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Chapter 11: Evidence-Based Decision Making and Treatment Guidelines Test Bank

Chapter 11: Evidence-Based Decision Making and Treatment Guidelines Test Bank

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Chapter 11: Evidence-Based Decision Making and Treatment Guidelines
Test Bank
MULTIPLE CHOICE
1.   The primary care nurse practitioner (NP) is using critical thinking skills when:
a.

using standardized protocols to guide patient care.

b.

adhering to scientific principles to solve a patient problem.

c.

following the practices of seasoned mentors when giving care.

d.

analyzing current research and synthesizing new approaches to patient care.

2.   The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement. The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child’s parents do not want the procedure. The NP should:
a.

compromise with the parents and order a nasogastric tube for feedings.

b.

initiate a discussion with the parents about the potential outcomes of each possible action.

c.

refer the family to a case manager who can help guide the parents to the best decision.

d.

understand that the child’s parents have a right to make choices that override those of the medical team.

3.   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.

4.   A patient takes a cardiac medication that has a very narrow therapeutic range. The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient’s medical plan. The NP knows that the bioavailability of the drug varies from brand to brand. The NP should:
a.

contact the insurance provider to explain why this particular formulation is necessary.

b.

change the patient’s medication to a different drug class that doesn’t have these bioavailability variations.

c.

accept the situation and monitor the patient closely for drug effects with each prescription refill.

d.

ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense.

5.   A patient comes to the clinic reporting dizziness and fatigue associated with nausea and vomiting. The primary care NP suspects anemia and orders a complete blood count. The patient’s hemoglobin is elevated. The NP correctly concludes that the patient is not anemic. The NP has made an error in:
a.

context formulation.

b.

inappropriate knowledge base.

c.

cost-versus-benefit analysis.

d.

hypothesis triggering and information processing.


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