Chapter 10 - Pharmacology for the Primary Care Provider - Test Bank

Chapter 10: Practical Tips on Writing Prescriptions Test Bank MULTIPLE CHOICE 1. 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: a. the electronic prescription is received. b. the patient brings a written copy of the prescription. c. a copy of the written prescription is faxed to the pharmacy. d. the pharmacist accesses the patient?s electronic record to verify. ANS: A E-sign effectively voids requirements that prescriptions be written on paper or printed as a hard copy. Some scheduled drugs still require written copies. Faxed copies of this drug would be allowed but are not necessary for the pharmacist to fill the prescription. The patient?s electronic medical record stands as evidence of the need for a prescription of a drug but is not needed for the pharmacist to fill the prescription. DIF: Cognitive Level: Understanding (Comprehension) REF: 116 2. When prescribing a medication for a chronic condition, the primary care NP should tell the patient: a. to contact the pharmacy whenever refills are needed. b. that it is necessary to return to the clinic for each monthly refill of the medication. c. about the frequency of clinic visits necessary for the number of refills authorized. d. to ask the pharmacist to supply several months? worth of the medication at a time. ANS: C Nonscheduled drugs may be ordered with refills so that the patient does not have to be seen each time a refill is needed. It is important to determine how closely a patient should be monitored while taking a drug for a chronic condition and to let the patient know how frequently he or she needs to be seen. Patients may contact a pharmacy when they still have authorized refills to pick up, but this is determined by the clinician. Pharmacists usually cannot dispense more than 30 days? worth of a medication. DIF: Cognitive Level: Applying (Application) REF: 116 - 117 3. The neighbor of a primary care NP asks the NP to write a prescription for an antibiotic. The NP should tell the neighbor: a. a prescription will be written one time only. b. she will ask a colleague to write the prescription. c. that it is illegal to write prescriptions for friends. d. that it is best if the neighbor sees a health care provider before obtaining a prescription. ANS: D It is not illegal to prescribe antibiotics for friends, but it is unethical. It is better if patients are seen and diagnosed appropriately before antibiotics are prescribed. The NP should recommend that the neighbor see a health care provider. DIF: Cognitive Level: Applying (Application) REF: 116 - 117 4. The primary care NP is prescribing a medication for an off-label use. To help prevent a medication error, the NP should: a. write ?off-label use? on the prescription and provide a rationale. b. call the pharmacist to explain why the instructions deviate from common use. c. write the alternative drug regimen on the prescription and send it to the pharmacy. d. tell the patient to ignore the label directions and follow the verbal instructions given in the clinic. ANS: A When prescribing a drug for an off-label use, the provider should specify this on the written prescription and should provide a rationale so that the pharmacist understands why the prescription is different from the normal use. Calling the pharmacist would not provide written documentation. Merely writing the different instructions can lead to errors if the pharmacist changes the label to conform to usual standards. The patient may forget verbal instructions and follow the usual regimen instead. DIF: Cognitive Level: Applying (Application) REF: 116 - 117 5. The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is ?off-formulary.? The NP should: a. inform the patient that an out-of-pocket expense will be necessary. b. write the prescription for a generic drug if it meets the patient?s needs. c. call the patient?s insurance provider to advocate for this particular drug. d. contact the pharmaceutical company to see if medication samples are available. ANS: B Medicaid often stipulates which medications are or are not covered. Unless the particular drug is absolutely necessary, the NP should substitute with an acceptable generic drug. Insisting that the patient pay out of pocket may mean that the prescription is not filled. If the drug is necessary, the NP may advocate for its use by contacting the third-party payer. Asking for drug samples is not a long-term solution for the problem. DIF: Cognitive Level: Applying (Application) REF: 121 6. A patient who has asthma and who is known to the primary care NP calls the NP after hours and asks for a refill of an albuterol metered-dose inhaler. The patient has not been seen in the clinic for more than a year. The NP should: a. call the pharmacy to order the medication with several refills. b. send an electronic prescription to the pharmacy for one time only. c. send the patient to the emergency department for evaluation of symptoms. d. refill the drug and tell the patient that an office visit is necessary for further refills. ANS: D The patient needs the medication and is known to the NP so a refill is not inconsistent with practice guidelines. However, further refills should not be provided until the patient is seen and has an updated asthma action plan. The patient should be informed of this; simply refilling the prescription sends a message that it is acceptable to get refills without being seen. DIF: Cognitive Level: Applying (Application) REF: 116 7. A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic to ask for a refill of the medication. The primary care NP notes that the medication refill is not due for 2 weeks. The patient tells the NP that the refill is needed because he is going out of town. The NP should: a. fill the prescription and document the patient?s explanation of the reason. b. review the patient?s chart to see if this is a one-time or repeat occurrence. c. call the patient?s pharmacist and report suspicion of drug-seeking behaviors. d. confront the patient about misuse of narcotics and refuse to fill the prescription. ANS: B When patients fill prescriptions early for drugs that have abuse potential, providers should be alert to possible abuse. The first step would be to see if this is a one-time occurrence or a pattern. Providers should do this before refilling the prescription. If this is a pattern, the pharmacist should be notified. Patients should be confronted if a problem is apparent, and practitioners should not refill the prescriptions. DIF: Cognitive Level: Applying (Application) REF: 121