NR508 Test Banking Chapter 1-5

Chapter 01: Prescriptive Authority and Role Implementation: Tradition vs. Change Test Bank

MULTIPLE CHOICE

1.            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

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.

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 evidence- based 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.

 

 

Chapter 02: Historical Review of Prescriptive Authority: The Role of Nurses (NPs, CNMs, CRNAs, and CNSs) and Physician Assistants

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.

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.

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.

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.

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.

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.

 

 

 

 

 

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 drug excretion is based on an understanding of:

a.            bioavailability.

b.            pharmacokinetics.

c.             pharmacodynamics.

d.            anatomy and physiology.

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.

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.

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

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.

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.

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.

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.

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.

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.

11.          A primary care NP is prescribing a drug for a patient who does not take any other medications. The NP should realize that:

a.            CYP450 enzyme reactions will not interfere with this drug’s metabolism.

b.            substrates such as alcohol cannot interfere with the drug when the patient is abstaining.

c.             food-drug interactions are limited to those where food enhances or inhibits drug absorption.

d.            a thorough history of diet, alcohol use, smoking, and over-the-counter and herbal products is required.

 

 

 

Chapter 04: Special Populations: Geriatrics Test Bank

MULTIPLE CHOICE

1.            A nurse practitioner (NP) is considering a possible drug regimen for an 80-year-old patient who reports being forgetful. To promote adherence to the regimen, the NP should:

a.            select drugs that can be given once or twice daily.

b.            provide detailed written instructions for each medication.

 c.            order medications that can be given on an empty stomach.

d.            instruct the patient to take a lower dose if side effects occur.

2.            A 75-year-old patient who lives alone will begin taking a narcotic analgesic for pain. To help ensure patient safety, the NP prescribing this medication should:

a.            assess this patient’s usual sleeping patterns.

b.            ask the patient about problems with constipation.

c.             obtain a baseline creatinine clearance test before the first dose.

d.            perform a thorough evaluation of cognitive and motor abilities.

3.            A thin 90-year-old patient who will begin taking warfarin has experienced a recent weight loss of 15 pounds. The NP caring for this patient should:

a.            obtain a baseline liver function test (LFT) before starting the drug.

b.            write the initial prescription at the lowest possible dose.

c.             encourage the patient to consume a diet high in fat and protein.

 d.           counsel the patient to take the drug with food to enhance absorption.

4.            An 86-year-old patient is seen in clinic for a scheduled follow-up after starting a new oral medication 1 month prior. The patient reports no change in symptoms, and a laboratory test reveals a subtherapeutic serum drug level. The NP caring for this patient should:

a.            consider ordering more frequent dosing of the drug.

b.            titrate the patient’s dose upward and recheck in 1 month.

c.             ask the patient about any increased frequency of bowel movements.

d.            determine the number of pills left in the patient’s prescription bottle.

5.            An NP learns that a 90-year-old patient is chronically constipated and has frequent problems with acid reflux. The NP notes a weight loss of 20 pounds in this patient in the previous 6 months. Which of the following drugs that this patient is taking is cause for concern?

a.            Quinidine

b.            Naproxen

c.             Calcium citrate

d.            Calcium channel blocker

6.            An NP is caring for a 70-year-old patient who reports having seasonal allergies with severe rhinorrhea. Using the Beers criteria, which of the following medications should the NP recommend for this patient?

a.            Loratadine (Claritin)

b.            Hydroxyzine (Vistaril)

c.             Diphenhydramine (Benadryl)

d.            Chlorpheniramine maleate (Chlorphen 12)

7.            An NP orders an inhaled corticosteroid 2 puffs twice daily and an albuterol metered-dose inhaler 2 puffs every 4 hours as needed for cough or wheezing for a 65-year-old patient with recent onset of reactive airways disease who reports symptoms occurring every 1 or 2 weeks. At a follow-up appointment several months later, the patient reports no change in frequency of symptoms. The NP’s initial action should be to:

a.            order spirometry to evaluate pulmonary function.

b.            prescribe a systemic corticosteroid to help with symptoms.

c.             ask the patient to describe how the medications are taken each day.

d.            give the patient detailed information about the use of metered-dose inhalers.

 

Chapter 05: Special Populations: Pediatrics

 Test Bank

MULTIPLE CHOICE

1.            A nurse practitioner (NP) is preparing to prescribe a medication for a 5-year-old child. To determine the correct dose for this child, the NP should:

a.            calculate the dose at one third of the recommended adult dose.

b.            estimate the child’s body surface area (BSA) to calculate the medication dose.

c.             divide the recommended adult dose by the child’s weight in kilograms (kg).

d.            follow the drug manufacturer’s recommendations for medication dosing.

2.            An NP is prescribing a drug that is known to be safe in children but is unable to find recommendations about drug dosing. The recommended adult dose is 100 mg per dose. The child weighs 14 kg. Using Clark’s rule, the NP should order                 mg per dose.

a.            20

b.            10

c.             14

d.            9.3

3.            A child who weighs 22 lb, 2 oz needs a medication. The NP learns that the recommended dosing for this drug is 25 to 30 mg per kg per day in three divided doses. The NP should order:

 a.           100 mg daily.

b.            100 mg tid.

c.             300 mg daily.

d.            300 mg tid.

4.            The mother of a 3-year-old child who weighs 15 kg tells the NP that she has liquid acetaminophen at home but does not know what dose to give her child. The NP should tell the mother:

a.            to give 1 teaspoon every 4 to 6 hours as needed.

b.            to throw away the old medication and get a new bottle.

c.             that she may give 5 to 7.5 mL per dose every 4 to 6 hours.

d.            to find out whether she has a preparation made for infants or children.

5.            The parent of a toddler asks the NP about using a topical antihistamine to treat the child’s atopic dermatitis symptoms. The NP should tell the parent that:

a.            topical medications have fewer side effects in children.

b.            medications given by this route are not absorbed well in young children.

c.             topical application of an antihistamine may result in drug toxicity in children.

 d.           it is important to apply topical medications liberally over a large surface area.

6.            An NP is prescribing a medication for a 6-month-old infant. The medication comes in the following formulations. Which one should the NP select to improve absorption and distribution of the medication?

a.            Oral elixir

b.            Rectal suppository

c.             Lipid soluble compound

d.            Sustained-release capsule

7.            An NP prescribes an oral elixir medication for a child who is to take 1 tsp PO bid. When counseling the child’s parents about administering this drug, the NP should tell them to:

a.            shake the medication well before giving each dose.

b.            mix the medication with cereal or applesauce to improve its taste.

c.             administer the medication on an empty stomach to enhance absorption.

d.            use a syringe purchased at the pharmacy to measure the medication accurately.

 8.           A 4-month-old infant has a viral illness with high fever and cough. The infant’s parent asks the NP about what to give the infant to help with symptoms. The NP should prescribe which of the following?

a.            Aspirin to treat the fever

b.            Acetaminophen as needed

c.             Dextromethorphan for coughing

d.            An antibiotic to prevent increased infection

9.            A parent brings a 5-year-old child to a clinic for a hospital follow-up appointment. The child is taking a medication at a dose equal to an adult dose. The parent reports that the medication is not producing the desired effects. The NP should:

a.            order renal function tests.

b.            prescribe another medication to treat this child’s symptoms.

c.             discontinue the drug and observe the child for toxic side effects.

d.            obtain a serum drug level and consider increasing the drug dose.

10.          An NP is prescribing an antibiotic for a child who will need to take a total of 750 mg per day. Which dosing regimen should the NP prescribe to promote compliance?

a.            250 mg/5 mL—375 mg PO bid

b.            250 mg/5 mL—250 mg PO tid

c.             500 mg/5 mL—375 mg PO bid

d.            500 mg/5 mL—250 mg PO tid

11.          An NP sees a preschooler in clinic for the first time. When obtaining a medication history, the NP notes that the child is taking a medication for which safety and effectiveness in children has not been established in drug information literature. The NP should:

a.            discontinue the medication.

b.            order serum drug levels to evaluate toxicity.

c.             report the prescribing provider to the Food and Drug Administration (FDA).

d.            ask the parent about the drug’s use and side effects.