NUR 607 FINAL EXAM STUDY GUIDE
Module 1,2,8 And Correct Answers.
What factors affect medication compliance? - Answer complex medication regimens, cost of the drug,
side effects of the drug, ease of administration and/or drug form (e.g., large tablets or capsules),
education and communication between provider and patient, perceived side effects not truly related to
the medication, functional and/or mental deficits (eg. vision changes, dementia, arthritis of hands),
provider approachability, perception of patient respect, belief that the therapy is beneficial and
outweighs the risks or side effects, the degree to which the patient participates in the development of
the treatment regimen, degree to which patient believes that expectations and concerns are being met,
degree to which the practitioner motivates the patient to adhere to the regimen, degree to which the
regimen is compatible with the patient's busy lifestyle, medication taste.
What are important aspects of patient teaching to consider? - Answer Clear verbal instructions with
readable written instructions to take home if indicated. Educating regarding side effects in advance and
instructing patient to report to clinic with symptoms in order to prevent early discontinuation of drug.
Instill the belief in the patient that the drug will work for them in order to maintain adherence, advise
patient to use only one pharmacy in order to reduce drug to drug interactions.
Causes of poly-pharmacy in the elderly. - Answer Varied symptoms and complaints associated with
chronic illnesses; when a drug doesn't work, another is prescribed (known as the prescribing cascade);
stockpiling discontinued medications due (primarily due to the cost); placing prescriptions in different
bottles; sharing of medications between family members; seeing "polyproviders": seeing multiple
specialists for various chronic diseases; failure of providers to fully review the patient's other
medications before prescribing; lack of primary care provider;
Risks associated with polypharmacy in the elderly: - Answer Drug overuse and complications; ADRs;
creation of avoidable side effects and related complications
How do you address medication compliance issues? - Answer Consider the cost of the drug; give a
written list and instructions to the patient after each office visit of the medications to be taken; give
written instructions in large, easy to understand instructions to the elderly; explain and document both
the brand and generic names of the drug with the patient to avoid confusion and explain the important
reason for taking the medication; review medication changes with family/caregivers (especially for those
with cognitive impairments); recommend or provide medication planners or weekly/daily dosage
containers to improve compliance and promote safe administration; schedule timely follow-ups and
check for adherence at each visit.
, What data collection is included in a patient's health history encounter? - Answer Biographic data,
reason for seeking care, history of present illness (if in pain, remember old cart); past health history;
family history; ROS; functional health patterns (including activities of daily living); allergies; surgical
history; health habits; social history; current medications, vaccination history; travel history. The physical
exam and diagnostic tests then serve to develop differential diagnoses.
What variables are associated with improved medication adherence? - Answer The patient's
perception of the encounter and benefit of treatment; If a patient is non-adherent, it is important to
document this in the chart; Discuss the risks of non adherence and document; Ask the patient why they
aren't adhering and take actions to rectify this. Document.
If patient is using a SABA more than twice a week, they are not well-controlled. - Answer True
If a patient has any form of persistent asthma, they should be using an ICS. - Answer True.
How often should a patient with persistent asthma using an ICS be monitored? - Answer Every 1-6 mos.
A PEF (peak expiratory flow) should be done often. (Think of this as a simple FEv1). But you MUST know
the patient's baseline first. If it is 80% or above, this is good. If it is 50-80%, caution. If it is below 50%
emergency! If a patient has an exacerbation, they should be seen back in the office in one week. If a
patient has just started treatment for asthma, they should be seen in 3 months.
What vaccinations are especially important for those with COPD and asthma? - Answer influenza and
pneumococcal
When are oral corticosteroids indicated in asthma patients? - Answer When a patient has an acute
exacerbation, they will need a 5-10 day course of oral prednisone with rapid dose reduction. They may
also be prescribed for patients with poorly controlled asthma (e.g. severe persistent).
Should an ICS be prescribed as needed? - Answer Never. It should be used as maintenance therapy.
How should cortisone therapy be discontinued in asthma patients? - Answer If asthma symptoms are
well controlled for three months, oral steroids can be D/C'd first. Then the dose of inhaled
corticosteroids can be reduced by 50%. Further reduction in therapy can include reducing the ICS/LABA
Module 1,2,8 And Correct Answers.
What factors affect medication compliance? - Answer complex medication regimens, cost of the drug,
side effects of the drug, ease of administration and/or drug form (e.g., large tablets or capsules),
education and communication between provider and patient, perceived side effects not truly related to
the medication, functional and/or mental deficits (eg. vision changes, dementia, arthritis of hands),
provider approachability, perception of patient respect, belief that the therapy is beneficial and
outweighs the risks or side effects, the degree to which the patient participates in the development of
the treatment regimen, degree to which patient believes that expectations and concerns are being met,
degree to which the practitioner motivates the patient to adhere to the regimen, degree to which the
regimen is compatible with the patient's busy lifestyle, medication taste.
What are important aspects of patient teaching to consider? - Answer Clear verbal instructions with
readable written instructions to take home if indicated. Educating regarding side effects in advance and
instructing patient to report to clinic with symptoms in order to prevent early discontinuation of drug.
Instill the belief in the patient that the drug will work for them in order to maintain adherence, advise
patient to use only one pharmacy in order to reduce drug to drug interactions.
Causes of poly-pharmacy in the elderly. - Answer Varied symptoms and complaints associated with
chronic illnesses; when a drug doesn't work, another is prescribed (known as the prescribing cascade);
stockpiling discontinued medications due (primarily due to the cost); placing prescriptions in different
bottles; sharing of medications between family members; seeing "polyproviders": seeing multiple
specialists for various chronic diseases; failure of providers to fully review the patient's other
medications before prescribing; lack of primary care provider;
Risks associated with polypharmacy in the elderly: - Answer Drug overuse and complications; ADRs;
creation of avoidable side effects and related complications
How do you address medication compliance issues? - Answer Consider the cost of the drug; give a
written list and instructions to the patient after each office visit of the medications to be taken; give
written instructions in large, easy to understand instructions to the elderly; explain and document both
the brand and generic names of the drug with the patient to avoid confusion and explain the important
reason for taking the medication; review medication changes with family/caregivers (especially for those
with cognitive impairments); recommend or provide medication planners or weekly/daily dosage
containers to improve compliance and promote safe administration; schedule timely follow-ups and
check for adherence at each visit.
, What data collection is included in a patient's health history encounter? - Answer Biographic data,
reason for seeking care, history of present illness (if in pain, remember old cart); past health history;
family history; ROS; functional health patterns (including activities of daily living); allergies; surgical
history; health habits; social history; current medications, vaccination history; travel history. The physical
exam and diagnostic tests then serve to develop differential diagnoses.
What variables are associated with improved medication adherence? - Answer The patient's
perception of the encounter and benefit of treatment; If a patient is non-adherent, it is important to
document this in the chart; Discuss the risks of non adherence and document; Ask the patient why they
aren't adhering and take actions to rectify this. Document.
If patient is using a SABA more than twice a week, they are not well-controlled. - Answer True
If a patient has any form of persistent asthma, they should be using an ICS. - Answer True.
How often should a patient with persistent asthma using an ICS be monitored? - Answer Every 1-6 mos.
A PEF (peak expiratory flow) should be done often. (Think of this as a simple FEv1). But you MUST know
the patient's baseline first. If it is 80% or above, this is good. If it is 50-80%, caution. If it is below 50%
emergency! If a patient has an exacerbation, they should be seen back in the office in one week. If a
patient has just started treatment for asthma, they should be seen in 3 months.
What vaccinations are especially important for those with COPD and asthma? - Answer influenza and
pneumococcal
When are oral corticosteroids indicated in asthma patients? - Answer When a patient has an acute
exacerbation, they will need a 5-10 day course of oral prednisone with rapid dose reduction. They may
also be prescribed for patients with poorly controlled asthma (e.g. severe persistent).
Should an ICS be prescribed as needed? - Answer Never. It should be used as maintenance therapy.
How should cortisone therapy be discontinued in asthma patients? - Answer If asthma symptoms are
well controlled for three months, oral steroids can be D/C'd first. Then the dose of inhaled
corticosteroids can be reduced by 50%. Further reduction in therapy can include reducing the ICS/LABA
