Prescription Requirements and Medication Management, Exams of Pharmacology

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Advanced Pharmacology - Modules 1- 5 Questions And Answers 2024 A+ Review Solution

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. 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 - ANS-Sublingual

According to the Texas BON rules and regulations, a prescription must include: - ANS-(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. - ANS-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:

is absorbed less quickly.

has reduced bioavailability.

has fewer systemic side effects.

provides dosing that is easier to regulate. - ANS-has fewer systemic side effects.

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 - ANS-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. - ANS-pharmacokinetics.

According to Texas law, "dangerous drugs" include which of the following pharmacologic agents?

Experimental medications

Prescription medications

Controlled substances

Herbal and alternative therapies - ANS-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.

withhold all immunizations until the infant's temperature returns to normal and the cough is gone. - ANS-administer the 6-month immunizations at this visit today.

Minor upper respiratory infection or gastroenteritis, with or without fever, is not an indication for withholding a scheduled vaccine dose.

DIF: Cognitive Level: Applying (Application)

REF: 757

A patient has been using a nicotine patch for several weeks and uses the 15 mg/16 hour patch. The patient reports having frequent continual cravings for cigarettes, especially on awakening in the morning. The MSN-prepared nurse should:

prescribe varenicline (Chantix).

prescribe bupropion (Wellbutrin).

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. - ANS-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.

100 mg tid.

300 mg daily.

300 mg tid. - ANS-100 mg tid

The NP should first convert the child's weight to kg, which is about 10 kg. The dose is then calculated to be 250 to 300 mg per day in three divided doses, which is 83 to 100 mg per dose given tid.

DIF: Cognitive Level: Applying (Application)

REF: 65

A previsit health history on a new patient is obtained. The patient reports taking vitamins every day. The best response is to:

ask the patient to bring all vitamin bottles to the clinic appointment.

recommend natural vitamin products over synthetic vitamin products.

reassure the patient that vitamins that are high in folic acid are safe to take.

tell the patient that some vitamins, such as vitamin C, are safe in large doses. - ANS-ask the patient to bring all vitamin bottles to the clinic appointment.

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)

she should consider weaning her infant to formula if her headaches are frequent. - ANS-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.

beta carotene.

ascorbic acid. - ANS-beta carotene.

The patient is exhibiting signs of early vitamin A deficiency. Beta carotene is recommended to avoid vitamin A toxicity because beta carotene is converted to vitamin A as needed and there is no need to monitor intake levels as with vitamin A. Thiamine and ascorbic acid are not indicated.

DIF: Cognitive Level: Applying (Application)

REF: 804 - 805

The family nurse practitioner sees a patient for an annual physical examination. The patient reports chronic alcohol abuse. The FNP should refer the patient for treatment and should prescribe:

niacin.

thiamine.

folic acid.

vitamin B6. - ANS-thiamine.

Patients who are alcohol abusers are prone to thiamine deficiency.

DIF: Cognitive Level: Applying (Application)

REF: 807

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. - ANS-consider replacing her angiotensin converting enzyme inhibitor with methyldopa.

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

Acetaminophen drops for infants are three times as concentrated as the oral liquid for children. The drops have been pulled from the market, but many parents may still have old preparations on hand. The NP should first determine which preparation this mother has before giving dosage recommendations. If the mother has the oral liquid for children, answers A and C would both be acceptable because the concentration is 160 mg per 5 mL. The mother should not be counseled to throw away the medication until the NP has more information.

DIF: Cognitive Level: Applying (Application)

REF: 65

A MSN-prepared nurse 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 MSN- prepared nurse recommend for this patient?

Loratadine (Claritin)

Hydroxyzine (Vistaril)

Diphenhydramine (Benadryl)

Chlorpheniramine maleate (Chlorphen 12) - ANS-Loratadine (Claritin)

Loratadine is the only nonsedating antihistamine on this list. Older patients are especially susceptible to sedation side effects and should not use these medications if possible.

DIF: Cognitive Level: Applying (Application)

REF: 57

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. - ANS-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:

All bile acid sequestrants are equally effective. Colesevelam has an additional indication to improve glycemic control in adults with type 2 diabetes and so should be selected when prescribing a bile acid sequestrant for this patient.

DIF: Cognitive Level: Applying (Application)

REF: 298

The nurse practitioner sees a new patient who has diabetes and hypertension and has been taking a thiazide diuretic for 6 months. The patient's blood pressure at the beginning of treatment was 150/ mm Hg. The blood pressure today is 138/88 mm Hg. The NP should:

order a β-blocker.

add an angiotensin-converting enzyme inhibitor.

continue the current drug regimen.

change to an aldosterone antagonist medication. - ANS-add an angiotensin-converting enzyme inhibitor.

Evidence-based guidelines suggest that optimal control of hypertension to less than 130/80 mm Hg could prevent 37% of cardiovascular disease in men and 56% in women, so this patient, although showing improvement, could benefit from the 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/ 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. - ANS-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.

A patient who is taking an ACE inhibitor sees the Family Nurse Practitioner for a follow-up visit. The patient reports having a persistent cough. The FNP should:

consider changing the medication to an ARB.

order a bronchodilator to counter the bronchospasm caused by this drug.

ask whether the patient has had any associated facial swelling with this cough.

reassure the patient that tolerance to this adverse effect will develop over time. - ANS-consider changing the medication to an ARB.

A persistent cough may occur with ACE inhibitors and may warrant discontinuation of the drug. An ARB would be the next drug of choice because it does not have this side effect. The cough is not related to bronchospasm. Angioedema is not related to ACE inhibitor-induced cough. Patients do not develop tolerance to this side effect.

DIF: Cognitive Level: Applying (Application)

REF: 275

A patient is in the clinic for a follow-up examination after a myocardial infarction (MI). The patient has a history of left ventricular systolic dysfunction. The nurse should expect this patient to be taking:

nadolol (Corgard).

carvedilol (Coreg).

timolol (Blocadren).

propranolol (Inderal). - ANS-carvedilol (Coreg).

The 2012 guides for prevention of cardiovascular disease recommend that β-blocker therapy should be used in all patients with left ventricular systolic dysfunction with heart failure or prior MI. Use should be limited to carvedilol, metoprolol succinate, or bisoprolol.

DIF: Cognitive Level: Understanding (Comprehension)

REF: 259

A patient comes to the clinic with a recent onset of nocturnal and exertional dyspnea. The family nurse practitioner (FNP) auscultates S3 heart sounds but does not palpate hepatomegaly. The patient has mild peripheral edema of the ankles. The FNP should consult a cardiologist to discuss prescribing a(n):

β-blocker.

a loop diuretic.

an angiotensin-converting enzyme (ACE) inhibitor.

an angiotensin receptor blocker (ARB). - ANS-a loop diuretic.

This patient shows signs of systolic heart failure. Treatment for heart failure should begin with a loop diuretic, with an ACE inhibitor added after the diuretic has been taken. β-Blockers are used in patients with minimal fluid retention and would be added later. ARBs are used if ACE inhibitors are not tolerated or are ineffective.

DIF: Cognitive Level: Applying (Application)

REF: 251

A FNP is evaluating a patient who has COPD. The patient uses a LABA twice daily. The patient reports having increased exertional dyspnea, a frequent cough, and poor sleep. The patient also uses a short-