MCQ Quiz: Addressing the Patient’s Issue

Effectively addressing a patient’s issue is the cornerstone of patient-centered care and a critical skill for every pharmacist. It involves more than just identifying a problem; it requires a sophisticated blend of empathy, active listening, and strategic communication to understand the patient’s perspective, values, and readiness for change. The modern PharmD curriculum, particularly in courses like Patient Care and the Professional Skills Labs, emphasizes advanced techniques like Motivational Interviewing (MI) to move beyond simple advice-giving and instead empower patients to become active partners in their own health. This quiz will test your knowledge on the core principles and skills needed to truly hear and collaboratively address a patient’s issue.

1. The core spirit of Motivational Interviewing (MI) is best described as:

• a) A confrontational method to force patient compliance.
• b) A collaborative, goal-oriented style of communication with particular attention to the language of change.
• c) A technique where the pharmacist provides all the solutions for the patient.
• d) A quick, checklist-based approach to patient counseling. Answer: b) A collaborative, goal-oriented style of communication with particular attention to the language of change.

2. The ‘O’ in the core MI skill set OARS stands for:

• a) Offering advice
• b) Open-ended questions
• c) Overcoming resistance
• d) Observing behavior Answer: b) Open-ended questions

3. A patient says, “I know I should take my blood pressure medicine, but I hate the side effects.” Which response is the best example of reflective listening?

• a) “You need to take it or you’ll have a stroke.”
• b) “What side effects are you experiencing?”
• c) “So on one hand, you know the medicine is important, but on the other, the side effects are making it really difficult for you to take it.”
• d) “Everyone experiences side effects, you just have to get used to them.” Answer: c) “So on one hand, you know the medicine is important, but on the other, the side effects are making it really difficult for you to take it.”

4. When a patient expresses reasons for not changing their behavior (e.g., “I enjoy smoking”), this is referred to in MI as:

• a) Change talk
• b) Sustain talk
• c) A therapeutic impasse
• d) Non-compliance Answer: b) Sustain talk

5. The goal of “developing discrepancy” in MI is to help the patient see the gap between:

• a) The cost of the medication and their budget.
• b) The pharmacist’s opinion and the doctor’s opinion.
• c) Their current behavior and their core values or goals.
• d) The brand name drug and the generic equivalent. Answer: c) Their current behavior and their core values or goals.

6. Which question is the best example of an open-ended question?

• a) “Are you taking your medication every day?”
• b) “Do you have any questions for me?”
• c) “Tell me a little bit about what your concerns are with this new inhaler.”
• d) “Is your blood pressure high today?” Answer: c) “Tell me a little bit about what your concerns are with this new inhaler.”

7. “Rolling with resistance,” a key MI principle, means:

• a) Agreeing with everything the patient says, even if it’s harmful.
• b) Arguing with the patient to prove them wrong.
• c) Avoiding direct confrontation and inviting the patient to consider new perspectives.
• d) Immediately referring a resistant patient to another provider. Answer: c) Avoiding direct confrontation and inviting the patient to consider new perspectives.

8. Which of the following is an example of an “affirmation”?

• a) “You really need to try harder.”
• b) “I appreciate that you were willing to come in and talk about this today. It takes courage.”
• c) “If you don’t quit smoking, your health will decline.”
• d) “Here is the information pamphlet you asked for.” Answer: b) “I appreciate that you were willing to come in and talk about this today. It takes courage.”

9. The ‘S’ in the OARS model stands for Summaries. A key function of a summary is to:

• a) End the conversation quickly.
• b) Demonstrate that you have been listening and to allow the patient to clarify any misunderstandings.
• c) List all the things the patient is doing wrong.
• d) Provide a written transcript of the conversation. Answer: b) Demonstrate that you have been listening and to allow the patient to clarify any misunderstandings.

10. According to the Patient Care VII curriculum, the process of “Addressing the Patient’s Issue” is a key component of which MI module?

• a) comMIt Module 4: Developing Rapport
• b) comMIt Module 6: Addressing the Patient’s Issue
• c) comMIt Module 3: Sense-Making
• d) The SBAR Communication Module Answer: b) comMIt Module 6: Addressing the Patient’s Issue

11. A patient says, “I guess it would be better for my health if I lost some weight.” This is an example of:

• a) Sustain talk
• b) Change talk
• c) Resistance
• d) A closed-ended question Answer: b) Change talk

12. The SCHOLAR-MAC acronym is a tool taught in the skills lab curriculum primarily used for:

• a) Structuring a formal debate.
• b) Documenting a SOAP note.
• c) Gathering information during a self-care consultation.
• d) Performing a physical assessment. Answer: c) Gathering information during a self-care consultation.

13. When a pharmacist uses the “teach-back” method, they are:

• a) Asking the patient to teach them about a new drug.
• b) Asking the patient to explain in their own words what they need to do, to ensure understanding.
• c) Re-teaching the same information multiple times.
• d) Giving the patient a written test. Answer: b) Asking the patient to explain in their own words what they need to do, to ensure understanding.

14. A patient is hesitant to start a new injectable medication due to a fear of needles. The first step in addressing this issue is to:

• a) Tell them there is no other option.
• b) Explore their specific fears and acknowledge their concern with empathy.
• c) Show them the needle immediately to prove it is small.
• d) Offer to give them the first injection without discussion. Answer: b) Explore their specific fears and acknowledge their concern with empathy.

15. A key principle of patient-centered care is:

• a) The provider makes all the decisions for the patient.
• b) The patient’s values and preferences guide clinical decisions.
• c) The focus is on the disease, not the person.
• d) The fastest, cheapest option is always chosen. Answer: b) The patient’s values and preferences guide clinical decisions.

16. The four processes of Motivational Interviewing are Engaging, Focusing, Evoking, and:

• a) Persuading
• b) Planning
• c) Predicting
• d) Punishing Answer: b) Planning

17. “It sounds like you’re feeling frustrated with your progress.” This statement is an example of:

• a) A simple reflection
• b) A complex reflection (reflecting feeling)
• c) An affirmation
• d) A summary Answer: b) A complex reflection (reflecting feeling)

18. When a patient is not ready to change, the appropriate MI strategy is to:

• a) End the conversation and label the patient as non-compliant.
• b) Raise your voice to emphasize the importance of change.
• c) Respect their autonomy, state your concern, and leave the door open for future conversations.
• d) Refer them to a different pharmacist. Answer: c) Respect their autonomy, state your concern, and leave the door open for future conversations.

19. As taught in the Professional Skills Lab curriculum, demonstrating empathy is a critical skill for addressing a patient’s issue because it:

• a) Proves the pharmacist is smarter than the patient.
• b) Builds rapport and trust, making the patient more willing to share information.
• c) Is a way to manipulate the patient into agreeing with you.
• d) Takes less time than a normal conversation. Answer: b) Builds rapport and trust, making the patient more willing to share information.

20. A patient tells you they are not taking their cholesterol medication because they read online that it causes muscle pain. The best initial response is:

• a) “The internet is wrong, you should always listen to your doctor.”
• b) “That’s a valid concern. Can you tell me more about what you read and if you’ve experienced any muscle pain yourself?”
• c) “Muscle pain is a rare side effect, so you shouldn’t worry about it.”
• d) “If you don’t take it, you’ll have a heart attack.” Answer: b) “That’s a valid concern. Can you tell me more about what you read and if you’ve experienced any muscle pain yourself?”

21. The “Focusing” process in MI involves:

• a) Finding a specific target behavior or issue to discuss.
• b) The initial process of establishing a connection.
• c) Eliciting the patient’s own motivations for change.
• d) Developing a specific change plan. Answer: a) Finding a specific target behavior or issue to discuss.

22. Using structured communication like SBAR (Situation, Background, Assessment, Recommendation) is most useful when addressing a patient’s issue with:

• a) The patient’s family member
• b) The patient themselves
• c) Another healthcare provider
• d) An insurance company representative Answer: c) Another healthcare provider

23. Which of the following helps in “evoking” change talk?

• a) Asking about the disadvantages of staying the same and the advantages of changing.
• b) Telling the patient all the bad things that will happen if they don’t change.
• c) Focusing only on the patient’s past failures.
• d) Asking only yes/no questions. Answer: a) Asking about the disadvantages of staying the same and the advantages of changing.

24. The spirit of MI includes “Compassion,” which means:

• a) Feeling sorry for the patient.
• b) Actively promoting the patient’s welfare and prioritizing their needs.
• c) Being detached from the patient’s situation.
• d) Sharing your own personal problems with the patient. Answer: b) Actively promoting the patient’s welfare and prioritizing their needs.

25. When addressing a patient’s issue, “normalizing” a patient’s feelings (e.g., “A lot of people find it difficult at first…”) is a technique used to:

• a) Minimize the patient’s problem.
• b) Show that their problem is not important.
• c) Reduce shame and show the patient they are not alone.
• d) Change the subject. Answer: c) Reduce shame and show the patient they are not alone.

26. Asking a patient, “On a scale from 1 to 10, how ready are you to start exercising?” is a way to assess:

• a) Their physical strength
• b) Their motivation and readiness for change
• c) Their understanding of the conversation
• d) Their satisfaction with your counseling Answer: b) Their motivation and readiness for change

27. If a patient rates their readiness to change as a “3,” the next MI-consistent question would be:

• a) “Why isn’t it a 10?”
• b) “Why is it a 3 and not a 1?”
• c) “You should really be at an 8 or higher.”
• d) “Clearly you aren’t ready to talk about this.” Answer: b) “Why is it a 3 and not a 1?”

28. Addressing a patient’s issue with non-adherence should begin with:

• a) Assuming the patient is forgetful and irresponsible.
• b) A non-judgmental exploration of the reasons and barriers behind the non-adherence.
• c) A lecture on the importance of taking medications as prescribed.
• d) Calling the patient’s doctor to report their non-compliance. Answer: b) A non-judgmental exploration of the reasons and barriers behind the non-adherence.

29. The ultimate goal of addressing a patient’s issue is to:

• a) Make the patient do what you want them to do.
• b) Collaboratively develop a plan that the patient finds acceptable and achievable.
• c) Spend as little time as possible with the patient.
• d) Sell the patient the most expensive product. Answer: b) Collaboratively develop a plan that the patient finds acceptable and achievable.

30. The counseling component of the GATOR Way rubric, as mentioned in the skills lab syllabus, emphasizes:

• a) The use of open-ended questions and verifying patient understanding.
• b) Speaking in complex medical terminology.
• c) A one-way delivery of information from pharmacist to patient.
• d) Avoiding any discussion of side effects. Answer: a) The use of open-ended questions and verifying patient understanding.

31. The “Evoking” process of MI is centered on:

• a) The pharmacist’s desire for the patient to change.
• b) The patient’s own arguments for change.
• c) The doctor’s orders.
• d) The insurance company’s policies. Answer: b) The patient’s own arguments for change.

32. A patient states, “I’m not going to quit smoking. It’s the only thing that calms my nerves.” An MI-consistent response would be:

• a) “You will die if you don’t quit.”
• b) “It sounds like smoking is a very important tool for you to manage stress.”
• c) “That’s a bad excuse for a terrible habit.”
• d) “Let me get you a nicotine patch right now.” Answer: b) “It sounds like smoking is a very important tool for you to manage stress.”

33. Using a “decisional balance” exercise involves asking the patient to explore:

• a) The pros and cons of changing versus not changing a behavior.
• b) The balance in their checking account.
• c) Their ability to balance on one foot.
• d) The balance between diet and exercise. Answer: a) The pros and cons of changing versus not changing a behavior.

34. The difference between simple advice-giving and MI-based advice is that in MI, advice is given:

• a) At the very beginning of the conversation.
• b) Only after asking for permission and exploring the patient’s own ideas first.
• c) Forcefully and without options.
• d) In a written format only. Answer: b) Only after asking for permission and exploring the patient’s own ideas first.

35. A “therapeutic paradox” is an advanced MI technique where the provider:

• a) Argues against change, which may cause a resistant patient to argue for it.
• b) Uses a paradox to confuse the patient.
• c) Prescribes a medication that has paradoxical effects.
• d) Contradicts their own advice. Answer: a) Argues against change, which may cause a resistant patient to argue for it.

36. Addressing the patient’s issue effectively requires the pharmacist to first understand the patient’s:

• a) Health literacy level and cultural background.
• b) Financial situation.
• c) Beliefs about their illness and treatment.
• d) All of the above. Answer: d) All of the above.

37. When a patient raises an issue about cost, the best approach is to:

• a) Tell them health is priceless and cost shouldn’t be a factor.
• b) Ignore the comment and continue talking about the drug’s benefits.
• c) Acknowledge the concern and explore options like generic alternatives, dosage form changes, or patient assistance programs.
• d) State that you have no control over drug prices. Answer: c) Acknowledge the concern and explore options like generic alternatives, dosage form changes, or patient assistance programs.

38. The “Engaging” process in MI is foundational because:

• a) No progress can be made if a respectful therapeutic relationship is not established.
• b) It is the longest and most difficult part of the process.
• c) It involves creating the final treatment plan.
• d) It requires the patient to sign a contract. Answer: a) No progress can be made if a respectful therapeutic relationship is not established.

39. A pharmacist who consistently uses MI to address patient issues is demonstrating which of the ten pharmacist attributes from the PPD curriculum?

• a) Communication and Patient Advocacy
• b) Innovation and Entrepreneurship
• c) Only Professionalism
• d) Only Leadership Answer: a) Communication and Patient Advocacy

40. A patient says, “I know I have diabetes, but I feel fine. I don’t think I need this medication.” This highlights an issue with the patient’s:

• a) Ability to pay.
• b) Fear of side effects.
• c) Illness perception and perceived need for treatment.
• d) Transportation to the pharmacy. Answer: c) Illness perception and perceived need for treatment.

41. Which of the following is a “closed-ended” question?

• a) “What questions do you have about this medication?”
• b) “How has your pain been since you started the new medicine?”
• c) “Can you show me how you use your inhaler?”
• d) “So you’re taking this once a day, correct?” Answer: d) “So you’re taking this once a day, correct?”

42. The “Planning” stage of MI should only begin when:

• a) The patient is expressing a high level of change talk and seems ready.
• b) The pharmacist runs out of other things to say.
• c) The appointment time is almost over.
• d) The patient’s doctor sends an order. Answer: a) The patient is expressing a high level of change talk and seems ready.

43. Addressing a patient’s issue often involves identifying and overcoming:

• a) The pharmacist’s own biases.
• b) The patient’s personal barriers to care.
• c) System-level barriers (e.g., insurance issues, clinic hours).
• d) All of the above. Answer: d) All of the above.

44. A key part of the “Assist” step of the 5 A’s for smoking cessation is:

• a) Telling the patient how disappointed you are in them.
• b) Providing practical counseling and problem-solving to help the patient overcome barriers.
• c) Assisting another pharmacist with their work.
• d) Assessing the patient’s weight. Answer: b) Providing practical counseling and problem-solving to help the patient overcome barriers.

45. Non-verbal communication, such as making eye contact and having open body language, is crucial for:

• a) Confusing the patient.
• b) Asserting dominance.
• c) Establishing rapport and showing you are engaged in addressing their issue.
• d) Distracting the patient from their problem. Answer: c) Establishing rapport and showing you are engaged in addressing their issue.

46. A patient says, “I can’t afford to take this medication every day, so I just take it when I feel bad.” The most immediate issue to address is:

• a) The patient’s lack of understanding of chronic disease management.
• b) The financial barrier preventing proper adherence.
• c) The patient’s distrust of the healthcare system.
• d) The color of the medication. Answer: b) The financial barrier preventing proper adherence.

47. When a patient is ambivalent, they are experiencing:

• a) A complete lack of caring.
• b) Conflicting motivations about whether to change or not.
• c) Anger towards the healthcare provider.
• d) A side effect of their medication. Answer: b) Conflicting motivations about whether to change or not.

48. Summarizing a conversation and asking “What’s the next step for you?” is a good way to transition into which MI process?

• a) Engaging
• b) Focusing
• c) Evoking
• d) Planning Answer: d) Planning

49. The overall philosophy of addressing a patient’s issue effectively is to see the pharmacist’s role as a:

• a) Director
• b) Cheerleader
• c) Guide
• d) Judge Answer: c) Guide

50. Addressing a patient’s issue effectively ultimately leads to improved:

• a) Medication adherence.
• b) Patient satisfaction.
• c) Clinical outcomes.
• d) All of the above. Answer: d) All of the above.