Calculating the total daily dose of opioids helps identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, or other measures to reduce risk of overdose. 50 MME/day: 50 mg of hydrocodone (10 tablets of hydrocodone/ acetaminophen 5/300) 33 mg of oxycodone (~2 tablets of oxycodone sustained-release 15 mg) 12 mg of methadone ( <3 tablets of methadone 5 mg) NURS 565 NURS 565 90 MME/day: • 90 mg of hydrocodone (9 tablets of hydrocodone/ acetaminophen 10/325) • 60 mg of oxycodone (~2 tablets of oxycodone sustained-release 30 mg) • ~20 mg of methadone (4 tablets of methadone 5 mg) How would you know when to refer someone to a pain specialist for pain management? - -If the cause of the pain is known (or unknown), serious disease excluded, no curative treatment is readily available, current treatment is not helping, or the pain interferes with daily function, referral should to a pain specialist should be considered. Prescription Drug Monitoring Program (PDMP) o What is it? o Why is it important? - -A prescription drug monitoring program (PDMP) is an electronic database that tracks controlled substance prescriptions. PDMPs can help identify patients who may be misusing prescription opioids or other prescription drugs and who may be at risk for overdose. It's an important step to improve opioid prescribing practices. How renal and hepatic function impact medication levels in the body - -The capacity of the liver to metabolise drugs depends on hepatic blood flow and liver enzyme activity, both of which can be affected by liver disease. In addition, liver failure can influence the binding of a drug to plasma proteins. Both prescription and over-the-counter medications are filtered by the kidneys. This means that your kidneys degrade and remove medications from the body. When your kidneys aren't working properly, medications can build up and cause you harm. How to assess someone for possible drug diversion - -Drug diversion is the transfer of a prescription drug from a lawful to an unlawful channelof distribution or us