# Test Bank – Pharmacology for the Primary Care Provider, 5th
Edition
Section 1: Prescriptive Authority and Role Implementation (Questions 1-20)
**1. Which of the following has influenced an emphasis on primary care education in medical
schools?**
A) Competition from nonphysicians desiring to meet primary care shortages
B) Changes in Medicare reimbursement methods recommended in 1992
C) The need for monopolistic control in the marketplace of primary outpatient care
D) The recognition that nonphysicians have variable success providing primary care
**Answer: B**
*Rationale:* The Physician Payment Review Commission in 1992 directly increased financial
reimbursement to clinicians who provide primary care. Coupled with a shortage of primary care
providers, this incentive led medical schools to place greater emphasis on preparing primary care
physicians .
**2. Which statement is true about the prescribing practices of physicians?**
A) Older physicians tend to prescribe more appropriate medications than younger physicians
B) Antibiotic medications remain in the top five classifications of medications prescribed
C) Most physicians rely on a "therapeutic armamentarium" that consists of less than 100 drug
preparations
D) The dominant form of drug information used by primary care physicians continues to be that
provided by pharmaceutical companies
**Answer: D**
*Rationale:* Even though most physicians claim to place little weight on drug advertisements, studies
show that commercial rather than scientific sources of drug information dominate their drug
information materials. Younger physicians tend to prescribe fewer and more appropriate drugs .
**3. As primary care NPs continue to develop their role as prescribers, it will be important to:**
A) Attain the same level of expertise as physicians who currently prescribe medications
B) Learn from the experiences of physicians and develop expertise based on evidence-based practice
C) Maintain collaborative and supervisory relationships with physicians who will oversee prescribing
practices
D) Develop relationships with pharmaceutical representatives to learn about new medications
,**Answer: B**
*Rationale:* As nonphysicians develop prescriptive authority roles, it is important to learn from past
experiences of physicians and develop prescribing practices based on evidence-based medicine. NPs
should work toward prescriptive authority that is not supervised by another professional .
**4. The NP should be aware that the federal physician supervision rule for CRNAs may be waived by
state governors, allowing CRNAs to:**
A) Write prescriptions without physician supervision in private practice
B) Write prescriptions and dispense drugs without physician supervision in a hospital setting
C) Write prescriptions in any situation but will not be reimbursed by government insurers
D) Write prescriptions only with physician supervision in both settings
**Answer: B**
*Rationale:* In 2001, the Centers for Medicare and Medicaid Services changed the federal physician
supervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write prescriptions
and dispense drugs without physician supervision .
**5. A CNM (Certified Nurse-Midwife):**
A) May treat only women
B) Has prescriptive authority in all 50 states
C) May administer only drugs used during labor and delivery
D) May practice only in birthing centers and home birth settings
**Answer: B**
*Rationale:* CNMs have prescriptive authority in all 50 states, reflecting their advanced practice role
in primary care for women .
**6. CRNAs in most states:**
A) Must have a DEA number to practice
B) Must have prescriptive authority to practice
C) Order and administer controlled substances but do not have full prescriptive authority
D) Administer medications, including controlled substances, under direct physician supervision
**Answer: C**
*Rationale:* Only five states grant independent prescriptive authority to CRNAs. CRNAs do not
require prescriptive authority because they dispense a drug immediately to a patient and do not
prescribe. Without prescriptive authority, they do not need a DEA number .
, **7. A primary care NP should understand that the knowledge of how age, race, and gender may
affect drug excretion is based on an understanding of:**
A) Bioavailability
B) Pharmacokinetics
C) Pharmacodynamics
D) Anatomy and physiology
**Answer: B**
*Rationale:* Pharmacokinetics is the study of the action of drugs in the body and may be thought of
as what the body does to the drug. Factors such as age, race, and gender may change the way the
body acts to metabolize and excrete a drug .
**8. A primary care NP is completing a history and physical exam on a new patient with liver disease.
The NP should understand that this may have an impact on which phase of pharmacokinetics?**
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
**Answer: C**
*Rationale:* The liver is the primary site of drug metabolism. Liver disease can significantly impair
drug metabolism, leading to increased drug levels and potential toxicity.
**9. A primary care NP is prescribing a highly protein-bound medication. Which patient factor may
affect the free drug concentration?**
A) Age
B) Gender
C) Serum albumin levels
D) Body mass index
**Answer: C**
*Rationale:* Highly protein-bound drugs rely on albumin to act as a systemic reservoir. In a patient
with low serum albumin (malnutrition, liver disease), there is less protein to bind the drug, resulting in
higher free drug concentrations and potential toxicity .
**10. A primary care NP is prescribing a medication that is renally excreted. Which patient factor may
affect drug excretion?**
Edition
Section 1: Prescriptive Authority and Role Implementation (Questions 1-20)
**1. Which of the following has influenced an emphasis on primary care education in medical
schools?**
A) Competition from nonphysicians desiring to meet primary care shortages
B) Changes in Medicare reimbursement methods recommended in 1992
C) The need for monopolistic control in the marketplace of primary outpatient care
D) The recognition that nonphysicians have variable success providing primary care
**Answer: B**
*Rationale:* The Physician Payment Review Commission in 1992 directly increased financial
reimbursement to clinicians who provide primary care. Coupled with a shortage of primary care
providers, this incentive led medical schools to place greater emphasis on preparing primary care
physicians .
**2. Which statement is true about the prescribing practices of physicians?**
A) Older physicians tend to prescribe more appropriate medications than younger physicians
B) Antibiotic medications remain in the top five classifications of medications prescribed
C) Most physicians rely on a "therapeutic armamentarium" that consists of less than 100 drug
preparations
D) The dominant form of drug information used by primary care physicians continues to be that
provided by pharmaceutical companies
**Answer: D**
*Rationale:* Even though most physicians claim to place little weight on drug advertisements, studies
show that commercial rather than scientific sources of drug information dominate their drug
information materials. Younger physicians tend to prescribe fewer and more appropriate drugs .
**3. As primary care NPs continue to develop their role as prescribers, it will be important to:**
A) Attain the same level of expertise as physicians who currently prescribe medications
B) Learn from the experiences of physicians and develop expertise based on evidence-based practice
C) Maintain collaborative and supervisory relationships with physicians who will oversee prescribing
practices
D) Develop relationships with pharmaceutical representatives to learn about new medications
,**Answer: B**
*Rationale:* As nonphysicians develop prescriptive authority roles, it is important to learn from past
experiences of physicians and develop prescribing practices based on evidence-based medicine. NPs
should work toward prescriptive authority that is not supervised by another professional .
**4. The NP should be aware that the federal physician supervision rule for CRNAs may be waived by
state governors, allowing CRNAs to:**
A) Write prescriptions without physician supervision in private practice
B) Write prescriptions and dispense drugs without physician supervision in a hospital setting
C) Write prescriptions in any situation but will not be reimbursed by government insurers
D) Write prescriptions only with physician supervision in both settings
**Answer: B**
*Rationale:* In 2001, the Centers for Medicare and Medicaid Services changed the federal physician
supervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write prescriptions
and dispense drugs without physician supervision .
**5. A CNM (Certified Nurse-Midwife):**
A) May treat only women
B) Has prescriptive authority in all 50 states
C) May administer only drugs used during labor and delivery
D) May practice only in birthing centers and home birth settings
**Answer: B**
*Rationale:* CNMs have prescriptive authority in all 50 states, reflecting their advanced practice role
in primary care for women .
**6. CRNAs in most states:**
A) Must have a DEA number to practice
B) Must have prescriptive authority to practice
C) Order and administer controlled substances but do not have full prescriptive authority
D) Administer medications, including controlled substances, under direct physician supervision
**Answer: C**
*Rationale:* Only five states grant independent prescriptive authority to CRNAs. CRNAs do not
require prescriptive authority because they dispense a drug immediately to a patient and do not
prescribe. Without prescriptive authority, they do not need a DEA number .
, **7. A primary care NP should understand that the knowledge of how age, race, and gender may
affect drug excretion is based on an understanding of:**
A) Bioavailability
B) Pharmacokinetics
C) Pharmacodynamics
D) Anatomy and physiology
**Answer: B**
*Rationale:* Pharmacokinetics is the study of the action of drugs in the body and may be thought of
as what the body does to the drug. Factors such as age, race, and gender may change the way the
body acts to metabolize and excrete a drug .
**8. A primary care NP is completing a history and physical exam on a new patient with liver disease.
The NP should understand that this may have an impact on which phase of pharmacokinetics?**
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
**Answer: C**
*Rationale:* The liver is the primary site of drug metabolism. Liver disease can significantly impair
drug metabolism, leading to increased drug levels and potential toxicity.
**9. A primary care NP is prescribing a highly protein-bound medication. Which patient factor may
affect the free drug concentration?**
A) Age
B) Gender
C) Serum albumin levels
D) Body mass index
**Answer: C**
*Rationale:* Highly protein-bound drugs rely on albumin to act as a systemic reservoir. In a patient
with low serum albumin (malnutrition, liver disease), there is less protein to bind the drug, resulting in
higher free drug concentrations and potential toxicity .
**10. A primary care NP is prescribing a medication that is renally excreted. Which patient factor may
affect drug excretion?**
