TEST BANK For Edmunds' Pharmacology for the Primary Care Provider, 5th Edition by Constance G Visovsky & Cheryl H Zambroski & Rebecca M Lutz | Verified Chapter's 1 - 73 | Complete Newest Version

Chapter 01: Prescriptive Authority and Role Implementation: Tradition vs. ChangeTest Bank MULTIPLE CHOICE 1. Which of the following has influenced an emphasis on primary care education in medicalschools? a. Changesin Medicare reimbursementmethods recommended in 1992 b. Competition from nonphysicians desiring to meet primary care shortages c. The need for monopolistic control in themarketplace of primary outpatient care d. The recognition that nonphysicians havevariable success providing primary care ANS: A The Physician Payment Review Commission in 1992 directly increased financial reimbursement to clinicians who provide primary care. Coupled with a shortage of primary care providers, this incentive led medicalschools to place greater emphasis on preparing primary care physicians. Competition from nonphysicians increased coincidentally as professionals from other disciplines stepped up to meet the needs. Nonphysicians have had increasing success at providing primary care and have been shown to be safe and effective. DIF: Cognitive Level: Remembering (Knowledge) REF: 2 2. Which ofthe following statements is true about the prescribing practices of physicians? a. Older physicianstend to prescribe moreappropriate medications than younger physicians. b. Antibiotic medications remain in the topfive classifications of medications prescribed. c. Most physicians rely on a “therapeutic armamentarium” that consists of less than 100 drug preparations per physician. d. The dominant form of drug information used by primary care physicians continuesto be that provided by pharmaceutical companies. ANS: D Even though most physicians claim to place little weight on drug advertisements, Test Bank - Pharmacology for the Primary Care Provider, 5th Edition (Edmunds), Chapter 1-73 5 Test Bank - Pharmacology for the Primary Care Provider, 5th Edition (Edmunds), Chapter 1-73 6 pharmaceutical representatives, and patient preference and state that they rely on academic sources for drug information, a study showed that commercial rather than scientific sources of drug information dominated their drug information materials. Younger physicians tend to prescribe fewer and more appropriate drugs. Antibiotics have dropped out of the top five classifications of drugs prescribed. Most physicians have a therapeutic armamentarium of about 144 drugs. DIF: Cognitive Level: Remembering (Knowledge) REF: 3 3. As primary care nurse practitioners (NPs) continue to develop their role as prescribers ofmedications, it will be important to: a. attain the same level of expertise asphysicians who currently prescribe medications. b. learn from the experiences of physicians and develop expertise based on evidence-based practice. c. maintain collaborative and supervisorialrelationships with physicians who will oversee prescribing practices. d. develop relationships with pharmaceuticalrepresentatives to learn about new medications as they are developed. ANS: B As nonphysicians develop the roles associated with prescriptive authority, it will be important to learn from the past experiences of physicians and to develop prescribing practices based on evidence-based medicine. It is hoped that all prescribers, including physicians and nurse practitioners, will strive to do better than in the past. NPs should work toward prescriptive authority and for practice that is not supervised by another professional. Pharmaceutical representatives provide information that carries some bias. Academic sources are better. DIF: Cognitive Level: Applying (Application) REF: 4 Chapter 02: Historical Review of Prescriptive Authority: The Role of Nurses (NPs,CNMs, CRNAs, and CNSs) and Physician Assistants Test Bank MULTIPLE CHOICE 1. A primary care NP will begin practicing in a state in which the governor has opted out ofthe federal facility reimbursement requirement. The NP should be aware that this defineshow NPs may write prescriptions: Test Bank - Pharmacology for the Primary Care Provider, 5th Edition (Edmunds), Chapter 1-73 7 a. without physician supervision in privatepractice. b. as CRNAs without physician supervision in a hospital setting. c. in any situation but will not be reimbursedfor this by government insurers. d. only with physician supervision in both private practice and a hospitalsetting. ANS: B In 2001, the Centers for Medicare and Medicaid Services changed the federal physician supervision rule for CRNAs to allow state governorsto opt out, allowing CRNAs to write prescriptions and dispense drugs without physician supervision. DIF: Cognitive Level: Understanding (Comprehension) REF: 9 2. CRNAs in most states: a. must have a Drug Enforcement Administration (DEA) number to practice. b. must have prescriptive authority topractice. c. order and administer controlled substancesbut do not have full prescriptive authority. d. administer medications, including controlled substances, under directphysician supervision. ANS: C Only five states grant independent prescriptive authority to CRNAs. CRNAs do not require prescriptive authority because they dispense a drug immediately to a patient anddo not prescribe. Without prescriptive authority, they do not need a DEA number. DIF: Cognitive Level: Understanding (Comprehension) REF: 9 3. A CNM: a. may treat only women. b. has prescriptive authority in all 50 states. c. may administer only drugs used duringlabor and delivery. d. may practice only in birthing centers andhome birth settings. ANS: B Test Bank - Pharmacology for the Primary Care Provider, 5th Edition (Edmunds), Chapter 1-73 8 CNMs have prescriptive authority in all 50 states. They may treat partners of women for sexually transmitted diseases. They have full prescriptive authority and are not limited todrugs used during childbirth. They practice in many other types ofsettings. DIF: Cognitive Level: Remembering (Knowledge) REF: 9 4. In every state, prescriptive authority for NPs includes the ability to write prescriptions: a. for controlled substances. b. for specified classifications of medications. c. without physician-mandated involvement. d. with full, independent prescriptiveauthority. ANS: B All states now have some degree of prescriptive authority granted to NPs, but not all states allow authority to prescribe controlled substances. Many states still require some degree of physician involvement with certain types of drugs. DIF: Cognitive Level: Understanding (Comprehension) REF: 12 5. The current trend toward transitioning NP programs to the doctoral level will mean that: a. NPs licensed in one state may practice inother states. b. full prescriptive authority will be grantedto all NPs with doctoral degrees. c. NPs will be better prepared to meet emerging health care needs of patients. d. requirementsfor physician supervision ofNPs will be removed in all states. ANS: C The American Association of Colleges of Nursing has recommended transitioning graduate level NP programs to the doctoral level as a response to changes in health care delivery and emerging health care needs. NPs with doctoral degrees will not necessarily have full prescriptive authority or be freed from requirements about physician supervision because those are subject to individualstate laws. NPs will still be required tomeet licensure requirements of each state. DIF: Cognitive Level: Understanding (Comprehension) REF: 12 6. An important difference between physician assistants (PAs) and NPsis PAs: a. always work under physician supervision. b. are not required to follow drug treatment Test Bank - Pharmacology for the Primary Care Provider, 5th Edition (Edmunds), Chapter 1-73 9 protocols. c. may write for all drug categories withphysician co-signatures. d. have both inpatient and outpatientindependent prescriptive authority. ANS: A PAs commonly have co-signature requirements and work under physician supervision. DIF: Cognitive Level: Understanding (Comprehension) REF: 17 Chapter 03: General Pharmacokinetic and Pharmacodynamic Principles Test Bank MULTIPLE CHOICE 1. A primary care nurse practitioner (NP) prescribes a drug to an 80-year-old African- American woman. When selecting a drug and determining the correct dose, the NP should understand that the knowledge of how age, race, and gender may affect drugexcretion is based on an understanding of: a. bioavailability. b. pharmacokinetics. c. pharmacodynamics. d. anatomy and physiology. ANS: B Pharmacokinetics is the study of the action of drugs in the body and may be thought of aswhat the body does to the drug. Factors such as age, race, and gender may change the way the body acts to metabolize and excrete a drug. Bioavailability refers to the amount of drug available at the site of action. Pharmacodynamics is the study of the effects of drugs on the body. Anatomy and physiology is a basic understanding of how the body functions. DIF: Cognitive Level: Understanding (Comprehension) REF: 21