PHAR 6128 PPS II Final Exam - Chicago State University School of Pharmacy

Explanation:

Correct Answer: (A) True

Antiviral treatment for Herpes Simplex Virus type 1 (HSV-1), which causes herpes labialis (cold sores), is most effective when initiated during the prodromal phase — the period before the visible lesion appears, characterized by tingling, burning, itching, or numbness at the site. During this phase, viral replication is just beginning, and early intervention with antiviral agents such as acyclovir, valacyclovir, or OTC docosanol can significantly reduce the severity, duration, and size of the outbreak. Once the cold sore has progressed to the vesicle, ulcer, or crusting stage, treatment is far less effective at altering the course of the outbreak.

Explanation:

Correct Answer: (C) Pain, anxiety, secretions, nausea

Pain, anxiety, secretions (such as excessive respiratory secretions), and nausea are among the most common and clinically significant symptoms encountered in hospice patients that pharmacists actively help manage through medication optimization. Pain management (using opioids, adjuvant analgesics), anxiolytic therapy (using benzodiazepines), antisecretory agents (such as hyoscine/scopolamine for death rattle), and antiemetics are all core components of the pharmacist's role in hospice medication management and symptom control.

Why Other Options are Incorrect:

A. Muscle spasms, chills, teeth chattering — While muscle spasms may occasionally occur in hospice patients, chills and teeth chattering are not primary or commonly managed hospice symptoms and do not represent the central focus of pharmacist-driven symptom management in this setting.

B. Incontinence, dizziness, infection, skin discoloration — While incontinence and dizziness may occur in hospice patients, infection treatment is generally not a hospice priority (comfort over cure), and skin discoloration is not a pharmacologically managed symptom by pharmacists in this setting.

D. Itching, dry skin, congestion, sneezing — Pruritus can occur in hospice patients, particularly in liver or renal failure, but dry skin, congestion, and sneezing are not the primary focus of pharmacist-managed hospice symptom control.

E. Dysgeusia, sweating, blurry vision, hair loss — These symptoms are more typically associated with medication side effects or chemotherapy toxicity rather than the core symptoms that pharmacists focus on managing in hospice care.

Explanation:

Correct Answer: (B) 15-15 rule

A blood glucose of 60 mg/dL combined with symptoms of lightheadedness, palpitations, and headache indicates mild to moderate hypoglycemia. The 15-15 rule is the standard management guideline for conscious hypoglycemic patients: consume 15 grams of fast-acting carbohydrates, wait 15 minutes, then recheck blood glucose. If still low, repeat the process until blood glucose returns to a safe level.

Why Other Options are Incorrect:

A. 10-10 rule — This is not a recognized standard clinical guideline for managing hypoglycemia. The amount of carbohydrates and waiting time are insufficient for effective correction.

C. 20-20 rule — This is not a recognized hypoglycemia management protocol. Using more carbohydrates than necessary could result in rebound hyperglycemia.

D. 30-30 rule — This is also not a recognized clinical guideline. Administering 30 grams of carbohydrates could overcorrect blood glucose levels and is not the standard of care.

Explanation:

Correct Answer: (C) Contact the patient's primary care provider for recommendations and (D) Because of multiple disease states and her age, this patient should NOT be managed with a self-care medication

This 87-year-old patient with diabetes, chronic kidney disease (CKD), and hypertension is experiencing severe diarrhea (7–8 watery stools in 24 hours) accompanied by lethargy, fatigue, and reduced oral intake — all of which are red flag symptoms indicating significant dehydration and potential electrolyte imbalance. Given her age, multiple serious comorbidities, and the severity of symptoms, self-care management is not appropriate. She requires medical evaluation and possible IV fluid resuscitation. Contacting her primary care provider is the safest and most appropriate recommendation.

Why Other Options are Incorrect:

A. A generic brand of probiotics — While probiotics have some evidence for reducing diarrhea duration, they are not appropriate as the primary intervention for an elderly patient with this severity of symptoms, multiple comorbidities, and signs of dehydration. Recommending probiotics could delay necessary medical care.

B. Loperamide 2 mg tablets — Loperamide is contraindicated in this patient for several critical reasons: she has CKD (renal impairment affects drug elimination), she is elderly (increased sensitivity to anticholinergic and CNS effects), and her severity of diarrhea with systemic symptoms (lethargy, reduced intake) suggests she needs medical evaluation rather than symptom suppression, which could mask a serious underlying condition such as infectious colitis or bowel obstruction.

Explanation:

Correct Answer: (A), (B), (C), and (D) — All of the above

Reflective listening is a comprehensive communication technique used in patient counseling to build rapport, demonstrate empathy, and ensure understanding. It involves actively listening to the patient, then reflecting back their thoughts and feelings using their own words or paraphrased versions of their statements. All four options accurately describe components of reflective listening, making this a select-all-that-apply question where every option is correct.

Why each option is correct:

A. Utilized to demonstrate empathy — Reflective listening signals to the patient that their feelings are heard and validated, which is a core expression of empathy in therapeutic communication.

B. Reflecting the patients' thoughts and feelings you heard in their words — This is the foundational definition of reflective listening, mirroring back what the patient expressed.

C. Paraphrasing patients' statements — Paraphrasing is a key technique within reflective listening that shows comprehension and encourages the patient to continue sharing.

D. Utilized to demonstrate interest and understanding of the patients' statements — Reflective listening communicates genuine engagement and comprehension, reinforcing a patient-centered approach to care.

Explanation:

Correct Answer: (B) Simethicone and (C) Activated Charcoal

Simethicone works by breaking down gas bubbles that have already formed in the gastrointestinal tract, making it easier for the body to expel them. It is the most widely used agent for relief of existing intestinal gas. Activated charcoal can adsorb intestinal gas and help reduce bloating and flatulence that has already developed.

Why Other Options are Incorrect:

A. Alpha-Galactosidase — This enzyme works preventatively by breaking down complex carbohydrates before they are fermented by gut bacteria into gas. It must be taken before consuming gas-producing foods and is therefore not effective for gas that has already formed.

D. Lactase Enzymes — Similar to alpha-galactosidase, lactase enzymes are taken before consuming dairy products to prevent gas formation in lactose-intolerant patients. They do not act on gas that has already been produced.

Explanation:

Correct Answer: (C) Nicotine patch

The nicotine patch is dosed according to the number of cigarettes a patient smokes per day. Patients who smoke more than 10 cigarettes per day typically start on the highest dose patch (21 mg), while those who smoke 10 or fewer cigarettes per day start on a lower dose (14 mg). This dosing approach ensures the patch delivers an appropriate level of nicotine to manage withdrawal symptoms effectively.

Why Other Options are Incorrect:

A. Nicotine gum — The nicotine gum is dosed based on the time of the first cigarette of the day, not the total number of cigarettes smoked. Patients who smoke within 30 minutes of waking use the 4 mg gum, while others use the 2 mg gum.

B. Nicotine lozenge — Similar to the gum, the nicotine lozenge is also dosed based on the time to first cigarette in the morning, not the number of cigarettes smoked per day.

D. All of the above — This is incorrect because gum and lozenge dosing is determined by time to first cigarette, not cigarette quantity, making this option inaccurate.

Explanation:

Correct Answer: (D) Denial, Anger, Bargaining, Depression, and Acceptance

The five stages of grief, originally described by psychiatrist Elisabeth Kübler-Ross in her 1969 work "On Death and Dying," are Denial, Anger, Bargaining, Depression, and Acceptance — commonly remembered by the acronym DABDA. These stages describe the emotional journey that individuals may experience when facing terminal illness, significant loss, or major life change. It is important to note that not everyone experiences all stages or in this exact order, and the stages are not linear.

Why Other Options are Incorrect:

A. Denial, Anger, Psychosis, Depression, and Acceptance — Psychosis is not one of Kübler-Ross's five stages of grief. It is a psychiatric condition involving loss of contact with reality and has no place in the grief stage model.

B. Denial, Anger, Bargaining, Relief, and Acceptance — Relief is not a recognized stage in the Kübler-Ross model. While some individuals may feel relief after a prolonged illness concludes, it is not one of the five defined grief stages.

C. Denial, Anger, Bargaining, Surprise, and Acceptance — Surprise is not one of the five stages of grief. The fourth stage is Depression, not Surprise.

E. Denial, Anger, Depression, Acceptance, and Celebration — This omits Bargaining entirely and adds Celebration, which is not part of the Kübler-Ross grief model. The order is also incorrect.

Explanation:

Correct Answer: (C) Simethicone

Simethicone is the safest and most appropriate OTC recommendation for an infant experiencing gas discomfort. It works by breaking up gas bubbles already formed in the gastrointestinal tract, providing relief from bloating and discomfort. It is not absorbed systemically and is considered safe for use in infants, including those as young as the patient described.

Why Other Options are Incorrect:

A. Activated charcoal — Activated charcoal is not recommended for infants due to safety concerns and lack of established dosing guidelines for this age group. It is also not a first-line recommendation for infantile gas.

B. Lactase enzyme — Lactase enzyme is used for lactose intolerance, which is not indicated as the cause of this infant's gas. Additionally, there is no mention of dairy-related triggers in this case.

D. Alpha galactosidase — This enzyme is used to prevent gas caused by the consumption of complex carbohydrates such as beans and vegetables. It is intended for adults and is not appropriate for an 11-month-old infant.