Test Bank for Primary Care: A Collaborative Practice, 6th Edition (Chapters 1-228)

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Test bank for buttaro primary care a collaborative practice 6thedition-latest-2022-2023

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 01: Interprofessional Collaborative Practice: Where We Are TodayButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.A small, rural hospital is part of an Accountable Care Organization (ACO) and is designatedas a Level 1 ACO. What is part of this designation?a.Bonuses based on achievement of benchmarksb.Care coordination for chronic diseasesc.Standards for minimum cash reservesd.Strict requirements for financial reportingANS: AA Level 1 ACO has the least amount of financial risk and requirements, but receives sharedsavings bonuses based on achievement of benchmarks for quality measures andexpenditures. Care coordination and minimum cash reserves standards are part of Level 2ACO requirements. Level 3 ACOs have strict requirements for financial reporting.2.What was an important finding of the Advisory Board survey of 2014 about primary carepreferences of patients?a.Associations with area hospitalsb.Costs of ambulatory carec.Ease of access to cared.The ratio of providers to patientsANS: CVERIFIED-TESTBANKAs part of the 2014 survey, the Advisory Board learned that patients desired 24/7 access tocare, walk-in settings and the ability to be seen within 30 minutes, and care that is close tohome. Associations with hospitals, costs of care, and the ratio of providers to patients werenot part of these results.MULTIPLE RESPONSE1.Which assessments of care providers are performed as part of the value-based purchasing(VBP) initiative? (Select all that apply.)a.Appraising costs per case of care for Medicare patientsb.Assessing patients’ satisfaction with hospital carec.Evaluating available evidence to guide clinical care guidelinesd.Monitoring mortality rates of all patients with pneumoniae.Requiring advanced IT standards and minimum cash reservesANS: A, B, DValue-based purchasing looks at five domain areas of processes of care, including efficiencyof care (cost per case), experience of care (patient satisfaction measures), and outcomes ofcare (mortality rates for certain conditions). Evaluation of evidence to guide clinical care ispart of evidence-based practice. The requirements for IT standards and financial status arepart of Accountable Care Organization standards.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 02: Translating Research into Clinical PracticeButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.What is the purpose of Level II research?a.To define characteristics of interest of groups of patientsb.To demonstrate the effectiveness of an intervention or treatmentc.To describe relationships among characteristics or variablesd.To evaluate the nature of relationships between two variablesANS: CLevel II research is concerned with describing the relationships among characteristics orvariables. Level I research is conducted to define the characteristics of groups of patients.Level II research evaluates the nature of the relationships between variables. Level IVresearch is conducted to demonstrate the effectiveness of interventions or treatments.2.Which is the most appropriate research design for a Level III research study?a.Epidemiological studiesb.Experimental designc.Qualitative studiesd.Randomized clinical trialsANS: BThe experimental design is the most appropriate design for a Level III study.Epidemiologicalstudies are aNpUprRopSrIiaNteGfTorBL.eCveOlMII studies.Qualitative designsareusefulfor Level I studies. Randomized clinical trials are used for Level IV studies.3.What is the purpose of clinical research trials in the spectrum of translational research?a.Adoption of interventions and clinical practices into routine clinical careb.Determination of the basis of disease and various treatment optionsc.Examination of safety and effectiveness of various interventionsd.Exploration of fundamental mechanisms of biology, disease, or behaviorANS: CClinical research trials are concerned with determining the safety and effectiveness ofinterventions. Adoption of interventions and practices is part of clinical implementation.Determination of the basis of disease and treatment options is part of the preclinical researchphase. Exploration of the fundamental mechanisms of biology, disease, or behavior is partof the basic research stage.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 03: Empowering Patients as Collaborative partners: A New Model forPrimary CareButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.Which statement made by a health care provider demonstrates the most appropriateunderstanding for the goal of a performance report?a.“This process allows me to critique the performance of the rest of the staff.”b.“Most organizations require staff to undergo a performance evaluation yearly.”c.“It is hard to be personally criticized but that’s how we learn to change.”d.“The comments should help me improve my management skills.”ANS: DThe goal of the performance report is to provide guidance to staff in the areas ofprofessional development, mentoring, and leadership development. A peer review is writtenby others who perform similar skills (peers). The remaining options may be true but do notprovide evidence of understanding of the goal of this professional requirement.MULTIPLE RESPONSE1.Which assessment question would a health care provider ask when engaging in the previsitstage of the new model for primary care? (Select all that apply.)a.“Are you ready to discuss some of the community resources that are available?”b.“Are you experiencing anNyUsRidSeIefNfeGctTsBfr.omCOyMour newly prescribed medications?”c.“Do you anticipate any problems with adhering to your treatment plan?”d.“Are you ready to discuss the results of your laboratory tests?”e.“Do you have any questions about the lab tests that have been ordered for you?”ANS: B, C, EThe nursing responsibilities in the previsit stage include assessing the patient’s tolerance ofprescribed medications, understanding of existing treatment plan, and education aboutrequired lab testing. The primary care provider is responsible for screening lab data anddiscussing community resources during the actual visit.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 04: Coordinated Chronic CareButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.To reduce adverse events associated with care transitions, the Centers for Medicare andMedicaid Service have implemented which policy?a.Mandates for communication among primary caregivers and hospitalistsb.Penalties for failure to perform medication reconciliations at time of dischargec.Reduction of payments for patients readmitted within 30 days after discharged.Requirements for written discharge instructions for patients and caregiversANS: CAs a component of the Affordable Care Act, the Centers for Medicare and Medicaid Servicedeveloped the Readmissions Reduction Program reducing payments for certain patientsreadmitted within 30 days of discharge. The CMS did not mandate communication, institutepenalties for failure to perform medication reconciliations, or require written dischargeinstructions.2.According to multiple research studies, which intervention has resulted in lower costs andfewer rehospitalizations in high-risk older patients?a.Coordination of posthospital care by advanced practice health care providersb.Frequent posthospital clinic visits with a primary care providerc.Inclusion of extended family members in the outpatient plan of cared.Telephone follow-up by the pharmacist to assess medication complianceVERIFIED-TESTBANKANS: AResearch studies provided evidence that high-risk older patients who had posthospital carecoordinated by an APN had reduced rehospitalization rates. It did not include clinic visitswith a primary care provider, inclusion of extended family members in the plan of care, ortelephone follow-up by a pharmacist.MULTIPLE RESPONSE1.Which advantages are provided to the chronically ill patient by personal electronicmonitoring devices? (Select all that apply.)a.Helps provide more patient control their health and lifestyleb.Eliminates need for regular medical and nursing follow-up visitsc.Helps the early identification of patient health-related problemsd.Helps health care providers in keeping track of the patient’s health statuse.Cost is often covered by MedicareANS: A, C, D, E

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTThe explosion in availability of personal electronic monitoring devices is potentially usefulto many patients with chronic disease and others hoping to maintain good health. Data isrecorded and can help people have more control over their health and lifestyle. It can alsohelp health care providers keep track of their patients’ health status, as information fromthese devices can be uploaded into Apps and electronic health records. These devices arebecoming more affordable and some are covered by Medicare. Coupled with telehealth,e-mail, or other electronic communication with health care providers allows patientproblems to be recognized early. Medical and nursing follow-up is still required as problemsarise.VERIFIED-TESTBANK

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 05: An Introduction to Health Care Disparities and Culturally ResponsivePrimary CareButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.A primary care provider administers the “Newest Vital Sign” health literacy test to a patientnewly diagnosed with a chronic disease. What information is gained by administering thistest?a.Ability to calculate data, along with general knowledge about healthb.Ease of using technology and understanding of graphic datac.Reading comprehension and reception of oral communicationd.Understanding of and ability to discuss health care concernsANS: AThe “Newest Vital Sign” tests asks patients to look at information on an ice cream containerlabel and answer questions that evaluate ability to calculate caloric data and to grasp generalknowledge about food allergies. It does not test understanding of technology or directlymeasure reading comprehension. It does not assess oral communication. The “Ask Me 3”tool teaches patients to ask three primary questions about their health care and management.2.What is the main reason for using the REALM-SF instrument to evaluate health literacy?a.It assesses numeracy skills.b.It enhances patient–provider communication.c.It evaluates medical word recognition.d.It measurestechnology knNoUwRleSdIgeN.GTB.COMANS: CThe Rapid Estimate of Adult Literacy in Medicine–Short Form (REALM-SF) is an easy andfast tool that measures medical word recognition. It does not evaluate numeracy. The “AskMe 3” tool enhances patient–provider communication. This tool does not evaluateunderstanding of technology.3.A female patient who is from the Middle East schedules an appointment in a primary careoffice. To provide culturally responsive care, what will the clinic personnel do whenmeeting this patient for the first time?a.Ensure that she is seen by a female provider.b.Include a male family member in discussions about health care.c.Inquire about the patient’s beliefs about health and treatment.d.Research middle eastern cultural beliefs about health care.ANS: CIt is important not to make assumptions about beliefs and practices associated with healthcare and to ask the patient about these. While certain practices are common in some culturaland ethnic groups, assuming that all members of those groups follow those norms is notculturally responsive.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 06: Patient/Family Education and Health LiteracyButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.A primary care provider is providing care for a postsurgical client who recently immigratedto the United States and speaks English only marginally. What intervention will provide themost effective means of communicating postdischarge information to the client?a.Postpone discharge until the client is fully recovered from the surgery.b.Requesting that a family member who speaks English be present during theteaching sessionc.Providing the necessary information in written form in the client’s native languaged.Requesting the services of a professional interpreter fluent in the client’s nativelanguageANS: DOnly approved, professional interpreters experienced in health care interpretation areappropriate interpreters for patients. Family members or friends should not be used asinterpreters. Use of family members or friends may create misinterpretation ormisunderstanding between the provider and the patient. Family members may notunderstand medical terms or may interpret only what they feel is important, or patientsmight feel uncomfortable divulging personal information to the person interpreting. Writteninformation in the client’s native language may be a means of reinforcing instructions butare not a substitute of person-to-person education. It is neither realistic nor necessary topostpone discharge for this reason.VERIFIED-TESTBANKMULTIPLE RESPONSE1.What question asked by the client newly diagnosed with congestive heart failuredemonstrates the effectiveness of previous education concerning theAsk Me 3healthliteracy tool? (Select all that apply.)a.“Where can I get assistance with the cost of my medications?”b.“Why is it important for me to take this newly prescribed medication?”c.“Is it true that high blood pressure isn’t causing my problem?”d.“Is congestive heart failure curable with appropriate treatment?”e.“Would watching my intake of salt help me manage this problem?ANS: B, C, EWhile all these questions are appropriate, theAsk Me 3tool encourages the client toquestion what the problem is, what they need to do to manage the problem, and why it isimportant to follow the treatment plan. Financial support and curability of the problem is notdirectly addressed by this tool.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 07: Genetic Considerations in Primary CareButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.A patient expresses concern that she is at risk for breast cancer. To best assess the risk forthis patient, what is the best initial action?a.Ask if there is a family history of breast cancer.b.Gather and record a three-generation pedigree.c.Order a genetic test for the breast cancer gene.d.Recommend direct-to-consumer genetic testing.ANS: BThe three-generation pedigree is the best way to evaluate genetic risk. Asking about afamily history is not a systematic risk assessment and does not specify who in the family hasthe history or whether there is a pattern. Genetic testing and direct-to-consumer (DTC)genetic testing are not the initial actions when assessing genetic risk.2.A patient asks about direct-to-consumer (DTC) genetic testing. What will the provider tellthe patient?a.It is not useful for identifying genetic diseases.b.Much of the information does not predict disease risk.c.The results are shared with the patient’s insurance company.d.The results must be interpreted by a provider.ANS: BVERIFIED-TESTBANKDTC testing gives a lot of information, but much of it does not contribute to diseaseprediction, since mutations are not necessarily related to specific diseases. The tests areuseful but must be interpreted accurately. The results are confidential and do not have to beinterpreted by a provider.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 08: Risk ManagementButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.What is an important part of patient care that can minimize the risk of a formal patientcomplaint even when a mistake is made?a.Ensuring informed consent for all proceduresb.Maintaining effective patient communicationc.Monitoring patient compliance and adherenced.Providing complete documentation of visitsANS: BEffective patient communication is key to building trust and rapport and ineffectivecommunication is a predictor for malpractice claims. The other items are important aspectsof care and may help the provider during the investigation of a claim, but do not minimizethe risk.MULTIPLE RESPONSE1.What are some causes for failures or delays in diagnosing patients resulting in malpracticeclaims? (Select all that apply.)a.Failing to recognize a medication complicationb.Failing to request appropriate consultationsc.Improper performance ofNaUtrReaStmINenGtTB.COMd.Not acting on diagnostic test resultse.Ordering a wrong medicationANS: B, DFailing to obtain consultations when indicated or not acting on diagnostic test results canlead to diagnosis-related failures. Failing to recognize medication complications andordering a wrong medication lead to medication prescribing allegations. Improperperformance of a treatment can lead to treatment-related malpractice claims.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 09: Adolescent IssuesButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.Which behavior is most characteristic of early adolescence?a.Arguing with parents and teachersb.Assimilating adult roles and thinkingc.Exhibiting fatigue more frequentlyd.Experimenting with sex and risky behaviorsANS: AEarly adolescents challenge authority, experience wide mood swings, reject the ideation ofchildhood, and can be argumentative and disobedient. Middle adolescents experiencefatigue and begin experimenting with sex and risky behaviors. Late adolescents begin toassimilate adult roles.2.What is the initial sign of puberty in the adolescent male?a.Deepening of the voiceb.Elongation of the penisc.Nocturnal emissionsd.Testicular enlargementANS: DTesticular enlargement is the initial sign of puberty in adolescent males. Penile growth andnocturnal emissionsoccur latNerUaRsSdoIeNsGdeTeBpe.nCinOgMof the voice.3.A parent reports that an adolescent child does well in school but seems to consistently makepoor decisions about activities with friends. What will the practitioner recommend as anapproach to help the adolescent make better decisions?a.Correcting the adolescent’s decisions and judgmentsb.Listening without making suggestions about choicesc.Making decisions for the adolescent to provide guidanced.Providing information about appropriate behaviorANS: BListening without correcting is the best approach to help adolescents learn to make gooddecisions. Correcting the decisions, making decisions for the adolescent, or givinginformation that is unsolicited is not recommended.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 10: LGBTQ Patient Care: Care of Sexual and Gender Minority PeopleButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.What is the focus of the Minority Stress Theory?a.Clarifying the various terms used to describe the LGBTQ communityb.Understanding the health needs of select members of the sexual minoritycommunityc.Helping health care providers eliminate biases in the care they provide to themembers of the LGBTQ communityd.Facilitating the management of stress related to the lifestyle choices made bymembers of sexual minority populations.ANS: BThe focus of the Minority Stress Theory is to provide a framework to the understanding ofthe health disparities in the sexual and gender minority (SGM) communities. The theorymay help achieve some aspect of the other options, but that is not its focus.2.What is the medical diagnostic term used to identify transgender patients?a.Gender dysphoriab.Gender expression disorderc.Gender identity disorderd.Gender role unconformityANS: AVERIFIED-TESTBANKGender dysphoria is the term used to identify transgender patients in order to justify themedical necessity of treatments for transgender patients. It replaces the previous “genderidentity disorder” designation.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 11: Pregnancy, Prenatal Care, and LactationButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.A woman who is currently pregnant reports that she has had three previous pregnancies: twinsdelivered at 35-weeks gestation (both living), one at 38-weeks gestation (living), and onemiscarriage at 16-weeks gestation. How will this be recorded as her G/TPAL in her electronicmedical record?a.G4P:1113b.G4P:1213c.G5P:1113d.G5P:1213ANS: AUsing the notation G (number of pregnancies), T (term deliveries), P (preterm deliveries), A(abortions—elective or spontaneous), and L (living children), this patient is G4P:1113. She isin her fourth pregnancy, so is G4. She has had one delivery at 38 weeks or more, one delivery(of twins) at less than 36 weeks gestation, one spontaneous abortion, and has three livingchildren.2.A pregnant woman who is overweight has no previous history of hypertension (HTN) ordiabetes mellitus (DM). Her initial screening exam reveals a blood pressure of 140/90 and afasting blood glucose of 128 mg/dL. What will the practitioner do?a.Initiate insulin therapy.b.Monitor blood pressureandNfUasRtiSngINblGooTdBg.luCcOosMe closely.c.Prescribe an antihypertensive medication.d.Refer the patient to a high-risk pregnancy specialist.ANS: BThis woman, although she has no previous history of HTN or DM, is at elevated risk becauseof obesity. Her initial screening lab values are at the high end of normal, indicating potentialdevelopment of gestational HTN and gestational DM. The initial response of the practitionershould be to monitor the patient closely and consider treatment at the first signs ofdevelopment of these complications. Referral is warranted when these conditions becomesevere.3.The mother of a 3-day-old newborn reports that her infant health care providers every 4 hoursduring the day and sleeps 6 hours at night. What will the provider recommend?a.Awakening the baby every 3 hours to health care providerb.Continuing this schedule until the infant is 6 months oldc.Ensuring that her infant health care providers for 15 to 20 minutes each timed.Pumping her breasts to maintain her milk supplyANS: ANewborn infants should health care provider 8 to 12 times daily and mothers should beencouraged to awaken a sleepy baby to health care provider every 2 to 3 hours or more often.The feedings will gradually space out as the infant is older.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TEST4.An infant who has just begun nursing develops hyperbilirubinemia. What will the provider tellthe mother?a.To decrease the frequency of breastfeedingb.To supplement feedings with extra waterc.To switch to formula until the bilirubin level dropsd.To use a breast pump to increase her milk supplyANS: DInfants with suboptimal breastfeeding can have starvation jaundice and mothers should beencouraged to increase the frequency of breastfeeding and should be offered a breast pump toincrease milk supply. It is not recommended to supplement with water or sugar water or toswitch to formula.5.A mother who has been breastfeeding her infant for several weeks develops a fever, breastwarmth, and breast tenderness. What will the provider recommend?a.Ice packs and decreased frequency of nursingb.Ice packs and increased frequency of nursingc.Warm packs and decreased frequency of nursingd.Warm packs and increased frequency of nursingANS: DThis mother has symptoms of mastitis. She should be encouraged to use warm packs forcomfort and to increase the frequency of nursing to relieve the pressure.MULTIPLE RESPONSE1.Apregnant woman reportsnotNhaUvRinSgIhNadGaTnBy.vCacOciMnationsasa child but requestsvaccinesduring her pregnancy. Which vaccines may be given? (Select all that apply.)a.Human papillomavirus (HPV)b.Inactivated influenzac.Live, attenuated influenzad.Measles, mumps, and rubella (MMR)e.Tetanus, diphtheria, and acellular pertussis (Tdap)f.VaricellaANS: A, B, ETdap is recommended to pregnant woman, optimally between 27- and 36-weeks gestation.Inactivated is strongly recommended and may be given at any point in the pregnancy.Hepatitis B is given to women at risk if needed. Live, attenuated influenza vaccine, MMR,and varicella vaccines are not recommended during pregnancy.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 12: Human TraffickingButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.An unaccompanied teenager is being treated in the emergency department for stomach pains.Which statement would alert the health care provider to the possibility that the patient may bea victim of human trafficking?a.“I can’t pay to see a doctor.”b.“I’ve never been to a hospital before.”c.“You are being very nice to me.”d.“Please, please, don’t hurt me.”ANS: DVictims of human trafficking may display a profound fearfulness during examination oftenfocusing on being hurt. None of the other options provide such a trigger for suspicion sincepoverty and unfamiliarity with established health care providers is not uncommon.2.A health care provider strongly suspects that the patient being treated for a laceration to theforehead may be a victim of human trafficking. What intervention should be implementedinitially before proceeding with a complete screening?a.Determine the patient’s ability to consent to treatment.b.Begin cleansing the wound in preparation for suturing.c.Transfer the patient to a private treatment room.d.Notify the police of the situation.ANS: CVERIFIED-TESTBANKFirst and foremost, the provider will want to provide a private location and to make sure thepatient is alone before asking any questions. The remaining options can wait to be initiateduntil privacy is provided.MULTIPLE RESPONSE1.What assessment data would trigger the health care provider’s suspicion that the patient seenin the emergency department may be a victim of human trafficking? (Select all that apply.)a.Provides details related to cause of injuryb.Appears to be illiteratec.Has “$50” tattooed on the left shoulder bladed.Cannot provide a local address of residencee.Looks much younger than state age of 21ANS: B, C, D, EVictims of sex trafficking may appear younger than their stated age, demonstrate learningdisabilities, and have unusual tattoos. Often, the victim will not be able to provide theiraddress, identification documents, and they can be unaware of their location or date. Such apatient is likely to present vague or inconsistent stories related to their illness or injury.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 13: Aging and Common Geriatric SyndromesButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.What intervention will the provider implement when prescribing medications to an80-year-old patient?a.Beginning with higher doses and decrease according to the patient’s responseb.Consulting the Beers list to help identify potentially problematic drugsc.Ensuring that the patient does not take more than five concurrent medicationsd.Reviewing all patient medications at the annual health maintenance visitANS: BThe Beers list provides a list of potentially inappropriate medications in all patients aged 65and older and helps minimize drug-related problems in this age group. Older patients shouldbe started on lower doses with gradual increase of doses depending on response and sideeffects. Patients who take five or more drugs are at increased risk for problems ofpolypharmacy, but many will need to take more than five drugs; providers must monitor theirresponse more closely. Medications should be reviewed at all visits, not just annually.2.An 80-year-old woman who lives alone is noted to have a recent weight loss of 5 pounds. Sheappears somewhat confused, according to her daughter, who is concerned that she isdeveloping dementia. The provider learns that the woman still drives, volunteers at the localhospital, and attends a book club with several friends once a month. What is the initial step inevaluating this patient?a.Obtaining a CBC,serum elNecUtrRolSyIteNs,GBTUBN.,CanOdMglucoseb.Ordering a CBC, serum ferritin, and TIBCc.Referring the patient to a dietician for nutritional evaluationd.Referring the patient to a neurologist for evaluation for ADANS: APatients with weight loss, confusion, and lethargy are often dehydrated and this should beevaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient is currently leadingan active life, so the likelihood that recent symptoms are related to AD, although this may beevaluated if dehydration is ruled out. Anemia would be a consideration when dehydration isruled out. Referrals are not necessary unless initial evaluations suggest that malnutrition orAD is present.MULTIPLE RESPONSE1.The practitioner is establishing a plan for routine health maintenance for a new client who is80 years old. The client has never smoked and has been in good health. What will thepractitioner include in routine care for this patient? (Select all that apply.)a.Annual hypertension screeningb.Baseline abdominal aorta ultrasoundc.Colonoscopy every 10 yearsd.One-time hepatitis B vaccinee.Pneumovax vaccine if not previously givenf.Yearly influenza vaccine

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTANS: E, FFor older clients a one-time pneumovax is given after age 65. Influenza vaccine should begiven every year. Hypertension screening should be performed at each office visit, not justannually. An abdominal aorta US is performed once for every smoking male. Colonoscopy isperformed every 10 years after age 50, but not after age 74.VERIFIED-TESTBANK

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 14: Palliative CareButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.When should palliative care be initiated by a primary care provider?a.After an ill patient asks for Hospice servicesb.As part of routine health maintenancec.When a patient is diagnosed with a serious diseased.When an interdisciplinary team is formed to manage a diseaseANS: BPalliative care support begins with an understanding of a patient’s preferences and helping thepatient to identify goals of care. Health care providers should initiate such discussions as acomponent of the initial history of adults regardless of age or health status. Palliative careservices may be ordered when a patient is diagnosed with a serious disease; waiting until thepatient asks for Hospice services or when an interdisciplinary team is formed increases thechances of providing end-of-life care that does not meet the patient’s needs.MULTIPLE RESPONSE1.When using the “Five Wishes” approach to documenting patient preferences for end-of-lifecare, the provider will document which types of preferences? (Select all that apply.)a.A directive to avoid calling 911 at the time of deathb.A specific list of treatments the patient does not wantc.Howmuch information to gNivUeRvSarIioNuGsTfaBm.ilCyOmMembersd.The level of sedation versus alertness the patient desirese.The people designated to make care decisions for the patientANS: C, D, EThe Five Wishes approach addresses the type of care a patient wants as a disease progressesand is less defensive than the traditional advance directive which indicates the type of care apatient does not want. Calling 911 may be done without requiring resuscitation if the patienthas an appropriate advanced directive in place.2.A patient who is near death is exhibiting signs of agitation, anxiety, and intractable pain.When discussing palliative sedation with this patient’s family, what will be discussed? (Selectall that apply.)a.The chance that refractory symptoms will be alleviatedb.The fact that this is an intervention of last resortc.The likelihood that the patient will develop dependence on the drugsd.The need for informed consent from the patient and familye.The possibility that this measure may hasten deathANS: B, D, E

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTPalliative sedation is used as a treatment of last resort for patients whose symptoms areintolerable or refractory. Patients, if possible, and family members must give informedconsent. This treatment has the possibility of hastening death by inhibiting respirations.Symptoms will not be alleviated by using the measure. The chance of drug dependence isirrelevant in this situation.VERIFIED-TESTBANK

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 15: Acute, Chronic, Oncologic, and End-of-Life Pain Management in PrimaryCareButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.A patient who has chronic lower back pain reports increased difficulty sleeping unrelated todiscomfort, along with a desire to quit working. What will the provider do?a.Ask the patient about addiction issues.b.Consult with a social worker.c.Increase the dosage of prescribed pain medications.d.Order radiographic studies of the lower spine.ANS: BPatients who exhibit poor sleep and poor coping may be developing mental defeat as a resultof chronic pain and should be evaluated and treated early for this to prevent further disabilityand improve functionality. Substance abuse may be a part of mental defeat and should beevaluated based on assessment findings. Unless the symptoms are related to pain, increasingthe dose of analgesics and ordering diagnostic studies are not indicated.2.A patient with chronic leg pain describes the pain as “stabbing” and “throbbing.” This ischaracteristic of which type of pain?a.Neuropathic painb.Referred painc.Somatic paind.Visceral painANS: CVERIFIED-TESTBANKSomatic pain is caused by the activation of nociceptors in the peripheral tissues, includingskin, bones, muscles, and soft tissue and is usually well-localized and characterized asstabbing, aching, or throbbing. Neuropathic pain occurs from injury to or disease of thenervous system and is described as burning, shooting, or tingling. Referred pain is a kind ofvisceral pain that is localized, but not attributable to the involved organ. Visceral pain isrelated to an organ and is often referred and poorly localized.3.A patient is beginning treatment for chronic pain and is unable to tolerate nonsteroidalanti-inflammatory drugs. What will the provider prescribe for this patient?a.A mixed opiate productb.A pure opioid compoundc.A referral for a nerve block procedured.A selective serotonin reuptake inhibitor (SSRI)ANS: DUsing the three-step analgesic ladder, the provider should use step 1 medications that includeNSAIDs, tricyclic antidepressants, selective serotonin reuptake inhibitors, or anticonvulsants.Since the patient cannot tolerate NSAIDs, an SSRI is an appropriate choice. The next step ifthese fail is a mixed opioid product. The third step is a pure opioid product. If medicationtherapy fails, a referral for nerve block may be necessary.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 16: Wellness: An Integrated PerspectiveButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.An international traveler plans to travel to Kenya in sub-Saharan Africa. Which is animportant disease precaution for this person?a.Carrying chloroquine to take as neededb.Starting prophylactic doxycycline before travelc.Taking precautions against Chikungunya feverd.Understanding how Ebola virus is transmittedANS: BMalaria is a greater concern worldwide than Ebola virus and Chikungunya fever, althoughboth are emerging diseases. Travelers should take antimalarial medications and, in this part ofAfrica, where there is widespread resistance to chloroquine, doxycycline is a better choice asprophylaxis. Even when chloroquine is appropriate, it must be taken prior to travel and not asneeded. Chikungunya fever is a disease of the Western Hemisphere, especially in theCaribbean. Ebola virus is epidemic in western Africa and not in Kenya.2.A patient who is planning international travel to a developing country asks the provider aboutvaccinations. Which is true about pretravel vaccines?a.Country-specific guidelines are provided by individual embassies.b.Malaria vaccine is the most important vaccine for worldwide travel.c.Requirements should be reviewed at least 4 to 6 weeks prior to travel.d.There are at leastfive requiNreUdRvSacIcNinGesTfBor.eCnOtryMinto certain countries.ANS: CPatients seeking immunizations prior to international travel should have these reviewed atleast 4 to 6 weeks prior so that antibody responses and completion of vaccine series mayoccur. Country-specific guidelines may be found on the CDC website. Malaria is notprevented by vaccine, but by prophylactic antimalarial drugs. There are only two vaccines thatare required.3.What is a goal of theHealthy Peopleinitiative?a.To increase a patient’s quality of lifeb.To create physical environments that promote proper healthc.To achieve health equality by eliminating disparitiesd.To provide free health care to those unable to pay for caree.To promote healthy behaviors across all life stagesANS: COverarching goals of theHealthy Peopleinitiative are to increase quality and length of life,free of preventable disease, disability, injury, and premature death; to achieve health equalityby eliminating disparities; to create social and physical environments that promote properhealth; and to promote increased quality of life, healthy development, and healthy behaviorsacross all life stages, all goals consistent with the definition of wellness. Free health care isnot a stated goal of the initiative.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 17: Obesity and Weight ManagementButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.A woman who is obese has a neck circumference of 16.5 cm. Which test is necessary to assessfor complications of obesity in this patient based on this finding?a.Electrocardiographyb.Gallbladder ultrasonographyc.Mammographyd.PolysomnographyANS: DWomen with a neck circumference greater than 16 cm have an increased risk of obstructivesleep apnea and should have polysomnography to assess for this complication. The other testsmay be necessary for obese patients but are not specific to this finding.MULTIPLE RESPONSE1.Which medications are associated with weight gain? (Select all that apply.)a.Antibioticsb.Antidepressantsc.Antihistaminesd.Insulin analogse.AnticonvulsantsANS: B, C, D, EVERIFIED-TESTBANKAntidepressants, antihistamines, insulin and insulin analogs, and seizure medications are allassociated with weight gain. Antibiotics are not associated with weight gain.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 18: Principles of Occupational and Environmental Health in Primary CareButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.A patient who has a history of working around asbestos and silica fibers is concerned aboutdeveloping lung disease. The primary care provider determines that the patient has a previoushistory of asthma as a child and currently has frequent episodes of bronchitis. A physicalexamination is normal and pulmonary function tests and radiographs are negative. Whataction is correct?a.Reassure the patient about the normal findings.b.Refer the patient to an occupational health specialist.c.Request a workplace environmental assessment.d.Suggest that the patient follow up with a pulmonologist.ANS: BPatients with environmental exposure may not have symptoms or positive findings. Becausethis patient reports frequent bronchitis, this should be followed up with an occupational healthspecialist who can evaluate the degree of exposure and perform further testing. Normalfindings are not necessarily reassuring. The occupational specialist may request anenvironmental assessment. Pulmonologists are not trained in occupational health.MULTIPLE RESPONSE1.During a preplacement screening for a person hired for a job requiring heavy lifting, a primarycare provider notesthat the newNUemRpSloIyNeeGhTaBs.enCvOirMonmental allergies, a history ofgastroesophageal reflux disease (GERD), recurrent eczema, a previous history of an anklefracture, and normal lower back strength and flexibility. A urine drug screen is negative. Whatwill be included in the report to the employer? (Select all that apply.)a.GERD historyb.History of allergies and eczemac.History of ankle fractured.Lower back screening resultse.Urine drug screening resultsANS: D, EOnly findings related to the ability of the individual to perform position requirements for thejob are included in the report. Other findings should not be included, even though they mayneed to be addressed.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 19: College HealthButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.A female college student seeks information about emergency contraception. What is the mostimportant part of the assessment of this patient?a.Cultural considerations for use of contraceptionb.Feelings of guilt about a possible pregnancyc.Possible concerns about confidentialityd.The female’s sense of control in sexual situationsANS: DBecause college women are at greater risk for sexual violence and assault, a request foremergency contraception must be followed by an evaluation of possible rape or assault. Theother considerations may be part of the assessment but are not as important as determiningwhether a rape has occurred.2.A female freshman college student tells the primary care provider at the student health centerthat she has a history of anorexia nervosa that has been well-controlled for several years. Whatwill the provider recommend for this student?a.Dietary counselingb.Participation in sportsc.Regular weight assessmentsd.Stress management strategiesANS: DVERIFIED-TESTBANKStudents with previous eating disorders may regress when stressed, so stress management isessential. Unless she begins to regress, dietary counseling is not indicated. Many whoparticipate in sports will develop eating disorders to control weight. It is not necessary toevaluate weight regularly.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 20: Presurgical ClearanceButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.Which patient should have pulmonary function testing as part of the presurgical exam?a.A patient older than 60 years of ageb.A patient undergoing major intrathoracic surgeryc.A patient with a history of pneumonia in the last 2 yearsd.A patient with diabetes and morbid obesityANS: BAny patient undergoing major thoracic surgery should have pulmonary function testing. Ageover 60 years, a history of pneumonia, and diabetes and obesity do not require pulmonaryfunction testing unless there is comorbid COPD.MULTIPLE RESPONSE1.Which factors determine which diagnostic tests should be performed in a presurgicalclearance evaluation? (Select all that apply.)a.Patient’s ageb.Patient’s comorbiditiesc.Previous surgeriesd.Surgeon’s preferencee.Type of anesthetic agent plannedVERIFIED-TESTBANKANS: A, B, D, EThe patient’s age and comorbidities, surgeon preference, and the type of anesthetic planned alldetermine which presurgical diagnostic tests will be performed. The patient’s previoussurgeries do not determine presurgical testing.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 21: Preparticipation Sports PhysicalButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.During a preparticipation sports physical, the examiner notes a difference in strength of thepatient’s radial and femoral pulses with the femoral pulses being weaker. What will theprovider do?a.Evaluate for orthostatic hypotension.b.Obtain Doppler studies of lower extremity circulation.c.Reassure the patient that this is a normal finding.d.Refer the patient for a cardiologic exam.ANS: DDifferences in strength between radial and femoral pulses may indicate coarctation of theaorta and should be evaluated by a cardiologist. This finding does not indicate orthostatichypotension. The likelihood of decreased circulation is low in a young athlete.2.A high-school adolescent is being screened for fitness before participating in sports. Theadolescent has a normal examination and the examiner notes S1 and S2 heart sounds withoutmurmur, normal blood pressure, and equal pulses. The parent reports that the adolescent’sfather has a history or Wolff-Parkinson-White syndrome, which has been treated. What willthe provider do?a.Clear the adolescent to play sports.b.Perform an electrocardiogram.c.Refer the adolescent to a caNrdUioRlSogIisNt.GTB.COMd.Tell the adolescent that sports are not allowed.ANS: CA positive family history of Wolff-Parkinson-White syndrome requires physician consultationor referral before medical clearance can be given. The adolescent has a normal heart rate andphysical exam, so the ECG may not yield significant or useful results. The examiner cannotclear the adolescent without consulting with a specialist. The adolescent may be cleared forsports by the specialist.3.An overweight adolescent who takes metformin has type 2 diabetes with a HgA1C of 8.5%and asks about sports participation. What will the provider recommend?a.Losing weight prior to initiating sports participationb.Participation in strenuous sports to help with weight lossc.Referral to the endocrinologist for sports clearanced.Switching to insulin therapy prior to participationANS: CPatients with poorly controlled diabetes should be referred to a specialist prior to clearance forsports participation. This patient has an elevated HgA1C, indicating poor control. Theendocrinologist may suggest the other options, but the primary care provider should not clearthis patient for participation in sports.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 22: Acute BronchospasmButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.A patient diagnosed with asthma has been prescribed three bronchodilator treatments butcontinues to experience wheezing and shortness of breath. The health care provider caring forthe patient notes an oxygen saturation of 90% on room air. What action is indicated?a.Administer oxygen and continue to monitor the patient.b.Contact the respiratory therapist to administer another treatment.c.Notify the patient’s physician immediately.d.Reassure the patient that the treatments will take effect soon.ANS: CPatients with bronchospasm who have oxygen saturations less than 92% on room air and whofail to improve with nebulizer treatment given three times, need physician consultation. Whileoxygen administration and further nebulizer treatments may be indicated, it is incorrect tocontinue to monitor the patient without notifying the physician.2.Which symptom in a patient diagnosed with asthma indicates severe bronchospasm?a.Breathlessness with minimal activity or eatingb.Pausing to breathe while attempting to talkc.Repetitive, spasmodic coughing at nightd.Wheezing after exposure to a triggerANS: BInability to speak a fullsentencNeUwRitShoIuNtGpaTuBsi.ngCtOoMbreathe indicatessevere bronchospasm.Breathlessness, repetitive and spasmodic coughing, and wheezing are all common signs ofbronchospasm and do not necessarily indicate severe bronchospasm.MULTIPLE RESPONSE1.Which clinical findings are worrisome in a patient experiencing acute bronchospasm,requiring immediate treatment? (Select all that apply.)a.A silent chest after previously wheezingb.Decreasing blood pressurec.Presence of an urticarial rashd.Pulsus paradoxus of 10 mm Hge.Wheezing on both inspiration and expirationANS: A, B, CA silent chest indicates severe spasm and is an ominous sign. Decreasing blood pressure andurticarial rash are present with anaphylaxis, which is a respiratory emergency requiringoxygen, diphenhydramine or epinephrine. A pulsus paradoxus greater than 25 mm Hg isworrisome. Wheezing on inspiration and expiration is a common finding and not necessarilyan emergency.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 23: AnaphylaxisButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.A child with no previous history of asthma is brought to the emergency department withwheezing, stridor, and shortness of breath. When the child is started on oxygen and given anebulized bronchodilator treatment, the treatment team notes a wheal and flare rash on thechild’s trunk. What medication will be given immediately?a.Inhaled racemic epinephrineb.Intramuscular epinephrinec.Intravenous diphenhydramined.Intravenous ranitidineANS: BThe patient has signs of anaphylaxis and should be given IM or SC epinephrine immediatelyas first-line therapy, with this repeated every 5 to 20 minutes as needed to preventcardiovascular shock. Inhaled epinephrine is used for acute upper airway bronchospasm.Diphenhydramine and ranitidine are given as second-line treatment after epinephrine isadministered or for mild, non-life-threatening allergic reactions.2.A man self-administers aqueous epinephrine after experiencing a bee sting and developingangioedema and wheezing. What should the man do next?a.Obtain transport to an emergency department immediately.b.Repeat the epinephrine dose if needed and notify a physician of the episode.c.Resume normal activity ifsNyUmRptSoImNfrGeTeBaf.teCrO30Mto 60 minutes.d.Take oral diphenhydramine and report any symptoms to a provider.ANS: AThe man has a history of anaphylaxis and experienced symptoms after contact with a trigger.The aqueous epinephrine should be used immediately but does not prevent the need for followup in an emergency department for close observation, since continued reaction to the allergencan occur for 6 to 8 hours. The epinephrine dose may be given if needed before emergencypersonnel arrive, but a second dose is not enough to prevent ongoing reaction to the allergen.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROChapter 24: Bites and StingsButtaro: Primary Care: A Collaborative Practice, 6th EditionVERIFIED-TESTMULTIPLE CHOICE1.A child experiences a snake bite while camping and is seen in the emergency department. Thechild’s parents are not able to identify the type of snake. An inspection of the site reveals twopuncture wounds on the child’s arm with no swelling or erythema at the site. The child hasnormal vital signs. Which treatment is indicated?a.Administering antivenom and observing the child for 24 to 48 hoursb.Cleaning the wound, giving tetanus prophylaxis, and observing for 12 hoursc.Performing a type and cross match of the child’s bloodd.Referral to a surgeon for incision and suction of the woundANS: BThe child does not have immediate symptoms of envenomation, since there is no swelling orerythema. Because symptoms may be delayed, and the type of snake is unknown, the childshould be observed in an ED or hospital for 12 hours after providing wound care and tetanusprophylaxis. Antivenom is not indicated unless envenomation occurs. Type and cross match isdone if envenomation is severe. Incision and suction of the sound is not recommended.MULTIPLE RESPONSE1.A patient is seen in the emergency department after experiencing a spider bite. The spider is ina jar and is less than one inch in size, yellow-brown, and has a violin-shaped marking on itsback. Depending on the patientN’sUsRymSIptNomGsT,Bw.hiCcOhMtreatments and diagnostic evaluations maybe ordered? (Select all that apply.)a.Airway managementb.An acute abdominal seriesc.Antivenom therapyd.CBC, BUN, electrolytes, and creatininee.Coagulation studiesf.Tetanus prophylaxisANS: D, E, FThe spider is a brown recluse. If the patient exhibits systemic symptoms, laboratory workup,including CBC, BUN, creatinine, electrolytes, and coagulation studies should be performed.Tetanus prophylaxis is given. Airway management, an acute abdominal series, and antivenomtherapy are used for black widow spider bites.

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TEST BANK FOR PRIMARY CARE 6TH EDITION BY BUTTAROVERIFIED-TESTChapter 25: Bradycardia and TachycardiaButtaro: Primary Care: A Collaborative Practice, 6th EditionMULTIPLE CHOICE1.A patient prescribed a beta blocker medication is in the emergency department with reports ofsyncope, shortness of breath, and hypotension. A cardiac monitor reveals a heart rate of 35beats per minute. Which medication may be used to stabilize this patient?a.Adenosineb.Amiodaronec.Atropined.EpinephrineANS: DEpinephrine is indicated if unstable bradycardia is caused by beta blockers. This patient issymptomatic and unstable and should be treated. Adenosine and amiodarone are used to treattachycardia. Atropine is used for some types of bradycardia, but not when induced by betablockers.2.A patient reports heart palpitation but no other symptoms and has no prior history ofcardiovascular disease. The clinic provider performs an electrocardiogram and notes atrialfibrillation and a heart rate of 120 beats per minute. Which is the initial course of action intreating this patient?a.Administer atenolol intravenously.b.Admit to the hospital for urgent cardioversion.c.Refer the patient to a cardioNloUgRisSt.INGTB.COMd.Initiate steps to begin anticoagulant therapy.ANS: CThis patient has no history of serious heart disease and does not have symptoms of chestpressure, acute MI, or congestive heart failure and may be referred to a cardiologist forevaluation and treatment but anticoagulant therapy to minimize the risk of clot formationshould be started initially. The 2014 AHA Guidelines for Atrial Fibrillation recommendshared decision-making in regard to anticoagulation based on relative risk of the patient forthromboembolic event. Atenolol is given IV for patients who are unstable; the advanced lifesupport treatment guidelines do not recommend treatment of tachycardia if the patient isstable. Urgent cardioversion is rarely needed if the heart rate is less than 150 beats per minuteunless there are underlying heart conditions.3.Which cardiac arrhythmia in an unstable patient requires unsynchronized shocks, ordefibrillation?a.Atrial fibrillationb.Atrial flutterc.Monomorphic ventricular tachycardiad.Polymorphic ventricular tachycardiaANS: DPolymorphic ventricular tachycardia should be treated as ventricular fibrillation withunsynchronized shocks. The other arrhythmias are treated with synchronized cardioversion.

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