1|Page
NR565 / NR 565 Advanced Pharmacology Care of the
Fundamentals Midterm Exam | Chamberlain University |
Verified Questions & Answers with Rationales | Multiple
Choice & Open-Ended Q&A
Exam Structure:
Subject: Advanced Pharmacology (NR565) – Midterm Exam
Source: NR565 / NR 565 Advanced Pharmacology Care of the Fundamentals –
Midterm Exam Review (Chamberlain)
Format: Multiple Choice & Open-Ended Q&A
1. Which schedule drugs can APRNs prescribe?
Correct Answer: DEA license allows prescribing of Schedules II-V. There
can be restrictions as noted in collaborative agreements. May be
facility/state dependent.
Rationale:
1. Schedule I drugs have no accepted medical use and cannot be prescribed.
2. APRNs must register with the DEA to prescribe controlled substances.
3. State laws may restrict certain schedules or require collaboration.
4. Some states allow full independent prescribing; others require physician
oversight.
2. Who determines and regulates prescriptive authority?
Correct Answer: Determines: State practice acts (APRNs can prescribe
without limitation in some states). Regulates: State boards of nursing,
health professional boards. The federal government controls drug
regulation but has no control over prescriptive authority.
Rationale:
1. Each state’s Nurse Practice Act defines APRN scope of practice.
2. State Boards of Nursing, Medicine, or Pharmacy may regulate prescriptive
authority.
, 2|Page
3. Federal government (DEA) controls drug scheduling but not who can
prescribe.
4. Some states grant full practice authority; others require collaboration or
supervision.
3. How does limited prescriptive authority impact patients within the
healthcare system?
Correct Answer: Limited prescriptive authority creates numerous barriers
to quality, affordable, and accessible patient care. Restrictions on the
distance of the APRN from the physician may prevent outreach to areas of
greatest need. Increases patient wait times.
Rationale:
1. Delays in care when APRN must wait for physician co-signature.
2. Increased healthcare costs due to unnecessary office visits.
3. Barriers to timely pain management or medication refills.
4. Reduced access in rural or underserved areas where APRNs are primary
providers.
4. What are the key responsibilities of prescribing?
Correct Answer: Have a documented provider-patient relationship; do not
prescribe to family, friends, or yourself; document thorough history and
physical; include discussions of risk factors, side effects, and therapy
options; have documented plan for drug monitoring or titration; note
consultations with additional providers.
Rationale:
1. Prudent prescribing minimizes errors and adverse events.
2. A documented relationship is legally required for prescribing.
3. Prescribing for self or family lacks objectivity and is ethically problematic.
4. Thorough documentation protects both patient and provider.
5. What should be used to make prescribing decisions?
Correct Answer: Cost, availability, current practice guidelines, medication
interactions (including food), side effects, need for monitoring, how drug is
metabolized (hepatic or renal), special populations (pregnancy, nursing,
older adults).
Rationale:
1. Evidence-based guidelines provide the standard of care.
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2. Cost and availability affect patient adherence.
3. Hepatic/renal function determines dose adjustments.
4. Special populations require individualized dosing.
6. Be familiar with pharmacokinetic and pharmacodynamic changes
in older adults and how that translates to baseline information
needed to prescribe.
Correct Answer: Pharmacokinetics is the study of drug absorption,
distribution, metabolism, and excretion. The ability of older adults to
metabolize drugs is commonly decreased. Drug dosages may need to be
reduced to prevent toxicity.
Rationale:
1. Reduced renal function decreases drug excretion.
2. Reduced hepatic blood flow decreases first-pass metabolism.
3. Increased body fat increases volume of distribution for lipophilic drugs.
4. Decreased albumin increases free drug levels for highly protein-bound
drugs.
7. What are the Beers Criteria?
Correct Answer: Guidelines for prescribing medications to patients 65 and
older. Drugs on the list should be avoided unless benefits significantly
outweigh risks. Includes five lists: potentially inappropriate medications
(PIMs), PIMs due to medication-disease interactions, medications to use
cautiously, clinically significant drug interactions, and medications to avoid
or adjust in impaired kidney function.
Rationale:
1. Developed by the American Geriatrics Society.
2. Identifies high-risk medications for older adults.
3. Examples: benzodiazepines (falls, cognitive impairment), anticholinergics
(delirium).
4. Reduces adverse drug events and hospitalizations.
8. Why are the Beers Criteria important?
Correct Answer: Provides a list of medications that are potentially harmful
in the elderly. Identifies drugs with a high likelihood of causing adverse
effects. Beers Criteria are recommendations; prescribers must determine
NR565 / NR 565 Advanced Pharmacology Care of the
Fundamentals Midterm Exam | Chamberlain University |
Verified Questions & Answers with Rationales | Multiple
Choice & Open-Ended Q&A
Exam Structure:
Subject: Advanced Pharmacology (NR565) – Midterm Exam
Source: NR565 / NR 565 Advanced Pharmacology Care of the Fundamentals –
Midterm Exam Review (Chamberlain)
Format: Multiple Choice & Open-Ended Q&A
1. Which schedule drugs can APRNs prescribe?
Correct Answer: DEA license allows prescribing of Schedules II-V. There
can be restrictions as noted in collaborative agreements. May be
facility/state dependent.
Rationale:
1. Schedule I drugs have no accepted medical use and cannot be prescribed.
2. APRNs must register with the DEA to prescribe controlled substances.
3. State laws may restrict certain schedules or require collaboration.
4. Some states allow full independent prescribing; others require physician
oversight.
2. Who determines and regulates prescriptive authority?
Correct Answer: Determines: State practice acts (APRNs can prescribe
without limitation in some states). Regulates: State boards of nursing,
health professional boards. The federal government controls drug
regulation but has no control over prescriptive authority.
Rationale:
1. Each state’s Nurse Practice Act defines APRN scope of practice.
2. State Boards of Nursing, Medicine, or Pharmacy may regulate prescriptive
authority.
, 2|Page
3. Federal government (DEA) controls drug scheduling but not who can
prescribe.
4. Some states grant full practice authority; others require collaboration or
supervision.
3. How does limited prescriptive authority impact patients within the
healthcare system?
Correct Answer: Limited prescriptive authority creates numerous barriers
to quality, affordable, and accessible patient care. Restrictions on the
distance of the APRN from the physician may prevent outreach to areas of
greatest need. Increases patient wait times.
Rationale:
1. Delays in care when APRN must wait for physician co-signature.
2. Increased healthcare costs due to unnecessary office visits.
3. Barriers to timely pain management or medication refills.
4. Reduced access in rural or underserved areas where APRNs are primary
providers.
4. What are the key responsibilities of prescribing?
Correct Answer: Have a documented provider-patient relationship; do not
prescribe to family, friends, or yourself; document thorough history and
physical; include discussions of risk factors, side effects, and therapy
options; have documented plan for drug monitoring or titration; note
consultations with additional providers.
Rationale:
1. Prudent prescribing minimizes errors and adverse events.
2. A documented relationship is legally required for prescribing.
3. Prescribing for self or family lacks objectivity and is ethically problematic.
4. Thorough documentation protects both patient and provider.
5. What should be used to make prescribing decisions?
Correct Answer: Cost, availability, current practice guidelines, medication
interactions (including food), side effects, need for monitoring, how drug is
metabolized (hepatic or renal), special populations (pregnancy, nursing,
older adults).
Rationale:
1. Evidence-based guidelines provide the standard of care.
, 3|Page
2. Cost and availability affect patient adherence.
3. Hepatic/renal function determines dose adjustments.
4. Special populations require individualized dosing.
6. Be familiar with pharmacokinetic and pharmacodynamic changes
in older adults and how that translates to baseline information
needed to prescribe.
Correct Answer: Pharmacokinetics is the study of drug absorption,
distribution, metabolism, and excretion. The ability of older adults to
metabolize drugs is commonly decreased. Drug dosages may need to be
reduced to prevent toxicity.
Rationale:
1. Reduced renal function decreases drug excretion.
2. Reduced hepatic blood flow decreases first-pass metabolism.
3. Increased body fat increases volume of distribution for lipophilic drugs.
4. Decreased albumin increases free drug levels for highly protein-bound
drugs.
7. What are the Beers Criteria?
Correct Answer: Guidelines for prescribing medications to patients 65 and
older. Drugs on the list should be avoided unless benefits significantly
outweigh risks. Includes five lists: potentially inappropriate medications
(PIMs), PIMs due to medication-disease interactions, medications to use
cautiously, clinically significant drug interactions, and medications to avoid
or adjust in impaired kidney function.
Rationale:
1. Developed by the American Geriatrics Society.
2. Identifies high-risk medications for older adults.
3. Examples: benzodiazepines (falls, cognitive impairment), anticholinergics
(delirium).
4. Reduces adverse drug events and hospitalizations.
8. Why are the Beers Criteria important?
Correct Answer: Provides a list of medications that are potentially harmful
in the elderly. Identifies drugs with a high likelihood of causing adverse
effects. Beers Criteria are recommendations; prescribers must determine
