NUR 607 FINAL EXAM STUDY GUIDE (Mods 1,2,8 only)
Study online at https://quizlet.com/_hlmth6
1. What factors affect medication compliance?: complex medication regimens, cost of the drug,
side effects of the drug, ease of administration and/or drug form (e.g., large tablets or capsules), education and
communication between provider and patient, perceived side effects not truly related to the medication, functional
and/or mental deficits (eg. vision changes, dementia, arthritis of hands), provider approachability, perception of patient
respect, belief that the therapy is beneficial and outweighs the risks or side effects, the degree to which the patient
participates in the development of the treatment regimen, degree to which patient believes that expectations and
concerns are being met, degree to which the practitioner motivates the patient to adhere to the regimen, degree to
which the regimen is compatible with the patient's busy lifestyle, medication taste.
2. What are important aspects of patient teaching to consider?: Clear verbal instructions
with readable written instructions to take home if indicated. Educating regarding side effects in advance and instructing
patient to report to clinic with symptoms in order to prevent early discontinuation of drug. Instill the belief in the patient
that the drug will work for them in order to maintain adherence, advise patient to use only one pharmacy in order to
reduce drug to drug interactions.
3. Causes of poly-pharmacy in the elderly.: Varied symptoms and complaints associated with
chronic illnesses; when a drug doesn't work, another is prescribed (known as the prescribing cascade); stockpiling
discontinued medications due (primarily due to the cost); placing prescriptions in different bottles; sharing of medica-
tions between family members; seeing "polyproviders": seeing multiple specialists for various chronic diseases; failure
of providers to fully review the patient's other medications before prescribing; lack of primary care provider;
4. Risks associated with polypharmacy in the elderly:: Drug overuse and complications; ADRs;
creation of avoidable side effects and related complications
5. How do you address medication compliance issues?: Consider the cost of the drug; give a
written list and instructions to the patient after each office visit of the medications to be taken; give written instructions
in large, easy to understand instructions to the elderly; explain and document both the brand and generic names of the
drug with the patient to avoid confusion and explain the important reason for taking the medication; review medication
changes with family/caregivers (especially for those with cognitive impairments); recommend or provide medication
planners or weekly/daily dosage containers to improve compliance and promote safe administration; schedule timely
follow-ups and check for adherence at each visit.
6. What data collection is included in a patient's health history encounter?: Bio-
graphic data, reason for seeking care, history of present illness (if in pain, remember old cart); past health history; family
history; ROS; functional health patterns (including activities of daily living); allergies; surgical history; health habits;
social history; current medications, vaccination history; travel history. The physical exam and diagnostic tests then serve
to develop differential diagnoses.
1/7
, NUR 607 FINAL EXAM STUDY GUIDE (Mods 1,2,8 only)
Study online at https://quizlet.com/_hlmth6
7. What variables are associated with improved medication adherence?: The pa-
tient's perception of the encounter and benefit of treatment; If a patient is non-adherent, it is important to document
this in the chart; Discuss the risks of non adherence and document; Ask the patient why they aren't adhering and take
actions to rectify this. Document.
8. If patient is using a SABA more than twice a week, they are not well-con-
trolled.: True
9. If a patient has any form of persistent asthma, they should be using an
ICS.: True.
10. How often should a patient with persistent asthma using an ICS be moni-
tored?: Every 1-6 mos. A PEF (peak expiratory flow) should be done often. (Think of this as a simple FEv1). But you
MUST know the patient's baseline first. If it is 80% or above, this is good. If it is 50-80%, caution. If it is below 50%
emergency! If a patient has an exacerbation, they should be seen back in the office in one week. If a patient has just
started treatment for asthma, they should be seen in 3 months.
11. What vaccinations are especially important for those with COPD and asth-
ma?: influenza and pneumococcal
12. When are oral corticosteroids indicated in asthma patients?: When a patient has an
acute exacerbation, they will need a 5-10 day course of oral prednisone with rapid dose reduction. They may also be
prescribed for patients with poorly controlled asthma (e.g. severe persistent).
13. Should an ICS be prescribed as needed?: Never. It should be used as maintenance therapy.
14. How should cortisone therapy be discontinued in asthma patients?: If asthma
symptoms are well controlled for three months, oral steroids can be D/C'd first. Then the dose of inhaled corticosteroids
can be reduced by 50%. Further reduction in therapy can include reducing the ICS/LABA dose to once daily. If the
patient's asthma has been symptom-free for 6-12 months AND there are no risk factors for exacerbations, the long
term control regimen may be stopped.
15. When should asthma treatment be stepped up?: If the asthma isn't well-controlled with
2-3 months of long-term control medicine.
16. What is a possible issue related to self treatment with OTC drugs?: Masking
symptoms/delaying treatment. Additionally, many OTC drugs can counteract with prescribed medications, causing A/Es
and/or alteration in prescription drug efficacy or toxicity.
17. Pregnancy and smoking/cessation/teaching:: Patients should be instructed that no NRT has
been deemed safe in pregnancy. Behavioral therapy is indicated as first-line treatment for pregnant women and has
2/7
Study online at https://quizlet.com/_hlmth6
1. What factors affect medication compliance?: complex medication regimens, cost of the drug,
side effects of the drug, ease of administration and/or drug form (e.g., large tablets or capsules), education and
communication between provider and patient, perceived side effects not truly related to the medication, functional
and/or mental deficits (eg. vision changes, dementia, arthritis of hands), provider approachability, perception of patient
respect, belief that the therapy is beneficial and outweighs the risks or side effects, the degree to which the patient
participates in the development of the treatment regimen, degree to which patient believes that expectations and
concerns are being met, degree to which the practitioner motivates the patient to adhere to the regimen, degree to
which the regimen is compatible with the patient's busy lifestyle, medication taste.
2. What are important aspects of patient teaching to consider?: Clear verbal instructions
with readable written instructions to take home if indicated. Educating regarding side effects in advance and instructing
patient to report to clinic with symptoms in order to prevent early discontinuation of drug. Instill the belief in the patient
that the drug will work for them in order to maintain adherence, advise patient to use only one pharmacy in order to
reduce drug to drug interactions.
3. Causes of poly-pharmacy in the elderly.: Varied symptoms and complaints associated with
chronic illnesses; when a drug doesn't work, another is prescribed (known as the prescribing cascade); stockpiling
discontinued medications due (primarily due to the cost); placing prescriptions in different bottles; sharing of medica-
tions between family members; seeing "polyproviders": seeing multiple specialists for various chronic diseases; failure
of providers to fully review the patient's other medications before prescribing; lack of primary care provider;
4. Risks associated with polypharmacy in the elderly:: Drug overuse and complications; ADRs;
creation of avoidable side effects and related complications
5. How do you address medication compliance issues?: Consider the cost of the drug; give a
written list and instructions to the patient after each office visit of the medications to be taken; give written instructions
in large, easy to understand instructions to the elderly; explain and document both the brand and generic names of the
drug with the patient to avoid confusion and explain the important reason for taking the medication; review medication
changes with family/caregivers (especially for those with cognitive impairments); recommend or provide medication
planners or weekly/daily dosage containers to improve compliance and promote safe administration; schedule timely
follow-ups and check for adherence at each visit.
6. What data collection is included in a patient's health history encounter?: Bio-
graphic data, reason for seeking care, history of present illness (if in pain, remember old cart); past health history; family
history; ROS; functional health patterns (including activities of daily living); allergies; surgical history; health habits;
social history; current medications, vaccination history; travel history. The physical exam and diagnostic tests then serve
to develop differential diagnoses.
1/7
, NUR 607 FINAL EXAM STUDY GUIDE (Mods 1,2,8 only)
Study online at https://quizlet.com/_hlmth6
7. What variables are associated with improved medication adherence?: The pa-
tient's perception of the encounter and benefit of treatment; If a patient is non-adherent, it is important to document
this in the chart; Discuss the risks of non adherence and document; Ask the patient why they aren't adhering and take
actions to rectify this. Document.
8. If patient is using a SABA more than twice a week, they are not well-con-
trolled.: True
9. If a patient has any form of persistent asthma, they should be using an
ICS.: True.
10. How often should a patient with persistent asthma using an ICS be moni-
tored?: Every 1-6 mos. A PEF (peak expiratory flow) should be done often. (Think of this as a simple FEv1). But you
MUST know the patient's baseline first. If it is 80% or above, this is good. If it is 50-80%, caution. If it is below 50%
emergency! If a patient has an exacerbation, they should be seen back in the office in one week. If a patient has just
started treatment for asthma, they should be seen in 3 months.
11. What vaccinations are especially important for those with COPD and asth-
ma?: influenza and pneumococcal
12. When are oral corticosteroids indicated in asthma patients?: When a patient has an
acute exacerbation, they will need a 5-10 day course of oral prednisone with rapid dose reduction. They may also be
prescribed for patients with poorly controlled asthma (e.g. severe persistent).
13. Should an ICS be prescribed as needed?: Never. It should be used as maintenance therapy.
14. How should cortisone therapy be discontinued in asthma patients?: If asthma
symptoms are well controlled for three months, oral steroids can be D/C'd first. Then the dose of inhaled corticosteroids
can be reduced by 50%. Further reduction in therapy can include reducing the ICS/LABA dose to once daily. If the
patient's asthma has been symptom-free for 6-12 months AND there are no risk factors for exacerbations, the long
term control regimen may be stopped.
15. When should asthma treatment be stepped up?: If the asthma isn't well-controlled with
2-3 months of long-term control medicine.
16. What is a possible issue related to self treatment with OTC drugs?: Masking
symptoms/delaying treatment. Additionally, many OTC drugs can counteract with prescribed medications, causing A/Es
and/or alteration in prescription drug efficacy or toxicity.
17. Pregnancy and smoking/cessation/teaching:: Patients should be instructed that no NRT has
been deemed safe in pregnancy. Behavioral therapy is indicated as first-line treatment for pregnant women and has
2/7
