FREE CCP Clinical Care in Long-Term Care Questions and Answers

Question 1

An 85-year-old resident with an indwelling urinary catheter has cloudy, foul-smelling urine. The resident is afebrile, has no new costovertebral angle tenderness, and exhibits no new behavioral changes. A nurse requests an order for an antibiotic. What is the consultant pharmacist's most appropriate recommendation based on antimicrobial stewardship principles?

Accepted Answer

Recommend against antibiotic therapy at this time, explaining that the findings represent asymptomatic bacteriuria per the Loeb criteria for catheterized residents.

Answer

The Loeb criteria are evidence-based guidelines designed to reduce unnecessary antibiotic use in long-term care. For a resident with an indwelling catheter, clinical signs like cloudy or foul-smelling urine alone are not sufficient to diagnose a UTI. Initiation of antibiotics requires at least one systemic sign or symptom, such as fever, rigors, new-onset delirium, or new costovertebral tenderness. Recommending against antibiotics in this scenario prevents the treatment of asymptomatic bacteriuria, which is a key principle of antimicrobial stewardship.

Question 2

According to CMS regulations for long-term care facilities, for which of the following medication classes is a gradual dose reduction (GDR) attempt required for a resident within the first year of use, unless clinically contraindicated?

Accepted Answer

Antidepressants.

Answer

CMS defines psychotropic drugs broadly to include antipsychotics, anxiolytics, hypnotics, and antidepressants. Federal regulations (F-Tag 758) mandate that residents receiving any psychotropic medication undergo attempts at a gradual dose reduction. Specifically, for a new psychotropic medication, at least two separate GDR attempts must be made in the first year, unless clinically contraindicated and documented as such. Anticonvulsants for seizure disorders and medications for medical conditions like heart failure or pain are not subject to this specific GDR requirement.

Question 3

A 90-year-old, non-verbal resident with advanced dementia has become increasingly agitated and now grimaces and resists care during repositioning. The facility has a PRN order for lorazepam for agitation. What is the consultant pharmacist's most appropriate initial recommendation?

Accepted Answer

Recommend a trial of scheduled acetaminophen to assess for and treat potential underlying pain as the cause of the behaviors.

Answer

In non-verbal residents with dementia, behavioral disturbances such as agitation are often a primary manifestation of untreated pain. The American Geriatrics Society and other guidelines recommend assuming pain is present and conducting an analgesic trial when new pain-related behaviors emerge. Before escalating psychotropic medications, which can have significant side effects, the standard of care is to first assess for and treat potential underlying causes like pain.

Question 4

A consultant pharmacist is conducting a monthly inspection of a long-term care facility's Emergency Drug Kit (EDK). Which of the following findings represents a significant compliance concern that requires immediate correction?

Accepted Answer

The exterior of the kit is not labeled with the name and expiration date of the earliest-expiring drug inside.

Answer

While specific regulations vary by state, a universal best practice and common requirement is that the EDK be clearly and accurately labeled on the exterior. This labeling must include a list of contents, and often the expiration date of the drug that will expire first. This allows for efficient inspection and replacement of expiring drugs without opening the sealed kit, ensuring it is always ready for an emergency. The other options describe standard, compliant procedures for EDKs in long-term care.

Question 5

An 88-year-old resident with type 2 diabetes, moderate cognitive impairment, and multiple comorbidities has an A1c of 6.8%. The resident is experiencing occasional morning hypoglycemia (blood glucose ~65 mg/dL) on a regimen that includes a sulfonylurea. Based on current geriatric diabetes guidelines, which recommendation is most appropriate?

Accepted Answer

Suggest relaxing the glycemic target to an A1c of 8.0-8.5% and de-prescribing the sulfonylurea.

Answer

For frail, older adults in long-term care with cognitive impairment and multiple comorbidities, glycemic goals should be relaxed to prioritize the avoidance of hypoglycemia. An A1c target of 8.0-8.5% is often considered appropriate for this population. Sulfonylureas carry a high risk of hypoglycemia and are often targeted for de-prescribing. Aggressive targets increase hypoglycemia risk with little benefit on long-term complications in patients with limited life expectancy, and sliding scale insulin as monotherapy is discouraged.

(CCP) Certified Consultant Pharmacist Practice Test

(CCP) Certified Consultant Pharmacist Practice Test

FREE CCP Clinical Care in Long-Term Care Questions and Answers