1
BY LAURA D. ROSENTHAL
CHAPTER 1-92|
, 2
CHAPTER 1: PRESCRIPTIVE
AUTHORITY
MULTIPLE CHOICE
1. 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: COMPREHENSION
REF: P. 1
TOP: NURSING PROCESS: I
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
2. 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 FILLTHIS PRACTICE GAP.
DIF: COGNITIVE LEVEL: COMPREHENSION
REF: P. 2
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
, 3
3. WHICH FACTORS COULD BE ATTRIBUTED TO LIMITED PRESCRIPTIVE
AUTHORITY FOR APRNS? SELECT ALL THAT APPLY.
, 4
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: COMPREHENSION
REF:P. 2
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
4. 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:COMPREHENSION
REF: PP. 1-2
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
5. 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.
, 5
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:
, 6
COMPREHENSION
REF: PP. 1-2
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL
THERAPIES
6. A FAMILY NURSE PRACTITIONER PRACTICING IN MAINE IS HIRED AT A
PRACTICE ACROSS STATE LINES IN VIRGINIA. WHICH ASPECT OF PRACTICE
MAY CHANGE FOR THE APRN?
a. THE APRN WILL HAVE LESS PRESCRIPTIVE AUTHORITY IN THE NEW POSITION.
b. THE APRN WILL HAVE MORE PRESCRIPTIVE AUTHORITY IN THE NEW POSITION.
c. THE APRN WILL HAVE EQUAL PRESCRIPTIVE AUTHORITY IN THE NEWPOSITION.
d. THE APRN’S AUTHORITY WILL DEPEND ON FEDERALREGULATIONS.
ANS: A
VIRGINIA ALLOWS LIMITED PRESCRIPTIVE AUTHORITY, WHILE MAINE GIVES FULL
AUTHORITY TO CERTIFIED NURSE PRACTITIONERS. THE FEDERAL GOVERNMENT DOES
NOT REGULATE PRESCRIPTIVE AUTHORITY.
DIF: COGNITIVE LEVEL: COMPREHENSION
REF: P. 3
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
CHAPTER 2: RATIONAL DRUG SELECTION AND PRESCRIPTION WRITING
MULTIPLE
CHOICE
7. HOW CAN COLLABORATION WITH A PHARMACIST IMPROVE POSITIVE
OUTCOMES FOR PATIENTS? SELECT ALL THAT APPLY.
a. PHARMACISTS CAN SUGGEST FOODS THAT WILL HELP WITH THE PATIENT’S
CONDITION.
b. PHARMACISTS HAVE ADDITIONAL INFORMATION ON DRUG INTERACTIONS.
c. THE PHARMACIST CAN SUGGEST ADEQUATE MEDICATION DOSING.
d. PHARMACISTS HAVE FIRSTHAND KNOWLEDGE OF THE FACILITY FORMULARY.
e. PHARMACY CAN ALTER PRESCRIPTIONS WHEN NECESSARY TO PREVENT PATIENT
HARM.
ANS: B , C , D
PROVIDERS SHOULD COLLABORATE WITH PHARMACISTS BECAUSE THEY WILL LIKELY
HAVE ADDITIONAL INFORMATION ON FORMULARY, DRUG INTERACTIONS, AND
SUGGESTIONS FOR ADEQUATE MEDICATION DOSING. DIETITIANS CAN MAKE FOODS
, 7
RECOMMENDATIONS TO TREAT THE PATIENT’S CONDITION. THE PHARMACIST CAN
CONTACT THE PRESCRIBER ABOUT QUESTIONABLE PRESCRIPTIONS, BUT CANNOT
ALTER THE PRESCRIPTION WITHOUT NOTIFICATION OF AND APPROVAL BY THE
PROVIDER.
DIF: COGNITIVE LEVEL: COMPREHENSION
REF: P. 9TOP: NURSING PROCESS: DIAGNOSIS
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
, 8
8. A PATIENT PRESENTS WITH DELIRIUM TREMENS REQUIRING ATIVAN
ADMINISTRATION. THE PROVIDER OF CARE IS NOT IN THE FACILITY. WHICH ACTION
BY THE NURSE IS MOST APPROPRIATE?
a. OBTAIN A TELEPHONE ORDER.
b. CONTACT THE ON-CALL HOSPITALIST.
c. OBTAIN AN ORDER FROM THE CHARGE NURSE.
d. WAIT FOR A WRITTEN ATIVAN ORDER.
ANS: A
IN AN EMERGENCY SITUATION, SUCH AS DELIRIUM TREMENS WITH SEIZURE ACTIVITY, IT
IS ACCEPTABLE TO PROVIDE A TELEPHONE ORDER. CONTACTING THE ON-CALL
HOSPITALIST OR WAITING FOR A WRITTEN ORDER WOULD TAKE MORE TIME THAN
AVAILABLE FOR A PATIENT WITH HIGH SEIZURE RISK. WRITING AN ORDER IS OUTSIDE
THE SCOPE OF PRACTICE FOR THE CHARGE NURSE.
DIF: COGNITIVE LEVEL: APPLICATION
REF: P. 7
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
9. A PATIENT WITH CHRONIC PAIN CALLS THE PROVIDER’S OFFICE TO REQUEST A
REFILL ON THEIR OXYCONTIN. WHICH ACTION IS MOST APPROPRIATE?
a. FAX AN ORDER TO THE PHARMACY.
b. SCHEDULE AN APPOINTMENT WITH THE PATIENT.
c. VERIFY THE PATIENT’S ADHERENCE TO DRUG REGIMEN.
d. DETERMINE THE PATIENT’S CURRENT MEDICATION DOSAGE.
ANS: B
SCHEDULE II MEDICATIONS ARE NOT ELIGIBLE FOR REFILLS, AND PRESCRIPTIONS
MUST BE HANDWRITTEN. IT IS IMPORTANT TO VERIFY THE PATIENT’S ADHERENCE TO
THE DRUG REGIMEN AND DETERMINE THE CURRENT DOSAGE OF MEDICATION;
HOWEVER, THIS CAN BE ACCOMPLISHED BY SCHEDULING AN APPOINTMENT AND
EVALUATING THE PATIENT IN PERSON.
DIF: COGNITIVE LEVEL: APPLICATION
REF: P. 8
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
10. A PATIENT PRESCRIBED AMOXICILLIN FOR STREPTOCOCCAL PHARYNGITIS
REPORTS NEW ONSET OF A FLAT, ITCHY RED RASH ON THE CHEST AND NECK.
WHICH ACTION IS MOST IMPORTANT?
a. PROVIDE A DIFFERENT PRESCRIPTION.
b. DISCONTINUE THE MEDICATION.
c. PRESCRIBE AN ANTIHISTAMINE CREAM.
d. ASSESS FOR RESPIRATORY COMPROMISE.
, 9
ANS: B
THE PRIORITY ACTION IS TO DISCONTINUE THE MEDICATION TO PREVENT WORSENING
OF THE PATIENT’S SYMPTOMS. A DIFFERENT PRESCRIPTION WOULD BE PROVIDED,
TOPICAL ANTIHISTAMINE MAY BE ADMINISTERED, AND THE PATIENT WOULD BE
ASSESSED FOR RESPIRATORY INVOLVEMENT, BUT THESE ACTIONS WOULD NOT BE
, 10
PERFORMED FIRST.
DIF: COGNITIVE LEVEL: APPLICATION
REF: P. 6
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
11. A PATIENT TAKING THREE MEDICATIONS FOR HYPERTENSION IS DIAGNOSED
WITH COPD. WHICH ACTION SHOULD BE TAKEN PRIOR TO PRESCRIBING
MEDICATIONS TO TREAT COPD?
a. OBTAIN BASELINE LABORATORY VALUES.
b. OBTAIN A COMPLETE MEDICATION HISTORY.
c. ASSESS LIVER ENZYME LEVELS.
d. DETERMINE IF PATIENT HAS INSURANCE COVERAGE.
ANS: B
PRIOR TO ADDING MEDICATIONS TO THE TREATMENT REGIMEN, IT IS ESSENTIAL TO
ASSESS FOR ANY POTENTIAL DRUG- DRUG INTERACTIONS THROUGH A COMPLETE
MEDICAL HISTORY. BASELINE LABORATORY VALUES ARE NOT NECESSARY FOR COPD
TREATMENT. LIVER ENZYME LEVELS MAY GIVE INSIGHT INTO THE POSSIBILITY OF
ALTERED METABOLISM BUT WOULD NOT BE THE FIRST ACTION. THE PRESENCE OF
INSURANCE COVERAGE WOULD AFFECT THE PATIENT’S ACCESS TO TREATMENT BUT
MAY NOT AFFECT THE TYPE OF MEDICATION PRESCRIBED.
DIF: COGNITIVE LEVEL: APPLICATION
REF: P. 6
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
12. A PATIENT WITH DIABETES REPORTS LOSING THEIR JOB AND AN
INABILITY TO PURCHASE REQUIRED MEDICATIONS. WHICH ACTION IS
MOST APPROPRIATE?
a. PROVIDE A 7-DAY SAMPLE PACK.
b. DECREASE THE DAILY DOSE BY HALF.
c. CONTACT A DIFFERENT PHARMACY.
d. PRESCRIBE A DIFFERENT MEDICATION.
ANS: C
PROVIDING A 7-DAY SAMPLE WILL ADDRESS THE PATIENT’S IMMEDIATE NEED, BUT
WILL NOT HELP WITH THE PATIENT’S LONG-TERM NEED FOR MEDICATION.
DECREASING THE DAILY DOSE WILL DIMINISH THE EFFECTIVENESS OF THE
MEDICATION. SELECTING A DIFFERENT PHARMACY COULD DECREASE THE COST OF
THE MEDICATION, AS COSTS VARY BASED ON THE LOCATION AND THE PHARMACY
DISPENSING THE MEDICATION. PRESCRIBING A DIFFERENT MEDICATION WOULD BE
THE LAST OPTION.
BY LAURA D. ROSENTHAL
CHAPTER 1-92|
, 2
CHAPTER 1: PRESCRIPTIVE
AUTHORITY
MULTIPLE CHOICE
1. 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: COMPREHENSION
REF: P. 1
TOP: NURSING PROCESS: I
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
2. 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 FILLTHIS PRACTICE GAP.
DIF: COGNITIVE LEVEL: COMPREHENSION
REF: P. 2
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
, 3
3. WHICH FACTORS COULD BE ATTRIBUTED TO LIMITED PRESCRIPTIVE
AUTHORITY FOR APRNS? SELECT ALL THAT APPLY.
, 4
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: COMPREHENSION
REF:P. 2
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
4. 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:COMPREHENSION
REF: PP. 1-2
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
5. 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.
, 5
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:
, 6
COMPREHENSION
REF: PP. 1-2
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL
THERAPIES
6. A FAMILY NURSE PRACTITIONER PRACTICING IN MAINE IS HIRED AT A
PRACTICE ACROSS STATE LINES IN VIRGINIA. WHICH ASPECT OF PRACTICE
MAY CHANGE FOR THE APRN?
a. THE APRN WILL HAVE LESS PRESCRIPTIVE AUTHORITY IN THE NEW POSITION.
b. THE APRN WILL HAVE MORE PRESCRIPTIVE AUTHORITY IN THE NEW POSITION.
c. THE APRN WILL HAVE EQUAL PRESCRIPTIVE AUTHORITY IN THE NEWPOSITION.
d. THE APRN’S AUTHORITY WILL DEPEND ON FEDERALREGULATIONS.
ANS: A
VIRGINIA ALLOWS LIMITED PRESCRIPTIVE AUTHORITY, WHILE MAINE GIVES FULL
AUTHORITY TO CERTIFIED NURSE PRACTITIONERS. THE FEDERAL GOVERNMENT DOES
NOT REGULATE PRESCRIPTIVE AUTHORITY.
DIF: COGNITIVE LEVEL: COMPREHENSION
REF: P. 3
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: PHARMACOLOGIC AND PARENTERAL THERAPIES
CHAPTER 2: RATIONAL DRUG SELECTION AND PRESCRIPTION WRITING
MULTIPLE
CHOICE
7. HOW CAN COLLABORATION WITH A PHARMACIST IMPROVE POSITIVE
OUTCOMES FOR PATIENTS? SELECT ALL THAT APPLY.
a. PHARMACISTS CAN SUGGEST FOODS THAT WILL HELP WITH THE PATIENT’S
CONDITION.
b. PHARMACISTS HAVE ADDITIONAL INFORMATION ON DRUG INTERACTIONS.
c. THE PHARMACIST CAN SUGGEST ADEQUATE MEDICATION DOSING.
d. PHARMACISTS HAVE FIRSTHAND KNOWLEDGE OF THE FACILITY FORMULARY.
e. PHARMACY CAN ALTER PRESCRIPTIONS WHEN NECESSARY TO PREVENT PATIENT
HARM.
ANS: B , C , D
PROVIDERS SHOULD COLLABORATE WITH PHARMACISTS BECAUSE THEY WILL LIKELY
HAVE ADDITIONAL INFORMATION ON FORMULARY, DRUG INTERACTIONS, AND
SUGGESTIONS FOR ADEQUATE MEDICATION DOSING. DIETITIANS CAN MAKE FOODS
, 7
RECOMMENDATIONS TO TREAT THE PATIENT’S CONDITION. THE PHARMACIST CAN
CONTACT THE PRESCRIBER ABOUT QUESTIONABLE PRESCRIPTIONS, BUT CANNOT
ALTER THE PRESCRIPTION WITHOUT NOTIFICATION OF AND APPROVAL BY THE
PROVIDER.
DIF: COGNITIVE LEVEL: COMPREHENSION
REF: P. 9TOP: NURSING PROCESS: DIAGNOSIS
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
, 8
8. A PATIENT PRESENTS WITH DELIRIUM TREMENS REQUIRING ATIVAN
ADMINISTRATION. THE PROVIDER OF CARE IS NOT IN THE FACILITY. WHICH ACTION
BY THE NURSE IS MOST APPROPRIATE?
a. OBTAIN A TELEPHONE ORDER.
b. CONTACT THE ON-CALL HOSPITALIST.
c. OBTAIN AN ORDER FROM THE CHARGE NURSE.
d. WAIT FOR A WRITTEN ATIVAN ORDER.
ANS: A
IN AN EMERGENCY SITUATION, SUCH AS DELIRIUM TREMENS WITH SEIZURE ACTIVITY, IT
IS ACCEPTABLE TO PROVIDE A TELEPHONE ORDER. CONTACTING THE ON-CALL
HOSPITALIST OR WAITING FOR A WRITTEN ORDER WOULD TAKE MORE TIME THAN
AVAILABLE FOR A PATIENT WITH HIGH SEIZURE RISK. WRITING AN ORDER IS OUTSIDE
THE SCOPE OF PRACTICE FOR THE CHARGE NURSE.
DIF: COGNITIVE LEVEL: APPLICATION
REF: P. 7
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
9. A PATIENT WITH CHRONIC PAIN CALLS THE PROVIDER’S OFFICE TO REQUEST A
REFILL ON THEIR OXYCONTIN. WHICH ACTION IS MOST APPROPRIATE?
a. FAX AN ORDER TO THE PHARMACY.
b. SCHEDULE AN APPOINTMENT WITH THE PATIENT.
c. VERIFY THE PATIENT’S ADHERENCE TO DRUG REGIMEN.
d. DETERMINE THE PATIENT’S CURRENT MEDICATION DOSAGE.
ANS: B
SCHEDULE II MEDICATIONS ARE NOT ELIGIBLE FOR REFILLS, AND PRESCRIPTIONS
MUST BE HANDWRITTEN. IT IS IMPORTANT TO VERIFY THE PATIENT’S ADHERENCE TO
THE DRUG REGIMEN AND DETERMINE THE CURRENT DOSAGE OF MEDICATION;
HOWEVER, THIS CAN BE ACCOMPLISHED BY SCHEDULING AN APPOINTMENT AND
EVALUATING THE PATIENT IN PERSON.
DIF: COGNITIVE LEVEL: APPLICATION
REF: P. 8
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
10. A PATIENT PRESCRIBED AMOXICILLIN FOR STREPTOCOCCAL PHARYNGITIS
REPORTS NEW ONSET OF A FLAT, ITCHY RED RASH ON THE CHEST AND NECK.
WHICH ACTION IS MOST IMPORTANT?
a. PROVIDE A DIFFERENT PRESCRIPTION.
b. DISCONTINUE THE MEDICATION.
c. PRESCRIBE AN ANTIHISTAMINE CREAM.
d. ASSESS FOR RESPIRATORY COMPROMISE.
, 9
ANS: B
THE PRIORITY ACTION IS TO DISCONTINUE THE MEDICATION TO PREVENT WORSENING
OF THE PATIENT’S SYMPTOMS. A DIFFERENT PRESCRIPTION WOULD BE PROVIDED,
TOPICAL ANTIHISTAMINE MAY BE ADMINISTERED, AND THE PATIENT WOULD BE
ASSESSED FOR RESPIRATORY INVOLVEMENT, BUT THESE ACTIONS WOULD NOT BE
, 10
PERFORMED FIRST.
DIF: COGNITIVE LEVEL: APPLICATION
REF: P. 6
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
11. A PATIENT TAKING THREE MEDICATIONS FOR HYPERTENSION IS DIAGNOSED
WITH COPD. WHICH ACTION SHOULD BE TAKEN PRIOR TO PRESCRIBING
MEDICATIONS TO TREAT COPD?
a. OBTAIN BASELINE LABORATORY VALUES.
b. OBTAIN A COMPLETE MEDICATION HISTORY.
c. ASSESS LIVER ENZYME LEVELS.
d. DETERMINE IF PATIENT HAS INSURANCE COVERAGE.
ANS: B
PRIOR TO ADDING MEDICATIONS TO THE TREATMENT REGIMEN, IT IS ESSENTIAL TO
ASSESS FOR ANY POTENTIAL DRUG- DRUG INTERACTIONS THROUGH A COMPLETE
MEDICAL HISTORY. BASELINE LABORATORY VALUES ARE NOT NECESSARY FOR COPD
TREATMENT. LIVER ENZYME LEVELS MAY GIVE INSIGHT INTO THE POSSIBILITY OF
ALTERED METABOLISM BUT WOULD NOT BE THE FIRST ACTION. THE PRESENCE OF
INSURANCE COVERAGE WOULD AFFECT THE PATIENT’S ACCESS TO TREATMENT BUT
MAY NOT AFFECT THE TYPE OF MEDICATION PRESCRIBED.
DIF: COGNITIVE LEVEL: APPLICATION
REF: P. 6
TOP: NURSING PROCESS: IMPLEMENTATION
MSC: NCLEX CLIENT NEEDS
CATEGORY: PHYSIOLOGIC INTEGRITY: REDUCTION OF RISK POTENTIAL
12. A PATIENT WITH DIABETES REPORTS LOSING THEIR JOB AND AN
INABILITY TO PURCHASE REQUIRED MEDICATIONS. WHICH ACTION IS
MOST APPROPRIATE?
a. PROVIDE A 7-DAY SAMPLE PACK.
b. DECREASE THE DAILY DOSE BY HALF.
c. CONTACT A DIFFERENT PHARMACY.
d. PRESCRIBE A DIFFERENT MEDICATION.
ANS: C
PROVIDING A 7-DAY SAMPLE WILL ADDRESS THE PATIENT’S IMMEDIATE NEED, BUT
WILL NOT HELP WITH THE PATIENT’S LONG-TERM NEED FOR MEDICATION.
DECREASING THE DAILY DOSE WILL DIMINISH THE EFFECTIVENESS OF THE
MEDICATION. SELECTING A DIFFERENT PHARMACY COULD DECREASE THE COST OF
THE MEDICATION, AS COSTS VARY BASED ON THE LOCATION AND THE PHARMACY
DISPENSING THE MEDICATION. PRESCRIBING A DIFFERENT MEDICATION WOULD BE
THE LAST OPTION.
