APC Patient Assessment and Evaluation 2 — Questions and Answers
Question 1: A patient presents with a 3-day history of productive cough, fever of 38.5°C, and shortness of breath. Which assessment finding would most suggest pneumonia requiring urgent medical referral?
- Mild rhinorrhea with clear discharge
- Oxygen saturation of 91% on room air (Correct answer)
- Sore throat with no cervical lymphadenopathy
- Dry cough for less than 24 hours
Correct answer: Oxygen saturation of 91% on room air
An oxygen saturation of 91% indicates hypoxemia and is a red flag requiring urgent medical referral as it suggests significant respiratory compromise.
Question 2: When taking a medication history, a pharmacist uses the SCHOLAR-MAC acronym. What does the 'A' in MAC stand for?
- Allergies
- Associated symptoms (Correct answer)
- Age of patient
- Adherence to therapy
Correct answer: Associated symptoms
In SCHOLAR-MAC, the 'A' in MAC stands for Associated symptoms, helping to characterize the full clinical picture of the complaint.
Question 3: A 65-year-old patient taking warfarin reports starting a course of St John's Wort for low mood. Which assessment approach is most appropriate?
- Continue warfarin and monitor INR at the next scheduled check
- Advise the patient to halve their warfarin dose immediately
- Assess INR urgently and refer to the prescriber due to significant drug-herb interaction (Correct answer)
- Recommend the patient stop St John's Wort without informing the prescriber
Correct answer: Assess INR urgently and refer to the prescriber due to significant drug-herb interaction
St John's Wort is a CYP450 inducer that significantly reduces warfarin levels, increasing thrombotic risk, requiring urgent INR assessment and prescriber notification.
Question 4: During a patient consultation, which finding in a child under 2 years with diarrhea indicates moderate-to-severe dehydration?
- Moist mucous membranes and normal skin turgor
- Sunken fontanelle, dry mouth, and decreased urine output (Correct answer)
- Mild irritability with normal capillary refill
- Two loose stools in 12 hours with normal activity
Correct answer: Sunken fontanelle, dry mouth, and decreased urine output
Sunken fontanelle, dry mucous membranes, and decreased urine output are classic signs of moderate-to-severe dehydration in infants requiring urgent referral.
Question 5: A patient asks for advice on a rash. Which feature of the rash would be an absolute indication for immediate medical referral?
- Small, raised, itchy welts across the forearm after gardening
- Non-blanching purpuric spots on the lower limbs with fever (Correct answer)
- Dry, scaly patches on the elbows present for several years
- Mild erythema at the site of a new adhesive bandage
Correct answer: Non-blanching purpuric spots on the lower limbs with fever
Non-blanching purpuric rash with fever may indicate meningococcal disease or vasculitis, constituting a medical emergency requiring immediate referral.
Question 6: When assessing a patient's pain using the PQRST framework, what does the 'P' stand for?
- Pain intensity on a numeric scale
- Provoking and palliating factors (Correct answer)
- Previous episodes of similar pain
- Patient's preferred analgesic
Correct answer: Provoking and palliating factors
In the PQRST pain assessment tool, 'P' stands for Provoking and Palliating factors — what makes the pain better or worse.
Question 7: A patient with type 2 diabetes reports frequent episodes of dizziness and sweating before meals. Which assessment question is most critical to ask first?
- Are you exercising more than usual?
- What medications are you currently taking and at what doses? (Correct answer)
- Have you recently changed your diet?
- Do you test your blood glucose regularly?
Correct answer: What medications are you currently taking and at what doses?
Identifying current medications and doses is critical first because sulfonylureas and insulin are common causes of hypoglycemia, and knowing the regimen guides the assessment.
APC Patient Assessment and Evaluation 2
A patient presents with a 3-day history of productive cough, fever of 38.5°C, and shortness of breath.
Which assessment finding would most suggest pneumonia requiring urgent medical referral?