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Advanced Practice Nurses and Prescriptive Authority, Exams of Nursing

Chamberlain College of NursingNursing

The history and current state of advanced practice nurses' (APNs) ability to prescribe medications. It covers the barriers that have limited APNs' prescriptive authority, the most practical formulary for regulating prescriptive authority, and the historical progression of APNs' attainment of prescriptive authority. The document also includes questions and answers related to the topic.

Typology: Exams

2023/2024

Available from 02/02/2024

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ADVANCED PRACTICE NURSES AND
PRESCRIPTIVE AUTHORITY
Chapter 6: Advanced Practice Nurses and Prescriptive Authority
QUESTIONS
1. Which of the following changed the ability of all advanced practice nurses (APNs) to prescribe
medications?
1. Risk of harm to patients
2. Lack of a physician on site
3. Nurse practitioner (NP) practice in primary care
4. Interruption of patient flow
Answer:
2. Which of the following has been the main source of barriers limiting advanced
practice registered nurses’ (APRNs’) prescriptive authority? 1. Limitations in state
legislation and regulations
2. Concerns about patient safety and quality of care
3. Requirement for Drug Enforcement (DEA) number
4. Organized lobbying by medical organizationsAnswer:
3. Which of the following was found to be the most practical formulary for regulating
prescriptive authority? 1. Open
2. Exclusionary
3. Collaborative4. Regulator established Answer:
4. Which of the following is a main reason a clinical nurse specialist (CNS) would refrain from
obtaining prescriptive authority?
1. Lack of title recognition
2. Preservation of autonomy
3. Educational requirements 4. Required physician oversight Answer:
5. Which of the following increased certified registered nurse anesthetists’ (CRNAs’) involvement
with other advanced practice registered nurses (APRNs) to obtain prescriptive authority?
1. Limited authority
2. Legislative restrictions
3. Role in pain management4. Required physician supervision Answer:
6. Which of the following describes the historical progression of advanced practice registered
nurses’ (APRNs’) attainment of prescriptive authority? Select all that apply.
1. Standardization of educational programs
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ADVANCED PRACTICE NURSES AND

PRESCRIPTIVE AUTHORITY

Chapter 6: Advanced Practice Nurses and Prescriptive Authority QUESTIONS

  1. Which of the following changed the ability of all advanced practice nurses (APNs) to prescribe medications?
  2. Risk of harm to patients
  3. Lack of a physician on site
  4. Nurse practitioner (NP) practice in primary care
  5. Interruption of patient flow Answer:
  6. Which of the following has been the main source of barriers limiting advanced practice registered nurses’ (APRNs’) prescriptive authority? 1. Limitations in state legislation and regulations
  7. Concerns about patient safety and quality of care
  8. Requirement for Drug Enforcement (DEA) number
  9. Organized lobbying by medical organizationsAnswer:
  10. Which of the following was found to be the most practical formulary for regulating prescriptive authority? 1. Open
  11. Exclusionary
  12. Collaborative4. Regulator established Answer:
  13. Which of the following is a main reason a clinical nurse specialist (CNS) would refrain from obtaining prescriptive authority?
  14. Lack of title recognition
  15. Preservation of autonomy
  16. Educational requirements 4. Required physician oversight Answer:
  17. Which of the following increased certified registered nurse anesthetists’ (CRNAs’) involvement with other advanced practice registered nurses (APRNs) to obtain prescriptive authority?
  18. Limited authority
  19. Legislative restrictions
  20. Role in pain management4. Required physician supervision Answer:
  21. Which of the following describes the historical progression of advanced practice registered nurses’ (APRNs’) attainment of prescriptive authority? Select all that apply.
  22. Standardization of educational programs
  1. Lack of primary care in underserved areas
  2. Complexity of the federal legislation process
  3. Persuasion of legislators and state governors5. Lack of title recognition in nurse practice acts Answer:
  4. Which of the following contributes to the increase in the likelihood of advanced practice registered nurses (APRNs) attaining nationwide prescriptive authority?
  5. Quality of care
  6. Cost-effectiveness
  7. Uniform nurse practice acts
  8. Designation as a midlevel practitioner 5. Endorsement of APRN Consensus Model Answer:
  9. The medications most frequently prescribed by nurse practitioners (NPs) in the Department of Veterans Affairs (VA) are _______________ and ___________________. Answer:
  10. The primary document that supports advance practice registered nurses’ (APRNs’) unrestricted prescriptive authority and provides recommendations for APRNs’ education and certification is _______________. Answer:
  11. Reorder the steps for changing a state’s nurse practice act (first to last).
  12. Hearing to give testimony
  13. Introduction of legislation
  14. Sent to floor of both chambers
  15. Referral to committee of jurisdiction
  16. Passage through appropriate committees Answer:
  1. This is incorrect. Though some legislators and governors have set limitations in statutes and administrative rules governing advanced practice registered nurses (APRNs), the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of APRNs.
  2. This is incorrect. Though opposition to prescriptive authority has often been couched in the language of “protecting public safety,” the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs).
  3. This is incorrect. Though the requirement of a Drug Enforcement Administration (DEA) number by insurance companies to pay for prescriptions is still problematic, the majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs).
  4. This is correct. The majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs).
  5. Which of the following was found to be the most practical formulary for regulating prescriptive authority? 1. Open
  6. Exclusionary
  7. Collaborative
  8. Regulator established Answer: 2 Page: 11 Feedback
  9. This is incorrect. The open formulary is the most flexible framework for prescriptive authority. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority.
  10. This is correct. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority.
  11. This is incorrect. A collaborative formulary allows the advanced practice registered nurse (APRN) to create a formulary most useful to his or her practice in collaboration with an identified physician who serves as a collaborator. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority.
  12. This is incorrect. An established formulary was used in the early days of advanced practice registered nurse (APRN) prescribing activity to determine an agreed-on list of drugs APRNs could prescribe. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority.
  13. Which of the following is a main reason a clinical nurse specialist (CNS) would refrain from obtaining prescriptive authority?
  14. Lack of title recognition
  15. Preservation of autonomy
  16. Educational requirements
  17. Required physician oversight Answer: 2 Page: 17 Feedback
  1. This is incorrect. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable.
  2. This is correct. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable.
  3. This is incorrect. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable.
  4. This is incorrect. The lack of authorization and the desire to maintain autonomy in nursing practice led many clinical nurse specialists (CNSs) to choose not to obtain authorization in settings in which such authorization is attainable.
  5. Which of the following increased certified registered nurse anesthetists’ (CRNAs’) involvement with other advanced practice registered nurses (APRNs) to obtain prescriptive authority?
  6. Limited authority
  7. Legislative restrictions
  8. Role in pain management
  9. Required physician supervision Answer: 3 Page: 8 Feedback
  10. This is incorrect. The authority of certified registered nurse anesthetists (CRNAs) to select and administer anesthesia has long been recognized. Until recently, CRNAs have been less involved in the struggle to obtain prescriptive authority than the other three disciplines. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve.
  11. This is incorrect. Limitations set in state statutes and regulations affect the practice of all advanced practice registered nurses (APRNs). Certified registered nurse anesthetists (CRNAs) have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve.
  12. This is correct. Certified registered nurse anesthetists (CRNAs), particularly in rural areas, suffer from similar problems. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve.
  13. This is incorrect. Requirements for formalized collaborative agreements with physicians to practice and receive reimbursement have been most challenging for nurse practitioners (NPs) and certified nurse-midwives (CNMs). Certified registered nurse anesthetists (CRNAs) have supervising or cooperating physicians in most states (AANA, 2016), whereas clinical nurse specialists (CNSs), in the states in which they have prescriptive authority, tend to have the same requirements as NPs. CRNAs have the need to prescribe as they are becoming more involved in pain management of patients in the practices they serve.
  14. Which of the following describes the historical progression of advanced practice registered nurses’ (APRNs’) attainment of prescriptive authority? Select all that apply.
  15. Standardization of educational programs
  16. Lack of primary care in underserved areas
  17. Complexity of the federal legislation process 4 Persuasion of legislators and state governors

enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide.

  1. This is incorrect. Because licensure for all professions occurs at the state rather than the federal level, the movement to achieve prescriptive authority does not progress equally. States with the most need make legislative changes most rapidly. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost- effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. This is incorrect. Confusion about the role and scope of practice of an advanced practice registered nurse (APRN) through the grouping of nurse practitioners (NPs), certified nursemidwives (CNMs), and physician assistants (PAs) as “midlevel practitioners” has created problems for APRNs. Though totally unfettered authority by all APRNs has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide.
  2. This is correct. Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide.
  3. The medications most frequently prescribed by nurse practitioners (NPs) in the Department ofVeterans Affairs (VA) are _______________ and _______________. Answer: antihypertensives and cardiac or cardiac and antihypertensives. Page: 16 Feedback: The majority of nurse practitioners (NPs) in the Department of Veterans Affairs (VA) hospital setting most frequently prescribe antihypertensives and cardiovascular drugs.
  4. The primary document that supports advanced practice registered nurses’ (APRNs’) unrestricted prescriptive authority and provides recommendations for APRNs’ education and certification is _______________. Answer: APRN Consensus Model Page: 17 Feedback: The APRN Consensus Model (2016) includes recommendations for the education and certification of advanced practice registered nurses (APRNs) and reinforces the authorization of APRNs to function at their full educational scope, which includes unrestricted prescriptive authority for APRNs.
  5. Reorder the steps for changing a state’s nurse practice act (first to last).
  6. Hearing to give testimony
  7. Introduction of legislation
  8. Sent to floor of both chambers
  9. Referral to committee of jurisdiction
  10. Passage through appropriate committees

Answer: 2, 4, 1, 5, 3 Page: 9 This is the correct order.

  1. Legislation must be introduced that amends or adds to current law.
  2. Once legislation is introduced, it is referred to a committee of jurisdiction (usually a professional licensure committee) for consideration.
  3. Once the legislation is in committee, the chair of that committee generally calls for a hearing to allow proponents and opponents of the legislation to give testimony regarding the introduced legislation.
  4. After passing through all appropriate committees, the legislation, at the discretion of the majority party leadership, is taken to the floor of the voting chamber for a vote. In some states, proposed legislation must also go through the appropriations committee of at least one of the voting chambers to determine cost and evaluate fiscal impact on the state.
  5. After passing through all appropriate committees, the legislation is taken to the floor of the voting chambers. Sometimes this is done simultaneously in both chambers of the state legislature; in others, the legislation passes through one chamber at a time. Pow ered by TC PDF (ww w.tc pdf.org)