Rosenthal: Lehne's Pharmacotherapeutics
for Advanced Practice Providers, 1st Ed.
Chapter 1: Prescriptive Authority
An APRN works in a urology clinic under the supervision of a physician who does not restrict the
types of medications the APRN is allowed to prescribe. State law does not require the APRN to
practice under physician supervision. How would the APRN's prescriptive authority be
described?
A. Full authority
B. Independent
C. Without limitation
D. Limited authority - ANSANS: B
The APRN has independent prescriptive authority because the regulating body does not require
that the APRN work under physician supervision. Full prescriptive authority gives the provider
the right to prescribe independently and without limitation. Limited authority places restrictions
on the types of drugs that can be prescribed.
DIF: Cognitive Level: ComprehensionREF: p. 1TOP: Nursing Process: I MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
Which factors increase the need for APRNs to have full prescriptive authority?
A. More patients will have access to health care.
B. Enrollment in medical schools is predicted to decrease.
C. Physician's assistants are being utilized less often.
D. APRN education is more complex than education for physicians. - ANSANS: A
Implementation of the Affordable Care Act has increased the number of individuals with health
care coverage, and thus the number who have access to health care services. The increase in
the number of patients creates the need for more providers with prescriptive authority. APRNs
can fill this practice gap.
DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
Which factors could be attributed to limited prescriptive authority for APRNs? Select all that
apply.
A. Inaccessibility of patient care
,B. Higher health care costs
C . Higher quality medical treatment
D. Improved collaborative care
E. Enhanced health literacy - ANSANS: A,B
Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and
accessible patient care. It may also lead to poor collaboration among providers and higher
health care costs. It would not directly impact patient's health literacy.
DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
Which aspects support the APRN's provision for full prescriptive authority? Select all that apply.
A. Clinical education includes prescription of medications and disease processes.
B. Federal regulations support the provision of full authority for APRNs.
C. National examinations provide validation of the APRN's ability to provide safe care.
D. Licensure ensures compliance with health care and safety standards.
E. Limiting provision can decrease health care affordability. - ANSANS: A,C,D
APRNs are educated to practice and prescribe independently without supervision. National
examinations validate the ability to provide safe and competent care. Licensure ensures
compliance with standards to promote public health and safety. Limited prescriptive authority
creates numerous barriers to quality, affordable, and accessible patient care.
DIF: Cognitive Level: ComprehensionREF: pp. 1-2TOP: Nursing Process: Implementation MSC:
A family nurse practitioner practicing in Maine is hired at a practice across state lines in Virginia.
Which aspect of practice may change for the APRN?
A. The APRN will have less prescriptive authority in the new position.
B. The APRN will have more prescriptive authority in the new position.
C. The APRN will have equal prescriptive authority in the new position.
D. The APRN's authority will depend on federal regulations. - ANSANS: A
Virginia allows limited prescriptive authority, while Maine gives full authority to certified nurse
practitioners. The federal government does not regulate prescriptive authority.
DIF: Cognitive Level: ComprehensionREF: p. 3TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
How can collaboration with a pharmacist improve positive outcomes for patients? Select all that
apply.
A. Pharmacists can suggest foods that will help with the patient's condition.
B. Pharmacists have additional information on drug interactions.
C. The pharmacist can suggest adequate medication dosing.
,D. Pharmacists have firsthand knowledge of the facility formulary.
E. Pharmacy can alter prescriptions when necessary to prevent patient harm. - ANSANS: B,C,D
Providers should collaborate with pharmacists because they will likely have additional
information on formulary, drug interactions, and suggestions for adequate medication dosing.
Dietitians can make food recommendations to treat the patient's condition. The pharmacist can
contact the prescriber about questionable prescriptions, but cannot alter the prescription without
notification of and approval by the provider.
DIF: Cognitive Level: ComprehensionREF: p. 9TOP: Nursing Process: Diagnosis MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
A patient presents with delirium tremens requiring Ativan administration. The provider of care is
not the facility. Which action by the nurse is the most appropriate?
A. Obtain a telephone order.
B. Contact the on-call hospitalist.
C. Obtain an order from the charge nurse.
D. Wait for a written Ativan order. - ANSANS: A
In an emergency situation, such as delirium tremens with seizure activity, it is acceptable to
provide a telephone order. Contacting the on-call hospitalist or waiting for a written order would
take more time than available for a patient with high seizure risk. Writing an order is outside the
scope of practice for the charge nurse.
DIF: Cognitive Level: ApplicationREF: p. 7TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
A patient with chronic pain calls the provider's office to request a refill on their oxycontin. Which
action is most appropriate?
A. Fax an order to the pharmacy.
B. Schedule an appointment with the patient.
C. Verify the patient's adherence to drug regimen.
D. Determine the patient's current medication dosage. - ANSANS: B
Schedule II medications are not eligible for refills, and prescriptions must be handwritten. It is
important to verify the patient's adherence to the drug regimen and determine the current
dosage of medication; however, this can be accomplished by scheduling an appointment and
evaluating the patient in person.
DIF: Cognitive Level: ApplicationREF: p. 8TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
A patient prescribed amoxicillin for streptococcal pharyngitis reports new onset of a flat, itchy
red rash on the chest and neck. Which action is most important?
, A. Provide a different prescription.
B. Discontinue the medication.
C. Prescribe an antihistamine cream.
D. Assess for respiratory compromise. - ANSANS: B
The priority action is to discontinue the medication to prevent worsening of the patient's
symptoms. A different prescription would be provided, topical antihistamine may be
administered, and the patient would be assessed for respiratory involvement, but these actions
would not be performed first.
DIF: Cognitive Level: ApplicationREF: p. 6TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
A patient taking three medications for hypertension is diagnosed with COPD. Which action
should be taken prior to prescribing medications to treat COPD?
A. Obtain baseline laboratory values.
B. Obtain a complete medication history.
C. Assess liver enzyme levels.
D. Determine if the patient has insurance coverage. - ANSANS: B
Prior to adding medications to the treatment regimen, it is essential to assess for any potential
drug- drug interactions through a complete medical history. Baseline laboratory values are not
necessary for COPD treatment. Liver enzyme levels may give insight into the possibility of
altered metabolism but would not be the first action. The presence of insurance coverage would
affect the patient's access to treatment but may not affect the type of medication prescribed.
DIF: Cognitive Level: ApplicationREF: p. 6TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
A patient with diabetes reports losing their job and an inability to purchase required medications.
Which action is most appropriate?
A. Provide a 7-day sample pack.
B. Decrease the daily dose by half.
C. Contact a different pharmacy.
D. Prescribe a different medication. - ANSANS: C
Providing a 7-day sample will address the patient's immediate need, but will not help with the
patient's long-term need for medication. Decreasing the daily dose will diminish the
effectiveness of the medication. Selecting a different pharmacy could decrease the cost of the
medication, as costs vary based on the location and the pharmacy dispensing the medication.
Prescribing a different medication would be the last option.
DIF: Cognitive Level: ApplicationREF: p. 5TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
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