MCQ Quiz: Inpatient Rounding

Inpatient rounding is a cornerstone of modern clinical pharmacy practice, where pharmacists function as integral members of the interprofessional healthcare team. This dynamic, collaborative process involves reviewing patient cases, optimizing medication regimens, and making evidence-based recommendations directly to physicians and nurses at the point of care. As emphasized in the Professional Practice Skills Lab and experiential readiness courses, mastering the skills of patient presentation, problem identification, and clear communication is essential for improving patient safety and outcomes in the hospital setting. This quiz will test your knowledge on the fundamental principles and practical skills required for effective participation in inpatient rounds.

1. The primary purpose of a clinical pharmacist participating in inpatient rounds is to:

• a) Deliver medications to the nursing station.
• b) Provide real-time medication expertise to optimize patient therapy and ensure safety.
• c) Bill for the physician’s services.
• d) Take notes for the medical team.

Answer: b) To provide real-time medication expertise to optimize patient therapy and ensure safety.

2. Before morning rounds, what is the most important preparatory task for the pharmacist?

• a) Checking the pharmacy’s inventory.
• b) Reviewing their assigned patients’ charts, labs, and medication administration records (MARs) to identify potential drug therapy problems.
• c) Preparing the daily departmental budget.
• d) Calling the patient’s family to get a diet history.

Answer: b) Reviewing their assigned patients’ charts, labs, and medication administration records (MARs) to identify potential drug therapy problems.

3. When presenting a patient on rounds, the most effective approach is to be:

• a) As detailed as possible, reading every lab value from the past week.
• b) Focused only on the patient’s social history.
• c) Silent unless a direct question is asked.
• d) Succinct, organized, and focused on the active medication-related issues and recommendations.

Answer: d) Succinct, organized, and focused on the active medication-related issues and recommendations.

4. A common format for organizing a patient presentation on rounds is the SOAP note format. The “S” stands for:

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

Answer: c) Subjective

5. A patient’s complaint of nausea would be included in which part of the SOAP presentation?

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

Answer: a) Subjective

6. The patient’s serum creatinine of 1.8 mg/dL would be presented in which part of the SOAP note?

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

Answer: b) Objective

7. A pharmacist states, “The patient’s acute kidney injury is likely due to the initiation of high-dose NSAIDs.” This statement belongs in which section of the SOAP note?

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

Answer: c) Assessment

8. The “Plan” portion of a pharmacist’s presentation should include:

• a) A list of the patient’s chronic conditions.
• b) Specific, actionable recommendations for medication changes, monitoring, and patient education.
• c) The patient’s vital signs from admission.
• d) A summary of the previous day’s events.

Answer: b) Specific, actionable recommendations for medication changes, monitoring, and patient education.

9. During rounds, the medical resident asks about the appropriate dose adjustment for vancomycin in a patient with renal dysfunction. This is an example of the pharmacist’s role as a(n):

• a) Dispensing technician
• b) Drug information resource
• c) Unit clerk
• d) Phlebotomist

Answer: b) Drug information resource

10. When making a recommendation to the medical team, it is most effective to:

• a) State your opinion without any supporting facts.
• b) Provide a concise recommendation supported by evidence from clinical guidelines or primary literature.
• c) Wait until after rounds to email the physician.
• d) Tell the nurse to pass the message along to the physician.

Answer: b) Provide a concise recommendation supported by evidence from clinical guidelines or primary literature.

11. The term “interprofessional team” on inpatient rounds typically includes a physician, a pharmacist, a nurse, and which other key member?

• a) A hospital administrator
• b) A case manager or social worker
• c) A patient transport associate
• d) A billing specialist

Answer: b) A case manager or social worker

12. A pharmacist on rounds notes that a patient is on two different medications for DVT prophylaxis. This is an example of what type of drug therapy problem?

• a) Subtherapeutic dosage
• b) Unnecessary drug therapy / Therapeutic duplication
• c) Need for additional drug therapy
• d) Adverse drug reaction

Answer: b) Unnecessary drug therapy / Therapeutic duplication

13. What is a key reason for a pharmacist to physically attend rounds at the patient’s bedside?

• a) To observe the patient’s clinical status and engage in direct patient communication.
• b) To check the room’s temperature.
• c) To ensure the TV in the room is working.
• d) To get more steps on their fitness tracker.

Answer: a) To observe the patient’s clinical status and engage in direct patient communication.

14. If a physician disagrees with a pharmacist’s recommendation on rounds, the most professional response is to:

• a) Argue with the physician in front of the patient and team.
• b) Silently accept the decision and do nothing.
• c) Listen to the physician’s reasoning, present your rationale calmly, and if disagreement persists, agree to follow up after rounds.
• d) Report the physician to the head of the hospital.

Answer: c) Listen to the physician’s reasoning, present your rationale calmly, and if disagreement persists, agree to follow up after rounds.

15. A patient’s antibiotic is being de-escalated based on culture and sensitivity results. This is an example of:

• a) A medication error.
• b) Therapeutic failure.
• c) Antimicrobial stewardship.
• d) A drug-drug interaction.

Answer: c) Antimicrobial stewardship.

16. An important safety check a pharmacist should perform during their pre-rounding review is:

• a) Verifying allergies and checking for potential cross-reactivities.
• b) Confirming appropriate DVT and stress ulcer prophylaxis is ordered.
• c) Assessing the need for renal or hepatic dose adjustments.
• d) All of the above.

Answer: d) All of the above.

17. The “Presenting Patients” module in the skills lab curriculum is designed to prepare students for what activity?

• a) Counseling patients at discharge.
• b) Compounding IV medications.
• c) Communicating patient information effectively and efficiently during inpatient rounds.
• d) Taking a final exam.

Answer: c) Communicating patient information effectively and efficiently during inpatient rounds.

18. After a recommendation is accepted on rounds, what is the pharmacist’s responsibility?

• a) To assume the nurse will automatically implement the change.
• b) To do nothing further.
• c) To follow up to ensure the order is written correctly and the change is implemented.
• d) To tell the patient to change the order themselves.

Answer: c) To follow up to ensure the order is written correctly and the change is implemented.

19. A pharmacist recommends initiating a high-intensity statin for a patient post-myocardial infarction. This recommendation is based on:

• a) The pharmacist’s personal preference.
• b) The cost of the medication.
• c) Evidence-based secondary prevention guidelines.
• d) The patient’s request.

Answer: c) Evidence-based secondary prevention guidelines.

20. A well-organized rounding “worksheet” or “rounding list” helps the pharmacist to:

• a) Keep track of patient information and medication-related issues in a systematic way.
• b) Make the pre-rounding review process take longer.
• c) Create more work for the medical students.
• d) Replace the need to look at the electronic health record.

Answer: a) Keep track of patient information and medication-related issues in a systematic way.

21. A pharmacist is asked, “What’s the half-life of piperacillin-tazobactam in a patient on dialysis?” Being able to answer this question demonstrates the pharmacist’s value in providing:

• a) Patient-specific pharmacokinetic information.
• b) General medical advice.
• c) Billing information.
• d) A diagnosis.

Answer: a) Patient-specific pharmacokinetic information.

22. “Closed-loop communication” is an effective technique on rounds. It means:

• a) The team does not communicate with the patient.
• b) The sender gives a message, the receiver repeats it back, and the sender confirms it was understood correctly.
• c) All communication is done via encrypted email.
• d) Only the attending physician is allowed to speak.

Answer: b) The sender gives a message, the receiver repeats it back, and the sender confirms it was understood correctly.

23. One of the main goals of the APPE Readiness course is to prepare students to:

• a) Function effectively as a member of an inpatient team during their fourth-year rotations.
• b) Pass the pharmacy law exam.
• c) Learn how to manage a community pharmacy.
• d) Develop new drugs.

Answer: a) Function effectively as a member of an inpatient team during their fourth-year rotations.

24. The term “rounding” originates from:

• a) The circular shape of the nurses’ station.
• b) The historical practice of physicians and students physically walking in a “round” from room to room.
• c) The need to “round up” medication doses.
• d) The shape of pills.

Answer: b) The historical practice of physicians and students physically walking in a “round” from room to room.

25. A pharmacist identifies that a patient’s home dose of levothyroxine 100 mcg daily was incorrectly transcribed on admission as 100 mg daily. The pharmacist’s immediate action should be to:

• a) Wait until rounds the next day to mention it.
• b) Correct the error in the MAR themselves.
• c) Contact the prescribing physician immediately to clarify and correct the order before a dose is given.
• d) Ask the patient if they feel a difference.

Answer: c) Contact the prescribing physician immediately to clarify and correct the order before a dose is given.

26. Why is it important for the pharmacist on rounds to be familiar with the hospital’s formulary?

• a) To recommend preferred, therapeutically appropriate agents that are readily available.
• b) It is not important.
• c) To ensure only the most expensive drugs are used.
• d) To order medications for the entire hospital.

Answer: a) To recommend preferred, therapeutically appropriate agents that are readily available.

27. In “table rounds” or “card-flipping rounds,” the team typically discusses patients:

• a) At each patient’s bedside.
• b) In a conference room, reviewing patient data collectively.
• c) In the hospital cafeteria.
• d) Over the phone.

Answer: b) In a conference room, reviewing patient data collectively.

28. A pharmacist on rounds should be prepared to provide education on:

• a) New or high-risk medications.
• b) Hospital policies and protocols related to medication use.
• c) Drug-drug interactions.
• d) All of the above.

Answer: d) All of the above.

29. The ultimate goal of having a pharmacist on the inpatient rounding team is to:

• a) Increase the number of medication orders.
• b) Find errors made by other healthcare professionals.
• c) Improve patient safety and clinical outcomes.
• d) Make the rounding process take longer.

Answer: c) Improve patient safety and clinical outcomes.

30. An effective oral patient presentation starts with:

• a) A detailed review of the patient’s social history.
• b) A concise one-liner that summarizes the patient’s name, age, and reason for admission.
• c) A list of all the patient’s medications.
• d) The pharmacist’s final recommendation.

Answer: b) A concise one-liner that summarizes the patient’s name, age, and reason for admission.

31. A patient with a history of heart failure is prescribed ibuprofen by the surgical team for post-operative pain. The pharmacist on rounds should recommend changing this order because:

• a) Ibuprofen is not an effective pain reliever.
• b) The patient has an allergy to ibuprofen.
• c) NSAIDs can exacerbate heart failure by causing sodium and water retention.
• d) Ibuprofen is not on the hospital formulary.

Answer: c) NSAIDs can exacerbate heart failure by causing sodium and water retention.

32. A pharmacist’s daily “to-do” list is often generated from:

• a) The hospital’s daily menu.
• b) Issues and recommendations identified during morning rounds.
• c) The hospital’s newsletter.
• d) A random assignment of tasks.

Answer: b) Issues and recommendations identified during morning rounds.

33. What is a key difference between rounding in a teaching hospital versus a community hospital?

• a) There are no pharmacists in community hospitals.
• b) Teaching hospital rounds often involve a larger team with medical students, residents, and fellows, and may have a stronger educational focus.
• c) Only teaching hospitals have electronic health records.
• d) Patient care is better in community hospitals.

Answer: b) Teaching hospital rounds often involve a larger team with medical students, residents, and fellows, and may have a stronger educational focus.

34. In the context of inpatient rounding, a “clinical pearl” is:

• a) A piece of jewelry worn by the pharmacist.
• b) A small, relevant piece of clinical information or a teaching point shared with the team.
• c) A complaint about a patient.
• d) A type of medication error.

Answer: b) A small, relevant piece of clinical information or a teaching point shared with the team.

35. A pharmacist is preparing to round on a patient admitted for a COPD exacerbation. Which objective data is most important to review?

• a) The patient’s lipid panel from last year.
• b) The patient’s blood type.
• c) Arterial blood gas (ABG) results, oxygen saturation, and recent chest X-ray report.
• d) The patient’s weight from five years ago.

Answer: c) Arterial blood gas (ABG) results, oxygen saturation, and recent chest X-ray report.

36. After making a recommendation to switch a patient from IV to PO antibiotics, the pharmacist is contributing to:

• a) A potential medication error.
• b) Increased length of stay.
• c) Cost-effective care and facilitating an earlier discharge.
• d) The development of antibiotic resistance.

Answer: c) Cost-effective care and facilitating an earlier discharge.

37. The ability to anticipate potential medication-related problems before they occur is a skill of a(n):

• a) Novice practitioner
• b) Experienced clinical pharmacist
• c) Pharmacy technician
• d) Medical student

Answer: b) Experienced clinical pharmacist

38. The HIPPE syllabus emphasizes collaboration with interdisciplinary teams to develop policies and procedures. This skill is practiced on rounds when the team:

• a) Ignores a medication safety issue.
• b) Collectively decides to change a protocol based on new evidence presented by the pharmacist.
• c) Works in complete silence.
• d) Blames another department for a problem.

Answer: b) Collectively decides to change a protocol based on new evidence presented by the pharmacist.

39. Documentation of a pharmacist’s interventions made on rounds is important for:

• a) Justifying the role and value of the clinical pharmacist.
• b) Communicating with other healthcare professionals.
• c) Ensuring continuity of care.
• d) All of the above.

Answer: d) All of the above.

40. A pharmacist on rounding a patient with an infection notes that the ordered antibiotic is not appropriate based on the patient’s renal function. This is an example of identifying a drug therapy problem related to:

• a) Adherence
• b) Safety (inappropriate dose)
• c) Efficacy
• d) Indication

Answer: b) Safety (inappropriate dose)

41. An effective pharmacist on rounds does not just identify problems, they also:

• a) Create more problems.
• b) Provide well-reasoned, evidence-based solutions.
• c) Wait for someone else to find a solution.
• d) Document the problem and move on.

Answer: b) Provide well-reasoned, evidence-based solutions.

42. Which communication tool can be useful for structuring a recommendation during rounds?

• a) SBAR (Situation, Background, Assessment, Recommendation)
• b) PICO (Patient, Intervention, Comparison, Outcome)
• c) Apgar score
• d) FAST acronym

Answer: a) SBAR (Situation, Background, Assessment, Recommendation)

43. A pharmacist’s ability to quickly access and interpret drug information from a mobile device or online resource during rounds is a:

• a) Sign of being unprepared.
• b) Critical skill for providing real-time, evidence-based care.
• c) Violation of hospital policy.
• d) Distraction from patient care.

Answer: b) Critical skill for providing real-time, evidence-based care.

44. What is one of the most common interventions made by pharmacists on inpatient rounds?

• a) Diagnosing new diseases.
• b) Recommending adjustments to medication doses, especially for renal impairment.
• c) Performing physical exams.
• d) Writing prescriptions for discharge.

Answer: b) Recommending adjustments to medication doses, especially for renal impairment.

45. To be a valuable member of the rounding team, a pharmacist must possess:

• a) Strong clinical knowledge and critical thinking skills.
• b) Excellent communication skills.
• c) A professional and collaborative attitude.
• d) All of the above.

Answer: d) All of the above.

46. A patient is admitted with a blood glucose of 500 mg/dL. An appropriate pharmacist intervention on rounds would be to:

• a) Recommend an oral diabetes medication.
• b) Suggest a regular diet.
• c) Develop an insulin therapy plan (e.g., basal-bolus regimen or insulin drip protocol).
• d) Wait for the endocrinology consult.

Answer: c) Develop an insulin therapy plan (e.g., basal-bolus regimen or insulin drip protocol).

47. Understanding the roles and responsibilities of other team members (e.g., nurse, physician, case manager) helps the pharmacist to:

• a) Tell them how to do their jobs.
• b) Make more appropriate and collaborative recommendations.
• c) Avoid speaking to them.
• d) Complete their own work faster.

Answer: b) Make more appropriate and collaborative recommendations.

48. On rounds, the team is discussing a patient who is not eating well. The pharmacist’s contribution could be to:

• a) Order the patient a different meal from the cafeteria.
• b) Review the patient’s medications to see if any are causing nausea or loss of appetite.
• c) Force the patient to eat.
• d) Suggest a surgical consult.

Answer: b) Review the patient’s medications to see if any are causing nausea or loss of appetite.

49. A key professional behavior on rounds is:

• a) Showing up late.
• b) Being prepared and respectful of all team members’ contributions.
• c) Dominating the conversation.
• d) Looking at your phone when others are speaking.

Answer: b) Being prepared and respectful of all team members’ contributions.

50. The inpatient rounding experience in the Pharm.D. curriculum is designed to simulate the real-world practice environment and develop a student’s:

• a) Clinical confidence and competence.
• b) Interprofessional skills.
• c) Problem-solving abilities.
• d) All of the above.

Answer: d) All of the above.