Advanced Pharmacology for Nursing Practice – Comprehensive Pharmacology Textbook & Clinical Drug Guide

ADVANCEDPHARMACOLOGYTESTBANKALL b b b b




CHAPTERS QUESTIONS AND ANSWERS WITH
b b b b b




RATIONALES b




Chapter 01: Prescriptive Authority andRole Implementation: Tradition vs. Change
b b b b b b b b b




Test Bank
b b




MULTIPLE CHOICE b




1. Which of the following has influenced an emphasis on primary care education in medical
b b b b b b b b b b b b b




b schools?
a. Changes inMedicarereimbursement b b b




methods recommended in 1992
b b b b




b. Competitionfrom nonphysicians desiring to b b b b




meet primary care shortages
b b b b




c. Theneed for monopolistic control in the
b b b b b b




marketplace of primary outpatient care
b b b b b




d. Therecognition thatnonphysicians have
b b b b




variable success providing primary care
b b b b b




ANS: A b




The Physician Payment Review Commission in 1992 directly increased financial
b b b b b b b b b




reimbursement to clinicians who provide primary care. Coupled with a shortage of primary
b b b b b b b b b b b b b




care providers, this incentive led medical schools to place greater emphasis on preparing
b b b b b b b b b b b b b




primary care physicians. Competition from nonphysicians increased coincidentally as
b b b b b b b b b




professionals from other disciplines stepped up to meet the needs.
b b b b b b b b b b




Nonphysicians have had increasing success at providing primary care and have been shown to
b b b b b b b b b b b b b




be safe and effective.
b b b b




DIF: Cognitive Level: Remembering (Knowledge) b b b REF: 2 b




2. Which of the following statements is true about the prescribing practices of physicians?
b b b b b b b b b b b b




a. Olderphysicians tend to prescribemore
b b b b b




appropriate medications than younger
b b b b




physicians.
b. Antibioticmedications remain inthetop five b b b b b b




classifications of medications prescribed.
b b b b




c. Most physicians rely on a “therapeutic
b b b b b




armamentarium”that consists oflessthan
b b b b b b




100 drug preparations per physician.
b b b b b




d. The dominant form of drug information
b b b b b




used byprimarycarephysicians continues to
b b b b b b b




be that provided by pharmaceutical
b b b b b




companies.
b

, ANS: D b




Even though most physicians claim to place little weight on drug advertisements,
b b b b b b b b b b b




pharmaceutical representatives, and patient preference and state that they rely on academic b b b b b b b b b b b




sources for drug information, a study showed that commercial rather than scientific sources
b b b b b b b b b b b b b




of drug information dominated their drug information materials. Youngerphysicians tend to
b b b b b b b b b b b b




prescribe fewer and more appropriate drugs.Antibiotics have dropped out of the top five
b b b b b b b b b b b b b b




classifications of drugs prescribed. Most physicians have a therapeutic armamentarium of
b b b b b b b b b b b




about 144 drugs.
b b b




DIF: Cognitive Level: Remembering (Knowledge) b b b REF: 3 b




3. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of
b b b b b b b b b b b b b




b medications, it will be important to: b b b b b




a. attain the same level of expertise as b b b b b b




physicians who currently prescribe
b b b b




medications.
b




b. learn from the experiences of physicians
b b b b b




and develop expertise based onevidence-
b b b b b b




based practice.
b b




c. maintaincollaborative andsupervisorial b b b




relationships with physicians who will
b b b b b




oversee prescribing practices.
b b b




d. develop relationships withpharmaceutical b b b




representatives to learn about new
b b b b b




medications as they are developed.
b b b b b




ANS: B b




As nonphysicians develop the roles associated with prescriptive authority, it will be
b b b b b b b b b b b




important to learn from the past experiences of physicians and to develop prescribing
b b b b b b b b b b b b b




practices based on evidence-based medicine. It is hoped that all prescribers, including
b b b b b b b b b b b b




physicians and nurse practitioners, will strive to do better than in the past. NPs should work
b b b b b b b b b b b b b b b b




toward prescriptive authority and for practice that is not supervised by another professional.
b b b b b b b b b b b b b




Pharmaceutical representatives provide information that carries some bias. Academic
b b b b b b b b b




sources are better.
b b b




DIF: Cognitive Level: Applying (Application) b b b REF: 4 b




Chapter 02: Historical Review of Prescriptive Authority: The Role of Nurses (NPs,
b b b b b b b b b b b




CNMs, CRNAs, and CNSs) and Physician Assistants
b b b b b b b




Test Bank
b




MULTIPLE CHOICE b




1. A primary care NP will begin practicing in a state in which the governor has opted out of the
b b b b b b b b b b b b b b b b b b




federal facility reimbursement requirement. The NP should be aware that this defines how
b b b b b b b b b b b b b




NPs may write prescriptions:
b b b b

, a. without physician supervision inprivate b b b b




practice.
b




b. as CRNAswithoutphysician supervision in
b b b b b




a hospital setting.
b b b




c. in anysituation but will not be reimbursed for
b b b b b b b b




this by government insurers.
b b b b




d. only withphysician supervision in both
b b b b b




private practice and a hospital setting.
b b b b b b




ANS: B b




In 2001, the Centers for Medicare and Medicaid Services changed the federal physician
b b b b b b b b b b b b




supervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write
b b b b b b b b b b b b b b b




prescriptions and dispense drugs without physician supervision.
b b b b b b b




DIF: Cognitive Level: Understanding (Comprehension)
b b b REF: 9 b




2. CRNAs in most states: b b b




a. must have a Drug Enforcementb b b b




Administration(DEA)numbertopractice.
b b b b b




b. musthaveprescriptiveauthority to practice.
b b b b b




c. orderand administer controlled substances
b b b b




but do not have full prescriptive authority.
b b b b b b b




d. administer medications, including b b




controlled substances, under direct
b b b b




physician supervision.
b b




ANS: C b




Only five states grant independent prescriptive authority to CRNAs. CRNAs do not require
b b b b b b b b b b b b




prescriptive authority because they dispense a drug immediately to a patient and do not
b b b b b b b b b b b b b b




prescribe. Without prescriptive authority, they do not need a DEA number.
b b b b b b b b b b b




DIF: Cognitive Level: Understanding (Comprehension)
b b b REF: 9 b




3. A CNM:
b




a. may treat only women. b b b




b. has prescriptive authority in all 50 states.
b b b b b b




c. mayadministeronly drugs used during labor
b b b b b b




and delivery.
b b




d. maypracticeonlyin birthing centers and
b b b b b b




home birth settings.
b b b




ANS: B b

, CNMs have prescriptive authority in all 50 states. They may treat partners of women for
b b b b b b b b b b b b b b




sexually transmitted diseases. They have full prescriptive authority and are not limited to
b b b b b b b b b b b b b




drugs used during childbirth. They practice in many other types of settings.
b b b b b b b b b b b b




DIF: b b Cognitive Level: Remembering (Knowledge) b b b REF: 9 b




4. In every state, prescriptive authority for NPs includes the ability to write prescriptions:
b b b b b b b b b b b b




a. for controlled substances.
b b




b. forspecified classifications of
b b b




medications.
b




c. without physician-mandated involvement. b b




d. with full,independent prescriptive b b b




authority.
b




ANS: B b




All states now have some degree of prescriptive authority granted to NPs, but not all states
b b b b b b b b b b b b b b b




allow authority to prescribe controlled substances. Many states still require some degree of
b b b b b b b b b b b b b




physician involvement with certain types of drugs.
b b b b b b b




DIF: Cognitive Level: Understanding (Comprehension) b b b REF: 12 b




5. The current trend toward transitioning NP programs to the doctoral level will mean that:
b b b b b b b b b b b b b




a. NPs licensed in one state may practice in
b b b b b b b




other states.
b b




b. full prescriptive authoritywill begranted to
b b b b b b




all NPs with doctoral degrees.
b b b b b




c. NPs will be better prepared to meet
b b b b b b




emerging health careneeds ofpatients.
b b b b b b




d. requirements forphysician supervisionof b b b b




NPs will be removed in all states.
b b b b b b b




ANS: C b




The American Association of Colleges of Nursing has recommended transitioning graduate
b b b b b b b b b b




level NP programs to the doctoral level as a response to changes in health care delivery and
b b b b b b b b b b b b b b b b b




emerging health care needs. NPs with doctoral degrees will not necessarily have full
b b b b b b b b b b b b b




prescriptive authority or be freed from requirements about physician supervision because
b b b b b b b b b b b




those are subject to individual state laws. NPs will still be required to meet licensure
b b b b b b b b b b b b b b b




requirements of each state.
b b b b




DIF: Cognitive Level: Understanding (Comprehension) b b b REF: 12 b




6. An important difference between physician assistants (PAs)and NPs is PAs:
b b b b b b b b b b




a. always work under physician supervision. b b b b




b. are not required to follow drug treatment
b b b b b b