Clinical Decision Making in Primary Care Review
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Course Introduction
Clinical Decision Making in Primary Care focuses on developing the skills and knowledge necessary for healthcare professionals to effectively assess, diagnose, and manage common health conditions encountered in primary care settings. The course emphasizes evidence-based practice, patient-centered care, and the integration of clinical judgment with current guidelines and diagnostic tools. Students will explore clinical reasoning processes, risk assessment, and the application of ethical and legal considerations in primary care decision making. Through the analysis of case studies and real-world scenarios, learners will enhance their critical thinking capabilities, communication skills, and approach to shared decision making with patients and interdisciplinary teams.
Recommended Textbook
Primary Care Art and Science of Advanced Practice Nursing 4th Edition by Dunphy
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Chapter 3: Health Promotion
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Q1) "There are 1,185,000 cases of HIV/AIDS in the United States" is an example of the morbidity rate.
A)True
B)False
Answer: True
Q2) Which of the following is an example of secondary prevention in a 50-year-old woman?
A)Yearly mammogram
B)Low animal fat diet
C)Use of seat belt
D)Daily application of sunscreen
Answer: A
Q3) Immunizations are an example of which type of prevention?
A)Primary
B)Secondary
C)Tertiary
Answer: A
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Chapter 5: Evidence-Based Care
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Q1) Which of the following would be considered the research design for Level II evidence?
A)Single descriptive or qualitative study
B)Well-designed case control or cohort studies
C)Single, well-designed, randomized clinical trial
D)Systematic review of randomized clinical trial studies
Q2) Which of the following would be considered the research design for Level III evidence?
A)Well-designed controlled trials without randomization
B)Systematic reviews of descriptive or qualitative studies
C)Systematic review of randomized clinical trial studies
D)Opinion of authorities and expert committees
Q3) Applying evidence at the point of care requires:
A)Readily available evidence-based resources
B)Ability to review research literature
C)Single articles in journals
D)Current textbooks
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Chapter 6: Neurological Problems
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Sample Questions
Q1) Which of the following signs is seen in a patient with more advanced PD?
A)Resting tremor
B)Bradykinesia
C)Rigidity
D)Postural instability
Q2) What antiplatelet agent is most widely used for secondary prevention of stroke?
A)Aspirin
B)Ticlopidine
C)Clopidogrel
D)Aspirin and clopidogrel
Q3) Which statement about confusion is true?
A)Confusion is a disease process.
B)Confusion is always temporary.
C)Age is a reliable predictor of confusion.
D)Polypharmacy is a major contributor to confusion in older adults.
Q4) Which of the following is a specific test to MS?
A)Magnetic resonance imaging (MRI)
B)Computed tomography (CT) scan
C)A lumbar puncture
D)There is no specific test.
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Chapter 7: Skin Problems
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Q1) A bulla is:
A)A vesicle larger than 1 cm in diameter
B)An elevated solid mass with a hard texture; the shape and borders can be regular or irregular
C)A superficial elevated lesion filled with purulent fluid
D)Thinning of the skin (epidermis and dermis) that appears white or translucent
Q2) Why do people of African descent have a lower incidence of non-melanoma skin cancer?
A)They have an increased number of melanocytes.
B)Their darker skin protects from ultraviolet radiation.
C)Their skin is thicker.
D)Their immune system is stronger.
Q3) Marci has a wart on her hand.She says she heard something about "silver duct tape therapy." What do you tell her about his?
A)It is an old wives' tale.
B)It is used as a last resort.
C)Salicylic acid is more effective.
D)It is a simple treatment that should be tried first.
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Chapter 8: Eyes, Ears, Nose, and Throat
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Q1) Which of the following is an example of sensorineural hearing loss?
A)Perforation of the tympanic membrane
B)Otosclerosis
C)Cholesteatoma
D)Presbycusis
Q2) Otitis media is considered chronic when:
A)Inflammation persists more than 3 months with intermittent or persistent otic discharge.
B)There are more than six occurrences of otitis media in a 1-year period.
C)Otitis media does not resolve after two courses of antibiotics.
D)All of the above
Q3) A patient presents to the clinician complaining of ear pain.On examination, the clinician finds that the patient has tenderness on traction of the pinna as well as when applying pressure over the tragus.These findings are classic signs of which condition?
A)Otitis media
B)Meniere's disease
C)Tinnitus
D)Otitis externa
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Chapter 9: Respiratory Problems
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Q1) Joyce is taking a long-acting beta agonist for her asthma.What additional medication should she be taking?
A)Inhaled corticosteroid
B)Leukotriene receptor antagonist
C)Systemic corticosteroid
D)Methyl xanthenes
Q2) Supplemental oxygen for how many hours per day has been shown to improve the mortality associated with COPD?
A)3 to 5 hours
B)6 to 10 hours
C)11 to 14 hours
D)15 to 18 hours
Q3) A patient with hypertension comes in and insists that one of his new medications is causing him to cough.When looking at his list of medications, you think the cough must be from:
A)Metoprolol
B)Clopidogrel
C)Tadalafil
D)Captopril
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Chapter 10: Cardiovascular Problems
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Q1) You just started Martha on HTN therapy.The Eighth Joint National Committee recommends that if her goal BP is not reached in what length of time, you should increase the initial drug or add a second drug to it?
A)1 month
B)3 months
C)6 months
D)1 year .
Q2) Which heart sound may be heard with poorly controlled hypertension, angina, and ischemic heart disease?
A)A physiologic split S2
B)A fixed split S2
C)S3
D)S4
Q3) Lifestyle modifications to manage hypertension (HTN) include:
A)Maintaining a body mass index of 17
B)Restricting dietary sodium to 2 grams per day
C)Engaging in exercise or physical activity for 90 minutes a day
D)Limiting beer intake to 24 ounces per day
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Chapter 11: Abdominal Problems
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Q1) A 28-year-old patient is seen in the clinic with colicky abdominal pain particular with meals.She has frequent constipation, flatulence, and abdominal distension.Which of the data make a diagnosis of diverticulitis unlikely?
A)Her age
B)Frequent constipation
C)Flatulence
D)Colicky abdominal pain
Q2) A patient is diagnosed with GERD, and his endoscopic report reveals the presence of Barrett's epithelium.Which of the following should the PCP include in the explanation of the pathology report?
A)This is a premalignant tissue.
B)This tissue is resistant to gastric acid.
C)This tissue supports healing of the esophagus.
D)All of the above
Q3) Which of the following is most effective in diagnosing appendicitis?
A)History and physical
B)Sedimentation rate
C)Kidney, ureter, and bladder x-ray
D)Complete blood count (CBC) with differentials
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Chapter 12: Renal Problems
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Sample Questions
Q1) A 42-year-old woman is seen in the clinic with fever, chills, vomiting, and severe dysuria.She is diagnosed with acute pyelonephritis.How should this patient be managed?
A)3-day course of oral antibiotics
B)Hospitalization
C)Encourage cranberry juice intake.
D)6-week course of antibiotics
Q2) A 34-year-old patient was treated for a UTI and has not responded to antibiotic therapy.Which of the following actions should be taken next?
A)Send a urine specimen for microscopy and evaluate for fungal colonies.
B)Increase the dose of antibiotic.
C)Order a cytoscopy.
D)Order a different antibiotic.
Q3) Which of the following foods should be limited in a patient with CRF?
A)Milk
B)Bananas
C)Soy sauce
D)All of the above
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Chapter 13: Mens Health Problems
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Q1) What is the treatment of choice for a patient diagnosed with testicular cancer?
A)Radical orchidectomy
B)Lumpectomy
C)Radiation implants
D)All of the above
Q2) Which of the following should be considered in a patient presenting with erectile dysfunction?
A)Diabetes mellitus
B)Hypertension
C)Atherosclerosis
D)All of the above
Q3) Which test is used to confirm a diagnosis of epididymitis?
A)Urinalysis
B)Gram stain of urethral discharge
C)Complete blood cell count with differential
D)Ultrasound of the scrotum
Q4) Hepatitis A is considered a sexually transmitted infection by the Centers for Disease Control and Prevention.
A)True
B)False
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Chapter 14: Womens Health Problems
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Q1) A 58-year-old woman, who had a total abdominal hysterectomy at the age of 45, is diagnosed with atrophic vaginitis.Which of the following is the most appropriate treatment?
A)Conjugated estrogen, 0.625 mg/day oral
B)Estradiol, 7.5 mcg/24 hr vaginal ring
C)Medroxyprogesterone, 10 mg/day oral
D)Conjugated estrogen, 0.3 mg + medroxyprogesterone 1.5 mg/day oral
Q2) A 40-year-old woman is seen for her yearly examination.She is single and not in a monogamous relationship.Her social history includes smoking cigarettes "occasionally" and drinking about two beers a day.Her body mass index (BMI) is 25.She is requesting birth control.Which of the following methods would be best for this patient?
A)Intrauterine device
B)Oral contraceptive
C)Condom
D)Vaginal contraceptive sponge
Q3) Most breast cancer cases are in women with a family history of breast cancer.
A)True
B)False
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Chapter 15: Musculoskeletal Problems
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Sample Questions
Q1) What is the recommended daily calcium intake for adults over the age of 50 with low bone mass?
A)1,200 mg/day
B)1,000 mg/day
C)1,300 mg/day
D)1,500 mg/day
Q2) Which stage of Paget's disease is characterized by elevated numbers of osteoblasts, resulting in abnormal increases in bone remodeling and leading to an irregular deposition of collagen fibers?
A)Lytic
B)Mixed
C)Sclerotic
D)All of the above
Q3) Osteoarthritis is primarily a noninflammatory condition.
A)True
B)False
Q4) The presence of a positive rheumatoid factor is always indicative of rheumatoid arthritis.
A)True
B)False
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Chapter 16: Endocrinemetabolic Problems
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Q1) A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine.Which of the following conditions that the patient also has would be a contraindication to taking metformin?
A)Ketoacidosis
B)Cirrhosis
C)Hypoglycemic episodes
D)All of the above
Q2) Which of the following tests should you order to confirm Mr.W's diagnosis?
A)Bone scan
B)Computed tomography (CT) scan
C)X-ray of the foot
D)Culture of the ulcer
Q3) After removing a tack from a type 2 diabetic's heel and evaluating the site for infection, what is the best plan for this patient?
A)Suggest she use a heating pad to improve circulation.
B)Refer to a podiatrist for a foot care treatment plan.
C)Send her for acupuncture treatments.
D)All of the above
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Chapter 17: Hematologic and Immune Problems
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Sample Questions
Q1) Which person is four times more likely to develop SLE than a Caucasian?
A)Persons of African descent
B)Asians
C)Hispanics
D)Middle Eastern Jews .
Q2) Sandra is 42 years old and has just been diagnosed with leukemia.She is complaining of bone and joint pain.Which type of leukemia is most likely the culprit?
A)Acute lymphocytic leukemia
B)Acute myelogenous leukemia
C)Chronic myelogenous leukemia
D)Chronic lymphocytic leukemia
Q3) An important complication of antiretroviral (ARV) therapy in patients with advanced AIDS is which of the following?
A)Immune reconstitution inflammatory syndrome
B)Improvement in opportunistic infections
C)Restoration of immune system to preinfection status
D)Progression to AIDS
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Chapter 18: Psychosocial Problems
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Q1) It is important to educate patients with depression and their family members about reporting signs of increasing depression and suicidal thoughts.This is especially true during which time period?
A)Before the initiation of treatment
B)1 to 2 weeks after the initiation of treatment
C)When switching to a different medication
D)1 to 2 weeks after tapering off medications
Q2) A no-suicide contract can prevent a suicide attempt.
A)True
B)False
Q3) The use of benzodiazepines in the patient with generalized anxiety disorder and comorbid depression can exacerbate depressive symptoms.
A)True
B)False
Q4) Rapid eye movement (REM) sleep occurs how frequently during non-REM sleep?
A)Every 30 minutes
B)Every 60 minutes
C)Every 90 minutes
D)Every 180 minutes
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Chapter 19: Emergency Problems
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Sample Questions
Q1) After a head injury, what is it called when air enters into the cerebrospinal fluid (CSF)Ðfilled spaces within the head?
A)Pneumocephalus
B)Hemotympanum
C)Battle's sign
D)Raccoon sign
Q2) What percentage of burns is involved using the rule of nines if both front legs are burned?
A)9%
B)18%
C)24%
D)36%
Q3) When giving discharge instructions to a patient with a laceration injury to his lower leg, which is the most important one?
A)Recommend isometric exercises to prevent a deep vein thrombosis (DVT).
B)Recommend cleansing the wound every 4 hours to prevent an infection.
C)Keep the leg elevated at waist level to prevent any edema.
D)Keep the leg completely immobile to prevent extension of the laceration.
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Chapter 20: Palliative Care
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Q1) A 75-year-old man is being treated as an outpatient for metastatic prostate cancer.Which of the following statements is true regarding the management of pain with opioids in the elderly?
A)Opioids with a long half-life, such as methadone, are a good choice, because they stay in the system longer, and patients do not have to remember to take multiple pills.
B)Serum creatinine is the best measurement of renal function in the elderly and should be done prior to the initiation of treatment with opioids.
C)Renal clearance of medications is faster in the elderly, so higher dosages of medications are needed to adequately control pain.
D)None of the above
Q2) Which of the following is the best description of dyspnea?
A)An oxygen saturation of less than 90%
B)Respiratory rate greater than 24
C)A psychological state resulting in the feeling of air hunger
D)A subjective feeling of breathlessness
Q3) Some anticonvulsant drugs can be used as an adjuvant treatment for mild pain.
A)True
B)False
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Page 19
Chapter 21: Ethical and Legal Issues of a Caring-Based Practice
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Q1) The relationship between ethics and law is such that:
A)What is ethical is also legal
B)What is unethical is also illegal
C)Legal actions may be both ethical and unethical
D)There is no relationship between the law and ethics
Q2) The main mechanism for avoiding a lawsuit involves:
A)Good liability insurance
B)A collaborating physician
C)Good documentation
D)Open communication skills
Q3) Which statement about the American Nurses Association Code of Ethics is accurate?
A)The state's legal requirements exceed those of the Code of Ethics.
B)The primary purpose of the Code is to show physicians that nurses are professional.
C)The Code was formulated by physicians for all nurses.
D)The Code sets forth the values and ethical principles that guide clinical decisions.
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Page 20
Chapter 22: Business of Advanced Practice
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Q1) Health-care billing is a significant reason for bankruptcy in the United States.The following provision of the Affordable Care Act (ACA) legislation was included to reduce this from occurring with insured patients:
A)Consumer assistance programs
B)Preventative care options standardized
C)Young adult coverage (under 26 years)
D)Elimination of lifetime limits
Q2) Identify one of the primary reasons for an APRN to develop a business plan?
A)To monitor monthly actual expense to budgeted expense
B)To reduce the likelihood of litigation action
C)To identify the marketing needed to grow the APRN practice
D)To assure accreditation standards are met
Q3) Accounting keeps track of the financial state of a business.The accounting report that demonstrates the growth in assets is:
A)Net income statement
B)Balance sheet
C)Cash flow statement
D)Operating statement
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Chapter 23: The 15-Minute Hour
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Q1) BATHEing the patient refers to:
A)A technique used in primary care to get the patient to accept the need for psychological or psychiatric referral
B)A technique used to facilitate cultural understanding
C)A technique used to perform psychotherapy
D)A technique that is a quick screen for psychiatric issues and interventions for psychological problems
Q2) Commonalities among psychotherapeutic techniques include the following:
A)Dream therapy, listening, and reflection
B)Psychodrama, group psychotherapy, and 12-step programs
C)Self-help groups
D)Obtaining external perspective and participation in a helping relationship
Q3) BATHEing the patient is an advanced practice nursing intervention that allows the practitioner to:
A)Develop a therapeutic relationship without "owning" the patient's problem
B)Conduct psychological counseling within the context of the primary care encounter
C)Focus on the "process" and not the assessment
D)Make the patient and family happier
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Chapter 24: Putting Caring Into Practice: Caring for Self
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Q1) A new era of health care leads to:
A)Greater opportunity for independent practice, yet increased legal risk in accountability for patients
B)Lowered reimbursement for all health-care services and providers
C)Decrease in status for health-care providers
D)No ability to individualize care
Q2) Self-care and personal development are built into the standards of practice of:
A)The American Holistic Nurses Association
B)The American Nurses Association
C)The American Association of Nurse Practitioners
D)The American Academy of Nursing
Q3) The World Health Organization defines self-care as:
A)An important global activity for all health-care providers
B)A set of deliberate actions that all individuals, families, and communities should engage in to maintain good health
C)Essential to efficacious advanced practice nursing (APRN) practice
D)An awareness by the APRN of their self-care behaviors as related to diet, activity, and mental attitude
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