MTM Patient Assessment & Care Planning 5 — Questions and Answers
Question 1: A patient taking lithium reports increased thirst, frequent urination, and hand tremors. During assessment, the pharmacist notes a lithium level of 1.6 mEq/L. What is the most appropriate care plan action?
- Reassure the patient that these are expected side effects requiring no action
- Recommend increasing fluid intake and continuing the current dose
- Classify this as an adverse drug reaction due to toxicity and recommend urgent prescriber contact (Correct answer)
- Add another mood stabilizer to offset the toxic effects
Correct answer: Classify this as an adverse drug reaction due to toxicity and recommend urgent prescriber contact
A lithium level of 1.6 mEq/L exceeds the therapeutic range of 0.6–1.2 mEq/L, and toxicity symptoms confirm an adverse drug reaction requiring urgent intervention.
Question 2: When gathering a medication history during patient assessment, which source provides the most complete and accurate picture of current medications?
- The patient's memory alone
- A single pharmacy's dispensing records
- A brown bag review combined with pharmacy records and patient interview (Correct answer)
- The most recent hospital discharge summary only
Correct answer: A brown bag review combined with pharmacy records and patient interview
A brown bag review combined with pharmacy records and a thorough patient interview captures prescription, OTC, and herbal medications across all providers.
Question 3: An MTM patient taking warfarin reports she started taking St. John's Wort for low mood. What drug therapy problem does this represent?
- Needs additional drug therapy
- Dosage too high
- Adverse drug reaction due to a drug-herb interaction reducing warfarin efficacy (Correct answer)
- Unnecessary drug therapy
Correct answer: Adverse drug reaction due to a drug-herb interaction reducing warfarin efficacy
St. John's Wort induces CYP2C9 and P-glycoprotein, reducing warfarin levels and increasing thromboembolic risk, representing a clinically significant drug-herb interaction.
Question 4: In the Pharmacists' Patient Care Process (PPCP), which step directly follows 'Collect'?
- Implement
- Assess (Correct answer)
- Follow-up and Monitor
- Plan
Correct answer: Assess
The PPCP sequence is Collect → Assess → Plan → Implement → Follow-up and Monitor, making Assess the step that directly follows data collection.
Question 5: A newly diagnosed hypertensive patient refuses to start amlodipine due to fear of side effects. How should the pharmacist address this in the care plan?
- Document the refusal and take no further action
- Override the patient's decision and recommend they fill the prescription anyway
- Explore the patient's concerns using motivational interviewing, provide education, and document the barrier (Correct answer)
- Immediately report the patient to their prescriber for noncompliance
Correct answer: Explore the patient's concerns using motivational interviewing, provide education, and document the barrier
Patient-centered care requires exploring concerns, providing accurate information, and documenting barriers to treatment as part of the collaborative care plan.
Question 6: Which of the following lab values is most relevant when assessing the safety of prescribing an ACE inhibitor in a patient with chronic kidney disease?
- Fasting glucose
- Serum potassium and creatinine/eGFR (Correct answer)
- Hemoglobin A1C
- Total cholesterol and LDL
Correct answer: Serum potassium and creatinine/eGFR
ACE inhibitors can cause hyperkalemia and may affect renal function, making serum potassium and eGFR critical safety parameters in CKD patients.
Question 7: A pharmacist completes an MTM session and documents a personal medication record (PMR). What distinguishes the PMR from the medication action plan (MAP)?
- The PMR lists the patient's action steps, while the MAP lists all their medications
- The PMR is a comprehensive list of all the patient's medications, while the MAP outlines patient self-care actions (Correct answer)
- The PMR is sent only to prescribers, while the MAP is filed internally
- The PMR is optional under CMS MTM guidelines, while the MAP is not required
Correct answer: The PMR is a comprehensive list of all the patient's medications, while the MAP outlines patient self-care actions
The PMR is a complete medication list given to the patient for reference, while the MAP is a prioritized action list of steps the patient should take to improve their health.
MTM Patient Assessment & Care Planning 5
A patient taking lithium reports increased thirst, frequent urination, and hand tremors.
During assessment, the pharmacist notes a lithium level of 1.6 mEq/L.
What is the most appropriate care plan action?