Test Bank For Lehne’s Pharmacotherapeutics for
Advanced Practice Nurses and Physician Assistants 2nd
Edition by Jacqueline Burchum; Laura D. Rosenthal
Chapter 1: Prescriptive Authority
Test Bank
Multiple Choice
1. The nurse is assessing a newly admitted older patient who has recently lost 15 pounds. The
nurse notes that the patient is taking warfarin (Coumadin). Which laboratory tests will the nurse
discuss with this patient’s provider?
a. Blood glucose and C-reactive protein
b. Complete blood count and hepatic function tests
c. Renal function tests and serum electrolytes
d. Serum albumin and coagulation studies
ANS: D
Older patients and those who are malnourished are at increased risk for low serum albumin. Since
warfarin binds to albumin, such patients are at increased risk for elevated warfarin levels, which
can cause increased bleeding. The nurse should request albumin levels and coagulation
studies.DIF: Cognitive Level: AnalysisREF: p. 54TOP: Nursing Process: Assessment MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential
adverse effects from this drug, the nurse will review which of this patient’s laboratory results?
a. Albumin
b. Blood urea nitrogen (BUN) and creatinine
c. Hepatic enzymes
d. Serum electrolytes
ANS: D
Patients with low serum potassium are at risk for fatal cardiac dysrhythmias when taking digoxin,
and it is essential to know this level before this medication is administered. Knowing a patient’s
albumin level would be important when giving drugs that are protein bound. The BUN and
creatinine levels are indicators of renal function. Hepatic enzymes are important to know when
drugs are metabolized by the liver.DIF: Cognitive Level: ApplicationREF: p. 51TOP: Nursing
,Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of
Risk Potential
3. A nurse administers the same medication in the same preparation in the same dose to several
patients and notes that some patients have a better response to the drug than others. What is the
most likely explanation for this phenomenon?
a. Altered bioavailability of the drug
b. Patient compliance with the therapeutic regimen
c. Pharmacogenomic differences among individuals
d. Placebo effects enhancing expectations of drug efficacy
ANS: C
Each patient’s genetic makeup can determine how that patient responds to drugs quantitatively and
qualitatively, and this is the most likely cause of individual variation when the same drug is given
at the same dose. The bioavailability of a drug is determined by the drug’s composition and varies
across formulations of the drug. The patients in this example were given the same drug. The nurse
was administering the medication to the patients, so compliance is not an issue. Nothing in this
example indicates that a placebo effect was in play.DIF: Cognitive Level: ComprehensionREF: p.
53TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
4. A nurse is teaching a group of women about medications. The women want to know why so
many drugs have unpredictable effects in women. The nurse will tell them that:
a. drugs usually have more toxic effects in women.
b. most known drug effects are based on drug trials in men.
c. women have varying responses to drugs during menstrual cycles.
d. women metabolize drugs more slowly.
ANS: B
Until 1997 almost all clinical drug trials were performed in men. Women may have more toxic
effects with some drugs and fewer toxic effects with others. Not all drugs are influenced by
hormonal changes. Women metabolize some drugs more slowly and other drugs more quickly.
Unless drug trials are performed in both women and men, the effects of drugs in women will not
be clear.DIF: Cognitive Level: ApplicationREF: p. 55TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
5. The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients
receiving certain medications. Genetic testing helps prescribers:
a. better establish a drug’s therapeutic index.
b. determine whether a patient is a rapid or slow metabolizer of the drug.
c. identify racial characteristics that affect psychosocial variation in drug response.
d. produce a drug that is tailored to an individual patient’s genetic makeup.
,ANS: B
Pharmacogenomics is the study of the ways genetic variations affect individual responses to drugs
through alterations in genes that code for drug-metabolizing enzymes and drug receptors. For some
drugs, the FDA requires genetic testing, and for others, this testing is recommended but not
required. Genetic testing does not determine a drug’s therapeutic index; this is a measure of a
drug’s safety based on statistics of the drug’s use in the general population (see Chapter 5). Any
distinct physiologic differences in drug response among various racial populations are related to
genetic differences and do not affect psychosocial differences in drug responses. Genetic testing
is recommended to identify how a patient will respond to a drug and not to design a drug specific
to an individual.DIF: Cognitive Level: AnalysisREF: pp. 53-54TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
6. An APRN works in a urology clinic under the supervision of a physician who does not restrict
the types of medications the APRN is allowed to prescribe. State law does not require the
APRN to practice under physician supervision. How would the APRN’s prescriptive authority
be described?
a. Full authority
b. Independent
c. Without limitation
d. Limited authority
ANS: B
The APRN has independent prescriptive authority because the regulating body does not require
that the APRN work under physician supervision. Full prescriptive authority gives the provider
the right to prescribe independently and without limitation. Limited authority places restrictions
on the types of drugs that can be prescribed.DIF: Cognitive Level: ComprehensionREF: p. 1TOP:
Nursing Process: I MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
7. Which factors increase the need for APRNs to have full prescriptive authority?
a. More patients will have access to health care.
b. Enrollment in medical schools is predicted to decrease.
c. Physician’s assistants are being utilized less often.
d. APRN education is more complex than education for physicians.
ANS: A
Implementation of the Affordable Care Act has increased the number of individuals with health
care coverage, and thus the number who have access to health care services. The increase in the
number of patients creates the need for more providers with prescriptive authority. APRNs can fill
this practice gap.DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
8. Which factors could be attributed to limited prescriptive authority for APRNs?
Select all that apply.
, a. Inaccessibility of patient care
b. Higher health care costs
c. Higher quality medical treatment
d. Improved collaborative care
e. Enhanced health literacy
ANS: A , B
Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible
patient care. It may also lead to poor collaboration among providers and higher health care costs.
It would not directly impact patient’s health literacy.DIF: Cognitive Level: ComprehensionREF:
p. 2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
9. Which aspects support the APRN’s provision for full prescriptive authority?
Select all that apply.
a. Clinical education includes prescription of medications and disease processes.
b. Federal regulations support the provision of full authority for APRNs.
c. National examinations provide validation of the APRN’s ability to provide safecare.
d. Licensure ensures compliance with health care and safety standards.
e. Limiting provision can decrease health care affordability.
ANS: A , C , D
APRNs are educated to practice and prescribe independently without supervision. National
examinations validate the ability to provide safe and competent care. Licensure ensures
compliance with standards to promote public health and safety. Limited prescriptive authority
creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level:
ComprehensionREF: pp. 1-2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
10. Which aspects support the APRN’s provision for full prescriptive authority?
Select all that apply.
a. Clinical education includes prescription of medications and disease processes.
b. Federal regulations support the provision of full authority for APRNs.
c. National examinations provide validation of the APRN’s ability to provide safecare.
d. Licensure ensures compliance with health care and safety standards.
ANS: A , C , D
APRNs are educated to practice and prescribe independently without supervision. National
examinations validate the ability to provide safe and competent care. Licensure ensures
compliance with standards to promote public health and safety. Limited prescriptive authority
creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level:
Advanced Practice Nurses and Physician Assistants 2nd
Edition by Jacqueline Burchum; Laura D. Rosenthal
Chapter 1: Prescriptive Authority
Test Bank
Multiple Choice
1. The nurse is assessing a newly admitted older patient who has recently lost 15 pounds. The
nurse notes that the patient is taking warfarin (Coumadin). Which laboratory tests will the nurse
discuss with this patient’s provider?
a. Blood glucose and C-reactive protein
b. Complete blood count and hepatic function tests
c. Renal function tests and serum electrolytes
d. Serum albumin and coagulation studies
ANS: D
Older patients and those who are malnourished are at increased risk for low serum albumin. Since
warfarin binds to albumin, such patients are at increased risk for elevated warfarin levels, which
can cause increased bleeding. The nurse should request albumin levels and coagulation
studies.DIF: Cognitive Level: AnalysisREF: p. 54TOP: Nursing Process: Assessment MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A nurse is preparing to care for a patient who is receiving digoxin. When screening for potential
adverse effects from this drug, the nurse will review which of this patient’s laboratory results?
a. Albumin
b. Blood urea nitrogen (BUN) and creatinine
c. Hepatic enzymes
d. Serum electrolytes
ANS: D
Patients with low serum potassium are at risk for fatal cardiac dysrhythmias when taking digoxin,
and it is essential to know this level before this medication is administered. Knowing a patient’s
albumin level would be important when giving drugs that are protein bound. The BUN and
creatinine levels are indicators of renal function. Hepatic enzymes are important to know when
drugs are metabolized by the liver.DIF: Cognitive Level: ApplicationREF: p. 51TOP: Nursing
,Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of
Risk Potential
3. A nurse administers the same medication in the same preparation in the same dose to several
patients and notes that some patients have a better response to the drug than others. What is the
most likely explanation for this phenomenon?
a. Altered bioavailability of the drug
b. Patient compliance with the therapeutic regimen
c. Pharmacogenomic differences among individuals
d. Placebo effects enhancing expectations of drug efficacy
ANS: C
Each patient’s genetic makeup can determine how that patient responds to drugs quantitatively and
qualitatively, and this is the most likely cause of individual variation when the same drug is given
at the same dose. The bioavailability of a drug is determined by the drug’s composition and varies
across formulations of the drug. The patients in this example were given the same drug. The nurse
was administering the medication to the patients, so compliance is not an issue. Nothing in this
example indicates that a placebo effect was in play.DIF: Cognitive Level: ComprehensionREF: p.
53TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
4. A nurse is teaching a group of women about medications. The women want to know why so
many drugs have unpredictable effects in women. The nurse will tell them that:
a. drugs usually have more toxic effects in women.
b. most known drug effects are based on drug trials in men.
c. women have varying responses to drugs during menstrual cycles.
d. women metabolize drugs more slowly.
ANS: B
Until 1997 almost all clinical drug trials were performed in men. Women may have more toxic
effects with some drugs and fewer toxic effects with others. Not all drugs are influenced by
hormonal changes. Women metabolize some drugs more slowly and other drugs more quickly.
Unless drug trials are performed in both women and men, the effects of drugs in women will not
be clear.DIF: Cognitive Level: ApplicationREF: p. 55TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
5. The U.S. Food and Drug Administration (FDA) recommends genetic testing of patients
receiving certain medications. Genetic testing helps prescribers:
a. better establish a drug’s therapeutic index.
b. determine whether a patient is a rapid or slow metabolizer of the drug.
c. identify racial characteristics that affect psychosocial variation in drug response.
d. produce a drug that is tailored to an individual patient’s genetic makeup.
,ANS: B
Pharmacogenomics is the study of the ways genetic variations affect individual responses to drugs
through alterations in genes that code for drug-metabolizing enzymes and drug receptors. For some
drugs, the FDA requires genetic testing, and for others, this testing is recommended but not
required. Genetic testing does not determine a drug’s therapeutic index; this is a measure of a
drug’s safety based on statistics of the drug’s use in the general population (see Chapter 5). Any
distinct physiologic differences in drug response among various racial populations are related to
genetic differences and do not affect psychosocial differences in drug responses. Genetic testing
is recommended to identify how a patient will respond to a drug and not to design a drug specific
to an individual.DIF: Cognitive Level: AnalysisREF: pp. 53-54TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
6. An APRN works in a urology clinic under the supervision of a physician who does not restrict
the types of medications the APRN is allowed to prescribe. State law does not require the
APRN to practice under physician supervision. How would the APRN’s prescriptive authority
be described?
a. Full authority
b. Independent
c. Without limitation
d. Limited authority
ANS: B
The APRN has independent prescriptive authority because the regulating body does not require
that the APRN work under physician supervision. Full prescriptive authority gives the provider
the right to prescribe independently and without limitation. Limited authority places restrictions
on the types of drugs that can be prescribed.DIF: Cognitive Level: ComprehensionREF: p. 1TOP:
Nursing Process: I MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
7. Which factors increase the need for APRNs to have full prescriptive authority?
a. More patients will have access to health care.
b. Enrollment in medical schools is predicted to decrease.
c. Physician’s assistants are being utilized less often.
d. APRN education is more complex than education for physicians.
ANS: A
Implementation of the Affordable Care Act has increased the number of individuals with health
care coverage, and thus the number who have access to health care services. The increase in the
number of patients creates the need for more providers with prescriptive authority. APRNs can fill
this practice gap.DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
8. Which factors could be attributed to limited prescriptive authority for APRNs?
Select all that apply.
, a. Inaccessibility of patient care
b. Higher health care costs
c. Higher quality medical treatment
d. Improved collaborative care
e. Enhanced health literacy
ANS: A , B
Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible
patient care. It may also lead to poor collaboration among providers and higher health care costs.
It would not directly impact patient’s health literacy.DIF: Cognitive Level: ComprehensionREF:
p. 2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
9. Which aspects support the APRN’s provision for full prescriptive authority?
Select all that apply.
a. Clinical education includes prescription of medications and disease processes.
b. Federal regulations support the provision of full authority for APRNs.
c. National examinations provide validation of the APRN’s ability to provide safecare.
d. Licensure ensures compliance with health care and safety standards.
e. Limiting provision can decrease health care affordability.
ANS: A , C , D
APRNs are educated to practice and prescribe independently without supervision. National
examinations validate the ability to provide safe and competent care. Licensure ensures
compliance with standards to promote public health and safety. Limited prescriptive authority
creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level:
ComprehensionREF: pp. 1-2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
10. Which aspects support the APRN’s provision for full prescriptive authority?
Select all that apply.
a. Clinical education includes prescription of medications and disease processes.
b. Federal regulations support the provision of full authority for APRNs.
c. National examinations provide validation of the APRN’s ability to provide safecare.
d. Licensure ensures compliance with health care and safety standards.
ANS: A , C , D
APRNs are educated to practice and prescribe independently without supervision. National
examinations validate the ability to provide safe and competent care. Licensure ensures
compliance with standards to promote public health and safety. Limited prescriptive authority
creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level:
