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. – 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 – Sublingual
According to the Texas BON rules and regulations, a prescription must include: – (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. – 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.
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has reduced bioavailability.
has fewer systemic side effects.
provides dosing that is easier to regulate. – has fewer systemic side effects.
A primary care NP is prescribing a drug for a patient who does not take any other medications. The NP should
realize that:
CYP450 enzyme reactions will not interfere with this drug’s metabolism.
substrates such as alcohol cannot interfere with the drug when the patient is abstaining.
food-drug interactions are limited to those where food enhances or inhibits drug absorption.
a thorough history of diet, alcohol use, smoking, and over-the-counter and herbal products is required. – a
thorough history of diet, alcohol use, smoking, and over-the-counter and herbal products is required.
The neighbor of a primary care NP asks the NP to write a prescription for an antibiotic. The NP should tell the
neighbor:
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. – 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 – 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. – pharmacokinetics.
According to Texas law, “dangerous drugs” include which of the following pharmacologic agents?
Experimental medications
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Prescription medications
Controlled substances
Herbal and alternative therapies – 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. – 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 MSNprepared nurse should:
prescribe varenicline (Chantix).
prescribe bupropion (Wellbutrin).
change to a 21 mg/24 hour nicotine patch.
suggest adding nicotine nasal spray for cravings. – change to a 21 mg/24 hour nicotine patch.
It is important to begin therapy with a dose sufficient to deliver enough nicotine so that patients will not want to
smoke. Patients who awaken with nicotine 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.
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a Nicotrol inhaler.
varenicline (Chantix). – 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. – 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. – 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.