MTM Transitions of Care & Reconciliation 2

Question 1

A patient is discharged from the hospital on warfarin 5 mg daily, but their outpatient record shows warfarin 2.5 mg daily. What is the pharmacist's FIRST action?

Accepted Answer

Contact the discharging physician to clarify the intended dose

Answer

Dose discrepancies require immediate clarification with the prescriber before dispensing to prevent patient harm.

Question 2

During a post-discharge MTM visit, which tool is MOST useful for identifying medications the patient is actually taking versus what was prescribed?

Accepted Answer

Brown bag medication review

Answer

A brown bag review allows the pharmacist to physically inspect all medications the patient has at home, capturing the most accurate picture of actual use.

Question 3

Which patient population is at HIGHEST risk for medication errors during care transitions?

Accepted Answer

Elderly patients with multiple chronic conditions on polypharmacy

Answer

Elderly patients with polypharmacy are most vulnerable due to complex regimens, cognitive changes, and multiple prescribers.

Question 4

A pharmacist conducting medication reconciliation at hospital admission finds a patient takes an herbal supplement not listed on any prior record. What should the pharmacist do?

Accepted Answer

Document it and assess for drug-herb interactions

Answer

All supplements must be documented and evaluated for potential interactions with prescribed medications.

Question 5

Which of the following BEST describes the purpose of the 'teach-back' method during care transition counseling?

Accepted Answer

Confirming patient understanding by asking them to explain information back

Answer

Teach-back confirms comprehension by having the patient restate information in their own words, identifying gaps in understanding.

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

(MTM) Medication Therapy Management Certification for Pharmacists Practice Test

MTM Transitions of Care & Reconciliation 2