chap 6

Question 1

A comprehensive assessment of a patient should be holistic when trying to determine competence in drug administration. Which of the following factors would the NP omit from this type of assessment?

1. Financial status
2. Mobility
3. Social support
4. Sexual practices

Answer 1

4. Sexual practices

Question 2

Elena Vasquez’s primary language is Spanish, and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed?

1. Use correct medical terminology because Spanish has a Latin base.
2. Use a family member who speaks more English to act as an interpreter.
3. Use a professional interpreter or a reliable staff member who can act as an interpreter.
4. Use careful, detailed explanations.

Answer 2

3. Use a professional interpreter or a reliable staff member who can act as an interpreter.

Question 3

Rod, age 68, has hearing difficulty. Which of the following would NOT be helpful in assuring that he understands teaching about his drug?

1. Stand facing him and speak slowly and clearly.
2. Speak in low tones or find a provider who has a lower voice.
3. Write down the instructions as well as speaking them.
4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds.

Answer 3

4. If he reads lips, exaggerate lips movements when pronouncing the vowel sounds.

Question 4

Which of the following factors may adversely affect a patient’s adherence to a therapeutic drug regimen?

1. Complexity of the drug regimen
2. Patient perception of the potential adverse effects of the drugs
3. Both 1 and 2
4. Neither 1 nor 2

Answer 4

3. Both 1 and 2

Question 5

The health-care delivery system itself can create barriers to adherence to a treatment regimen. Which of the following system variables creates such a barrier?

1. Increasing copayments for care
2. Unrestricted formularies for drugs, including brand names
3. Increasing the number of people who have access to care
4. Treating a wider range of disorders

Answer 5

1. Increasing copayments for care

Question 6

Ralph’s blood pressure remains elevated despite increased doses of his drug. The NP is concerned that he might not be adhering to his treatment regimen. Which of the following events would suggest that he might not be adherent?

1. Ralph states that he always takes the drug “when I feel my pressure is going up.”
2. Ralph contacts his NP to discuss the need to increase the dosage.
3. Ralph consistently keeps his follow-up appointments to check his blood pressure.
4. All of the above show that he is adherent to the drug regimen.

Answer 6

1. Ralph states that he always takes the drug “when I feel my pressure is going up.”

Question 7

Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that:

1. Has a short half-life so that missing one dose has limited effect
2. Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down
3. Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea and dizziness
4. Must be taken no more than twice a day

Answer 7

3. Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea and dizziness

Question 8

Factors in chronic conditions that contribute to nonadherence include:

1. The complexity of the treatment regimen
2. The length of time over which it must be taken
3. Breaks in the usual daily routine, such as vacations and weekends
4. All of the above

Answer 8

4. All of the above

Question 9

While patient education about their drugs is important, information alone does not necessarily lead to adherence to a drug regimen. Patients report greater adherence when:

1. The provider spent a lot of time discussing the drugs with them
2. Their concerns and specific area of knowledge deficit were addressed
3. They were given written material, such as pamphlets, about the drugs
4. The provider used appropriate medical and pharmacological terms

Answer 9

2. Their concerns and specific area of knowledge deficit were addressed

Question 10

Patients with psychiatric illnesses have adherence rates to their drug regimen between 35% and 60%. To improve adherence in this population, prescribe drugs:

1. With a longer half-life so that missed doses produce a longer taper on the drug curve
2. In oral formulations that are more easily taken
3. That do not require frequent monitoring
4. Combined with patient education about the need to adhere even when symptoms are absent

Answer 10

1. With a longer half-life so that missed doses produce a longer taper on the drug curve

Question 11

Many disorders require multiple drugs to treat them. The more complex the drug regimen, the less likely the patient will adhere to it. Which of the following interventions will NOT improve adherence?

1. Have the patient purchase a pill container with compartments for daily or multiple times-per-day dosing.
2. Match the clinic appointment to the next time the drug is to be refilled.
3. Write prescriptions for new drugs with shorter times between refills.
4. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug.

Answer 11

4. Give the patient a clear drug schedule that the provider devises to fit the characteristic of the drug.

Question 12

Pharmacologic interventions are costly. Patients for whom the cost/benefit variable is especially important include:

1. Older adults and those on fixed incomes
2. Patients with chronic illnesses
3. Patients with copayments for drugs on their insurance
4. Patients on public assistance

Answer 12

1. Older adults and those on fixed incomes

Question 13

Providers have a responsibility for determining the best plan of care, but patients also have responsibilities. Patients the provider can be assured will carry through on these responsibilities include those who:

1. Are well-educated and affluent
2. Have chronic conditions
3. Self-monitor drug effects on their symptoms
4. None of the above guarantee adherence

Answer 13

4. None of the above guarantee adherence

Question 14

Monitoring adherence can take several forms, including:

1. Patient reports from data in a drug diary
2. Pill counts
3. Laboratory reports and other diagnostic markers
4. All of the above

Answer 14

4. All of the above

Question 15

Factors that explain and predict medication adherence include:

1. Social
2. Financial
3. Health system
4. All of the above

Answer 15

4. All of the above