Which of the following has influenced an emphasis on primary care education in medical
schools?
a. Changes in Medicare reimbursement
methods recommended in 1992
b. Competition from nonphysicians desiring
to meet pri
...
Which of the following has influenced an emphasis on primary care education in medical
schools?
a. Changes in Medicare reimbursement
methods recommended in 1992
b. Competition from nonphysicians desiring
to meet primary care shortages
c. The need for monopolistic control in the
marketplace of primary outpatient care
d. The recognition that nonphysicians have
variable 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 medical schools 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 of the following statements is true about the prescribing practices of physicians?
a. Older physicians tend to prescribe more
appropriate medications than younger
physicians.
b. Antibiotic medications remain in the top
five 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 continues
to be that provided by pharmaceutical
companies.
ANS: D
Even though most physicians claim to place little weight on drug advertisements,
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 of
medications, it will be important to:
a. attain the same level of expertise as
physicians who currently prescribe
medications.
b. learn from the experiences of physicians
and develop expertise based on evidencebased practice.
c. maintain collaborative and supervisorial
relationships with physicians who will
oversee prescribing practices.
d. develop relationships with pharmaceutical
representatives 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 of
the federal facility reimbursement requirement. The NP should be aware that this defines
how NPs may write prescriptions:
a. without physician supervision in private
practice.
b. as CRNAs without physician supervision
in a hospital setting.
c. in any situation but will not be reimbursed
for this by government insurers.
d. only with physician supervision in both
private practice and a hospital setting.
ANS: B
In 2001, the Centers for Medicare and Medicaid Services changed the federal physician
supervision rule for CRNAs to allow state governors to 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 to
practice.
c. order and administer controlled substances
but do not have full prescriptive authority.
d. administer medications, including
controlled substances, under direct
physician 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 and
do 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 during
labor and delivery.
d. may practice only in birthing centers and
home birth settings.
ANS: B
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 to
drugs used during childbirth. They practice in many other types of settings.
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 prescriptive
authority.
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 in
other states.
b. full prescriptive authority will be granted
to all NPs with doctoral degrees.
c. NPs will be better prepared to meet
emerging health care needs of patients.
d. requirements for physician supervision of
NPs 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 individual state laws. NPs will still be required to
meet licensure requirements of each state.
DIF: Cognitive Level: Understanding (Comprehension) REF: 12
6. An important difference between physician assistants (PAs) and NPs is PAs:
a. always work under physician supervision.
b. are not required to follow drug treatment
protocols.
c. may write for all drug categories with
physician co-signatures.
d. have both inpatient and outpatient
independent 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 AfricanAmerican 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 drug
excretion 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 as
what 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
2. A patient asks the primary care NP which medication to use for mild to moderate pain.
The NP should recommend:
a. APAP.
b. Tylenol.
c. acetaminophen.
d. any over-the-counter pain product.
ANS: C
Providers should use generic drug names when prescribing drugs or recommending them
to patients, unless a particular brand is essential for some reason. Because acetaminophen
can have many trade names, it is important for patients to understand that the drug is the
same for all to avoid overdosing on acetaminophen. APAP is a commonly used
abbreviation but should not be used when recommending the drug to patients.
DIF: Cognitive Level: Applying (Application) REF: 21
3. A patient wants to know why a cheaper version of a drug cannot be used when the
primary care NP writes a prescription for a specific brand name of the drug and writes,
“Dispense as Written.” The NP should explain that a different brand of this drug:
a. may cause different adverse effects.
b. does not necessarily have the same
therapeutic effect.
c. is likely to be less safe than the brand
specified in the prescription.
d. may vary in the amount of drug that
reaches the site of action in the body.
ANS: D
Different formulations of the same drug may have varying degrees of bioavailability, and
it may be important to stick to a particular brand for drugs with narrow therapeutic
ranges. All drugs with similar active ingredients should have the same therapeutic actions
and side effects and should be equally safe.
DIF: Cognitive Level: Applying (Application) REF: 22
4. A primary care NP wishes to order a drug that will be effective immediately after
administration of the drug. Which route should the NP choose?
a. Rectal
b. Topical
c. Sublingual
d. Intramuscular
ANS: C
The sublingual route is preferred for quick action because the drug is directly absorbed
into the bloodstream and avoids the pass through of the liver, where much of an oral drug
is metabolized. Rectal routes have unpredictable absorption rates. Topical routes are the
slowest. Intramuscular routes are slow.
DIF: Cognitive Level: Remembering (Knowledge) REF: 22
5. A patient receives an inhaled corticosteroid to treat asthma. The patient asks the primary
care NP why the drug is given by this route instead of orally. The NP should explain that
the inhaled form:
a. is absorbed less quickly.
b. has reduced bioavailability.
c. has fewer systemic side effects.
d. provides dosing that is easier to regulate.
ANS: C
An inhaled corticosteroid goes directly to the site of action and does not have to pass
through gastrointestinal tract absorption or the liver to get to the lungs. It is generally well
absorbed at this site, although dosing is not necessarily easier to regulate because it is not
always clear how much of an inhaled drug gets into the lungs.
DIF: Cognitive Level: Applying (Application) REF: 21
6. A patient takes an oral medication that causes gastrointestinal upset. The patient asks the
primary care NP why the drug information insert cautions against using antacids while
taking the drug. The NP should explain that the antacid may:
a. alter drug absorption.
b. alter drug distribution.
c. lead to drug toxicity.
d. increase stomach upset.
ANS: A
Changing the pH of the gastric mucosa can alter the absorption of the drug. Drug
distribution is not affected. It may indirectly cause drug toxicity if a significant amount
more of the drug is absorbed. It would decrease stomach upset.
DIF: Cognitive Level: Applying (Application) REF: 22
7. A patient will begin taking two drugs that are both protein-bound. The primary care NP
should:
a. prescribe increased doses of both drugs.
b. monitor drug levels, actions, and side
effects.
c. teach the patient to increase intake of
protein.
d. stagger the doses of drugs to be given 1
hour apart.
ANS: B
Protein-bound drugs bind to albumin, and serum albumin levels may affect how drugs are
distributed. The provider should monitor drug levels, actions, and side effects and change
dosing accordingly. Increasing the dose of both drugs is not recommended unless
monitoring indicates. Increasing dietary protein does not affect this. Staggering the drugs
will not affect this.
DIF: Cognitive Level: Applying (Application) REF: 25
8. A patient is taking drug A and drug B. The primary care NP notes increased effects of
drug B. The NP should suspect that in this case drug A is a cytochrome P450 (CYP450)
enzyme:
a. inhibitor.
b. substrate.
c. inducer.
d. metabolizer.
ANS: A
If drug A is a CYP450 enzyme inhibitor, it decreases the capacity of the enzyme to
metabolize drug B, causing more of drug B to be available. A substrate is a drug acted on
by the enzyme. If drug B is an enzyme inducer, it would cause increased metabolism of
drug A.
DIF: Cognitive Level: Applying (Application) REF: 26 - 27
9. The primary care NP should understand that a drug is at a therapeutic level when it is:
a. at peak plasma level.
b. past 4 or 5 half-lives.
c. at its steady plasma state.
d. between minimal effective concentration
and toxic levels.
ANS: D
The therapeutic range of a drug is the area between the minimal effective concentration
and the toxic concentration. Peak plasma level is the highest level the drug reaches and
may be well into the toxic range. Steady state occurs when there is a stable concentration
of the drug and generally occurs after 4 or 5 half-lives.
DIF: Cognitive Level: Applying (Application) REF: 31
10. A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear
kinetics. The NP should:
a. monitor frequently for desired and adverse
effects.
b. administer a much higher initial dose as a
loading dose.
c. monitor creatinine clearance at baseline
and periodically.
d. administer the drug via a route that avoids
the first-pass effect.
ANS: A
Drugs with nonlinear kinetics are not eliminated based on dose or concentration of the
drug, and these drugs have a narrow therapeutic window and must be monitored closely
for desired effects and toxicity.
DIF: Cognitive Level: Applying (Application) REF: 32
[Show More]
