NR 565 – Chamberlain - Advanced Pharmacology
Midterm Exam Latest 2024 Actual Exam
Questions with Correct Verified Answers/
Graded A+
During what trimester is a pregnant woman most at risk for adverse drug reactions with
potential long term consequences? - Correct Answer - 1st trimester (fetus most at risk
d/t rapid growth)
Who regulates prescriptive authority? - Correct Answer - the jurisdiction of a health
professional board. This may be the State Board of Nursing, the State Board of
Medicine, or the State Board of Pharmacy, as determined by each state.
What is scope of practice determined by? - Correct Answer - is determined by state
practice and licensure laws.
What is full practice authority? - Correct 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.
What is reduced practice authority? - Correct Answer - Nurse practitioners are limited in
at least one element of practice. The state requires a formal collaborative agreement
with an outside health discipline for the nurse practitioner to provide patient care. ex/
physician involvement for 5 yrs than independent
What is restricted practice authority? - Correct Answer - Nurse practitioners are limited
in at least one element of practice by requiring supervision, delegation, or team
management by an outside health discipline for the nurse practitioner to provide patient
care.- typically doctor on site
pg. 1
,What is the purpose of the Genetic Information Non-Discriminatory Act? - Correct
Answer - Protects patients from discrimination by employers and insurance providers
based on genetic information
Difference between practice authority and prescriptive authority? - Correct Answer -
Practice authority refers to the nurse practitioner's ability to practice without physician
oversight, whereas prescriptive authority refers to the nurse practitioner's authority to
prescribe medications independently and without limitations.
What is the most important cause of adverse drug reactions? (older age)
a. high drug dosages
b. lack of monitoring medications
c. decreased renal excretion
d. overprescribing/polypharmacy - Correct Answer - decreased renal excretion
Distribution of medication can be affected in the elderly in what ways? SATA
1. decreased hormones
2. increased body fat
3. decreased lean mass
4. decreased albumin - Correct Answer - 2, 3, 4
changes in body composition associated with age due to an increase in body fat
percentage and decrease in lean muscle mass. There is also a decrease in total body
water. Distribution can also be impacted by decreased total body water and decreased
cardiac output. Absorption can be impacted by increase gastric pH, decreased
absorption surface area decreased G.I. motility and decrease gastric emptying.
Metabolism can be impacted by de Cristo paddock blood flow, paddock mask, and
activity of hepatic enzymes. Excretion can be impacted by decreased renal blood flow,
decrease GFR, decrees to both secretion, and decrease number of nephrons
An 82 year old male visits the clinic complaining that his pain medications "take forever"
to work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
pg. 2
,2.Sometimes as you get older, absorption may be slower resulting in a delayed
response.
3.As we get older the gastric acid decreases and may slow absorption. - Correct Answer
- 2&3
What are some potential problems that arise with written prescriptions? - Correct
Answer - Must contain all elements
May have pre-populated information
Write legibly
Avoid error prone abbreviations
Tamper resistant scripts are often required
Reasons for monitoring drug therapy - Correct Answer - determining therapeutic dosage
evaluating medication adequacy
identifying adverse effects
serious or life-threatening risks.
Which schedules of drugs can APRNs prescribe? - Correct Answer - depends on state -
most II-V
What are black box warnings? - Correct Answer - Is the strongest safety warning a drug
can carry and still remain on the market. Usually presented on the label with a heavy
black border.
Why are black box warnings issued? - Correct Answer - Issued by the FDA due to
having serious or life-threatening risks
What is neonate and infant drug dosing based on? - Correct Answer - weight or body
surface area (BSA)
pg. 3
, How does limited prescriptive authority impact patients within the healthcare system? -
Correct Answer - longer wait times to sign a prescription
limits practitioners that are needed in rural areas
unequal relationships between providers. Ex. one has more power
high need for providers due to lack of providers and high amounts of patients.
Independent practitioners= more patients being seen= lessens the patient/provider load
Provider key responsibilities when prescribing? - Correct Answer - safe and competent
practice
understanding of the drugs, reactions, and pharmacology
Be aware of the age group you are prescribing to
Ex. Children vs older adults
What should be used to make prescribing decisions? - Correct Answer - documented
provider-patient relationship, not prescribing for family or friends, documenting a
thorough H&P, including discussions with the patient, drug monitoring/titrating.
cost, guidelines, availability, interactions, side effects, allergies, hepatic and renal
function, need for monitoring, and special populations
What happens when someone has a poor metabolism phenotype? - Correct Answer -
medications metabolized slower, medication might not work or put them at risk for side-
effects
What does the US food and drug administration regulate when it comes to medications?
- Correct Answer - Whether the drug is safe, effective, and benefits of a drug outweigh
the risks
reasons for medication non-adherence - Correct Answer - patients never filling/refilling
prescriptions (resulting in therapeutic failure)
multiple chronic disorders
multiple prescription medications
multiple doses per day for each medication
pg. 4
Midterm Exam Latest 2024 Actual Exam
Questions with Correct Verified Answers/
Graded A+
During what trimester is a pregnant woman most at risk for adverse drug reactions with
potential long term consequences? - Correct Answer - 1st trimester (fetus most at risk
d/t rapid growth)
Who regulates prescriptive authority? - Correct Answer - the jurisdiction of a health
professional board. This may be the State Board of Nursing, the State Board of
Medicine, or the State Board of Pharmacy, as determined by each state.
What is scope of practice determined by? - Correct Answer - is determined by state
practice and licensure laws.
What is full practice authority? - Correct 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.
What is reduced practice authority? - Correct Answer - Nurse practitioners are limited in
at least one element of practice. The state requires a formal collaborative agreement
with an outside health discipline for the nurse practitioner to provide patient care. ex/
physician involvement for 5 yrs than independent
What is restricted practice authority? - Correct Answer - Nurse practitioners are limited
in at least one element of practice by requiring supervision, delegation, or team
management by an outside health discipline for the nurse practitioner to provide patient
care.- typically doctor on site
pg. 1
,What is the purpose of the Genetic Information Non-Discriminatory Act? - Correct
Answer - Protects patients from discrimination by employers and insurance providers
based on genetic information
Difference between practice authority and prescriptive authority? - Correct Answer -
Practice authority refers to the nurse practitioner's ability to practice without physician
oversight, whereas prescriptive authority refers to the nurse practitioner's authority to
prescribe medications independently and without limitations.
What is the most important cause of adverse drug reactions? (older age)
a. high drug dosages
b. lack of monitoring medications
c. decreased renal excretion
d. overprescribing/polypharmacy - Correct Answer - decreased renal excretion
Distribution of medication can be affected in the elderly in what ways? SATA
1. decreased hormones
2. increased body fat
3. decreased lean mass
4. decreased albumin - Correct Answer - 2, 3, 4
changes in body composition associated with age due to an increase in body fat
percentage and decrease in lean muscle mass. There is also a decrease in total body
water. Distribution can also be impacted by decreased total body water and decreased
cardiac output. Absorption can be impacted by increase gastric pH, decreased
absorption surface area decreased G.I. motility and decrease gastric emptying.
Metabolism can be impacted by de Cristo paddock blood flow, paddock mask, and
activity of hepatic enzymes. Excretion can be impacted by decreased renal blood flow,
decrease GFR, decrees to both secretion, and decrease number of nephrons
An 82 year old male visits the clinic complaining that his pain medications "take forever"
to work after he takes his pill. What are possible reasons you can explain to him?
1.Perhaps we need to increase your dosage.
pg. 2
,2.Sometimes as you get older, absorption may be slower resulting in a delayed
response.
3.As we get older the gastric acid decreases and may slow absorption. - Correct Answer
- 2&3
What are some potential problems that arise with written prescriptions? - Correct
Answer - Must contain all elements
May have pre-populated information
Write legibly
Avoid error prone abbreviations
Tamper resistant scripts are often required
Reasons for monitoring drug therapy - Correct Answer - determining therapeutic dosage
evaluating medication adequacy
identifying adverse effects
serious or life-threatening risks.
Which schedules of drugs can APRNs prescribe? - Correct Answer - depends on state -
most II-V
What are black box warnings? - Correct Answer - Is the strongest safety warning a drug
can carry and still remain on the market. Usually presented on the label with a heavy
black border.
Why are black box warnings issued? - Correct Answer - Issued by the FDA due to
having serious or life-threatening risks
What is neonate and infant drug dosing based on? - Correct Answer - weight or body
surface area (BSA)
pg. 3
, How does limited prescriptive authority impact patients within the healthcare system? -
Correct Answer - longer wait times to sign a prescription
limits practitioners that are needed in rural areas
unequal relationships between providers. Ex. one has more power
high need for providers due to lack of providers and high amounts of patients.
Independent practitioners= more patients being seen= lessens the patient/provider load
Provider key responsibilities when prescribing? - Correct Answer - safe and competent
practice
understanding of the drugs, reactions, and pharmacology
Be aware of the age group you are prescribing to
Ex. Children vs older adults
What should be used to make prescribing decisions? - Correct Answer - documented
provider-patient relationship, not prescribing for family or friends, documenting a
thorough H&P, including discussions with the patient, drug monitoring/titrating.
cost, guidelines, availability, interactions, side effects, allergies, hepatic and renal
function, need for monitoring, and special populations
What happens when someone has a poor metabolism phenotype? - Correct Answer -
medications metabolized slower, medication might not work or put them at risk for side-
effects
What does the US food and drug administration regulate when it comes to medications?
- Correct Answer - Whether the drug is safe, effective, and benefits of a drug outweigh
the risks
reasons for medication non-adherence - Correct Answer - patients never filling/refilling
prescriptions (resulting in therapeutic failure)
multiple chronic disorders
multiple prescription medications
multiple doses per day for each medication
pg. 4
