History and Prescribing Regulations

Question 1

What are the types of prescriptive authority for APRNs?

Answer 1

Fully Independent, Reduced or Limited, and Restricted

Question 2

What is fully independent prescriptive authority?

Answer 2

NPs can evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—including prescribe medications—under the exclusive licensure authority of the state board of nursing.

This is the model recommended by the Institute of Medicine and National Council of State Boards of Nursing.

Question 3

What is reduced prescriptive authority?

Answer 3

APRNs can diagnose and treat patients, but need physician oversight to prescribe medications.

Question 4

What is restricted prescriptive authority?

Answer 4

APRNs need physician oversight to prescribe, diagnose, and treat patients.

Texas APRNs are under restricted authority.

Question 5

What are the five states with joint control of practice and licensure within the state’s board of nursing and board of medicine?

Answer 5

DELAWARE
MASSACHUSETTS
NORTH CAROLINA
SOUTH DAKOTA
VIRGINIA

Question 6

What should you consider when prescribing a drug?

Answer 6

• Is There a Clear Indication for Drug Therapy?
• What Drugs Are Effective in Treating This Disorder?
• What Is the Goal of Therapy With This Drug?
• Under What Conditions Is It Determined That a Drug Is Not Meeting the Goal and a Different Therapy or Drug Should Be Tried?
• Are There Unnecessary Duplications With Other Drugs That the Patient Is Already Taking?
• Would an Over-the-Counter Drug Be Just as Useful as a Prescription Drug?
• What About Cost?
• Where Is the Information to Answer These Questions?

Question 7

What are examples of irrational medication use outlined as described by the WHO?

Answer 7

• Polypharmacy
• Inappropriate prescribing of antimicrobials
• Overuse of injections versus oral preparations
• Failure to follow guidelines when prescribing

Question 8

WHAT IS THE PROCESS OF RATIONAL DRUG PRESCRIBING?

Answer 8

1- Define the Patient’s Problem 
2- Specify the Therapeutic Objective 
3- Choose the Treatment 
4- Start the Treatment 
5- Educate the Patient 
6- Monitor Effectiveness

Question 8

WHAT IS THE PROCESS OF RATIONAL DRUG PRESCRIBING?

Answer 8

1- Define the Patient’s Problem 
2- Specify the Therapeutic Objective 
3- Choose the Treatment 
4- Start the Treatment 
5- Educate the Patient 
6- Monitor Effectiveness

Question 9

Define the Patient’s Problem Notes

Answer 9

• Make the diagnosis
• Develop a plan of care
• Is there a clear indication for drug therapy?
• What drugs are effective in treating this disorder?

Question 10

Specify the Therapeutic Objective Notes

Answer 10

• Clarify whether the treatment goals are curative, symptom relieving, or preventive
• Include the patient as a partner in the treatment regimen
• Elicit patient beliefs and preferences especially in chronic diseases that require long-term drug treatment
• Look at costs and how well the drug fits into the patient’s lifestyle

Question 11

Choose the Treatment Notes

Answer 11

A two-step process:

1) Determining what would be the appropriate therapy based on evidence-based guidelines
2) Individualizing the drug choice for the specific patient using analytical or nonanalytical reasoning.

Question 12

What is the analytical approach to choosing drug therapy?

Answer 12

Novice providers use an analytical approach, which is slow, time-consuming, systematic, and evidence-based.

Question 13

What is the nonanalytical approach to choosing drug therapy?

Answer 13

More experienced providers use their experience and pattern recognition to carry out a nonanalytical process in a faster, subconscious manner until presented with a complex patient situation.

Question 14

Educate the Patient Notes

Answer 14

1) Purpose of the medication
2) Instructions for administration
3) Potential adverse drug effects
4) Tailored to the patient
5) Presented in plain language (fifth- or sixth-grade reading level), with an understanding that nine out of 10 adults have difficulty reading health information

Question 15

What are the types of monitoring for drug effectiveness?

Answer 15

passive and active

Question 16

What is passive monitoring?

Answer 16

Patient is educated on the expected outcome of the drug therapy and is instructed to contact the provider if the treatment is not effective or if adverse drug effects occur.

This is common when short-term treatment, such as an antibiotic, is prescribed, and no test of cure is required.

Question 17

What is active monitoring?

Answer 17

Active monitoring occurs when the provider schedules a follow-up examination to determine the effectiveness of the drug therapy. It may include evaluating therapeutic blood levels and making dosage adjustments, as is necessary in anticoagulant therapy or patients taking an antiseizure medication.

Active monitoring may also include adding or subtracting medications from the treatment regimen based on the effectiveness of the treatment.

Question 18

What do you educate the patient concerning a prescription?

Answer 18

1) Purpose of the medication
2) Istructions for administration
3) Potential adverse drug effects

Present info in plain language (fifth- or sixth-grade reading level), with an understanding that nine out of 10 adults have difficulty reading health information.

Question 19

WHAT ARE THE 7 DRUG FACTORS INFLUENCING DRUG SELECTION

Answer 19

1) Pharmacokinetics
2) Pharmacodynamics
3) Therapeutic issues
4) Safety
5) Cost
6) Patient factors
7) Provider factors

Question 20

What is the therapeutic index?

Answer 20

The relationship between a drug’s desired therapeutic effects and its adverse effects

Question 21

What is pharmacodynamics?

Answer 21

The branch of pharmacology concerned with the effects of drugs and the mechanism of their action.

Question 22

What is pharmacokinetics?

Answer 22

The branch of pharmacology concerned with the movement of drugs within the body.

Question 23

What are the pharmacokinetics factors considered when selecting a drug?

Answer 23

1) Bioavailability
2) Metabolism
3) Dose–concentration curve and half-life will determine the dosing schedule, with fewer doses per day