PEBC Clinical Assessment Methods 5 — Questions and Answers
Question 1: A pharmacist counsels a patient newly prescribed a statin. Which laboratory value should be established as a baseline before initiating therapy?
- Serum potassium
- Creatine kinase (CK) and liver enzymes (ALT) (Correct answer)
- Complete blood count (CBC)
- Thyroid-stimulating hormone (TSH)
Correct answer: Creatine kinase (CK) and liver enzymes (ALT)
Baseline CK and hepatic transaminases (ALT) should be measured before statin initiation to detect pre-existing myopathy or liver disease.
Question 2: When assessing for signs of dehydration in a pediatric patient, which clinical sign is most reliable?
- Body temperature above 38°C
- Capillary refill time greater than 2 seconds (Correct answer)
- Heart rate below 60 bpm
- Presence of mild periorbital edema
Correct answer: Capillary refill time greater than 2 seconds
Prolonged capillary refill time (>2 seconds) is a reliable clinical indicator of dehydration and reduced peripheral perfusion in children.
Question 3: A pharmacist performing a comprehensive medication review uses the Beers Criteria. This tool is specifically designed to identify:
- Drug-drug interactions in any adult patient
- Potentially inappropriate medications in older adults (≥65 years) (Correct answer)
- Off-label drug use in pediatric patients
- High-alert medications in hospital settings
Correct answer: Potentially inappropriate medications in older adults (≥65 years)
The Beers Criteria identifies potentially inappropriate medications that carry greater risk than benefit in adults aged 65 and older.
Question 4: A patient reports taking their antihypertensive medications only on days they 'feel their blood pressure is high.' This pattern indicates:
- Adequate symptom-based self-management
- Intentional non-adherence based on health beliefs (Correct answer)
- Medication intolerance requiring a drug change
- Appropriate dose titration by the patient
Correct answer: Intentional non-adherence based on health beliefs
Taking medications only when symptomatic reflects intentional non-adherence driven by health beliefs, as hypertension is typically asymptomatic.
Question 5: In clinical assessment documentation, a SOAP note's 'O' section should contain:
- Patient's reported symptoms and chief complaint
- Objective findings including vital signs, lab results, and physical exam findings (Correct answer)
- The pharmacist's clinical diagnosis and drug therapy problems identified
- The recommended treatment plan and monitoring parameters
Correct answer: Objective findings including vital signs, lab results, and physical exam findings
The 'O' (Objective) section includes measurable, observable data such as vital signs, laboratory values, and physical examination findings.
Question 6: A pharmacist identifies that a patient's HbA1c is 9.2%. According to Diabetes Canada guidelines, this value indicates:
- Well-controlled diabetes at target
- Slightly above target, lifestyle counseling sufficient
- Poor glycemic control requiring medication intensification (Correct answer)
- Hypoglycemia risk requiring dose reduction
Correct answer: Poor glycemic control requiring medication intensification
HbA1c of 9.2% reflects poor glycemic control; Diabetes Canada targets are generally ≤7.0% for most patients, warranting therapy adjustment.
Question 7: When a pharmacist observes yellowing of a patient's sclera during a medication review, this finding is termed:
- Cyanosis
- Jaundice (icterus) (Correct answer)
- Pallor
- Erythema
Correct answer: Jaundice (icterus)
Yellowing of the sclera is called icterus or jaundice and indicates elevated bilirubin levels, warranting investigation of hepatic or hemolytic causes.
PEBC Clinical Assessment Methods 5
A pharmacist counsels a patient newly prescribed a statin.
Which laboratory value should be established as a baseline before initiating therapy?