Question 1

A primary care NP sees a 5-year-old child who is morbidly obese.The child has an elevated hemoglobin A₁c and increased lipid levels.Both of the child's parents are overweight but not obese,and they tell the NP that they see nothing wrong with their child.They both state that it is difficult to refuse their child's requests for soda or ice cream.The NP should:

A) suggest that they give the child diet soda and low-fat frozen yogurt.
B) understand and respect the parents' beliefs about their child's self-image.
C) initiate a dialogue with the parents about the implications of the child's laboratory values.
D) suggest family counseling to explore ways to improve parenting skills and limits.

Accepted Answer

In this case,the child is at risk if the parents do not intervene.The NP should help the parents to see the potential adverse effects so that they can understand the need for treatment.The other answers are examples of the NP creating solutions.Unless the parents see the problem,they are not likely to engage in the treatment regimen.

Question 2

A primary care NP prepares to teach a patient about the management of a chronic condition.The patient says,"I don't want to know all of that.Just tell me what to take and when." The NP should initially:

A) give the patient basic written instructions about medications, follow up visits, and symptoms.
B) ask the patient to describe the disease process and the medications to evaluate understanding.
C) explain to the patient that without mutual cooperation, the treatment regimen will not be effective.
D) ask the patient to explore feelings and fears about having a chronic disease and taking medications.

Accepted Answer

The patient has stated expectations about care and treatment for the condition.The NP should begin by respecting that and providing the amount of information the patient wants.As the therapeutic relationship grows,the NP may elicit more active participation and understanding.

Question 3

To increase the likelihood of successful pharmacotherapy,when teaching a patient about using a medication,the primary care nurse practitioner (NP)should:&#10;A) encourage the patient to participate in the choice of the medication.&#10;B) provide education about the medication actions and adverse effects.&#10;C) stress the importance of taking the medication exactly as it is prescribed.&#10;D) give the patient copies of medication package inserts describing the drug use.

Accepted Answer

It is important that the patient "owns the problem" and has a part in the solution.Providing education about the medication,stressing the importance of following medication instructions,and distributing package inserts may be useful,but it is essential that patients take an active role in their care.

Question 4

A primary care NP writes a prescription for an off-label use for a drug.To help ensure compliance,the NP should:&#10;A) include information about the off-label use on the E-script.&#10;B) provide the patient with written instructions about how to use the medication.&#10;C) tell the patient to let the pharmacist know that the drug is being used for an off-label use.&#10;D) follow up by phone in several days to see if the patient is using the drug appropriately.

Accepted Answer

Effective communication extends beyond just the patient-provider relationship.It is important to include anyone involved in the patient's care.The best way in this case is to include the information on the E-script so that there is a record of the off-label use and to help clarify or reinforce the provider's instructions.

Question 5

A patient bursts into tears when the primary care NP diagnoses diabetes.The NP should:&#10;A) ask the patient about past experiences with anyone who has this diagnosis.&#10;B) reassure the patient that the medications and blood tests will become routine.&#10;C) call in a social worker to assist the patient to obtain equipment and supplies.&#10;D) refer the patient to a diabetes educator to provide teaching about the disease.

Accepted Answer

To help patients participate in their disease management,the NP must have an understanding of the patient's concerns and fears.The first step when the patient is obviously upset is to determine what the patient knows and fears about the disease.

Question 6

A parent brings a child who has moderate-persistent asthma to the clinic and tells the primary care NP that none of the child's medications are working.The parent says,"Everybody tells me something different.I don't know what to do." The NP suspects that the parent is not administering the medications appropriately.The NP should initially:

A) perform a careful history of the child's symptoms and the medications that are given.
B) provide a written asthma action plan and encourage the parent to call when symptoms are worse.
C) review what other providers have prescribed in the past and explain these interventions to the parent.
D) explain the different purposes of maintenance and rescue medications and give the parent a schedule for medication administration.

Accepted Answer

Clinical providers must refine listening and questioning skills and focus on the patient and the environment.It is important to begin with a thorough history and to elicit the patient's understanding of a disease or a medication to identify potential problems.Providing written action plans,reviewing past providers' prescriptions,and explaining medications are useful only after the NP determines what the problem is.

Question 7

A patient has recurrent symptoms and tells the primary care NP that she can't remember to take her medication all the time.The NP should:&#10;A) give her shortened regimens of the drug to facilitate compliance.&#10;B) provide written information about her condition and the medication.&#10;C) administer the medication in the clinic to ensure that she takes the drug.&#10;D) ask her about her lifestyle, her schedule, and her understanding of her condition.

Accepted Answer

If the attitude is that the patient has a problem for the health care provider to solve,then the provider owns the problem and often hastens to solve it.When patients own their problems,they are more likely to engage in their care and treatment.Giving shortened regimens,providing written information,and administrating medication in the clinic are examples of the provider solving the problem for the patient.

Deck 9: Establishing the Therapeutic Relationship