Module 2 Buttaro Ch 4,7, 9-15, 16-21

Question 1

To reduce adverse events associated with care transitions, the Center for Medicare and Medicaid Service have implemented which policy?

a. Mandates for communication among primary caregivers and hospitalists
b. Penalties for failure to perform medication reconciliations at time of discharge
c. Reduction of payments for patients readmitted within 30 days after d/c
d. Requirements for written discharge instructions for patients and caregivers

Answer 1

c. Reduction of payments for patients readmitted within 30 days after d/c

Patients with chronic health problems are at risk for adverse events related to the fact that they see so many providers which causes increase in hospital admissions and cost to patients.

MAJORITY OF THE TIME IT IS DUE TO POOR COMMINICATION BETWEEN PROVIDERS AND IS PREVETABLE

Question 2

According to multiple research studies, which intervention has resulted in lower costs and fewer rehospitalizations in high risk older patients?

a. Coordination of posthospital care by advanced practice health providers
b. frequent posthospital clinic visits with a primary care providers
c. Inclusion of extended family members in the outpatient plan of care
d. telephone follow up by the pharmacist to asses medication compliance

Answer 2

a. Coordination of posthospital care by advanced practice health providers

Research studies provided evidence that high risk older patients who had posthospital care coordinated by an APN had reduced rehospitalizations in high risk older patients.

Question 3

Which advantages are provided to the chronically ill patient by personal electronic monitoring devices? select all that apply

a. Helps provide more patient control of their health
b. eliminates need for regular medical and nursing follow up
c. Helps the early identification of patient health related problems
d. Helps health care providers in keeping track of the patient’s health status
e. cost is often covered by Medicare

Answer 3

A,C,D,E

Question 4

A patient expresses concern that she is at risk for breast cancer. To best assess the risk for this patient, what is the best initial action?

a. Ask if there is a family history of breast cancer
b. Gather and record a three generation pedigree
c. Order a genetic test for the breast cancer gene
d. Recommend direct to consumer genetic testing.

Answer 4

b. Gather and record a three generation pedigree

This is the first step of assessing for genetic risk factors
must do at least 3 generation on maternal and paternal sides

Question 5

A patient asks about direct to consumer genetic testing, What will the provider tell the patient?

a. It is not useful for identifying genetic diseases
b. Much of the information does not predict disease risk
c. The results are shared with the patient’s insurance company
d. The results must be interpreted by the provider

Answer 5

b. Much of the information does not predict disease risk

There are multiple companies that offer genetic testing without a provider ex 23 and me

Pros; increase awareness of genetic diseases,
CONS: do not offer genetic counseling
-They may show markers for a disease but they
are strongest to indicate disease
- they cannot be used to predict the likely hood
of specific diseases occurring.

Question 6

Which behavior is most characteristic of early adolescence?

a. arguing with parents and teachers
b. assimilating adult roles and thinking
c. exhibiting fatigue more frequently
d. experimenting with sex and risky behaviors

Answer 6

a. arguing with parents and teachers

Early ( 10-14)
mood swings, argumentative, tremendous physical growth, body changes

Middle (15-17)
fatigue and are experimenting with risky behaviors
strongly influenced by peers

Late ( 18-21)
abstract thinking, assimilate adult roles

Question 7

What is the initial sign of puberty in the adolescent male?

a. Deepening of the voice
b. elongation of the penis
c. nocturnal emissions
d. testicular enlargement

Answer 7

d. testicular enlargement

Question 8

A parent reports that an adolescent child does well in school, but seems to consistently make poor decisions about activities with friends. What will the practitioner recommend as an approach to help the adolescent make better decisions?

a. Correcting the adolescent’s decisions and judgments
b. Listening without making suggestions about choices
c. Making decisions for the adolescent to provide guidance
d. providing information about appropriate behavior

Answer 8

b. Listening without making suggestions about choices

Question 9

What is the focus of the Minority Stress Theory?

a. clarifying the various terms used to describe the LGBTQ community
b. understanding the health needs of select members of the sexual minority community
c. helping health care providers eliminate biases in the care they provide to the members of the LGBTQ community
d. facilitating the management of stress related to the lifestyle choices made by members of sexual minority populations

Answer 9

b. understanding the health needs of select members of the sexual minority community

The focus of the Minority stress theory is to provide a framework to the understanding of the health disparities in the sexual and gender minority communities.

Question 10

What is the medical diagnostic term used to identify transgender patients? 
a. gender dysphoria
b. gender expression disorder
c. gender identity disorder
d, gender role unconformity

Answer 10

a. gender dysphoria

Question 11

A woman who is currently pregnant reports that she has had three previous pregnancies: twins delivered at 35 weeks gestation (both living), one at 38 weeks gestation (living), and one miscarriage at 16 weeks gestation. How will this be recorded as her G/TPAL in her electronic record?

a. G4P: 1113
b. G4P: 1213
c. G5P: 1113
d. G5P: 1213

Answer 11

a. G4P: 1113

Gravidity (G) = total # of pregnancies that has occurred in her lifetime (includes if currently pregnant)
T = # of term pregnancies (born > 37 weeks)
P = # of preterm (born between 20-36 wks)
A = # of abortive (spontaneous or elective)
L = Living births

Question 12

A pregnant woman who is overweight has no previous history of hypertension or diabetes. Her initial screening exam reveals a blood pressure of 140/90 and a fasting blood glucose of 128. What will the practitioner do?

a. Initiate Insulin therapy
b. Monitor blood pressure and fasting blood glucose closely
c. prescribe and antihypertensive medication
d. refer the patient to a high risk pregnancy specialist

Answer 12

b. Monitor blood pressure and fasting blood glucose closely

This patient is at risk for HTN and DM during r/t patient being overweight

Her BP and glucose are in the high end of normal in which case should monitor closely. Also watch for protein.
BP 120 to 140/90 no lower than 105

Question 13

The mother of a 3-day old newborn reports that her infant feeds every 4 hours during the day and sleeps 6 hours at night. What will the provider recommend?

a. awakening the baby every 3 hours to feed
b. continue this schedule until the infant is 6 months
c. ensuring that her infant feed for 15-20 minutes each time
d. pumping her breasts to maintain her milk supply

Answer 13

a. awakening the baby every 3 hours to feed

Newborns should feed 8-12 times a day and mothers should be encouraged to awaken a sleepy baby to feed every 2-3 hours or more.
as the baby grows feeds can be spaced out

Question 14

An infant who has just begun nursing develops hyperbilirubinemia. What will the provider tell the mother?

a. To decrease the frequency of breastfeeding
b. to supplement feedings with extra water
c. to switch formula until bilirubin level drops
d. to use a breast pump to increase her milk supply

Answer 14

d. to use a breast pump to increase her milk supply

Infants with suboptimal breastfeeding can have starvation jaundice and mothers should be encouraged to increase the frequency of breastfeeding and should be offered a breast pump to increase milk supply.

starvation jaundice happens when feedings are infrequent ( can be related to decrease in mother’s supple) then so are stools and bilirubin gets reabsorbed through meconium

Question 15

A mother who has been breastfeeding her infant for several weeks develops a fever, breast warmth and breast tenderness. What will the provider recommend?

a. Ice packs and decreased frequency of nursing
b. Ice packs and increased frequency of nursing
c. warm packs and decreased frequency of nursing
d. warm packs and increased frequency of nursing

Answer 15

d. warm packs and increased frequency of nursing

this mother has symptoms of mastitis

Question 16

A pregnant woman reports not having had any vaccinations during her pregnancy. Which vaccines may be given?

a. HPV
b. Inactivated flu
c. Live, attenuated flu
d. MMR
e. TDAP
f. Varicella

Answer 16

a. HPV
b. Inactivated flu
e. TDAP

No live vaccines like flu, varicella or MMR
Tdap is recommended to all patients between 26-36 weeks

Question 17

An unaccompanied teenager is being treated in the emergency room for stomach pains. Which statement would alert the health care provider to the possibility that the patient may be a victim of human trafficking?

a. “I can’t pay to see a doctor.”
b. I’ve never been to a hospital before.”
c. “you are being very nice to me.”
d. “please, please don’t hurt me.”

Answer 17

d. “please, please don’t hurt me.”

Red flags of victim of human trafficking:

• profound fearfulness during exam
• avoiding eye contact
• disoriented to time and place
• signs of abuse
• substance use
• tattoos
• inconsistent story
• do not know address of residence
• illiterate
• often appears younger than stated age

Question 18

A health care provider strongly suspects that the patient being treated for a laceration to he forehead may be a victim of human trafficking. What intervention should be implemented initially before proceeding with a complete screening?

a. determine the patients ability to consent to treatment
b. begin cleansing the wound in preparation for suturing
c. transfer the patient to a private treatment room
d. notify the police of the situation

Answer 18

c. transfer the patient to a private treatment room

must provide privacy and a secure location for questioning away from any one

Question 19

What assessment data would trigger the health care provider’s suspicion that the patient seen in the ER may be a victim of human trafficking? Select all that apply

a. Provides details related to cause of injury
b. appears to be illiterate
c. has a “$50” tattooed on the left shoulder
d. cannot provide a local address of residence
e. looks much younger that stated age of 21

Answer 19

B,C,D,E

Question 20

What intervention will the provider implement when prescribing medications to an 80-year old patient?

a. beginning with higher doses and decrease according to the patient’s response
b. Consulting the Beers list to help identify potentially problematic drugs
c. ensuring that the patient does not take more that five concurrent medications
d. reviewing all patient medications at the annual health maintenance visit.

Answer 20

b. Consulting the Beers list to help identify potentially problematic drugs

The Beers list provides a list of potentially inappropriate medications in all patients aged 65 and older and helps minimize drug-related problems in the age group. older patients should started on lower doses wit gradual increase depending on responses. Patient who take 5 or more drugs are at risk for increased problem however most patients take more. they just must be monitored more closely

Question 21

An 80-year old women who lives alone is noted to have a recent weight loss of 5 pounds. She appears somewhat confused., according to her daughter, who is concerned that she is developing dementia. The provider learns that the woman still drives, volunteers at the local hospital and attends a book club with several friends once a month. What is the initial step in evaluating this patient?

a. obtaining a CBC, serum electrolytes,, Bun, and glucose
b. ordering a CB serum ferritin and TIBC
c. Referring the patient to a dietician for nutritional evaluation
d. referring the patient to a neurologist for evaluation for AD

Answer 21

a. obtaining a CBC, serum electrolytes,, Bun, and glucose

mental cognition changes in older adults may have other possible differential diagnosis. Detailed history from patients family and friends are vital in determining the diagnosis of dementia.

could be dehydration, poly pharmacy related, nutritonal problems UTIs etc

Question 22

The practitioner is establishing a plan for routine health maintenance for a new client who is 80 years old the client has never smoked and has been in good health. What will the practitioner include in routine care for this patient? select all that apply

a. annual htn screening
b. baseline abd aorta uS
c. colonoscopy every 10 years
d. one-time hepatitis B vaccine
e. Pneumovax vaccine if not previously given
f. Yearly influenza

Answer 22

e. Pneumovax vaccine if not previously given
f. Yearly influenza

One time pneumovax is given after age 65. Influenza should be offered every year. HTN should be screened at EVERY visit. abd aorta is only performed once on a every smoking male. Colonoscopy is performed every 10 years after the age of 50 but not after the age of 74

health screening for older adults is controversial and not routinely done other than a few things.

Question 23

When should palliative care be initiated by a primary care provider?

a. after an ill patient asks for hospice services
b. as part of routine health maintenance
c. when a patient is diagnosed with a serious disease
d. when an interdisciplinary team is formed to manage a disease

Answer 23

b. as part of routine health maintenance

Palliative care support begins with an understanding of a patient’s preferences and helping tis patient to identify goals of care. **must of good communication” health care providers must initiate conversation as part of initial health history regardless of health status. Does not have to wait to be started when diagnosed with serious disease or when patient asks for hospice.

Question 24

When should palliative care be initiated by a primary care provider?

a. after an ill patient asks for hospice services
b. as part of routine health maintenance
c. when a patient is diagnosed with a serious disease
d. when an interdisciplinary team is formed to manage a disease

Answer 24

b. as part of routine health maintenance

Palliatieve care support begins with an understanding of a patinet’s preferences and helping tis patient to identify goals of care. **must of good communication

Question 25

When using “the Five Wishes” approach to documenting patient preferences for end-of-life care, the provider will document which types of preferences? select all that apply.

a. A directive to avoid calling 911 at the time of death
b. a specific list of treatments the patient does not want
c. How much information to give various family members
d. the level of sedation versus alertness the patient desires
e. the people designated to make care decisions for the patient

Answer 25

c. How much information to give various family members
d. the level of sedation versus alertness the patient desires
e. the people designated to make care decisions for the patient

The Five Wishes approach addresses the types of care a patient wants as a disease progresses and is less defensive than the traditional advice directive which indicates the type of care a patient does not want.
Calling 911 may be done without requiring resuscitation if the patine has an appropriate advanced directive in place

Question 26

A patient who is near death is exhibiting signs of agitation, anxiety, and intractable pain. When discussing palliative sedation with this patient’s family, what will be discussed. select all that apply

a. the chance that refractory symptoms will be alleviated
b. the fact that this is an intervention of last resort
c. the likelihood that the patient will develop dependence on the drugs
d. the need for informed consent from the patient and family
e. the possibility that this measure may hasten death

Answer 26

b. the fact that this is an intervention of last resort
d. the need for informed consent from the patient and family
e. the possibility that this measure may hasten death

palliative sedation is used as a treatment of last resort only after all other options have been exhausted whose symptoms are intractable. Family members must give informed consent. and this treatment does have the possibility of hastening death by inhibiting respirations
the chance of drug dependence is irrelevant

Question 27

A patient who has chronic low back pain reports increased difficulty sleeping unrelated to discomfort, along with a desire to quit working. What will the provider do?

a. ask the patient about addiction issues
b. consult with a social worker
c. increase the dosage of prescribed pain medication
d. order radiographic studies of the lower spine

Answer 27

b. consult with a social worker

Patient who develop poor sleep and poor coping may be developing mental defeat as a result of chronic pain and should be evaluate and treated early for this to prevent further disability and improve functionality. substance use should be evaluated based on assessment findings. unless the symptoms are related to pain, increasing the dose of analgesics and ordering diagnostic studies are not indicated

Question 28

A patient with chronic leg pain describes the pain as “stabbing” and “throbbing” This is characteristic of which type of pain.

a. neuropathic pain
b. referred pain
c. somatic pain
d. visceral pain

Answer 28

c. somatic pain

Somatic pain- caused by activation of nociceptors in the peripheral tissue, including skin bone and muscle, It is generally well localized

neuropathic pain- occurs from injury to or disease of the nervous system and is described as burning, shooting, or tingling.

referred pain is a type of visceral pain that is localized but not attributable to the involved organ

visceral pain is related to an organ and is often referred and poorly localized

Question 29

A patient is beginning treatment for chronic pain and is unable to tolerate nonsteroidal anti-inflammatory drugs. What will the provider prescribe for this patient?

a. a mixed opiate product
b. a pure opioid compound
c. a referral for a nerve block procedure
d. a selective serotonin reuptake inhibitor

Answer 29

d. a selective serotonin reuptake inhibitor

Using the WHO 3 step ladder approach
step 1: NSAIDS, TCAs, SSRIs for mild to moderate pain
step 2. if those fail should prescribe mixed opioid compounds (codeine, Lortab, Percocet) moderate pain
step 3: pure opioid product ford mod-severe pain
lastly if all else falls then nerve block

Question 30

An international traveler plans to travel to Kenya in sub Sahara Africa. which is an important disease precaution for this person?
a. carrying chloroquine to take as needed
b, starting prophylactic Doxyclycline before travel
c. taking precautions against chikungunya fever
d, understanding how Ebola virus is transmitted

Answer 30

b, starting prophylactic Doxyclycline before travel

due to risk of malaria

Question 31

A patient who is planning international travel to a developing country asks the provider about vaccinations. Which is true about pretravel vaccines?
a. country-specific guidelines are provided by individual embassies
b. malaria vaccine is the most important vaccine for travel worldwide
c, requirements should be reviewed at least 4-6 weeks prior to travel
d. there are at least five required vaccines for entry into certain countries

Answer 31

c, requirements should be reviewed at least 4-6 weeks prior to travel

malaria is not prevented by vaccine prevented by antimalaria drug

Question 32

What is the goal of the Healthy People initiative?

a. to increase a patient’s quality of life
b. to create physical environments that promote proper health
c. to achieve health equality by eliminating disparities
d. to provide free health care to those unable to pay for care
e. to promote healthy behaviors across all live sages

Answer 32

c. to achieve health equality by eliminating disparities

Question 33

A women who is obese has a neck circumference of 16.5 cm. Which test is necessary to assess for complications of obesity in this patient based on this finding.

a. electrocardiography
b. gallbladder US
c. Mammography
d. Polysomnography

Answer 33

d. Polysomnography

women with neck circumference of >16 and men >17 are at an increased risk of OSA and should have a polysomnography done to assess for compliation
sx, morning headaches, daytime sleepinesss

Question 34

Which medications are associated with weight gain? select all that apply

a. antibiotics
b. antidepressants
c. antihistamines
d. insulin analogs
e. anticonvulsants

Answer 34

b. antidepressants
c. antihistamines
d. insulin analogs
e. anticonvulsants

Question 35

a patient who has a history of working around asbestos and silica fivers is concerned about developing lung disease. The primary care provider determines that the patient has a previous history of asthma as a child and currently has frequent episodes of bronchitis. A physical exam is normal and pulmonary function tests and radiographs are negative. What action is correct.

a. reassure the patient about the normal findings
b. refer the patient to an occupational health specialist
c. request a workplace environmental assessment
d. suggest that the patin follow up with a pulmonologist

Answer 35

b. refer the patient to an occupational health specialist

Patients with environmental exposure may not have symptoms or positive findings. Because this patient reports frequent bronchitis, this should be followed up with an occupational health specialist who can evaluate the degree of exposure and perform further testing. Normal findings are not necessarily reassuring.. The OT may request a environmental assessment. Pulmonologist are not trained in occupational health

Question 36

During a pre-placement screening for a person hired for a job requiring heavy lifting, a primary care provider notes that the new employee has environmental allergies, a history of GERD, reoccurring eczema, a previous history of an ankle fracture, and normal lower back strength and flexibility. a urine drug screen is negative what would be included in the report to the employer.

a. GERD history
b. history of allergies and eczema
c. history of ankle fracture
d. lower back screening results
e. Urine drug screening results.

Answer 36

d. lower back screening results
e. Urine drug screening results.

Only findings related to the ability of the individual to perform position requirements for the job are included in the report. Other findings should not be included, even though they may need to be addressed

musculoskeletal injuries in the work place are a common major cause of work place absence

Question 37

A female college student seeks information about emergency contraception. What is the most important part of the assessment of this patient?

a. cultural considerations for use of contraception
b. feelings of guilt about possible pregnancy
c. possible concerns about confidentiality
d. the females sense of control in sexual situations

Answer 37

d. the females sense of control in sexual situations

because college women are at greater risk for sexual violence and assault, a request for emergency contraception must be followed by an evaluation of possible rape or assault.

Question 38

A female freshman college student tells the primary care provider at the student health center that she has a history of anorexia nervosa that has been well-controlled for several years. What will the provider recommend for this student

a. dietary counseling
b. participation in sports
c. regular weight assessments
d. stress management

Answer 38

d. stress management

students with previous eating disorders may regress when stressed, so stress management is essential

Question 39

Which patient should have PFT as part of the pre-surgical exam?

a. a pt older than 60 years of age
b. a patient undergoing major intra-thoracic surgery
c. a patient with a history of pneumonia in the last 2 years
d. a patient with dm and morbid obesity

Answer 39

b. a patient undergoing major intra-thoracic surgery

Question 40

Which factors determine which diagnostic tests should be performed in a pre-surgical clearance evaluation?

a. Patient’s age
b. patients co-morbidities
c. previous surgeries
d. surgeon’s preference
e. Type of anesthesia

Answer 40

a. Patient’s age
b. patients co-morbidities
d. surgeon’s preference
e. Type of anesthesia

and presenting diagnosis

Question 41

During a participation sports physical, the examiner notes a difference in strength of the patient’s radial and femoral pulses with the femoral pulses being weaker. What will the provider do?

a. evaluate for ortho static hypertension
b. obtain doppler studies
c. reassure the patient that this sis a normal finding
d. refer the patient for a cardiology exam

Answer 41

d. refer the patient for a cardiology exam

may indicate coarctation

cardiovascular exam and history are crucial component to sports physicals

Question 42

A high school adolescent is being screened for fitness before participating in sports. the adolescent has a normal exam and the examiner notes s1,s2, a normal heart rhythm and normal bp and equal pulses. The parent reports history of wolf-Parkinson white syndrome, which has been treated. What will the provider do?

a. clear the adolescent to play sports
b. perform an ecg
c. refer the adolescent to a cardiologist
d. tell the adolescent that sports are not allowed

Answer 42

c. refer the adolescent to a cardiologist

Question 43

an overweight adolescent who takes metformin has type 2 diabetes with a HgbA1C of 8.5 % and asks about sports participation. What will the provider recommend?

a. losing weight prior to imitating sports participation
b. participation in strenuous sports to help with weight loss
c. referral to the endocrinologist for sports clearance
d. switching to insulin therapy prior to participation

Answer 43

c. referral to the endocrinologist for sports clearance

HgbA1C of > 7 is considered uncontrolled DM and should see their endocrinologist to suggest other options