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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. CORRECT ANSWERS✅ B. for specified classifications of medications. 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? Rectal Topical Sublingual Intramuscular CORRECT ANSWERS✅ Sublingual According to the Texas BON rules and regulations, a prescription must include: CORRECT ANSWERS✅ (1) the patient's name and address; (2) the name, strength, and quantity of the drug to be dispensed; (3) directions to the patient regarding taking of the drug and the dosage; (4) the intended use of the drug, if appropriate; (5) the name, address, and telephone number of the physician with whom the APRN has a prescriptive authority agreement (6) address and telephone number of the site at which the prescription drug order was issued;
(7) the date of issuance; (8) the number of refills permitted; (9) the name, prescription authorization number, and original signature of the APRN who authorized the prescription drug order; and (10) the United States Drug Enforcement Administration numbers of the APRN and the delegating physician, if the prescription drug order is for a controlled substance. The primary care nurse practitioner (NP) writes a prescription for an antibiotic using an electronic drug prescription system. The pharmacist will fill this prescription when: the electronic prescription is received. the patient brings a written copy of the prescription. a copy of the written prescription is faxed to the pharmacy. the pharmacist accesses the patient's electronic record to verify. CORRECT ANSWERS✅ the electronic prescription is received. A patient receives an inhaled corticosteroid to treat asthma. The patient asks the nurse why the drug is given by this route instead of orally. The nurse should explain that the inhaled form:
a prescription will be written one time only. she will ask a colleague to write the prescription. that it is illegal to write prescriptions for friends. that it is best if the neighbor sees a health care provider before obtaining a prescription. CORRECT ANSWERS✅ that it is best if the neighbor sees a health care provider before obtaining a prescription. Under Texas law, Advance Practice Registered Nurses (APRNs) must receive a prescribing number from the Texas Board of Nursing before applying for supervision and prescriptive delegation with the Texas Medical Board? True or False CORRECT ANSWERS✅ True 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: bioavailability. pharmacokinetics.
pharmacodynamics. anatomy and physiology. CORRECT ANSWERS✅ pharmacokinetics. According to Texas law, "dangerous drugs" include which of the following pharmacologic agents? Experimental medications. Prescription medications. Controlled substances. Herbal and alternative therapies CORRECT ANSWERS✅ Prescription medications The family nurse practitioner sees a 6-month-old infant for a routine physical examination and notes that the infant has a runny nose and a cough. The parents report a 2-day history of a temperature of 99° F to 100° F and two to three loose stools per day. Other family members have similar symptoms. The infant has had two sets of immunizations at 2 and 4 months of age. The FNP should: administer the 6-month immunizations at this visit today. schedule an appointment in 2 weeks for 6-month immunizations. administer DTaP, Hib, IPV, hepatitis B, and PCV13 today and RV in 2 weeks.
cravings should wear a 24-hour patch. Prescribing varenicline or bupropion may be necessary if the patch fails after appropriate dosing is established. Whichever nicotine replacement method is chosen, the patient should use only one particular product to avoid nicotine toxicity. DIF: Cognitive Level: Applying (Application) REF: 785 A patient who smokes reports repeated attempts to quit smoking using a nicotine replacement patch. The patient says, "I always do well for a few weeks and then I just start smoking again." The advance practice nurse with prescriptive authority should prescribe: nortriptyline. Nicorette gum. a Nicotrol inhaler. varenicline (Chantix). CORRECT ANSWERS✅ varenicline (Chantix). Varenicline interferes with the enjoyment of nicotine so that smokers do not get pleasure when they smoke. Nicotine replacement medications do not improve relapse rates, and this patient has relapsed several times. Nortriptyline is not a first-line smoking cessation medication. DIF: Cognitive Level: Applying (Application) REF: 780
A parent calls a clinic for advice about giving an over-the-counter cough medicine to a 6-year-old child. The parent explains that the medication label does not give instructions about how much to give a child. The best action is to: order a prescription antitussive medication for the child. ask the parent to identify all of the ingredients listed on the medication label. calculate the dose for the active ingredient in the over-the-counter preparation. tell the parent to approximate the dose at about one third to one half the adult dose. CORRECT ANSWERS✅ ask the parent to identify all of the ingredients listed on the medication label. Over-the-counter cough medications often contain dextromethorphan, which can be toxic to young children. It is important to identify ingredients of an over-the- counter medication before deciding if it is safe for children. A prescription antitussive is probably not warranted until the cough is evaluated to determine the cause. Until the ingredients are known, it is not safe to approximate the child's dose based on only the active ingredient. DIF: Cognitive Level: Applying (Application) REF: 89 A child who weighs 22 lb, 2 oz needs a medication. The advance practice nurse learns that the recommended dosing for this drug is 25 to 30 mg per kg per day in three divided doses. The advance practice nurse should order: 100 mg daily.
It is important to determine exactly what the patient is taking, so asking patients to bring vitamin bottles to the clinic is appropriate. There is no evidence that natural products are better than synthetic products. High doses of folic acid may mask signs of vitamin B12 deficiency. Vitamin C in high doses can cause dependency. DIF: Cognitive Level: Applying (Application) REF: 89 An adolescent girl has decided to become a vegetarian. The nurse should counsel her about iron intake and considering a vitamin containing: zinc. vitamin A. vitamin C. potassium. CORRECT ANSWERS✅ zinc. Patients who are vegetarians often do not consume adequate amounts of zinc. DIF: Cognitive Level: Understanding (Comprehension) REF: 816 A woman who is breastfeeding her infant asks what she can use for headaches while she is nursing. The appropriate response is to tell her:
most medications enter breast milk and are not safe. most over-the-counter medications are safe for the breastfed infant. she may need to interrupt breastfeeding when taking headache medications. she should consider weaning her infant to formula if her headaches are frequent. CORRECT ANSWERS✅ most over-the-counter medications are safe for the breastfed infant. Most over-the-counter medications are considered safe for the breastfed infant and do not necessitate a disruption of breastfeeding, even though most medications cross easily into breast milk. Any interruption of breastfeeding carries a risk of premature weaning and so is indicated only when the mother must take medications known to cause serious harm to the baby. It is not recommended that she wean her infant to formula when she needs medications for her headaches. DIF: Cognitive Level: Applying (Application) REF: 85 A patient exhibits keratin deposits around hair follicles and has hardened pigmented "goose bump" lesions on all extremities. The nurse should consider recommending: thiamine. vitamin A.
A woman who takes an angiotensin converting enzyme inhibitor for hypertension tells her primary care nurse practitioner that she is trying to get pregnant. The nurse practitioner should: consider replacing her angiotensin converting enzyme inhibitor with methyldopa. lower her angiotensin converting enzyme inhibitor dose during the first trimester. counsel her to increase her antihypertensive medications during pregnancy. add an angiotensin receptor blocker (ARB) during the first trimester of her pregnancy. CORRECT ANSWERS✅ consider replacing her angiotensin converting enzyme inhibitor with methyldopa. Angiotensin converting enzyme inhibitors, ARBs, and statins are contraindicated during the first trimester of pregnancy and should be discontinued before conception and replaced by safer alternatives, such as methyldopa. The use of antihypertensives during pregnancy remains controversial; increasing the dose is not indicated. DIF: Cognitive Level: Applying (Application) REF: 80 A patient is diagnosed with lupus and reports occasional use of herbal supplements. The nurse should caution this patient to avoid: ginseng.
echinacea. ginkgo biloba. St. John's wort. CORRECT ANSWERS✅ echinacea. Patients with lupus who take echinacea may experience an increase in symptoms, even if the patient is taking immunosuppressants. DIF: Cognitive Level: Understanding (Comprehension) REF: 98 The mother of a 3-year-old child who weighs 15 kg tells the advance practice nurse that she has liquid acetaminophen at home but does not know what dose to give her child. The advance practice nurse should tell the mother: to give 1 teaspoon every 4 to 6 hours as needed. to throw away the old medication and get a new bottle. that she may give 5 to 7.5 mL per dose every 4 to 6 hours. to find out whether she has a preparation made for infants or children. CORRECT ANSWERS✅ to find out whether she has a preparation made for infants or children.
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Persistent atrial fibrillation (AF) is diagnosed in a patient who has valvular disease, and the cardiologist has prescribed warfarin (Coumadin). The patient is scheduled for electrical cardioversion in 3 weeks. The patient asks the family care nurse practitioner (FNP) why the procedure is necessary. The FNP should tell the patient: this medication prevents clots but does not alter rhythm. if the medication proves effective, the procedure may be canceled. there are no medications that alter the arrhythmia causing AF. to ask the cardiologist if verapamil may be ordered instead of cardioversion. CORRECT ANSWERS✅ this medication prevents clots but does not alter rhythm. Persistent AF lasts longer than 7 days and episodes fail to terminate on their own, but episodes can be terminated by electrical cardioversion after therapeutic warfarin therapy for 3 weeks. Warfarin does not alter AF. β-Blockers, calcium channel blockers, and digoxin are sometimes given to alter the rate. Verapamil is not an alternative to cardioversion for patients with persistent AF. DIF: Cognitive Level: Applying (Application) REF: 283 The advance practice nurse is preparing to prescribe isosorbide dinitrate sustained release (Dilatrate SR) for a patient who has chronic, stable angina. The APN should recommend initial dosing of:
60 mg four times daily at 6-hour intervals. 40 mg twice daily 30 minutes before meals. 60 mg on awakening and 40 mg 7 hours later. 80 mg three times daily at 8:00 AM, 1:00 PM, and 6:00 PM. CORRECT ANSWERS✅ 40 mg twice daily 30 minutes before meals. Long-acting nitrates should be considered to treat chronic, stable angina. The main limitation is tolerance, which can be limited by providing a nitrate-free period of 6 to 10 hours each day. The medication should be taken on an empty stomach, 30 to 60 minutes before a meal. An appropriate initial dose of isosorbide dinitrate is 40 mg every 12 hours. This dose can be increased as needed. Isosorbide mononitrate is given on awakening and again 7 hours later. The medication is not given four times daily. Dosing may be increased to 80 mg tid, and the dosing schedule of 8:00 AM, 1:00 PM, and 6:00 PM. would be appropriate at that point. DIF: Cognitive Level: Applying (Application) REF: 241 A patient who has type 2 diabetes mellitus will begin taking a bile acid sequestrant. Which bile acid sequestrant should the prescriber order? Colesevelam (Welchol) Colestipol (Colestid)
addition of another medication. An angiotensin-converting enzyme inhibitor is an appropriate drug for patients who also have diabetes. β-Blockers and aldosterone antagonist medications are not recommended for patients with diabetes. DIF: Cognitive Level: Applying (Application) REF: 229| Table 17- An African-American patient who is obese has persistent blood pressure readings greater than 150/95 mm Hg despite treatment with a thiazide diuretic. The prescriber should consider starting a(n): angiotensin receptor blocker. β-blocker. ACE inhibitor. calcium channel blocker. CORRECT ANSWERS✅ calcium channel blocker. African-American patients are considered good candidates for calcium channel blockers to treat hypertension. Treatment with calcium channel blockers as monotherapy in African-American patients has proved to be more effective than some other classes of antihypertensive agents. DIF: Cognitive Level: Applying (Application) REF: 268 A 55-year-old woman has a history of myocardial infarction (MI). A lipid profile reveals LDL of 130 mg/dL, HDL of 35 mg/dL, and triglycerides 150 mg/dL. The
woman is sedentary with a body mass index of 26. The woman asks the prescriber about using a statin medication. The prescriber should: recommend dietary and lifestyle changes first. begin therapy with atorvastatin 10 mg per day. discuss quality-of-life issues as part of the decision to begin medication. tell her there is no clinical evidence regarding efficacy of statin medication in her case. CORRECT ANSWERS✅ begin therapy with atorvastatin 10 mg per day. This woman would be using a statin medication for secondary prevention because she already has a history of MI, so a statin should be prescribed. Dietary and lifestyle changes should be a part of therapy, but not the only therapy. She is relatively young, and quality-of-life issues are not a concern. There is no clinical evidence to support use of statins as primary prevention in women. DIF: Cognitive Level: Applying (Application) REF: 296 A patient who has atrial fibrillation (AF) has been taking warfarin (Coumadin). The prescriber plans to change the patient's medication to dabigatran (Pradaxa). To do this safely, the prescriber should: initiate dabigatran when the patient's international normalized ratio (INR) is less than 2.
