FREE CCP Clinical Care in Long-Term Care Questions and Answers

Question 1

An 85-year-old resident with an indwelling urinary catheter has cloudy, foul-smelling urine.
The resident is afebrile, has no new costovertebral angle tenderness, and exhibits no new behavioral changes.
A nurse requests an order for an antibiotic.
What is the consultant pharmacist's most appropriate recommendation based on antimicrobial stewardship principles?

Accepted Answer

Recommend against antibiotic therapy at this time, explaining that the findings represent asymptomatic bacteriuria per the Loeb criteria for catheterized residents.

Answer

Suggest a broad-spectrum antibiotic, such as a fluoroquinolone, to prevent the development of urosepsis.

Answer

Recommend obtaining a urinalysis and starting empiric antibiotic therapy immediately pending culture results.

Answer

Advise changing the urinary catheter and then reassessing the need for an antibiotic in 24 hours.

Question 2

According to CMS regulations for long-term care facilities, for which of the following medication classes is a gradual dose reduction (GDR) attempt required for a resident within the first year of use, unless clinically contraindicated?

Accepted Answer

Antidepressants.

Answer

Anticonvulsants used for a diagnosed seizure disorder.

Answer

Loop diuretics for congestive heart failure.

Answer

Opioid analgesics for chronic pain.

Question 3

A 90-year-old, non-verbal resident with advanced dementia has become increasingly agitated and now grimaces and resists care during repositioning. The facility has a PRN order for lorazepam for agitation. What is the consultant pharmacist's most appropriate initial recommendation?

Accepted Answer

Recommend a trial of scheduled acetaminophen to assess for and treat potential underlying pain as the cause of the behaviors.

Answer

Advise increasing the frequency of the PRN lorazepam to better control the agitation.

Answer

Suggest discontinuing the PRN lorazepam and adding a low-dose routine antipsychotic.

Answer

Document that these behaviors are an expected part of dementia progression and require no intervention.

Question 4

A consultant pharmacist is conducting a monthly inspection of a long-term care facility's Emergency Drug Kit (EDK). Which of the following findings represents a significant compliance concern that requires immediate correction?

Accepted Answer

The exterior of the kit is not labeled with the name and expiration date of the earliest-expiring drug inside.

Answer

The kit contains several single-dose vials of controlled substances for emergency use.

Answer

The medical director, director of nursing, and pharmacist jointly determined the kit's contents.

Answer

A nurse properly documented removing a medication based on a physician's verbal order in an emergency.

Question 5

An 88-year-old resident with type 2 diabetes, moderate cognitive impairment, and multiple comorbidities has an A1c of 6.8%. The resident is experiencing occasional morning hypoglycemia (blood glucose ~65 mg/dL) on a regimen that includes a sulfonylurea. Based on current geriatric diabetes guidelines, which recommendation is most appropriate?

Accepted Answer

Suggest relaxing the glycemic target to an A1c of 8.0-8.5% and de-prescribing the sulfonylurea.

Answer

Add metformin to the regimen to achieve a more aggressive A1c target of less than 6.5%.

Answer

Maintain the current regimen, as the A1c is close to the standard target of 7.0%.

Answer

Replace the sulfonylurea with a sliding scale insulin regimen for more flexible glucose control.

Question 6

A resident is being discharged from a skilled nursing facility (SNF) back to their home. To ensure a safe transition of care and prevent adverse drug events, what is the consultant pharmacist's most critical contribution to the discharge process?

Accepted Answer

Performing a final medication reconciliation to create a clear, comprehensive, and accurate discharge medication list for the patient, caregiver, and receiving providers.

Answer

Calling the resident's outpatient pharmacy to transfer the prescriptions.

Answer

Providing verbal counseling to the resident about the importance of adherence.

Answer

Ensuring the resident has a 7-day supply of all medications from the facility's pharmacy stock.