PracticalApproach5thEditionByVirginiaPooleArcangelo,
B
AndrewMPeterson,Veronica Wilbur,TepM.Kang/All
B B B B B B B B B
B ChaptersCovered–LatestUpdate2024.
Nursepractitionerprescriptiveauthorityisregulatedby:
1. TheNationalCouncilofStateBoardsofNursing
2. TheU.S.DrugEnforcement Administration v
3. TheStateBoardofNursingforeachstate
4. TheStateBoardofPharmacy - Correct Answer - 3. The State Board of Nursing for each state B v v v v v v v v v v v v
ThebenefitstothepatientofhavinganAdvancedPracticeRegisteredNurse(APRN)prescriberinclude:B B B
1. NursesknowmoreaboutPharmacologythanotherprescribersbecausetheytakeitbothintheirbasic
B B B B B B B B B
nursing program and in their APRN program.
B B B B B B B
2. Nursescareforthepatientfromaholisticapproachandinclude thepatient indecisionmaking B B v B
regarding their care.
B B B
3. APRNsarelesslikelyto prescribenarcoticsandothercontrolledsubstances. B
4. APRNsareabletoprescribeindependentlyinallstates,whereasaphysician'sassistantneeds tohavea v B
physician supervising their practice. - Correct Answer - 2. Nurses care for the patient from a holistic
B B B B B v v v v v v v v v v v
approach and include the patient in decision making regarding their care.
v v v v v v v v v v v
Clinicaljudgmentinprescribingincludes:
1. Factoringinthecost tothepatientofthemedicationprescribed
B B B B
2. Alwaysprescribingthenewestmedication available for thediseaseprocess B B B
3. Handingout drugsamplesto poorpatients v B B
4. Prescribingallgenericmedicationsto cutcosts - Correct Answer - 1. Factoring in the cost to the B B v v v v v v v v v v vv
patient of the medication prescribed
v v v v
1
B
,Criteriaforchoosing aneffectivedrugforadisorderinclude: v
1. Askingthe patientwhatdrugthey thinkwouldwork bestforthem
B B B B B
2. Consultingnationallyrecognizedguidelinesfordiseasemanagement
3. Prescribingmedicationsthat areavailableas samples beforewritingaprescription B B B
4. FollowingU.S.DrugEnforcementAdministration guidelinesforprescribing - Correct Answer - 2. B B B v v v vv
Consulting nationally recognized guidelines for disease management
v v v v v v
Nursepractitionerpracticemay thriveunderhealth-carereformbecauseof: B
1. Thedemonstratedabilityofnursepractitionerstocontrolcostsandimprovepatientoutcomes B B
2. Thefactthatnursepractitionerswillbeabletopracticeindependently
3. The fact thatnursepractitionerswillhave full reimbursementunderhealth-carereform
B B B B
4. Theabilityto shiftaccountabilityforMedicaidtothestatelevel - Correct Answer - 1. The
B v B B B v v v v v
demonstrated ability of nurse practitioners to control costs and improve patient outcomes
B v v v v v v v v v v v
Apatient'snutritionalintake andlaboratoryresultsreflecthypoalbuminemia.This is v B B B
critical to prescribing because:
B B B B
1. Distributionofdrugsto target tissuemay beaffected. B B B B
2. Thesolubilityofthedrugwill notmatchthe siteof absorption. B B B
3. Therewillbeless freedrugavailableto generateaneffect. v v
4. Drugs boundtoalbuminarereadilyexcretedbythekidneys. -Correct Answer - 1. Distribution of drugs to
v B B B B v v v v v v v
target tissue may be affected.
v v v v v
Drugs that haveasignificant first-pass effect:
B B B v
1. Mustbegivenbytheenteral(oral)routeonly
2. Bypassthehepaticcirculation B
3. Arerapidlymetabolizedby theliverandmayhavelittleifanydesiredaction B
2
B
,4. Areconvertedbythelivertomoreactiveandfat-solubleforms - Correct Answer - 3. Are rapidly v B v v v v v vv
metabolized by the liver and may have little if any desired action
v v v v v v v v v v v
The routeofexcretionof avolatiledrug willlikely be the:
B B B B B B
1. Kidneys
2. Lungs
3. Bileandfeces B
4. Skin - Correct Answer - 2. Lungs
v v v v v v
Medroxyprogesterone(DepoProvera)isprescribedintramuscularly(IM)tocreateastoragereservoirofthe B
drug. Storage reservoirs:
B B B
1. Assurethatthedrugwillreach its intendedtarget tissue B B B
2. Arethereasonfor givingloading doses B B
3. Increasethelengthoftime adrugis availableandactive B v
4. Aremostcommonincollagentissues - Correct Answer - 3. Increase the length of time a drug is B B B v v v v v v v v v v v v vv
available and active v v
TheNPchoosestogivecephalexinevery8hours basedonknowledgeofthedrug's: B B v
1. Propensitytogo tothetargetreceptor B B
2. Biological half-life B
3. Pharmacodynamics
4. Safetyandsideeffects-Correct Answer - 2. Biological half-life v v v v v
Azithromycindosingrequires thatthefirstday'sdosagebetwicethoseoftheother 4days ofthe prescription.
B B B B B B B B v B B
This is considered a loading dose. A loading dose:
B B B B B B B B B
1. Rapidly achievesdruglevels inthetherapeuticrange
B B
2. Requiresfour-to five-half-livestoattain v
3. Isinfluencedbyrenalfunction
4. Isdirectly relatedtothedrugcirculatingtothetargettissues - Correct Answer - 1. Rapidly achieves
B B B v v v v v vv
drug levels in the therapeutic range
v v v v v
3
B
, Thepointintimeonthedrugconcentrationcurvethatindicatesthefirstsignofa therapeuticeffectis the:
B B B B B B B B B B B B
1. Minimumadverse effect level B B B
2. Peak ofaction v
3. Onsetof action B
4. Therapeuticrange-Correct Answer - 3. Onset of action B v v v v v v
Phenytoinrequiresthatatroughlevel be drawn.Peakandtroughlevels are done: B B B B B
1. Whenthe drughas awide therapeuticrange
B B B B
2. Whenthe drugwillbe administeredforashorttimeonly
v B B B B
3. Whenthereis ahighcorrelation betweenthe doseandsaturation ofreceptorsites
B B B B B B B
4. Todetermineifadrug isinthetherapeuticrange - Correct Answer - 4. To determine if a drug is in the
v B B v v v v v v v v v v v vv
therapeutic range v
Alaboratory resultindicates thatthepeaklevelfora drug is abovetheminimum toxicconcentration. Thismeans
B B B v B B B
thatthe:
B B
1. Concentrationwill produce therapeutic effects B B B
2. Concentrationwillproduceanadverseresponse
3. Timebetweendosesmustbeshortened
4. Durationofactionofthedrugistoo long- Correct Answer - 2. Concentration will produce an adverse B B B v v v v v v v v
response
B
Drugsthatarereceptoragonistsmaydemonstratewhatproperty?
1. Irreversiblebindingto thedrugreceptorsite B B
2. Upregulationwithchronicuse
3. Desensitizationor downregulation with continuous use B B B B B
4. Inverserelationshipbetweendrugconcentrationanddrugaction- Correct Answer - 3. Desensitization or B B v v v v v v
downregulation with continuous use
v v v v
pg. 4
B