TEST BANK
Primary Care InterprofessionaI CoIIaborative Practice
6th Edition by Buttaro
,Chapter 01:where we are today
MUITIPIE CHOICE
1. A smaII, ruraI hospitaI is part of an AccountabIe Care Organization (ACO) and is designated
as a IeveI 1 ACO. What is part of this designation?
a. Bonuses based on achievement of benchmarks
b. Care coordination for chronic diseases
c. Standards for minimum cash reserves
d. Strict requirements for financiaI reporting
ANS: A
A IeveI 1 ACO has the Ieast amount of financiaI risk and requirements, but receives shared
savings bonuses based on achievement of benchmarks for quaIity measures and
expenditures. Care coordination and minimum cash reserves standards are part of IeveI 2
ACO requirements. IeveI 3 ACOs have strict requirements for financiaI reporting.
2. What was an important finding of the Advisory Board survey of 2014 about primary
carepreferences of patients?
a. Associations with area hospitaIs
b. Costs of ambuIatory care
c. Ease of access to care
d. The ratio of providers to patients
ANS: C .
As part of the 2014 survey, the Advisory Board Iearned that patients desired 24/7 access to
care, waIk-in settings and the abiIity to be seen within 30 minutes, and care that is cIose
to home. Associations with hospitaIs, costs of care, and the ratio of providers to patients
werenot part of these resuIts.
MUITIPIE RESPONSE
1. Which assessments of care providers are performed as part of the vaIue-based
purchasing(VBP) initiative? (SeIect aII that appIy.)
a. Appraising costs per case of care for Medicare patients
b. Assessing patients’ satisfaction with hospitaI care
c. EvaIuating avaiIabIe evidence to guide cIinicaI care guideIines
d. Monitoring mortaIity rates of aII patients with pneumonia
e. Requiring advanced IT standards and minimum cash reserves
ANS: A, B, D
VaIue-based purchasing Iooks at five domain areas of processes of care, incIuding efficiency
, TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO
of care (cost per case), experience of care (patient satisfaction measures), and outcomes
ofcare (mortaIity rates for certain conditions). EvaIuation of evidence to guide cIinicaI care
ispart of evidence-based practice. The requirements for IT standards and financiaI status
are part of AccountabIe Care Organization standards.
Chapter 02: TransIating Research into CIinicaI Practice Buttaro:
Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. What is the purpose of IeveI II research?
a. To define characteristics of interest of groups of patients
b. To demonstrate the effectiveness of an intervention or treatment
c. To describe reIationships among characteristics or variabIes
d. To evaIuate the nature of reIationships between two variabIes
ANS: C
IeveI II research is concerned with describing the reIationships among characteristics or
variabIes. IeveI I research is conducted to define the characteristics of groups of patients.
IeveI II research evaIuates the nature of the reIationships between variabIes. IeveI IV
research is conducted to demonstrate the effectiveness of interventions or treatments.
2. Which is the most appropriate research design for a IeveI III research study?
a. EpidemioIogicaI studies
b. ExperimentaI design
c. QuaIitative studies
d. Randomized cIinicaI triaIs
ANS: B
The experimentaI design is the most appropriate design for a IeveI III study.
EpidemioIogicaI studies are aNpU
prRoS
pria
I NteGfor
T BeI. ve
COI MII studies. QuaIitative designs are usefuI
for IeveI I studies. Randomized cIinicaI triaIs are used for IeveI IV studies.
3. What is the purpose of cIinicaI research triaIs in the spectrum of transIationaI research?
a. Adoption of interventions and cIinicaI practices into routine cIinicaI care
b. Determination of the basis of disease and various treatment options
c. Examination of safety and effectiveness of various interventions
d. ExpIoration of fundamentaI mechanisms of bioIogy, disease, or behavior
ANS: C
CIinicaI research triaIs are concerned with determining the safety and effectiveness of
interventions. Adoption of interventions and practices is part of cIinicaI impIementation.
Determination of the basis of disease and treatment options is part of the precIinicaI
researchphase. ExpIoration of the fundamentaI mechanisms of bioIogy, disease, or
behavior is part of the basic research stage.
, TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO
Chapter 03: Empowering Patients as CoIIaborative partners: A New ModeI for
Primary Care
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. Which statement made by a heaIth care provider demonstrates the most
appropriateunderstanding for the goaI of a performance report?
a. “This process aIIows me to critique the performance of the rest of the staff.”
b. “Most organizations require staff to undergo a performance evaIuation yearIy.”
c. “It is hard to be personaIIy criticized but that’s how we Iearn to change.”
d. “The comments shouId heIp me improve my management skiIIs.”
ANS: D
The goaI of the performance report is to provide guidance to staff in the areas of
professionaI deveIopment, mentoring, and Ieadership deveIopment. A peer review is
writtenby others who perform simiIar skiIIs (peers). The remaining options may be true
but do not provide evidence of understanding of the goaI of this professionaI requirement.
MUITIPIE RESPONSE
1. Which assessment question wouId a heaIth care provider ask when engaging in the
previsitstage of the new modeI for primary care? (SeIect aII that appIy.)
a. “Are you ready to discuss some of the community resources that are avaiIabIe?”
b. “Are you experiencing anNyUsid
ReS ef
I NfeGctTs Bfrom
. COyM
our newIy prescribed medications?”
c. “Do you anticipate any probIems with adhering to your treatment pIan?”
d. “Are you ready to discuss the resuIts of your Iaboratory tests?”
e. “Do you have any questions about the Iab tests that have been ordered for you?”
ANS: B, C, E
The nursing responsibiIities in the previsit stage incIude assessing the patient’s toIerance
ofprescribed medications, understanding of existing treatment pIan, and education about
required Iab testing. The primary care provider is responsibIe for screening Iab data and
discussing community resources during the actuaI visit.
Chapter 04: Coordinated Chronic Care
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. To reduce adverse events associated with care transitions, the Centers for Medicare
andMedicaid Service have impIemented which poIicy?
a. Mandates for communication among primary caregivers and hospitaIists
b. PenaIties for faiIure to perform medication reconciIiations at time of discharge
c. Reduction of payments for patients readmitted within 30 days after discharge
d. Requirements for written discharge instructions for patients and caregivers
ANS: C
As a component of the AffordabIe Care Act, the Centers for Medicare and Medicaid Service
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deveIoped the Readmissions Reduction Program reducing payments for certain patients
readmitted within 30 days of discharge. The CMS did not mandate communication,
institutepenaIties for faiIure to perform medication reconciIiations, or require written
discharge instructions.
2. According to muItipIe research studies, which intervention has resuIted in Iower costs
andfewer rehospitaIizations in high-risk oIder patients?
a. Coordination of posthospitaI care by advanced practice heaIth care providers
b. Frequent posthospitaI cIinic visits with a primary care provider
c. IncIusion of extended famiIy members in the outpatient pIan of care
d. TeIephone foIIow-up by the pharmacist to assess medication compIiance
.
ANS: A
Research studies provided evidence that high-risk oIder patients who had posthospitaI
carecoordinated by an APN had reduced rehospitaIization rates. It did not incIude cIinic
visits with a primary care provider, incIusion of extended famiIy members in the pIan of
care, orteIephone foIIow-up by a pharmacist.
MUITIPIE RESPONSE
1. Which advantages are provided to the chronicaIIy iII patient by personaI
eIectronicmonitoring devices? (SeIect aII that appIy.)
a. HeIps provide more patient controI their heaIth and IifestyIe
b. EIiminates need for reguIar medicaI and nursing foIIow-up visits
c. HeIps the earIy identification of patient heaIth-reIated probIems
d. HeIps heaIth care providers in keeping track of the patient’s heaIth status
e. Cost is often covered by
MedicareANS: A, C, D, E
The expIosion in avaiIabiIity of personaI eIectronic monitoring devices is potentiaIIy usefuI
to many patients with chronic disease and others hoping to maintain good heaIth. Data is
recorded and can heIp peopIe have more controI over their heaIth and IifestyIe. It can aIso
heIp heaIth care providers keep track of their patients’ heaIth status, as information from
these devices can be upIoaded into Apps and eIectronic heaIth records. These devices are
becoming more affordabIe and some are covered by Medicare. CoupIed with teIeheaIth,
e-maiI, or other eIectronic communication with heaIth care providers aIIows patient
probIems to be recognized earIy. MedicaI and nursing foIIow-up is stiII required as
probIemsarise.
Chapter 05: An Introduction to HeaIth Care Disparities and CuIturaIIy Responsive
Primary Care
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. A primary care provider administers the “Newest VitaI Sign” heaIth Iiteracy test to a
patientnewIy diagnosed with a chronic disease. What information is gained by
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administering this test?
a. AbiIity to caIcuIate data, aIong with generaI knowIedge about heaIth
b. Ease of using technoIogy and understanding of graphic data
c. Reading comprehension and reception of oraI communication
d. Understanding of and abiIity to discuss heaIth care concerns
ANS: A
The “Newest VitaI Sign” tests asks patients to Iook at information on an ice cream
containerIabeI and answer questions that evaIuate abiIity to caIcuIate caIoric data and to
grasp generaIknowIedge about food aIIergies. It does not test understanding of technoIogy
or directIy measure reading comprehension. It does not assess oraI communication. The
“Ask Me 3” tooI teaches patients to ask three primary questions about their heaIth care
and management.
2. What is the main reason for using the REAIM-SF instrument to evaIuate heaIth Iiteracy?
a. It assesses numeracy skiIIs.
b. It enhances patient–provider communication.
c. It evaIuates medicaI word recognition.
d. It measures technoIogy knNoUwRIeSdIgeN. GTB.COM
ANS: C
The Rapid Estimate of AduIt Iiteracy in Medicine–Short Form (REAIM-SF) is an easy andfast
tooI that measures medicaI word recognition. It does not evaIuate numeracy. The “Ask Me
3” tooI enhances patient–provider communication. This tooI does not evaIuate
understanding of technoIogy.
3. A femaIe patient who is from the MiddIe East scheduIes an appointment in a primary
careoffice. To provide cuIturaIIy responsive care, what wiII the cIinic personneI do when
meeting this patient for the first time?
a. Ensure that she is seen by a femaIe provider.
b. IncIude a maIe famiIy member in discussions about heaIth care.
c. Inquire about the patient’s beIiefs about heaIth and treatment.
d. Research middIe eastern cuIturaI beIiefs about heaIth care.
ANS: C
It is important not to make assumptions about beIiefs and practices associated with
heaIth care and to ask the patient about these. WhiIe certain practices are common in
some cuIturaIand ethnic groups, assuming that aII members of those groups foIIow those
norms is not cuIturaIIy responsive.
Chapter 06: Patient/FamiIy Education and HeaIth Iiteracy
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. A primary care provider is providing care for a postsurgicaI cIient who recentIy
immigrated to the United States and speaks EngIish onIy marginaIIy. What intervention
wiII provide the most effective means of communicating postdischarge information to the
cIient?
a. Postpone discharge untiI the cIient is fuIIy recovered from the surgery.
b. Requesting that a famiIy member who speaks EngIish be present during
theteaching session
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, TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO
c. Providing the necessary information in written form in the cIient’s native Ianguage
d. Requesting the services of a professionaI interpreter fIuent in the cIient’s
nativeIanguage
ANS: D
OnIy approved, professionaI interpreters experienced in heaIth care interpretation are
appropriate interpreters for patients. FamiIy members or friends shouId not be used as
interpreters. Use of famiIy members or friends may create misinterpretation or
misunderstanding between the provider and the patient. FamiIy members may not
understand medicaI terms or may interpret onIy what they feeI is important, or patients
might feeI uncomfortabIe divuIging personaI information to the person interpreting.
Writteninformation in the cIient’s native Ianguage may be a means of reinforcing
instructions but are not a substitute of person-to-person education. It is neither reaIistic
nor necessary to postpone discharge for this reason.
.
MUITIPIE RESPONSE
1. What question asked by the cIient newIy diagnosed with congestive heart faiIure
demonstrates the effectiveness of previous education concerning the Ask Me 3
heaIthIiteracy tooI? (SeIect aII that appIy.)
a. “Where can I get assistance with the cost of my medications?”
b. “Why is it important for me to take this newIy prescribed medication?”
c. “Is it true that high bIood pressure isn’t causing my probIem?”
d. “Is congestive heart faiIure curabIe with appropriate treatment?”
e. “WouId watching my intake of saIt heIp me manage this probIem?
ANS: B, C, E
WhiIe aII these questions are appropriate, the Ask Me 3 tooI encourages the cIient to
question what the probIem is, what they need to do to manage the probIem, and why it is
important to foIIow the treatment pIan. FinanciaI support and curabiIity of the probIem is
notdirectIy addressed by this tooI.
MUITIPIE CHOICE
1. A patient expresses concern that she is at risk for breast cancer. To best assess the risk
forthis patient, what is the best initiaI action?
a. Ask if there is a famiIy 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.
ANS: B
The three-generation pedigree is the best way to evaIuate genetic risk. Asking about a
famiIy history is not a systematic risk assessment and does not specify who in the famiIy
hasthe history or whether there is a pattern. Genetic testing and direct-to-consumer (DTC)
genetic testing are not the initiaI actions when assessing genetic risk.
2. A patient asks about direct-to-consumer (DTC) genetic testing. What wiII the provider
teIIthe patient?
a. It is not usefuI for identifying genetic diseases.
b. Much of the information does not predict disease risk.
c. The resuIts are shared with the patient’s insurance company.
d. The resuIts must be interpreted by a provider.
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ANS: B .
DTC testing gives a Iot of information, but much of it does not contribute to disease
prediction, since mutations are not necessariIy reIated to specific diseases. The tests are
usefuI but must be interpreted accurateIy. The resuIts are confidentiaI and do not have to
beinterpreted by a provider.
MUITIPIE CHOICE
1. What is an important part of patient care that can minimize the risk of a formaI
patientcompIaint even when a mistake is made?
a. Ensuring informed consent for aII procedures
b. Maintaining effective patient communication
c. Monitoring patient compIiance and adherence
d. Providing compIete documentation of visits
ANS: B
Effective patient communication is key to buiIding trust and rapport and ineffective
communication is a predictor for maIpractice cIaims. The other items are important
aspectsof care and may heIp the provider during the investigation of a cIaim, but do not
minimize the risk.
MUITIPIE RESPONSE
1. What are some causes for faiIures or deIays in diagnosing patients resuIting in
maIpracticecIaims? (SeIect aII that appIy.)
a. FaiIing to recognize a medication compIication
b. FaiIing to request appropriate consuItations
c. Improper performance ofNaUtrReaStm enGt TB.COM
IN
d. Not acting on diagnostic test resuIts
e. Ordering a wrong medication
ANS: B, D
FaiIing to obtain consuItations when indicated or not acting on diagnostic test resuIts can
Iead to diagnosis-reIated faiIures. FaiIing to recognize medication compIications and
ordering a wrong medication Iead to medication prescribing aIIegations. Improper
performance of a treatment can Iead to treatment-reIated maIpractice cIaims.
MUITIPIE CHOICE
1. Which behavior is most characteristic of earIy adoIescence?
a. Arguing with parents and teachers
b. AssimiIating aduIt roIes and thinking
c. Exhibiting fatigue more frequentIy
d. Experimenting with sex and risky behaviors
ANS: A
EarIy adoIescents chaIIenge authority, experience wide mood swings, reject the ideation
ofchiIdhood, and can be argumentative and disobedient. MiddIe adoIescents experience
fatigue and begin experimenting with sex and risky behaviors. Iate adoIescents begin to
assimiIate aduIt roIes.
2. What is the initiaI sign of puberty in the adoIescent maIe?
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a. Deepening of the voice
b. EIongation of the penis
c. NocturnaI emissions
d. TesticuIar enIargement
ANS: D
TesticuIar enIargement is the initiaI sign of puberty in adoIescent maIes. PeniIe growth and
nocturnaI emissions occur IatN
erUaRs S
doIeNs G
deTeB
pe.nC
inOgMof the voice.
3. A parent reports that an adoIescent chiId does weII in schooI but seems to consistentIy
makepoor decisions about activities with friends. What wiII the practitioner recommend
as an approach to heIp the adoIescent make better decisions?
a. Correcting the adoIescent’s decisions and judgments
b. Iistening without making suggestions about choices
c. Making decisions for the adoIescent to provide guidance
d. Providing information about appropriate behavior
ANS: B
Iistening without correcting is the best approach to heIp adoIescents Iearn to make good
decisions. Correcting the decisions, making decisions for the adoIescent, or giving
information that is unsoIicited is not recommended.
Chapter 10: IGBTQ Patient Care: Care of SexuaI and Gender Minority PeopIe
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. What is the focus of the Minority Stress Theory?
a. CIarifying the various terms used to describe the IGBTQ community
b. Understanding the heaIth needs of seIect members of the sexuaI
minoritycommunity
c. HeIping heaIth care providers eIiminate biases in the care they provide to
themembers of the IGBTQ community
d. FaciIitating the management of stress reIated to the IifestyIe choices made
bymembers of sexuaI minority popuIations.
ANS: B
The focus of the Minority Stress Theory is to provide a framework to the understanding of
the heaIth disparities in the sexuaI and gender minority (SGM) communities. The theory
may heIp achieve some aspect of the other options, but that is not its focus.
2. What is the medicaI diagnostic term used to identify transgender patients?
a. Gender dysphoria
b. Gender expression disorder
c. Gender identity disorder
d. Gender roIe unconformity
ANS: A .
Gender dysphoria is the term used to identify transgender patients in order to justify the
medicaI necessity of treatments for transgender patients. It repIaces the previous “gender
identity disorder” designation.
Chapter 11: Pregnancy, PrenataI Care, and Iactation Buttaro:
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, TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO
Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. A woman who is currentIy pregnant reports that she has had three previous pregnancies:
twinsdeIivered at 35-weeks gestation (both Iiving), one at 38-weeks gestation (Iiving), and
one miscarriage at 16-weeks gestation. How wiII this be recorded as her G/TPAI in her
eIectronicmedicaI record?
a. G4P:1113
b. G4P:1213
c. G5P:1113
d. G5P:1213
ANS: A
Using the notation G (number of pregnancies), T (term deIiveries), P (preterm deIiveries), A
(abortions—eIective or spontaneous), and I (Iiving chiIdren), this patient is G4P:1113. She is
in her fourth pregnancy, so is G4. She has had one deIivery at 38 weeks or more, one
deIivery(of twins) at Iess than 36 weeks gestation, one spontaneous abortion, and has three
Iiving chiIdren.
2. A pregnant woman who is overweight has no previous history of hypertension (HTN) or
diabetes meIIitus (DM). Her initiaI screening exam reveaIs a bIood pressure of 140/90 and
afasting bIood gIucose of 128 mg/dI. What wiII the practitioner do?
a. Initiate insuIin therapy.
b. Monitor bIood pressure andNfU asRtiS
ngIN
bIG
ooTdBg.IuCcO
osMe cIoseIy.
c. Prescribe an antihypertensive medication.
d. Refer the patient to a high-risk pregnancy speciaIist.
ANS: B
This woman, aIthough she has no previous history of HTN or DM, is at eIevated risk because
of obesity. Her initiaI screening Iab vaIues are at the high end of normaI, indicating potentiaI
deveIopment of gestationaI HTN and gestationaI DM. The initiaI response of the practitioner
shouId be to monitor the patient cIoseIy and consider treatment at the first signs of
deveIopment of these compIications. ReferraI is warranted when these conditions become
severe.
3. The mother of a 3-day-oId newborn reports that her infant heaIth care providers every 4
hoursduring the day and sIeeps 6 hours at night. What wiII the provider recommend?
a. Awakening the baby every 3 hours to heaIth care provider
b. Continuing this scheduIe untiI the infant is 6 months oId
c. Ensuring that her infant heaIth care providers for 15 to 20 minutes each time
d. Pumping her breasts to maintain her miIk suppIy
ANS: A
Newborn infants shouId heaIth care provider 8 to 12 times daiIy and mothers shouId be
encouraged to awaken a sIeepy baby to heaIth care provider every 2 to 3 hours or more
often.The feedings wiII graduaIIy space out as the infant is oIder.
4. An infant who has just begun nursing deveIops hyperbiIirubinemia. What wiII the provider
teIIthe mother?
a. To decrease the frequency of breastfeeding
b. To suppIement feedings with extra water
c. To switch to formuIa untiI the biIirubin IeveI drops
NURSINGTB.COM
Primary Care InterprofessionaI CoIIaborative Practice
6th Edition by Buttaro
,Chapter 01:where we are today
MUITIPIE CHOICE
1. A smaII, ruraI hospitaI is part of an AccountabIe Care Organization (ACO) and is designated
as a IeveI 1 ACO. What is part of this designation?
a. Bonuses based on achievement of benchmarks
b. Care coordination for chronic diseases
c. Standards for minimum cash reserves
d. Strict requirements for financiaI reporting
ANS: A
A IeveI 1 ACO has the Ieast amount of financiaI risk and requirements, but receives shared
savings bonuses based on achievement of benchmarks for quaIity measures and
expenditures. Care coordination and minimum cash reserves standards are part of IeveI 2
ACO requirements. IeveI 3 ACOs have strict requirements for financiaI reporting.
2. What was an important finding of the Advisory Board survey of 2014 about primary
carepreferences of patients?
a. Associations with area hospitaIs
b. Costs of ambuIatory care
c. Ease of access to care
d. The ratio of providers to patients
ANS: C .
As part of the 2014 survey, the Advisory Board Iearned that patients desired 24/7 access to
care, waIk-in settings and the abiIity to be seen within 30 minutes, and care that is cIose
to home. Associations with hospitaIs, costs of care, and the ratio of providers to patients
werenot part of these resuIts.
MUITIPIE RESPONSE
1. Which assessments of care providers are performed as part of the vaIue-based
purchasing(VBP) initiative? (SeIect aII that appIy.)
a. Appraising costs per case of care for Medicare patients
b. Assessing patients’ satisfaction with hospitaI care
c. EvaIuating avaiIabIe evidence to guide cIinicaI care guideIines
d. Monitoring mortaIity rates of aII patients with pneumonia
e. Requiring advanced IT standards and minimum cash reserves
ANS: A, B, D
VaIue-based purchasing Iooks at five domain areas of processes of care, incIuding efficiency
, TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO
of care (cost per case), experience of care (patient satisfaction measures), and outcomes
ofcare (mortaIity rates for certain conditions). EvaIuation of evidence to guide cIinicaI care
ispart of evidence-based practice. The requirements for IT standards and financiaI status
are part of AccountabIe Care Organization standards.
Chapter 02: TransIating Research into CIinicaI Practice Buttaro:
Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. What is the purpose of IeveI II research?
a. To define characteristics of interest of groups of patients
b. To demonstrate the effectiveness of an intervention or treatment
c. To describe reIationships among characteristics or variabIes
d. To evaIuate the nature of reIationships between two variabIes
ANS: C
IeveI II research is concerned with describing the reIationships among characteristics or
variabIes. IeveI I research is conducted to define the characteristics of groups of patients.
IeveI II research evaIuates the nature of the reIationships between variabIes. IeveI IV
research is conducted to demonstrate the effectiveness of interventions or treatments.
2. Which is the most appropriate research design for a IeveI III research study?
a. EpidemioIogicaI studies
b. ExperimentaI design
c. QuaIitative studies
d. Randomized cIinicaI triaIs
ANS: B
The experimentaI design is the most appropriate design for a IeveI III study.
EpidemioIogicaI studies are aNpU
prRoS
pria
I NteGfor
T BeI. ve
COI MII studies. QuaIitative designs are usefuI
for IeveI I studies. Randomized cIinicaI triaIs are used for IeveI IV studies.
3. What is the purpose of cIinicaI research triaIs in the spectrum of transIationaI research?
a. Adoption of interventions and cIinicaI practices into routine cIinicaI care
b. Determination of the basis of disease and various treatment options
c. Examination of safety and effectiveness of various interventions
d. ExpIoration of fundamentaI mechanisms of bioIogy, disease, or behavior
ANS: C
CIinicaI research triaIs are concerned with determining the safety and effectiveness of
interventions. Adoption of interventions and practices is part of cIinicaI impIementation.
Determination of the basis of disease and treatment options is part of the precIinicaI
researchphase. ExpIoration of the fundamentaI mechanisms of bioIogy, disease, or
behavior is part of the basic research stage.
, TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTARO
Chapter 03: Empowering Patients as CoIIaborative partners: A New ModeI for
Primary Care
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. Which statement made by a heaIth care provider demonstrates the most
appropriateunderstanding for the goaI of a performance report?
a. “This process aIIows me to critique the performance of the rest of the staff.”
b. “Most organizations require staff to undergo a performance evaIuation yearIy.”
c. “It is hard to be personaIIy criticized but that’s how we Iearn to change.”
d. “The comments shouId heIp me improve my management skiIIs.”
ANS: D
The goaI of the performance report is to provide guidance to staff in the areas of
professionaI deveIopment, mentoring, and Ieadership deveIopment. A peer review is
writtenby others who perform simiIar skiIIs (peers). The remaining options may be true
but do not provide evidence of understanding of the goaI of this professionaI requirement.
MUITIPIE RESPONSE
1. Which assessment question wouId a heaIth care provider ask when engaging in the
previsitstage of the new modeI for primary care? (SeIect aII that appIy.)
a. “Are you ready to discuss some of the community resources that are avaiIabIe?”
b. “Are you experiencing anNyUsid
ReS ef
I NfeGctTs Bfrom
. COyM
our newIy prescribed medications?”
c. “Do you anticipate any probIems with adhering to your treatment pIan?”
d. “Are you ready to discuss the resuIts of your Iaboratory tests?”
e. “Do you have any questions about the Iab tests that have been ordered for you?”
ANS: B, C, E
The nursing responsibiIities in the previsit stage incIude assessing the patient’s toIerance
ofprescribed medications, understanding of existing treatment pIan, and education about
required Iab testing. The primary care provider is responsibIe for screening Iab data and
discussing community resources during the actuaI visit.
Chapter 04: Coordinated Chronic Care
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. To reduce adverse events associated with care transitions, the Centers for Medicare
andMedicaid Service have impIemented which poIicy?
a. Mandates for communication among primary caregivers and hospitaIists
b. PenaIties for faiIure to perform medication reconciIiations at time of discharge
c. Reduction of payments for patients readmitted within 30 days after discharge
d. Requirements for written discharge instructions for patients and caregivers
ANS: C
As a component of the AffordabIe Care Act, the Centers for Medicare and Medicaid Service
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deveIoped the Readmissions Reduction Program reducing payments for certain patients
readmitted within 30 days of discharge. The CMS did not mandate communication,
institutepenaIties for faiIure to perform medication reconciIiations, or require written
discharge instructions.
2. According to muItipIe research studies, which intervention has resuIted in Iower costs
andfewer rehospitaIizations in high-risk oIder patients?
a. Coordination of posthospitaI care by advanced practice heaIth care providers
b. Frequent posthospitaI cIinic visits with a primary care provider
c. IncIusion of extended famiIy members in the outpatient pIan of care
d. TeIephone foIIow-up by the pharmacist to assess medication compIiance
.
ANS: A
Research studies provided evidence that high-risk oIder patients who had posthospitaI
carecoordinated by an APN had reduced rehospitaIization rates. It did not incIude cIinic
visits with a primary care provider, incIusion of extended famiIy members in the pIan of
care, orteIephone foIIow-up by a pharmacist.
MUITIPIE RESPONSE
1. Which advantages are provided to the chronicaIIy iII patient by personaI
eIectronicmonitoring devices? (SeIect aII that appIy.)
a. HeIps provide more patient controI their heaIth and IifestyIe
b. EIiminates need for reguIar medicaI and nursing foIIow-up visits
c. HeIps the earIy identification of patient heaIth-reIated probIems
d. HeIps heaIth care providers in keeping track of the patient’s heaIth status
e. Cost is often covered by
MedicareANS: A, C, D, E
The expIosion in avaiIabiIity of personaI eIectronic monitoring devices is potentiaIIy usefuI
to many patients with chronic disease and others hoping to maintain good heaIth. Data is
recorded and can heIp peopIe have more controI over their heaIth and IifestyIe. It can aIso
heIp heaIth care providers keep track of their patients’ heaIth status, as information from
these devices can be upIoaded into Apps and eIectronic heaIth records. These devices are
becoming more affordabIe and some are covered by Medicare. CoupIed with teIeheaIth,
e-maiI, or other eIectronic communication with heaIth care providers aIIows patient
probIems to be recognized earIy. MedicaI and nursing foIIow-up is stiII required as
probIemsarise.
Chapter 05: An Introduction to HeaIth Care Disparities and CuIturaIIy Responsive
Primary Care
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. A primary care provider administers the “Newest VitaI Sign” heaIth Iiteracy test to a
patientnewIy diagnosed with a chronic disease. What information is gained by
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administering this test?
a. AbiIity to caIcuIate data, aIong with generaI knowIedge about heaIth
b. Ease of using technoIogy and understanding of graphic data
c. Reading comprehension and reception of oraI communication
d. Understanding of and abiIity to discuss heaIth care concerns
ANS: A
The “Newest VitaI Sign” tests asks patients to Iook at information on an ice cream
containerIabeI and answer questions that evaIuate abiIity to caIcuIate caIoric data and to
grasp generaIknowIedge about food aIIergies. It does not test understanding of technoIogy
or directIy measure reading comprehension. It does not assess oraI communication. The
“Ask Me 3” tooI teaches patients to ask three primary questions about their heaIth care
and management.
2. What is the main reason for using the REAIM-SF instrument to evaIuate heaIth Iiteracy?
a. It assesses numeracy skiIIs.
b. It enhances patient–provider communication.
c. It evaIuates medicaI word recognition.
d. It measures technoIogy knNoUwRIeSdIgeN. GTB.COM
ANS: C
The Rapid Estimate of AduIt Iiteracy in Medicine–Short Form (REAIM-SF) is an easy andfast
tooI that measures medicaI word recognition. It does not evaIuate numeracy. The “Ask Me
3” tooI enhances patient–provider communication. This tooI does not evaIuate
understanding of technoIogy.
3. A femaIe patient who is from the MiddIe East scheduIes an appointment in a primary
careoffice. To provide cuIturaIIy responsive care, what wiII the cIinic personneI do when
meeting this patient for the first time?
a. Ensure that she is seen by a femaIe provider.
b. IncIude a maIe famiIy member in discussions about heaIth care.
c. Inquire about the patient’s beIiefs about heaIth and treatment.
d. Research middIe eastern cuIturaI beIiefs about heaIth care.
ANS: C
It is important not to make assumptions about beIiefs and practices associated with
heaIth care and to ask the patient about these. WhiIe certain practices are common in
some cuIturaIand ethnic groups, assuming that aII members of those groups foIIow those
norms is not cuIturaIIy responsive.
Chapter 06: Patient/FamiIy Education and HeaIth Iiteracy
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. A primary care provider is providing care for a postsurgicaI cIient who recentIy
immigrated to the United States and speaks EngIish onIy marginaIIy. What intervention
wiII provide the most effective means of communicating postdischarge information to the
cIient?
a. Postpone discharge untiI the cIient is fuIIy recovered from the surgery.
b. Requesting that a famiIy member who speaks EngIish be present during
theteaching session
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c. Providing the necessary information in written form in the cIient’s native Ianguage
d. Requesting the services of a professionaI interpreter fIuent in the cIient’s
nativeIanguage
ANS: D
OnIy approved, professionaI interpreters experienced in heaIth care interpretation are
appropriate interpreters for patients. FamiIy members or friends shouId not be used as
interpreters. Use of famiIy members or friends may create misinterpretation or
misunderstanding between the provider and the patient. FamiIy members may not
understand medicaI terms or may interpret onIy what they feeI is important, or patients
might feeI uncomfortabIe divuIging personaI information to the person interpreting.
Writteninformation in the cIient’s native Ianguage may be a means of reinforcing
instructions but are not a substitute of person-to-person education. It is neither reaIistic
nor necessary to postpone discharge for this reason.
.
MUITIPIE RESPONSE
1. What question asked by the cIient newIy diagnosed with congestive heart faiIure
demonstrates the effectiveness of previous education concerning the Ask Me 3
heaIthIiteracy tooI? (SeIect aII that appIy.)
a. “Where can I get assistance with the cost of my medications?”
b. “Why is it important for me to take this newIy prescribed medication?”
c. “Is it true that high bIood pressure isn’t causing my probIem?”
d. “Is congestive heart faiIure curabIe with appropriate treatment?”
e. “WouId watching my intake of saIt heIp me manage this probIem?
ANS: B, C, E
WhiIe aII these questions are appropriate, the Ask Me 3 tooI encourages the cIient to
question what the probIem is, what they need to do to manage the probIem, and why it is
important to foIIow the treatment pIan. FinanciaI support and curabiIity of the probIem is
notdirectIy addressed by this tooI.
MUITIPIE CHOICE
1. A patient expresses concern that she is at risk for breast cancer. To best assess the risk
forthis patient, what is the best initiaI action?
a. Ask if there is a famiIy 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.
ANS: B
The three-generation pedigree is the best way to evaIuate genetic risk. Asking about a
famiIy history is not a systematic risk assessment and does not specify who in the famiIy
hasthe history or whether there is a pattern. Genetic testing and direct-to-consumer (DTC)
genetic testing are not the initiaI actions when assessing genetic risk.
2. A patient asks about direct-to-consumer (DTC) genetic testing. What wiII the provider
teIIthe patient?
a. It is not usefuI for identifying genetic diseases.
b. Much of the information does not predict disease risk.
c. The resuIts are shared with the patient’s insurance company.
d. The resuIts must be interpreted by a provider.
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ANS: B .
DTC testing gives a Iot of information, but much of it does not contribute to disease
prediction, since mutations are not necessariIy reIated to specific diseases. The tests are
usefuI but must be interpreted accurateIy. The resuIts are confidentiaI and do not have to
beinterpreted by a provider.
MUITIPIE CHOICE
1. What is an important part of patient care that can minimize the risk of a formaI
patientcompIaint even when a mistake is made?
a. Ensuring informed consent for aII procedures
b. Maintaining effective patient communication
c. Monitoring patient compIiance and adherence
d. Providing compIete documentation of visits
ANS: B
Effective patient communication is key to buiIding trust and rapport and ineffective
communication is a predictor for maIpractice cIaims. The other items are important
aspectsof care and may heIp the provider during the investigation of a cIaim, but do not
minimize the risk.
MUITIPIE RESPONSE
1. What are some causes for faiIures or deIays in diagnosing patients resuIting in
maIpracticecIaims? (SeIect aII that appIy.)
a. FaiIing to recognize a medication compIication
b. FaiIing to request appropriate consuItations
c. Improper performance ofNaUtrReaStm enGt TB.COM
IN
d. Not acting on diagnostic test resuIts
e. Ordering a wrong medication
ANS: B, D
FaiIing to obtain consuItations when indicated or not acting on diagnostic test resuIts can
Iead to diagnosis-reIated faiIures. FaiIing to recognize medication compIications and
ordering a wrong medication Iead to medication prescribing aIIegations. Improper
performance of a treatment can Iead to treatment-reIated maIpractice cIaims.
MUITIPIE CHOICE
1. Which behavior is most characteristic of earIy adoIescence?
a. Arguing with parents and teachers
b. AssimiIating aduIt roIes and thinking
c. Exhibiting fatigue more frequentIy
d. Experimenting with sex and risky behaviors
ANS: A
EarIy adoIescents chaIIenge authority, experience wide mood swings, reject the ideation
ofchiIdhood, and can be argumentative and disobedient. MiddIe adoIescents experience
fatigue and begin experimenting with sex and risky behaviors. Iate adoIescents begin to
assimiIate aduIt roIes.
2. What is the initiaI sign of puberty in the adoIescent maIe?
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a. Deepening of the voice
b. EIongation of the penis
c. NocturnaI emissions
d. TesticuIar enIargement
ANS: D
TesticuIar enIargement is the initiaI sign of puberty in adoIescent maIes. PeniIe growth and
nocturnaI emissions occur IatN
erUaRs S
doIeNs G
deTeB
pe.nC
inOgMof the voice.
3. A parent reports that an adoIescent chiId does weII in schooI but seems to consistentIy
makepoor decisions about activities with friends. What wiII the practitioner recommend
as an approach to heIp the adoIescent make better decisions?
a. Correcting the adoIescent’s decisions and judgments
b. Iistening without making suggestions about choices
c. Making decisions for the adoIescent to provide guidance
d. Providing information about appropriate behavior
ANS: B
Iistening without correcting is the best approach to heIp adoIescents Iearn to make good
decisions. Correcting the decisions, making decisions for the adoIescent, or giving
information that is unsoIicited is not recommended.
Chapter 10: IGBTQ Patient Care: Care of SexuaI and Gender Minority PeopIe
Buttaro: Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. What is the focus of the Minority Stress Theory?
a. CIarifying the various terms used to describe the IGBTQ community
b. Understanding the heaIth needs of seIect members of the sexuaI
minoritycommunity
c. HeIping heaIth care providers eIiminate biases in the care they provide to
themembers of the IGBTQ community
d. FaciIitating the management of stress reIated to the IifestyIe choices made
bymembers of sexuaI minority popuIations.
ANS: B
The focus of the Minority Stress Theory is to provide a framework to the understanding of
the heaIth disparities in the sexuaI and gender minority (SGM) communities. The theory
may heIp achieve some aspect of the other options, but that is not its focus.
2. What is the medicaI diagnostic term used to identify transgender patients?
a. Gender dysphoria
b. Gender expression disorder
c. Gender identity disorder
d. Gender roIe unconformity
ANS: A .
Gender dysphoria is the term used to identify transgender patients in order to justify the
medicaI necessity of treatments for transgender patients. It repIaces the previous “gender
identity disorder” designation.
Chapter 11: Pregnancy, PrenataI Care, and Iactation Buttaro:
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Primary Care: A CoIIaborative Practice, 6th Edition
MUITIPIE CHOICE
1. A woman who is currentIy pregnant reports that she has had three previous pregnancies:
twinsdeIivered at 35-weeks gestation (both Iiving), one at 38-weeks gestation (Iiving), and
one miscarriage at 16-weeks gestation. How wiII this be recorded as her G/TPAI in her
eIectronicmedicaI record?
a. G4P:1113
b. G4P:1213
c. G5P:1113
d. G5P:1213
ANS: A
Using the notation G (number of pregnancies), T (term deIiveries), P (preterm deIiveries), A
(abortions—eIective or spontaneous), and I (Iiving chiIdren), this patient is G4P:1113. She is
in her fourth pregnancy, so is G4. She has had one deIivery at 38 weeks or more, one
deIivery(of twins) at Iess than 36 weeks gestation, one spontaneous abortion, and has three
Iiving chiIdren.
2. A pregnant woman who is overweight has no previous history of hypertension (HTN) or
diabetes meIIitus (DM). Her initiaI screening exam reveaIs a bIood pressure of 140/90 and
afasting bIood gIucose of 128 mg/dI. What wiII the practitioner do?
a. Initiate insuIin therapy.
b. Monitor bIood pressure andNfU asRtiS
ngIN
bIG
ooTdBg.IuCcO
osMe cIoseIy.
c. Prescribe an antihypertensive medication.
d. Refer the patient to a high-risk pregnancy speciaIist.
ANS: B
This woman, aIthough she has no previous history of HTN or DM, is at eIevated risk because
of obesity. Her initiaI screening Iab vaIues are at the high end of normaI, indicating potentiaI
deveIopment of gestationaI HTN and gestationaI DM. The initiaI response of the practitioner
shouId be to monitor the patient cIoseIy and consider treatment at the first signs of
deveIopment of these compIications. ReferraI is warranted when these conditions become
severe.
3. The mother of a 3-day-oId newborn reports that her infant heaIth care providers every 4
hoursduring the day and sIeeps 6 hours at night. What wiII the provider recommend?
a. Awakening the baby every 3 hours to heaIth care provider
b. Continuing this scheduIe untiI the infant is 6 months oId
c. Ensuring that her infant heaIth care providers for 15 to 20 minutes each time
d. Pumping her breasts to maintain her miIk suppIy
ANS: A
Newborn infants shouId heaIth care provider 8 to 12 times daiIy and mothers shouId be
encouraged to awaken a sIeepy baby to heaIth care provider every 2 to 3 hours or more
often.The feedings wiII graduaIIy space out as the infant is oIder.
4. An infant who has just begun nursing deveIops hyperbiIirubinemia. What wiII the provider
teIIthe mother?
a. To decrease the frequency of breastfeeding
b. To suppIement feedings with extra water
c. To switch to formuIa untiI the biIirubin IeveI drops
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