MCQ Quiz: Ambulatory Care Practice

Ambulatory care pharmacy is a dynamic and rapidly expanding area of practice where pharmacists provide direct patient care in outpatient settings, such as clinics and physician offices. These pharmacists are integral members of the healthcare team, often working under collaborative practice agreements to manage chronic diseases like diabetes, hypertension, dyslipidemia, and anticoagulation. They perform comprehensive medication management, adjust therapies, educate patients, and work to improve health outcomes and quality of life. This quiz is designed for PharmD students to test their knowledge on the clinical skills, practice models, and disease state management principles that are fundamental to a successful career in ambulatory care pharmacy.

1. Which of the following best describes the primary role of an ambulatory care pharmacist?

• a) Dispensing medications in a community pharmacy.
• b) Managing medication therapy for chronic diseases in an outpatient clinic setting.
• c) Compounding sterile preparations in a hospital.
• d) Reviewing medication orders for inpatients.

Answer: b) Managing medication therapy for chronic diseases in an outpatient clinic setting.

2. A legal arrangement between a pharmacist and a physician that allows the pharmacist to assume professional responsibility for performing patient care functions is known as a:

• a) Standing Order
• b) Verbal Agreement
• c) Collaborative Practice Agreement (CPA)
• d) Pharmacy and Therapeutics (P&T) Committee Protocol

Answer: c) Collaborative Practice Agreement (CPA)

3. A 60-year-old male with type 2 diabetes has an A1c of 8.5%. His current regimen is metformin 1000 mg twice daily. According to ADA guidelines, what is an appropriate next step?

• a) Advise the patient to stop all medications and focus on diet.
• b) Add a second oral agent or a GLP-1 receptor agonist.
• c) Double the metformin dose to 2000 mg twice daily.
• d) Continue metformin alone and recheck A1c in 6 months.

Answer: b) Add a second oral agent or a GLP-1 receptor agonist.

4. A patient on warfarin for atrial fibrillation calls the anticoagulation clinic. Their target INR range is 2.0-3.0. Today’s INR is 4.5, and they have no signs of bleeding. What is the most appropriate instruction?

• a) “Continue your current dose and recheck in one week.”
• b) “Go to the emergency department immediately.”
• c) “Hold today’s dose of warfarin and follow up for new dosing instructions.”
• d) “Double your warfarin dose for the next two days.”

Answer: c) “Hold today’s dose of warfarin and follow up for new dosing instructions.”

5. A patient with hypertension and a history of angioedema with an ACE inhibitor should not be prescribed which of the following medications?

• a) Amlodipine
• b) Hydrochlorothiazide
• c) Valsartan
• d) Metoprolol

Answer: c) Valsartan

6. The “S” in a SOAP note, commonly used for documentation in ambulatory care, stands for:

• a) Summary
• b) Subjective
• c) Systemic
• d) Statin

Answer: b) Subjective

7. Which of the following is a key component of Medication Therapy Management (MTM) services?

• a) A comprehensive medication review (CMR).
• b) Dispensing a 90-day supply of medication.
• c) Administering vaccines.
• d) Compounding non-sterile preparations.

Answer: a) A comprehensive medication review (CMR).

8. A patient is being started on a high-intensity statin for secondary prevention of ASCVD. Which of the following is a high-intensity statin regimen?

• a) Simvastatin 20 mg daily
• b) Atorvastatin 80 mg daily
• c) Pravastatin 20 mg daily
• d) Lovastatin 40 mg daily

Answer: b) Atorvastatin 80 mg daily

9. A patient with COPD is prescribed a new inhaler. Which patient education technique is most effective for ensuring they use it correctly?

• a) Giving them the package insert to read.
• b) Demonstrating how to use the inhaler and then asking the patient to teach it back.
• c) Verbally explaining the steps once.
• d) Showing them a video of someone else using the inhaler.

Answer: b) Demonstrating how to use the inhaler and then asking the patient to teach it back.

10. “Incident-to” billing allows a pharmacist to bill for services under which healthcare program?

• a) Medicare Part D
• b) Medicare Part B
• c) Commercial private insurance only
• d) Medicaid

Answer: b) Medicare Part B

11. A 55-year-old patient with no comorbidities is diagnosed with hypertension. Her initial blood pressure is 145/92 mmHg. According to ACC/AHA guidelines, which is a recommended first-line agent?

• a) Clonidine
• b) Hydralazine
• c) Amlodipine
• d) Doxazosin

Answer: c) Amlodipine

12. An ambulatory care pharmacist is managing a patient’s diabetes. A key quality measure they might track is the percentage of patients who:

• a) Have an A1c less than 8%.
• b) Are on brand-name medications.
• c) Visit the clinic weekly.
• d) Have their blood pressure checked annually.

Answer: a) Have an A1c less than 8%.

13. When initiating basal insulin in a patient with type 2 diabetes, a common starting dose is:

• a) 30 units twice daily.
• b) 10 units subcutaneously at bedtime or 0.1-0.2 units/kg/day.
• c) 1 unit for every 10 grams of carbohydrates.
• d) A fixed dose of 50 units daily.

Answer: b) 10 units subcutaneously at bedtime or 0.1-0.2 units/kg/day.

14. A patient complains of a persistent, dry cough after starting a new blood pressure medication. Which medication is the most likely cause?

• a) Metoprolol
• b) Hydrochlorothiazide
• c) Lisinopril
• d) Losartan

Answer: c) Lisinopril

15. The primary goal of an anticoagulation clinic managed by a pharmacist is to:

• a) Increase the number of patients on warfarin.
• b) Maximize time in therapeutic range (TTR) to reduce the risk of thrombosis and bleeding.
• c) Solely focus on dispensing direct oral anticoagulants (DOACs).
• d) Eliminate the need for physicians in anticoagulation management.

Answer: b) Maximize time in therapeutic range (TTR) to reduce the risk of thrombosis and bleeding.

16. Which part of the SOAP note includes the pharmacist’s clinical judgment and reasoning?

• a) Subjective
• b) Objective
• c) Assessment
• d) Plan

Answer: c) Assessment

17. A patient with asthma is given a written action plan. The “green zone” of the plan typically indicates:

• a) The patient is having a severe exacerbation and should go to the emergency room.
• b) The patient’s asthma is well-controlled; they should continue their controller medications.
• c) The patient should use their rescue inhaler every 4 hours.
• d) The patient should start a course of oral corticosteroids.

Answer: b) The patient’s asthma is well-controlled; they should continue their controller medications.

18. When counseling a patient starting a DOAC like apixaban, it is critical to emphasize:

• a) The need for monthly INR checks.
• b) The importance of strict adherence to avoid stroke.
• c) That it can be taken on an as-needed basis.
• d) The need to maintain a consistent intake of vitamin K.

Answer: b) The importance of strict adherence to avoid stroke.

19. A Patient-Centered Medical Home (PCMH) is a practice model that emphasizes:

• a) Care that is coordinated, comprehensive, and patient-centered.
• b) Providing care only within the patient’s home.
• c) A focus on specialist care over primary care.
• d) A payment model based solely on the number of prescriptions dispensed.

Answer: a) Care that is coordinated, comprehensive, and patient-centered.

20. A patient on simvastatin 40 mg complains of new-onset muscle pain and weakness. The pharmacist should be concerned about:

• a) A common, harmless side effect.
• b) Statin-associated muscle symptoms (SAMS), including potential rhabdomyolysis.
• c) A drug interaction with their blood pressure medication.
• d) An allergic reaction.

Answer: b) Statin-associated muscle symptoms (SAMS), including potential rhabdomyolysis.

21. Which laboratory value is the best indicator of a patient’s glycemic control over the past 2-3 months?

• a) Fasting plasma glucose
• b) Random plasma glucose
• c) Hemoglobin A1c
• d) Serum creatinine

Answer: c) Hemoglobin A1c

22. An ambulatory care pharmacist is asked to help manage a patient’s resistant hypertension. This is defined as uncontrolled blood pressure despite the use of:

• a) One antihypertensive agent.
• b) Two antihypertensive agents.
• c) Three or more antihypertensive agents, including a diuretic.
• d) Four antihypertensive agents.

Answer: c) Three or more antihypertensive agents, including a diuretic.

23. What is a key counseling point for a patient using a home blood pressure monitor?

• a) Take your blood pressure immediately after exercising for the most accurate reading.
• b) Rest for 5 minutes in a chair with your feet flat on the floor before taking a measurement.
• c) The size of the cuff does not matter.
• d) It is only necessary to check your blood pressure once a month.

Answer: b) Rest for 5 minutes in a chair with your feet flat on the floor before taking a measurement.

24. The primary goal of treating dyslipidemia is to:

• a) Lower the HDL cholesterol.
• b) Reduce the risk of atherosclerotic cardiovascular disease (ASCVD).
• c) Increase triglyceride levels.
• d) Achieve a specific LDL number for all patients.

Answer: b) Reduce the risk of atherosclerotic cardiovascular disease (ASCVD).

25. A patient taking metformin should be counseled to stop taking it temporarily if they are undergoing what type of procedure?

• a) A routine dental cleaning.
• b) A procedure requiring iodinated contrast dye.
• c) A minor skin biopsy.
• d) An eye exam.

Answer: b) A procedure requiring iodinated contrast dye.

26. Which of the following is an example of an “Objective” finding in a SOAP note?

• a) The patient states, “I have a headache.”
• b) The patient’s blood pressure reading today is 150/95 mmHg.
• c) The pharmacist’s clinical opinion that the patient’s hypertension is uncontrolled.
• d) The plan to increase the lisinopril dose.

Answer: b) The patient’s blood pressure reading today is 150/95 mmHg.

27. What is a primary role of the pharmacist in transitions of care?

• a) Performing a comprehensive medication reconciliation to prevent discrepancies.
• b) Prescribing new medications at discharge.
• c) Driving the patient home from the hospital.
• d) Scheduling follow-up physician appointments.

Answer: a) Performing a comprehensive medication reconciliation to prevent discrepancies.

28. A patient with diabetes asks about the “sick day” rules. The pharmacist should advise them to:

• a) Stop taking their insulin and other diabetes medications until they feel better.
• b) Continue taking their medications, monitor their blood glucose more frequently, and stay hydrated.
• c) Avoid checking their blood glucose to prevent stress.
• d) Eat sugary foods to keep their energy up.

Answer: b) Continue taking their medications, monitor their blood glucose more frequently, and stay hydrated.

29. What does the term “polypharmacy” refer to?

• a) The use of a single, high-dose medication.
• b) The use of multiple medications by a single patient.
• c) The practice of pharmacy in multiple states.
• d) A type of specialty pharmacy.

Answer: b) The use of multiple medications by a single patient.

30. Which medication class for type 2 diabetes has shown significant cardiovascular benefits in patients with established ASCVD?

• a) Sulfonylureas (e.g., glipizide)
• b) SGLT2 inhibitors (e.g., empagliflozin)
• c) DPP-4 inhibitors (e.g., sitagliptin)
• d) Thiazolidinediones (e.g., pioglitazone)

Answer: b) SGLT2 inhibitors (e.g., empagliflozin)

31. In an ambulatory care setting, a pharmacist’s intervention to switch a patient from a costly brand-name drug to a more affordable, equally effective generic is an example of:

• a) Clinical inertia
• b) Therapeutic interchange
• c) Deprescribing
• d) Adherence monitoring

Answer: b) Therapeutic interchange

32. A patient with asthma is classified as having persistent asthma. They should be on a daily:

• a) Short-acting beta-agonist (SABA).
• b) Inhaled corticosteroid (ICS).
• c) Oral antibiotic.
• d) Long-acting muscarinic antagonist (LAMA).

Answer: b) Inhaled corticosteroid (ICS).

33. What is the target blood pressure for most patients with hypertension, according to the 2017 ACC/AHA guidelines?

• a) < 150/90 mmHg
• b) < 140/90 mmHg
• c) < 130/80 mmHg
• d) < 120/80 mmHg

Answer: c) < 130/80 mmHg

34. A patient reports that they often forget to take their evening dose of medication. This is an example of what type of medication-related problem?

• a) Adverse drug reaction
• b) Adherence issue
• c) Need for additional drug therapy
• d) Unnecessary drug therapy

Answer: b) Adherence issue

35. Which of the following is a primary goal of a comprehensive medication review (CMR)?

• a) To identify and resolve medication-related problems.
• b) To dispense all of the patient’s refills for the year.
• c) To enroll the patient in a clinical trial.
• d) To switch all medications to brand names.

Answer: a) To identify and resolve medication-related problems.

36. A patient on amiodarone for atrial fibrillation should be routinely monitored for toxicity affecting which organs?

• a) Kidneys and pancreas
• b) Thyroid, lungs, and liver
• c) Stomach and intestines
• d) Bones and joints

Answer: b) Thyroid, lungs, and liver

37. When working under a CPA for diabetes management, a pharmacist may be credentialed to:

• a) Independently prescribe insulin.
• b) Perform foot exams and order lab tests like A1c.
• c) Adjust doses of oral and injectable diabetes medications.
• d) All of the above.

Answer: d) All of the above.

38. Health literacy is an important consideration in ambulatory care because:

• a) All patients have high health literacy.
• b) Low health literacy is associated with poorer health outcomes and medication adherence.
• c) It is not the pharmacist’s responsibility to assess health literacy.
• d) It only affects elderly patients.

Answer: b) Low health literacy is associated with poorer health outcomes and medication adherence.

39. A patient is prescribed an Ozempic (semaglutide) pen for type 2 diabetes. A key counseling point is:

• a) It is an oral tablet.
• b) It is a once-weekly subcutaneous injection.
• c) It should be injected into a muscle.
• d) It is used to treat low blood sugar.

Answer: b) It is a once-weekly subcutaneous injection.

40. A major advantage of DOACs over warfarin is:

• a) They are less expensive.
• b) They do not require routine blood monitoring.
• c) They have a reversal agent for every drug in the class.
• d) They have no drug interactions.

Answer: b) They do not require routine blood monitoring.

41. The “P” in a SOAP note stands for:

• a) Problem
• b) Pharmacy
• c) Patient
• d) Plan

Answer: d) Plan

42. Which of the following is a barrier to the widespread implementation of ambulatory care pharmacy services?

• a) Lack of evidence showing pharmacist effectiveness.
• b) Inconsistent mechanisms for reimbursement and lack of provider status in some areas.
• c) Pharmacists’ unwillingness to manage chronic diseases.
• d) Patients’ preference for seeing only physicians.

Answer: b) Inconsistent mechanisms for reimbursement and lack of provider status in some areas.

43. A patient’s A1c goal might be relaxed to <8% (from the usual <7%) if the patient:

• a) Is newly diagnosed and highly motivated.
• b) Is young and has no comorbidities.
• c) Has a long life expectancy.
• d) Has a history of severe hypoglycemia and limited life expectancy.

Answer: d) Has a history of severe hypoglycemia and limited life expectancy.

44. A patient with heart failure and a reduced ejection fraction (HFrEF) should be on which of the following medication classes?

• a) A beta-blocker and an ACE inhibitor/ARB/ARNI.
• b) A calcium channel blocker.
• c) A non-steroidal anti-inflammatory drug (NSAID).
• d) A thiazolidinedione.

Answer: a) A beta-blocker and an ACE inhibitor/ARB/ARNI.

45. What is the purpose of a Medication Action Plan (MAP) provided to a patient after an MTM session?

• a) To serve as a legal contract.
• b) To provide the patient with a simple, actionable “to-do” list to help them manage their medications.
• c) To be a complete list of all their medications.
• d) To bill their insurance company.

Answer: b) To provide the patient with a simple, actionable “to-do” list to help them manage their medications.

46. An ambulatory care pharmacist works closely with a primary care physician to manage a panel of patients. This is an example of:

• a) Siloed care
• b) Interprofessional collaboration
• c) Independent practice
• d) Inpatient care

Answer: b) Interprofessional collaboration

47. A patient with COPD has an FEV1/FVC ratio of <0.70. This finding is:

• a) Normal.
• b) Suggestive of a restrictive lung disease.
• c) Diagnostic for obstructive lung disease.
• d) Indicative of pneumonia.

Answer: c) Diagnostic for obstructive lung disease.

48. A patient on spironolactone should be monitored for which electrolyte abnormality?

• a) Hypokalemia
• b) Hyperkalemia
• c) Hyponatremia
• d) Hypomagnesemia

Answer: b) Hyperkalemia

49. Deprescribing is a key function in ambulatory care, especially in the elderly. It involves:

• a) Prescribing fewer medications than are needed.
• b) The systematic process of identifying and discontinuing medications where the harm outweighs the benefit.
• c) Switching all brand-name drugs to generics.
• d) Refusing to fill new prescriptions.

Answer: b) The systematic process of identifying and discontinuing medications where the harm outweighs the benefit.

50. An ambulatory care pharmacist can help a patient afford their medications by:

• a) Recommending therapeutic alternatives that are on the patient’s insurance formulary.
• b) Assisting with applications for Patient Assistance Programs (PAPs).
• c) Identifying lower-cost generic options.
• d) All of the above.

Answer: d) All of the above