Test Bank for Edmunds Pharmacology for The Primary Care Provider 5th Edition by Constance G Visovsky. All Chapters. 2024/25. is written for Nurse Practitioners, other Advanced Practice Nursing prescribers, and Physician Assistants. Unlike other pharmacotherapeutics textbooks, it focuses on the drug...
Chapter 01: Prescriptive Authority and Role Implementation: Tradition vs. Change
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
CORRECT ANS: A
The Physician Payment Review Commission in 1992 directly increased financial reimbursement
to clinicians who provide primary care. Coupled with a shortage of primary care providers, this
C
incentive led medical schools to place greater emphasis on preparing primary care physicians.
Competition from nonphysicians increased coincidentally as professionals from other disciplines
LE
stepped up to meet the needs.
Nonphysicians have had increasing success at providing primary care and have been shown to be
safe and effective.
ST
2. Which of the following statements is true about the prescribing practices of physicians?
BE
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.
CORRECT ANS: D
Even though most physicians claim to place little weight on drug advertisements, pharmaceutical
representatives, and patient preference and state that they rely on academic sources for drug
information, a study showed that commercial rather than scientific sources of drug information
dominated their drug information materials. Younger physicians tend to prescribe fewer and
more appropriate drugs. Antibiotics have dropped out of the top five classifications of drugs
prescribed. Most physicians have a therapeutic armamentarium of about 144 drugs.
3. As primary care nurse practitioners (NPs) continue to develop their role as prescribers of
medications, it will be important to:
a. attains the same level of expertise as physicians who currently prescribe medications.
b. learns from the experiences of physicians and develop expertise based on evidence- based
practice.
c. maintains collaborative and supervisorial relationships with physicians who will oversee
prescribing practices.
d. develops relationships with pharmaceutical representatives to learn about new
medications as they are developed.
C
CORRECT ANS: B
As nonphysicians develop the roles associated with prescriptive authority, it will be important to
LE
learn from the past experiences of physicians and to develop prescribing practices based on
evidence-based medicine. It is hoped that all prescribers, including physicians and nurse
practitioners, will strive to do better than in the past. NPs should work toward prescriptive
authority and for practice that is not supervised by another professional. Pharmaceutical
representatives provide information that carries some bias. Academic sources are better.
ST
DIF: Cognitive Level: Applying (Application) REF: 4
BE
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.
CORRECT ANS: B
In 2001, the Centers for Medicare and Medicaid Services changed the federal physician
supervision rule for CRNAs to allow state governors to opt out, allowing CRNAs to write
prescriptions and dispense drugs without physician supervision.
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. administers medications, including controlled substances, under direct physician
supervision.
C
CORRECT ANS: C
Only five states grant independent prescriptive authority to CRNAs. CRNAs do not require
LE
prescriptive authority because they dispense a drug immediately to a patient and do not
prescribe. Without prescriptive authority, they do not need a DEA number.
ST
DIF: Cognitive Level: Understanding (Comprehension) REF: 9
3. A CNM:
BE
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.
CORRECT ANS: B
CNMs have prescriptive authority in all 50 states. They may treat partners of women for sexually
transmitted diseases. They have full prescriptive authority and are not limited to drugs used
during childbirth. They practice in many other types of settings.
4. In every state, prescriptive authority for NPs includes the ability to write prescriptions:
4
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