outside questions pt 1

Question 1

Which of the following is a benefit of standardizing the patient care process?
a. Facilitating development of supporting infrastructure, such as electronic health records (EHR).
b. Minimizing the amount of clinical training required for pharmacists.
c. Reducing the burden of HIPAA privacy requirements
d. Allowing pharmacists to bill their services at a higher level of complexity.

Answer 1

A

Question 2

Which of the following activities is generally associated with the “collect” step of the Pharmacist’s Patient Care Process?
a. Compiling a list of the patient’s medications.
b. Assessing a patient’s adherence to prescribed medications.
c. Educating the patient about the use of medications.
d. Contacting a prescriber with concerns about medications

Answer 2

A

Question 3

Which of the following activities is generally associated with the “implement” step of the Pharmacist’s Patient Care Process?
a. Provide education and self-management training to the patient or caregiver.
b. Assess immunization status and the need for preventive care and other health care services, where appropriate.
c. Evaluate relevant health data that may include medical history, health and wellness information, biometric test results, and physical assessment findings.
d. Review each medication for appropriateness, effectiveness, safety, and patient adherence.

Answer 3

A

Question 4

According to the consensus document Medication Therapy Management Services Definition and Program Criteria, which of the following activities would be considered a part of MTM services?
a. Answering a patient’s question when he or she picks up a prescription.
b. Performing chart reviews for a long-term care facility.
c. Performing a comprehensive medication review for a patient to identify, resolve, and prevent medication-related problems.
d. Providing recommendations to a formulary committee.

Answer 4

C

Question 5

Which of the following is an important distinction between MTM services and disease management programs?
a. Diet and exercise are never addressed during MTM services.
b. Disease management programs focus on a specific disease rather than the patient’s overall health concerns.
c. Disease management programs generally are not documented.
d. Only MTM services include clinical assessment such as taking a patient’s blood pressure.

Answer 5

B

Question 6

Which of the following statements about the core elements model framework for MTM services is true?
a. The model applies only to community pharmacy practice.
b. The model can be used only for MTM services that are delivered to patients with Medicare Part D coverage.
c. The model defines a minimum level of service required for services to be considered MTM.
d. The model is designed to improve the efficiency of MTM services while helping to address medication-related problems.

Answer 6

D

Question 7

Which of the following statements about a personal medication record (PMR) is true?
a. The PMR never needs to be updated.
b. The patient should keep the PMR private and not share it with other health care providers.
c. The PMR should include only prescription medications.
d. The PMR is designed as a tool to help patients self-manage their medications.

Answer 7

D

Question 8

The primary purpose of the patient’s medication-related action (MAP) plan is to:
a. Help the pharmacist create a list of therapy goals for the patient.
b. Provide the patient with a list of actions that he or she should perform to optimize medication use.
c. Be a communication tool for collaborating with other health care providers.
d. Act as a tool to report medication changes to third-party payers.

Answer 8

B

Question 9

When a pharmacist identifies a medication-related problem during the medication therapy review, which of the following actions would be an inappropriate intervention?
a. Collaborating with other health care professionals.
b. Providing services outside the scope of pharmacy practice without a physician’s approval.
c. Providing additional care within the scope of pharmacy practice based on the pharmacist’s level of expertise.
d. Referring the patient to another health care provider.

Answer 9

B

Question 10

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) helped establish MTM services through which of the following actions?
a. Granting Medicare Part B provider status to pharmacists.
b. Creating a definition for medication therapy management (MTM).
c. Allowing Medicare Part D prescription drug plans to pay pharmacists for providing MTM services.
d. Directing the Centers for Medicare and Medicaid Services (CMS) to establish “core elements” for MTM.

Answer 10

C

Question 11

The ACA directed CMS to create a standardized format for which of the following MTM-related documents?
a. Beneficiary cover letter, medication action plan, and personal medication list.
b. SOAP note, medication action plan, and personal medication list.
c. SOAP note, prescriber communication form, and personal medication list.
d. Beneficiary cover letter, prescriber communication form, and personal medication list.

Answer 11

A

Question 12

A benefit of telephonic patient care services, compared with face-to-face services, is that they:
a. May pose fewer logistical barriers for the patient.
b. Allow the pharmacist to visually assess the patient for signs and symptoms of medication-related problems.
c. Facilitate the review of written information with the patient.
d. Make it easier to verify that the patient knows how to administer inhaled and/or injectable medications.

Answer 12

A

Question 13

Which of the following statements about pharmacist provision of MTM services in patient-centered medical homes (PCMHs) is true?
a. Pharmacists who provide services in PCMHs can receive reimbursement directly from Medicare Part B.
b. The ACA states that primary care providers in PCMHs should be able to provide access to pharmacist-delivered MTM services.
c. Pharmacists can provide services for a PCMH only if they operate under the same roof as the primary care provider.
d. Pharmacists’ services in PCMHs are limited to transition of care activities.

Answer 13

B

Question 14

Which of the following accurately describes the distinction between a PCMH and an accountable care organization (ACO)?
a. PCMHs are more likely than ACOs to be structured around hospitals.
b. Only ACOs use quality measures.
c. The ACO is a financing model whereas the PCMH is a care delivery model.
d. ACOs are required to contract with PCMHs, but PCMHs are not required to contract with ACOs.

Answer 14

C

Question 15

The Affordable Care Act of 2010 (ACA) added several requirements for MTM services in Medicare Part D that take effect in 2013. These requirements include:
a. Eligible patients are automatically enrolled in the program and can opt out if they wish, rather than being required to opt in.
b. Establishment of minimum payment rates for pharmacists.
c. Creation of maximum allowable annual MTM benefits.
d. All MTM service providers are allowed access to patients’ electronic health records.

Answer 15

A

Question 16

Which organization has developed pharmacy quality measures that are being used to generate report cards for communicating pharmacy quality?
a. CMS.
b. AHRQ.
c. PQA.
d. APhA

Answer 16

C

Question 17

Which of the following organizations accredits PCMHs?
a. CMS.
b. PQA.
c. NCQA.
d. URAC.

Answer 17

C

Question 18

Which of the following statements about a SWOT analysis is true?
a. Strengths and weaknesses assess the internal aspects of the pharmacy or service in relation to its existing services.
b. Strengths and weaknesses assess the external aspects of the pharmacy or service in relation to the competition.
c. Opportunities and threats assess the external aspects of the pharmacy or service in relation to its existing services.
d. Opportunities and threats assess the internal aspects of the pharmacy or service in relation to the competition.

Answer 18

A

Question 19

A useful acronym to keep in mind when developing goals is SMART, which stands for:
a. Specific, material, achievable, realistic, time-limited.
b. Specific, measurable, achievable, realistic, time-limited.
c. Specific, measurable, adaptable, realistic, time-limited.
d. Specific, measurable, achievable, realistic, thoughtful.

Answer 19

B

Question 20

When working to maximize efficiency of patient care services, pharmacists should:
a. Delegate tasks that do not require clinical judgment to technicians and other support staff.
b. Set a maximum number of medication-related problems that they will resolve during a visit.
c. Only document services when time allows.
d. Ask the patient to independently fill out the patient medication record and medication-related action plan

Answer 20

A

Question 21

When billing health care services, which type of code describes the type of service that was provided?
a. CPT.
b. ICD.
c. RVU.
d. HITECH.

Answer 21

A

Question 22

A superbill is best described as:
a. A monthly report that the pharmacy generates to track billing for services.
b. A bill that pharmacists send to third-party payers requesting payment for all services provided to covered patients over a specified time period.
c. A billing mechanism that is used only for self-paying patients.
d. A paper summary of all the services provided by the pharmacy that the pharmacist fills out after a visit and provides as a receipt to the patient.

Answer 22

D

Question 23

To minimize liability for providing patient care services, pharmacists should:
a. Record as many subjective observations as possible.
b. Clearly label any questionable medications as “inappropriate.”
c. Ensure that documentation is clear, concise, and accurate.
d. Only document patient encounters in which medication-related problems are identified.

Answer 23

C

Question 24

Which of the following statements about the physical space for providing patient care services is true?
a. If electronic health records are used, it is not necessary to set aside space for storing any other paperwork.
b. Pharmacists should set up their patient care areas like physician exam rooms—with a table for the patient to sit on and be examined by the pharmacist.
c. It is necessary to create an area where conversations with patients will be private.
d. Records from patient care services should be separated from dispensing records to comply with HIPAA requirements.

Answer 24

C

Question 25

Which of the following is specifically required for pharmacists who want to provide point-of-care testing?
a. HIPAA certification.
b. A CLIA waiver.
c. CPR certification.
d. Immunization training

Answer 25

B

Question 26

When signing a contract, what does indemnification describe?
a. The terms under which the contract can be voided.
b. Legal responsibilities of each party in the contract to the other.
c. “Acts of God” under which the terms of the contract no longer must be honored (also known as “force majeure”).
d. The method for resolving disputes between parties

Answer 26

B

Question 27

Which of the following statements about implementing patient care services is true?
a. Pharmacists may want to start with a small program and build the service over time.
b. Once implemented, services are not likely to require any modifications.
c. Pharmacists should start providing services before writing the business plan to provide more perspective on various aspects of the plan.
d. Pilot services are generally not recommended because they send a message to patients that the pharmacy is not really committed to the service.

Answer 27

A

Question 28

Which of the following is a business purpose related to monitoring and evaluating patient outcomes?
a. Tracking of changes in a patient’s health and functional status.
b. Revision of the care plan as needed.
c. Demonstration of cost-benefit to payers.
d. Measurement of patient satisfaction.

Answer 28

C

Question 29

In evaluating results of therapy for a patient who is a young mother with asthma, which of the following is an example of a humanistic outcome?
a. Improved pulmonary function.
b. Reduced out-of-pocket costs for patient.
c. Reduced emergency department visits.
d. Improved ability of patient to play with her child.

Answer 29

D

Question 30

Why are self-insured employers a good marketing target for patient care services?
a. They generally have more money available to pay for value-added services.
b. They will directly benefit from the cost-saving benefits of patient care services.
c. They usually are very large companies, providing a large pool of potential patients.
d. Most already have experience with patient care services and are looking for more pharmacists to add to their provider networks

Answer 30

B

Question 31

When marketing patient care services to patients, it is recommended that pharmacists:
a. Seek to impress patients by using a lot of technical jargon and high-cost marketing materials.
b. Recognize that if a patient is not initially interested in the service, he or she probably cannot be convinced to schedule an appointment.
c. Educate patients about the value of patient care services in order to increase demand for the services based on their goals and needs.
d. Offer to provide the first appointment for free so that patients can experience the value of the service.

Answer 31

C

Question 32

When marketing patient care services to prescribers, the “asking for the sale” technique means that pharmacists should:
a. Buy something from the prescriber so the prescriber feels obligated to the pharmacist.
b. Offer to pay the prescriber for referring patients to the service.
c. Ask the prescriber if he or she can think of a patient to refer to the service.
d. Ask the prescriber to pay for patients who do not have third-party coverage for the service.

Answer 32

C

Question 33

If the pharmacist is unable to identify a specific rationale for a medication in the patient’s regimen, the medication-related problem is categorized as:
a. Unnecessary medication therapy.
b. Dosage too high.
c. Nonadherence.
d. Ineffective medication.

Answer 33

A

Question 34

Which of the following actions would likely cause the most harm for a patient experiencing moderate to severe adverse effects from a subtherapeutic dosage of a medication?
a. Contacting the prescriber to discuss potential treatment alternatives.
b. Contacting the prescriber to recommend a dosage increase.
c. Educating the patient about management strategies for the adverse event.
d. Educating the patient about nonpharmacologic strategies that also can be used to manage the patient’s condition.

Answer 34

B

Question 35

Which of the following outcomes were reported in studies that systematically discontinued medications in older adults to reduce polypharmacy?
a. Reduced costs and increased hospitalizations.
b. Improved adherence and increased mortality.
c. Reduced mortality and improved global health.
d. Reduced mortality and increased referrals to acute care.

Answer 35

C

Question 36

What is a significant drawback to the use of clinical practice guidelines?
a. They often do not comprehensively address the needs of patients with multiple diseases.
b. Almost all are updated on a yearly basis, making it difficult to keep track of all the changes.
c. Most professional groups charge high fees for the use of their guidelines.
d. Quality measures of pharmacy practice are usually unrelated to clinical practice guidelines.

Answer 36

A

Question 37

How do point-of-care testing services relate to MTM services?
a. They can be used to determine whether a patient is reporting his or her medication adherence rates honestly.
b. They can be used to determine whether a patient is eligible for services through a third-party payer.
c. They reduce the amount of time that the pharmacist must spend on the patient encounter.
d. They can be used to identify patients who are appropriate to be referred for diagnosis, and for ongoing monitoring of patients with chronic conditions.

Answer 37

D

Question 38

The Medication Appropriateness Index is designed to:
a. Assess patient adherence.
b. Assess the complexity of a patient’s medication regimen.
c. Provide a standardized method for medication risk assessment.
d. Serve as a tool for communicating with patients about medication risk

Answer 38

C

Question 39

Which of the following statements about immunizations and MTM services is true?
a. Immunizations involve administering a medication, which is not part of the definition of MTM services.
b. Pharmacists who are MTM providers do not require any other training to administer immunizations.
c. Pharmacists may be able to offer a variety of immunizations during an MTM visit, as allowed by the laws and regulations in their state.
d. CMS regulations allow a pharmacist to administer pneumococcal and zoster vaccines to any patient receiving MTM services, pre-empting state laws and regulations.

Answer 39

C

Question 40

Which of the following best describes medication reconciliation?
a. Compiling a list of a patient’s medications.
b. Performing a drug utilization review.
c. Performing a comprehensive evaluation of a patient’s medication regimen any time there is a change in therapy.
d. Reviewing a patient’s PMR with all prescribers.

Answer 40

C

Question 41

In general, a specialty medication can be best described as one that:
a. Requires additional attention and processes to ensure that the product is managed appropriately.
b. Is prescribed by a specialist.
c. Is injected or infused.
d. Is not available generically.

Answer 41

A

Question 42

In elderly patients with reduced total body water, which medications will have a larger volume of distribution, compared with healthy younger adults?
a. Lipid-soluble medications.
b. Water-soluble medications.
c. Medications with half-lives longer than 12 hours.
d. Medications that undergo first-pass hepatic metabolism

Answer 42

A

Question 43

Regarding pharmacodynamics in elderly patients, which of the following statements is true?
a. Elderly patients rarely show increased sensitivity to central nervous system agents.
b. Adverse events in elderly patients may be due to increased sensitivity to a medication.
c. When drug toxicity is evident in the presence of a low serum concentration, pharmacodynamic alterations are not likely to be the cause.
d. Adverse events due to pharmacodynamic changes are often preventable because the pharmacodynamic changes are predictable.

Answer 43

B

Question 44

Which one of the following conditions is a common geriatric syndrome?
a. Diabetes.
b. Congestive heart failure.
c. Hypertension.
d. Dementia.

Answer 44

D

Question 45

In regard to geriatric syndromes, the four functional domains are:
a. Cognitive function, motor function, sensory function, and psychosocial function.
b. Visual function, auditory function, tactile function, and vestibular function.
c. Neurologic function, autonomic function, sensory function, musculoskeletal function.
d. Motor function, vestibular function, psychosocial function, activities of daily living functions.

Answer 45

A

Question 46

What is the most frequent medication-related problem associated with hospital admission of elderly adults?
a. Nonadherence.
b. Adverse drug events.
c. Need for additional medication therapy.
d. Ineffective medication.

Answer 46

B

Question 47

The Beers criteria:
a. List medications that are potentially inappropriate in elderly patients and those with specific medical conditions.
b. Describe first-line therapeutic choices for elderly individuals.
c. List potential drug interactions that are more common in elderly individuals.
d. Provide a scale for rating the potential severity of adverse drug events.

Answer 47

A

Question 48

Why is the Cockcroft-Gault equation used more frequently than the Modification of Diet and Renal Disease study formula to determine dosage adjustments for renally cleared drugs?
a. Because it is the only formula that is appropriate for both young adults and older adults.
b. Because it is more accurate across all levels of kidney function.
c. Because the U.S. Food and Drug Administration has adopted this as the standard to use for all for renal adjustment recommendations in drug monographs.
d. Because it has been adopted as the standard by most health information technology vendors.

Answer 48

C

Question 49

An 80-year-old female patient has a serum creatinine of 1.0 mg/dL and her ideal body weight equals 110 lb. What is this patient’s estimated creatinine clearance using the Cockcroft-Gault equation?
a. 35 mL/min.
b. 46 mL/min.
c. 78 mL/min.
d. 92 mL/min.

Answer 49

A

Question 50

Ideal body weight is calculated as follows:

Men: 50 kg + [2.3 kg × (height in inches − 60)]
Women: 45.5 kg + [2.3 kg × (height in inches − 60)]
(1 kg = 2.2 lb)

What is the ideal body weight for a man who is 5’9”?
a. 70.7 kg (155.5 lb).
b. 71.6 kg (157.5 lb).
c. 73.0 kg (160.6 lb).
d. 74.2 kg (163.2 lb)

Answer 50

A

Question 51

The Cockcroft-Gault equation for estimating creatinine clearance is:
CrClmale = [(140 - Age) (IBW)] / [72 (SCr)]
CrClfemale = 0.85 [(140 - Age) (IBW)] / [72 (SCr)]
Using this equation, what would be the creatine clearance for a 68-year old woman who is 5’11” and has a serum creatinine of 1.3 mg/dL? Note: ideal body weight (IBW) for a woman is 45.5 kg + [2.3 kg × (height in inches − 60)]
a. 39.8 mL/min.
b. 42.4 mL/min.
c. 46.3 mL/min.
d. 57.9 mL/min.

Answer 51

C

Question 52

Which of the following is an open-ended question?
a. “Do you ever miss doses of this medication?”
b. “How many times a week do you miss doses of this medication?”
c. “How do you use this medication?”
d. “Do you know how to use this medication?”

Answer 52

C

Question 53

The best time to use a closed-ended question is when seeking information about:
a. Any adverse events the patient may be experiencing.
b. The patient’s exercise routines.
c. The effectiveness of a patient’s medication.
d. Clarification of a specific detail regarding the patient’s medication use.

Answer 53

D

Question 54

Which of the following strategies is intended to create an environment where patients feel safe and welcome?
a. Asking patients to stand while waiting for the pharmacist.
b. Begin by telling patients that they must be absolutely truthful in their answers or the visit will be worthless.
c. Greeting patients with a smile and making eye contact.
d. Calling all patients by their first name.

Answer 54

C

Question 55

Which of the following statements about health literacy is true?
a. Pharmacists should use a health literacy assessment tool during every MTM visit.
b. Pharmacists should not provide any written information to patients who are not proficient in health literacy.
c. Patients who are having difficulty with reading materials may state that they forgot to bring their reading glasses.
d. Pharmacists should insist that patients bring a literate friend or family member to the MTM visit.

Answer 55

C

Question 56

What does it mean to provide culturally competent health care?
a. To be able to provide care in multiple languages.
b. To tailor health care delivery to meet a patient’s social, cultural, and linguistic needs.
c. To provide care outside the mainstream medical system.
d. To have the same cultural background as the patient being treated.

Answer 56

B

Question 57

Which of the following best describes the “teach back” communication strategy?
a. Pharmacists provide education at a level at least 2 years lower than the last grade of school completed by the patient.
b. Pharmacists begin by discussing the least important issues with patients and then work toward priority issues so the most important information is fresh in the patient’s mind at the back end of the visit.
c. Pharmacists have the technician stand behind the patient so the technician can learn patient care information at the same time as the patients.
d. Pharmacists ask patients to explain back the information that the pharmacist just provided.

Answer 57

D

Question 58

The Transtheoretical Model of Change is used to describe:
a. The process of change experienced by patients who have modifications to their medication regimens during an MTM visit.
b. A description of how situational factors in patients’ lives affect their health care status.
c. Changes to pharmacodynamics and pharmacokinetics as patients age.
d. The stages of change that people pass through as they modify a behavior.
Feedback: The correct answer can be found in “Communication for Behavior Change and Motivational Interviewing.”

Answer 58

D

Question 59

Motivational interviewing is a communication technique that:
a. Focuses on explaining the clinical consequences of nonadherence to the treatment plan.
b. Is rooted in the use of closed-ended questions.
c. Is designed to provide patients with opportunities to talk themselves into changing.
d. Encourages patients to select from a menu of possible solutions.

Answer 59

C

Question 60

Using motivational interviewing, how might a pharmacist respond to a patient who rates his or her confidence in ability to change a behavior as a 2 on a 10-point scale?
a. “You don’t seem very confident about your ability to change your behavior right now so let’s address a different problem.”
b. “What would it take to increase this rating to a 5?”
c. “You really need to change this behavior if you want to avoid serious illness.”
d. “That’s pretty low but once I show you some strategies, you won’t have any problems.”

Answer 60

B

Question 61

When communicating a recommendation to a prescriber, it is best to:
a. Clearly state when a prescribed medication is “wrong” or “inappropriate” for a patient.
b. Allow the prescriber to develop a solution to the problem identified by the pharmacist.
c. Avoid providing clinical information that will likely be redundant with the prescriber’s records.
d. Be succinct and clearly state the recommended course of action.

Answer 61

D

Question 62

Which of the following documents would pharmacists most likely want to include in a welcome packet sent to patients prior to their first MTM visit?
a. A personal medication record for the patient to fill out.
b. A medication history form for the patient to fill out.
c. A completed superbill showing the anticipated charges for the visit.
d. A list of other MTM services providers in the community.

Answer 62

B

Question 63

When collecting information for an MTM encounter, the pharmacist should ask the patient about which of the following topics?
a. The patient’s level of health literacy.
b. The patient’s cognitive function.
c. The patient’s expectations for the visit.
d. The patient’s plans for follow-up visits.

Answer 63

C

Question 64

Asking a patient to complete a medication history form best aligns with which of the following steps from the Pharmacist-Centered Collaborative Care Process developed by JCPP?
a. Collect
b. b. Assess
c. c. Plan
d. d. Implement

Answer 64

A

Question 65

Which of the following statements is true?
a. All of a patient’s medication-related problems should be resolved during a medication therapy review.
b. The level of follow-up that a pharmacist expects to have with a patient may influence the interventions that the pharmacist provides.
c. Immunizations should not be given during the medication therapy review unless there are no other medication-related problems.
d. A patient’s readiness to change has no impact in the interventions used to improve medication adherence.

Answer 65

B