PEBC Clinical Assessment Methods 4 — Questions and Answers
Question 1: A pharmacist is conducting a medication review and notices a patient taking warfarin has an INR of 4.8 with no active bleeding. The most appropriate immediate action is:
- Administer vitamin K 10 mg IV immediately
- Hold warfarin and recheck INR in 1–2 days (Correct answer)
- Continue warfarin at the current dose
- Refer to emergency department regardless of symptoms
Correct answer: Hold warfarin and recheck INR in 1–2 days
For asymptomatic supratherapeutic INR (4.5–10), holding warfarin and monitoring closely is appropriate before deciding on further intervention.
Question 2: When assessing a patient's functional status, the Barthel Index measures:
- Cognitive function and memory recall
- Activities of daily living and independence (Correct answer)
- Cardiovascular fitness and exercise tolerance
- Depression and anxiety severity
Correct answer: Activities of daily living and independence
The Barthel Index assesses a patient's ability to perform activities of daily living (ADLs) such as feeding, bathing, and mobility.
Question 3: A pharmacist uses the Naranjo Algorithm to assess adverse drug reactions. A total score of 7 classifies the reaction as:
- Doubtful
- Possible
- Probable (Correct answer)
- Definite
Correct answer: Probable
Naranjo scores of 5–8 classify the ADR as 'Probable'; scores ≥9 = Definite, 1–4 = Possible, ≤0 = Doubtful.
Question 4: During a comprehensive geriatric assessment, the Timed Up and Go (TUG) test is used primarily to evaluate:
- Cognitive decline and dementia risk
- Fall risk and mobility in elderly patients (Correct answer)
- Nutritional status and muscle mass
- Urinary continence and bladder function
Correct answer: Fall risk and mobility in elderly patients
The TUG test measures time to rise from a chair, walk 3 meters, return, and sit — predicting fall risk in older adults.
Question 5: A pharmacist assesses a patient's alcohol use using the AUDIT-C tool. A score of 5 in a male patient suggests:
- No hazardous alcohol use
- Hazardous or harmful alcohol use (Correct answer)
- Alcohol dependence requiring detoxification
- Abstinence from alcohol
Correct answer: Hazardous or harmful alcohol use
AUDIT-C scores ≥4 in men and ≥3 in women indicate hazardous or harmful alcohol use warranting further assessment.
Question 6: Which physical assessment finding is most consistent with fluid overload in a patient with heart failure?
- Flat jugular veins and dry mucous membranes
- Pitting edema in lower extremities and crackles on auscultation (Correct answer)
- Hypotension and tachycardia at rest
- Decreased skin turgor and concentrated urine
Correct answer: Pitting edema in lower extremities and crackles on auscultation
Pitting peripheral edema and pulmonary crackles from fluid accumulation are hallmark signs of decompensated heart failure.
Question 7: In the context of clinical assessment, the term 'sentinel symptom' refers to:
- The first symptom to appear in a disease process
- A symptom requiring urgent referral due to potential serious pathology (Correct answer)
- A symptom that confirms a diagnosis without further testing
- A subjective symptom reported only by the patient
Correct answer: A symptom requiring urgent referral due to potential serious pathology
Sentinel (or 'red flag') symptoms signal potentially serious conditions requiring urgent medical evaluation rather than self-care.
PEBC Clinical Assessment Methods 4
A pharmacist is conducting a medication review and notices a patient taking warfarin has an INR of 4.8 with no active bleeding.
The most appropriate immediate action is: