The primary care NP prescribes an inhaled corticosteroid for a patient who has asthma. The third-party payer for this patient denies coverage for the brand that comes in the specific strength the NP prescribes. The NP should:
a. provide pharmaceutical company samples of the medication for the patient.
b. inform the patient that the drug must be paid for out of pocket because it is not covered.
c. order the closest formulary-approved approximation of the drug and monitor effectiveness.
d. write a letter of medical necessity to the insurer to explain the need for this particular medication.
C
The second step of medical decision making takes into account benefits versus costs along with an understanding that it is impossible to do everything because of limited resources. The NP should prescribe what is covered and evaluate its effectiveness; if it does not work, the third-party payer may be approached about the need for the other medication. Providing samples is not always possible, and this practice is being discouraged, so it is not a viable solution. Asking patients to pay out of pocket ultimately may be necessary but carries risks that the patient will not obtain the medication. Writing a letter of medical necessity may be indicated if the available drugs are not effective but is not the initial step.
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The staff notices that the 80-year-old client's behavior is changing. Where he once was outgoing and talkative, he now sits sullenly in his chair. Investigation of the client's person-ality changes is based on the premise that
1. personality patterns remain intact until death. 2. apathy in older people often goes unexpressed. 3. a change in personality is a normal sign of aging. 4. a change in personality indicates that death is near.
A nurse would most likely expect a primary health care provider to prescribe psyllium (Metamucil) to a client who is experiencing constipation related to which drug? Select all that apply
A) Spironolactone (Aldactone) B) Clonidine (Catapres) C) Enalapril (Vasotec) D) Fexofenadine (Allegra) E) Amitriptyline (Elavil)
A pregnant client is planning to breastfeed after delivery. How many additional calories per day should the nurse instruct the client to consume during the first 6 months of breastfeeding?
a. 430 kcal b. 500 kcal c. 630 kcal d. 730 kcal
When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these?
a. The time it takes for a drug to elicit a therapeutic response b. The amount of time needed to remove a drug from circulation c. The time it takes for a drug to achieve its maximum therapeutic response d. The time period at which a drug's con-centration is sufficient to cause a thera-peutic response