NURS 8024 PAST PAPERS EXAMS 2025 QUESTIONS AND
ANSWERS RATED A+
✔✔Cost-benefit ratio - ✔✔comparison of benefits to potential costs that might result
from change
✔✔Costs to consider with cost-benefit analysis - ✔✔• Patient and/or insurer cost
• Drugs
• Supplies/ monitoring
• Follow-up
• Consider treatment failure and retreatment costs, ED, Hospital costs
✔✔Steps in rational prescribing - ✔✔1. Make a specific diagnosis - even if a tentative
diagnosis
• Inform Patient
2. Consider pathophysiologic implications of the diagnosis
3. Have a specific therapeutic objective
• For the pathophysiologic processes defined in step 2
4. Select a drug of choice:
• Characteristics of the patient: age, comorbidities
• Clinical presentation of illness
• Don't forget about insurance formularies
5. Determine appropriate dosing regimen
• determined primarily by pharmacokinetics of the drug in that
patient
• Consider organs required for elimination of the drug
6. Plan for monitoring drug therapy/ patient response, and
determine an end point for treatment
• any drug effects? Labs? Monitoring?
7. Patient education
✔✔Common Errors in Prescribing Include: - ✔✔Wrong or unspecified dose
Incomplete directions
Illegible Writing
Confusing Abbreviations
Errors of Omission
Wrong drug name
Wrong dosing time
Hepatic or renal implications not considered
Not noting allergies
inappropriate use of zero
✔✔Complications of Patient/client prescription compliance/Adherance - ✔✔• Patient
doesn't obtain the medication (up to 1/3)
• Patients leave the hospital w/o discharge meds
• or w/o having prehospitalization meds resumed
,• Patient cannot afford prescribed medications
• Patient fails to take medication as prescribed
• results from lack of communication between patient/
prescriber/ pharmacist
• Premature discontinuation of medication
• Patient shares medication
✔✔Concerns for Prescribers include - ✔✔• Drug seeking behavior
• Over reporting symptoms
• Multiple somatic complaints
• Vague symptom complexes
• Insistence on specific
medications
• Refusal of generic
equivalents
• Self asserted high tolerance
• >2 prescribers of controlled
substances
• >2 pharmacies
• First visit insistence on
controlled prescriptions
• Demands for
polypharmacy
• Scams-
• seeking drugs to sell
• Pressure to prescribe can
be significant
• Frequent calls for refills
• Fear of confrontation
✔✔Advise for prescribers based on malpractice litigation - ✔✔• Write clearly or have
electronic system
• If suicidal ideation- no more than 7 days of any medication
that can be lethal OD
• Warn about side effects
• Discontinue if SE occurs
• Informed consent if drug has potential for permanent,
serious SE
• Document rationale for "off label" prescribing
• Monitor for known long term effects
• (if drug has to be continued)
• Ask, listen, alter the plan
✔✔Encouraging patient adherence to prescriptions - ✔✔• Build trusting relationship with
patient
• Involve patient in the plan
, • Gradual changes - step therapy
• Teach why, when, what
• Give specific instructions on separate paper
• Consider literacy
• Consider personal and cultural health beliefs
• Many prescriptions never filled
• Economic issues
✔✔Medication Reconciliation - ✔✔Provides assurance of patient drug accuracy as
patient moves across the system.
✔✔What is the role of the Food and Drug Administration (FDA)? - ✔✔Review of drugs
going through development; provide approval and official labeling of new drug; approve
consumer marketing of legend drugs.
✔✔FDA Sponsor Responsibilities - ✔✔File an Investigational New Drug Application
(INDA) prior to
phase I testing
• Reporting any serious and unexpected adverse effects within 10
days
• Bioavailability studies
• Seek final approval
✔✔The development and testing process to bring a drug to market in the USA. - ✔✔
✔✔Orphan Drug Act of 1983 - ✔✔Provided incentives for the development of orphan
drugs for treatment of rare diseases
✔✔Bioequivalence - Blue Book - ✔✔• Panel to determine whether drug products with
the same
physical and chemical composition would produce comparable
therapeutic effects
• bioequivalence
• not necessary to test all products in vivo
• Recommended list of interchangeable drug products
• Decides
• those for which bioequivalence is not essential
• those for which it is critical.
✔✔Therapeutic Equivalence and Orange Book - ✔✔• The FDA considers generic
products (w/ same ingredients) that
produce same therapeutic effect to be "therapeutically equivalent."
• Healthcare providers & states not required to accept therapeutic equivalence
recommendations in the Orange Book
• Must meet the following criteria:
ANSWERS RATED A+
✔✔Cost-benefit ratio - ✔✔comparison of benefits to potential costs that might result
from change
✔✔Costs to consider with cost-benefit analysis - ✔✔• Patient and/or insurer cost
• Drugs
• Supplies/ monitoring
• Follow-up
• Consider treatment failure and retreatment costs, ED, Hospital costs
✔✔Steps in rational prescribing - ✔✔1. Make a specific diagnosis - even if a tentative
diagnosis
• Inform Patient
2. Consider pathophysiologic implications of the diagnosis
3. Have a specific therapeutic objective
• For the pathophysiologic processes defined in step 2
4. Select a drug of choice:
• Characteristics of the patient: age, comorbidities
• Clinical presentation of illness
• Don't forget about insurance formularies
5. Determine appropriate dosing regimen
• determined primarily by pharmacokinetics of the drug in that
patient
• Consider organs required for elimination of the drug
6. Plan for monitoring drug therapy/ patient response, and
determine an end point for treatment
• any drug effects? Labs? Monitoring?
7. Patient education
✔✔Common Errors in Prescribing Include: - ✔✔Wrong or unspecified dose
Incomplete directions
Illegible Writing
Confusing Abbreviations
Errors of Omission
Wrong drug name
Wrong dosing time
Hepatic or renal implications not considered
Not noting allergies
inappropriate use of zero
✔✔Complications of Patient/client prescription compliance/Adherance - ✔✔• Patient
doesn't obtain the medication (up to 1/3)
• Patients leave the hospital w/o discharge meds
• or w/o having prehospitalization meds resumed
,• Patient cannot afford prescribed medications
• Patient fails to take medication as prescribed
• results from lack of communication between patient/
prescriber/ pharmacist
• Premature discontinuation of medication
• Patient shares medication
✔✔Concerns for Prescribers include - ✔✔• Drug seeking behavior
• Over reporting symptoms
• Multiple somatic complaints
• Vague symptom complexes
• Insistence on specific
medications
• Refusal of generic
equivalents
• Self asserted high tolerance
• >2 prescribers of controlled
substances
• >2 pharmacies
• First visit insistence on
controlled prescriptions
• Demands for
polypharmacy
• Scams-
• seeking drugs to sell
• Pressure to prescribe can
be significant
• Frequent calls for refills
• Fear of confrontation
✔✔Advise for prescribers based on malpractice litigation - ✔✔• Write clearly or have
electronic system
• If suicidal ideation- no more than 7 days of any medication
that can be lethal OD
• Warn about side effects
• Discontinue if SE occurs
• Informed consent if drug has potential for permanent,
serious SE
• Document rationale for "off label" prescribing
• Monitor for known long term effects
• (if drug has to be continued)
• Ask, listen, alter the plan
✔✔Encouraging patient adherence to prescriptions - ✔✔• Build trusting relationship with
patient
• Involve patient in the plan
, • Gradual changes - step therapy
• Teach why, when, what
• Give specific instructions on separate paper
• Consider literacy
• Consider personal and cultural health beliefs
• Many prescriptions never filled
• Economic issues
✔✔Medication Reconciliation - ✔✔Provides assurance of patient drug accuracy as
patient moves across the system.
✔✔What is the role of the Food and Drug Administration (FDA)? - ✔✔Review of drugs
going through development; provide approval and official labeling of new drug; approve
consumer marketing of legend drugs.
✔✔FDA Sponsor Responsibilities - ✔✔File an Investigational New Drug Application
(INDA) prior to
phase I testing
• Reporting any serious and unexpected adverse effects within 10
days
• Bioavailability studies
• Seek final approval
✔✔The development and testing process to bring a drug to market in the USA. - ✔✔
✔✔Orphan Drug Act of 1983 - ✔✔Provided incentives for the development of orphan
drugs for treatment of rare diseases
✔✔Bioequivalence - Blue Book - ✔✔• Panel to determine whether drug products with
the same
physical and chemical composition would produce comparable
therapeutic effects
• bioequivalence
• not necessary to test all products in vivo
• Recommended list of interchangeable drug products
• Decides
• those for which bioequivalence is not essential
• those for which it is critical.
✔✔Therapeutic Equivalence and Orange Book - ✔✔• The FDA considers generic
products (w/ same ingredients) that
produce same therapeutic effect to be "therapeutically equivalent."
• Healthcare providers & states not required to accept therapeutic equivalence
recommendations in the Orange Book
• Must meet the following criteria:
