NURS 5334 TESTBANK
UPDATED ACTUAL Exam Questions and CORRECT Answers
Question 1.
What is prescriptive authority?
Correct Answer: The ability and extent of NP's ability to prescribe medication
to patient is dependent on state nurse practice act
Wall EE EA has ruled that nurses in advanced practice roles may obtain
registered members, state practice acts dictate the level of prescriptive
authority allowed
Question 2.
Components of prescriptive authority
Correct Answer: are the right to prescribe independently, and the right to
prescribe without limitation. The prescriber who prescribes independently is
not subject to rules requiring physician supervision or collaboration. The
provider who prescribes without limitation may prescribe any drugs, including
controlled drugs, with the exception of Schedule 1 drugs, which have no
current medical use.
Question 3.
Prescriptive authority is determined by state law. As a result -
Correct Answer: of difference from state to state advanced practice providers
may have full prescriptive authority in some states, yet face a lot of
restrictions in other states. Texas, unfortunately, is a state where we are
restricted. The differences particularly affect providers who serve in locum
tenems staffing positions, or who have practices in two contiguous states. The
regulation of prescriptive authority is under the jurisdiction of a health
professional board. This may be the state board of nursing, state board of
medicine, or the state board of pharmacy as determined by each state.
Although the federal government controls drug regulation, it has no control
over prescriptive authority.
Question 4.
What is the argument for full prescriptive authority?
Correct Answer: Advanced practice providers complete rigorous programs of
study largely in accredited programs that meet stringent national standards.
Although there are differences in each program, they all include common
components. For example, they require extensive education focused on
assessment, diagnosis, and management of health problems. Diagnostic
reasoning, critical thinking and procedural skills are evaluated in both didactic
and clinical courses. National examinations validate the ability to provide safe
,and competent care, and licensure ensures that providers comply with
standards of practice that promote public health and safety. Advanced
practice providers are prepared to fully implement the advanced practice role
in their profession.
Question 5.
Limited prescriptive authority creates a number of barriers. What are some of those
barriers?
Correct Answer: It creates barriers to quality, affordable and accessible
patient care. An example is restrictions on the distance of the APRN from the
physician providing supervision or collaboration may prevent outreach to
areas that have the greatest need. A requirement to obtain the physician's
co-signature on prescriptions can increase patient waits. Despite the use of
terms such as collaborative arrangements. These relationships create a
situation in which one partner holds all the power. It is estimated that by the
year 2025, the physician shortage will be between 46,100 to 90,400. In
primary care alone a 12,500 to 31,100 physician shortage is anticipated.
APRN's with full prescriptive authority would help offset the shortage and
meet the future needs of healthcare demands.
Question 6.
Many factors are involved when considering drug selection. Some include -
Correct Answer: cost, guidelines, liability interactions, side effects, allergies,
liver and renal function, need for monitoring, and special populations.
Question 7.
If you find that your patient is having difficulty purchasing the prescribed medications,
what should you do?
Correct Answer: consider changing pharmacies or drug regimens. The cost of a
drug can vary widely between pharmacies, even within the same city. Many
corporations have created generic $4 lists or special prescription programs
that allow patients to fill their medications for a reasonable cost. When in
doubt, follow current guidelines for the treatment of a particular disease or
symptom. Almost all medical and nursing societies have published guidelines,
including the American Heart Association, the American College of Cardiology,
the Infectious Diseases Society of America, and the American Diabetes
Association. It is the provider's responsibility to keep abreast of new
recommendations or changes in guidelines and to incorporate these into their
prescribing practices. Although closely following the guidelines is desirable,
we must always take into account that our patients may not fit well into these
guidelines and that individualized care is always best. In these cases, it is
important to document the rationale for deviating from standard of care.
Every facility and pharmacy provide drugs according to a formulary. This
,formulary is selected by a panel of pharmacists and providers and may be
subject to following guidelines created by regulatory agencies, such as the
Centers for Medicare and Medicaid Services (CMS). The formulary may also
depend on regional and national drug supplies, drug costs and available
rebates, and the presence of generic medications on the market. In short, the
drug you want may not be available in your facility or at a specific pharmacy.
This can affect your choice in medications. Become familiar with the formulary
where you are employed and know that it can change over time. Often there
are substitutes or similar medications you can order in place of what you
originally intended.
Question 8.
Polypharmacy
Correct Answer: Polypharmacy greatly increases the risk for interactions.
Some of these interactions are negligible, but some can have life-threatening
consequences. It is of crucial importance to ask the patient about all current
drugs, including over-the-counter (OTC) medications and other herbal
preparations. Many patients do not consider OTC or alternative
pharmaceuticals as "medications" and may not mention them unless you ask
specifically. When adding a new medication to a patient regimen, check for
significant interactions. All drugs have side effects. Some are adverse, and
some may be beneficial. In addition, one patient may experience adverse
effects to a medication, whereas another patient may not. It is important to
note the pertinent side effects for each medication and to ask your patients
about presence of symptoms after initiating, stopping, or changing a
medication dose. When assessing the risk-to- benefit ratio of a medication,
one must consider the severity of the side effects. At times, guidelines may
suggest a particular drug for a specific ailment. Unfortunately, your patient
may have an allergy to that medication or class of drug. It is of critical
importance to determine the type of reaction and to document in the patient's
chart. Then, selection of an appropriate drug may begin. Many drugs are
metabolized and eliminated by the liver and kidneys. If these systems are
impaired, this can lead to increased adverse effects and possible medication
overdose. Frequently, drugs have special decreased doses or different dosing
schedules for patients with hepatic or renal impairment. This is known as
hepatic dosing or renal dosing.
Question 9.
Some drugs require frequent monitoring at initiation or throughout the duration of
treatment. Examples of these medications include -
Correct Answer: warfarin, lithium, opioids, and immunosuppressive therapies
(tacrolimus, sirolimus). When levels of these drugs are not within therapeutic
range, serious patient harm can occur. Populations that deserve special
mention when thinking about medications include pregnant or nursing
mothers, and older adults. We will cover special populations in the next
, module with drugs across the lifespan.
Question 10.
Types of prescriptions
Correct Answer: include telephone prescriptions, written, E- prescribing, and
refills. Telephone rxs are convenient. Schedule II medications cannot be
prescribed or refilled by phone. Written rxs must contain all the necessary
elements. Never write rxs on presigned scripts or presign blank scripts for
other providers or staff. Many facilities provide tamper resistant scripts, and
some states require their use. Many pharmacies have capabilities to accept
electronic prescriptions. These allow the provider to select a specific, patient
selected pharmacy and the rx is automatically sent to the selected pharmacy.
Direct transmission of information makes errors less likely. The rx will be
ready sooner. Some organizations do not have a functional EMR and some
pharmacies do not have software capabilities to process these requests. In
these instances, paper rxs are still required. When giving refills ask yourself:
Is this a newer medication for this patient: Am I changing dose or frequency of
the medication? Am I adding a new medication to the regimen? Is the patient
having undesired side effects? When do I expect to follow with this patient?
Do I need to see the patient prior to the refill? Is this a schedule II medication?
Question 11.
Education not only provides an opportunity to explain the importance of the medication,
but also allows the provider to dispel rumors about medications that often lead to
therapy failures. Education reduces medication errors by empowering the patients with
accurate information and clear guidelines.
Correct Answer:
Question 12.
There are basic components of education, and they need to be included when teaching
about any new medication including medication name generic vs trade name; purpose:
reason for taking the medication and desired effect; dosing regimen: how much, how
often, and time of day; administration: preparation for taking, with or without food; side
effects: all risks and how to manage them; special storage needs: refrigeration, original
container; associated lab testing: need for regular appointments; food or drug
interactions: what to avoid; and duration of therapy: length of administration.
Correct Answer:
Question 13.
Medication information is notoriously easy to forget, especially for patients taking
numerous medications. We recommend accompanying all verbal education with written
instructions. For those who are unable to read due to literacy or vision problems, video
or audio instructions can be used. The Patient Protection and Affordable Care Act of
UPDATED ACTUAL Exam Questions and CORRECT Answers
Question 1.
What is prescriptive authority?
Correct Answer: The ability and extent of NP's ability to prescribe medication
to patient is dependent on state nurse practice act
Wall EE EA has ruled that nurses in advanced practice roles may obtain
registered members, state practice acts dictate the level of prescriptive
authority allowed
Question 2.
Components of prescriptive authority
Correct Answer: are the right to prescribe independently, and the right to
prescribe without limitation. The prescriber who prescribes independently is
not subject to rules requiring physician supervision or collaboration. The
provider who prescribes without limitation may prescribe any drugs, including
controlled drugs, with the exception of Schedule 1 drugs, which have no
current medical use.
Question 3.
Prescriptive authority is determined by state law. As a result -
Correct Answer: of difference from state to state advanced practice providers
may have full prescriptive authority in some states, yet face a lot of
restrictions in other states. Texas, unfortunately, is a state where we are
restricted. The differences particularly affect providers who serve in locum
tenems staffing positions, or who have practices in two contiguous states. The
regulation of prescriptive authority is under the jurisdiction of a health
professional board. This may be the state board of nursing, state board of
medicine, or the state board of pharmacy as determined by each state.
Although the federal government controls drug regulation, it has no control
over prescriptive authority.
Question 4.
What is the argument for full prescriptive authority?
Correct Answer: Advanced practice providers complete rigorous programs of
study largely in accredited programs that meet stringent national standards.
Although there are differences in each program, they all include common
components. For example, they require extensive education focused on
assessment, diagnosis, and management of health problems. Diagnostic
reasoning, critical thinking and procedural skills are evaluated in both didactic
and clinical courses. National examinations validate the ability to provide safe
,and competent care, and licensure ensures that providers comply with
standards of practice that promote public health and safety. Advanced
practice providers are prepared to fully implement the advanced practice role
in their profession.
Question 5.
Limited prescriptive authority creates a number of barriers. What are some of those
barriers?
Correct Answer: It creates barriers to quality, affordable and accessible
patient care. An example is restrictions on the distance of the APRN from the
physician providing supervision or collaboration may prevent outreach to
areas that have the greatest need. A requirement to obtain the physician's
co-signature on prescriptions can increase patient waits. Despite the use of
terms such as collaborative arrangements. These relationships create a
situation in which one partner holds all the power. It is estimated that by the
year 2025, the physician shortage will be between 46,100 to 90,400. In
primary care alone a 12,500 to 31,100 physician shortage is anticipated.
APRN's with full prescriptive authority would help offset the shortage and
meet the future needs of healthcare demands.
Question 6.
Many factors are involved when considering drug selection. Some include -
Correct Answer: cost, guidelines, liability interactions, side effects, allergies,
liver and renal function, need for monitoring, and special populations.
Question 7.
If you find that your patient is having difficulty purchasing the prescribed medications,
what should you do?
Correct Answer: consider changing pharmacies or drug regimens. The cost of a
drug can vary widely between pharmacies, even within the same city. Many
corporations have created generic $4 lists or special prescription programs
that allow patients to fill their medications for a reasonable cost. When in
doubt, follow current guidelines for the treatment of a particular disease or
symptom. Almost all medical and nursing societies have published guidelines,
including the American Heart Association, the American College of Cardiology,
the Infectious Diseases Society of America, and the American Diabetes
Association. It is the provider's responsibility to keep abreast of new
recommendations or changes in guidelines and to incorporate these into their
prescribing practices. Although closely following the guidelines is desirable,
we must always take into account that our patients may not fit well into these
guidelines and that individualized care is always best. In these cases, it is
important to document the rationale for deviating from standard of care.
Every facility and pharmacy provide drugs according to a formulary. This
,formulary is selected by a panel of pharmacists and providers and may be
subject to following guidelines created by regulatory agencies, such as the
Centers for Medicare and Medicaid Services (CMS). The formulary may also
depend on regional and national drug supplies, drug costs and available
rebates, and the presence of generic medications on the market. In short, the
drug you want may not be available in your facility or at a specific pharmacy.
This can affect your choice in medications. Become familiar with the formulary
where you are employed and know that it can change over time. Often there
are substitutes or similar medications you can order in place of what you
originally intended.
Question 8.
Polypharmacy
Correct Answer: Polypharmacy greatly increases the risk for interactions.
Some of these interactions are negligible, but some can have life-threatening
consequences. It is of crucial importance to ask the patient about all current
drugs, including over-the-counter (OTC) medications and other herbal
preparations. Many patients do not consider OTC or alternative
pharmaceuticals as "medications" and may not mention them unless you ask
specifically. When adding a new medication to a patient regimen, check for
significant interactions. All drugs have side effects. Some are adverse, and
some may be beneficial. In addition, one patient may experience adverse
effects to a medication, whereas another patient may not. It is important to
note the pertinent side effects for each medication and to ask your patients
about presence of symptoms after initiating, stopping, or changing a
medication dose. When assessing the risk-to- benefit ratio of a medication,
one must consider the severity of the side effects. At times, guidelines may
suggest a particular drug for a specific ailment. Unfortunately, your patient
may have an allergy to that medication or class of drug. It is of critical
importance to determine the type of reaction and to document in the patient's
chart. Then, selection of an appropriate drug may begin. Many drugs are
metabolized and eliminated by the liver and kidneys. If these systems are
impaired, this can lead to increased adverse effects and possible medication
overdose. Frequently, drugs have special decreased doses or different dosing
schedules for patients with hepatic or renal impairment. This is known as
hepatic dosing or renal dosing.
Question 9.
Some drugs require frequent monitoring at initiation or throughout the duration of
treatment. Examples of these medications include -
Correct Answer: warfarin, lithium, opioids, and immunosuppressive therapies
(tacrolimus, sirolimus). When levels of these drugs are not within therapeutic
range, serious patient harm can occur. Populations that deserve special
mention when thinking about medications include pregnant or nursing
mothers, and older adults. We will cover special populations in the next
, module with drugs across the lifespan.
Question 10.
Types of prescriptions
Correct Answer: include telephone prescriptions, written, E- prescribing, and
refills. Telephone rxs are convenient. Schedule II medications cannot be
prescribed or refilled by phone. Written rxs must contain all the necessary
elements. Never write rxs on presigned scripts or presign blank scripts for
other providers or staff. Many facilities provide tamper resistant scripts, and
some states require their use. Many pharmacies have capabilities to accept
electronic prescriptions. These allow the provider to select a specific, patient
selected pharmacy and the rx is automatically sent to the selected pharmacy.
Direct transmission of information makes errors less likely. The rx will be
ready sooner. Some organizations do not have a functional EMR and some
pharmacies do not have software capabilities to process these requests. In
these instances, paper rxs are still required. When giving refills ask yourself:
Is this a newer medication for this patient: Am I changing dose or frequency of
the medication? Am I adding a new medication to the regimen? Is the patient
having undesired side effects? When do I expect to follow with this patient?
Do I need to see the patient prior to the refill? Is this a schedule II medication?
Question 11.
Education not only provides an opportunity to explain the importance of the medication,
but also allows the provider to dispel rumors about medications that often lead to
therapy failures. Education reduces medication errors by empowering the patients with
accurate information and clear guidelines.
Correct Answer:
Question 12.
There are basic components of education, and they need to be included when teaching
about any new medication including medication name generic vs trade name; purpose:
reason for taking the medication and desired effect; dosing regimen: how much, how
often, and time of day; administration: preparation for taking, with or without food; side
effects: all risks and how to manage them; special storage needs: refrigeration, original
container; associated lab testing: need for regular appointments; food or drug
interactions: what to avoid; and duration of therapy: length of administration.
Correct Answer:
Question 13.
Medication information is notoriously easy to forget, especially for patients taking
numerous medications. We recommend accompanying all verbal education with written
instructions. For those who are unable to read due to literacy or vision problems, video
or audio instructions can be used. The Patient Protection and Affordable Care Act of
