As future healthcare providers, pharmacists are uniquely positioned on the front lines to make a profound impact on public health, and there are few interventions more significant than helping a patient quit smoking. Managing smoking cessation is a core competency developed throughout the PharmD curriculum, combining in-depth pharmacotherapy knowledge from courses like Patient Care 3 with the crucial counseling skills practiced in the Professional Skills Lab 3. This quiz will test your ability to utilize motivational interviewing techniques, select appropriate pharmacologic therapies, and develop comprehensive plans to support patients on their journey to becoming tobacco-free.
1. Which of the following is the first step in the 5 A’s model for treating tobacco use and dependence?
- a. Advise
- b. Assess
- c. Arrange
- d. Ask
Answer: d. Ask
2. A patient smokes their first cigarette within 30 minutes of waking up. When recommending nicotine gum, which starting dose is most appropriate?
- a. 1 mg
- b. 2 mg
- c. 4 mg
- d. 6 mg
Answer: c. 4 mg
3. What is the correct “chew and park” technique for using nicotine gum?
- a. Chew the gum rapidly for 30 minutes until it dissolves.
- b. Chew the gum slowly until a peppery taste emerges, then “park” it between the cheek and gum.
- c. Park the gum under the tongue without chewing.
- d. Chew the gum like regular chewing gum.
Answer: b. Chew the gum slowly until a peppery taste emerges, then “park” it between the cheek and gum.
4. A major contraindication for the use of bupropion SR for smoking cessation is:
- a. Hypertension
- b. A history of seizure disorder.
- c. Hyperlipidemia
- d. Asthma
Answer: b. A history of seizure disorder.
5. Varenicline (Chantix) carries a warning for which potential side effect, requiring patient counseling?
- a. Severe rash
- b. Neuropsychiatric symptoms and changes in mood.
- c. Significant weight gain
- d. Dry cough
Answer: b. Neuropsychiatric symptoms and changes in mood.
6. The “A” in the motivational interviewing principle OARS stands for:
- a. Affirmations
- b. Assessment
- c. Advice
- d. Arrangement
Answer: a. Affirmations
7. When is the ideal time for a patient to start taking varenicline?
- a. On the day they quit smoking.
- b. The day after they quit smoking.
- c. One week before their scheduled quit date.
- d. One month after their scheduled quit date.
Answer: c. One week before their scheduled quit date.
8. Which of the following nicotine replacement therapy (NRT) formulations provides the most rapid delivery of nicotine?
- a. Nicotine patch
- b. Nicotine lozenge
- c. Nicotine gum
- d. Nicotine nasal spray
Answer: d. Nicotine nasal spray
9. Combination NRT, a highly effective strategy, typically involves using:
- a. Two different nicotine patches.
- b. A long-acting formulation (patch) plus a short-acting formulation (gum or lozenge).
- c. Nicotine gum and a nicotine lozenge at the same time.
- d. Nicotine patch plus bupropion.
Answer: b. A long-acting formulation (patch) plus a short-acting formulation (gum or lozenge).
10. A patient states, “I know I should quit, but I enjoy smoking and I’m not ready.” This statement reflects which stage of change?
- a. Precontemplation
- b. Contemplation
- c. Preparation
- d. Action
Answer: b. Contemplation
11. The mechanism of action of varenicline is best described as:
- a. A nicotine receptor antagonist.
- b. A selective serotonin reuptake inhibitor.
- c. A partial nicotinic receptor agonist.
- d. A dopamine and norepinephrine reuptake inhibitor.
Answer: c. A partial nicotinic receptor agonist.
12. The ability to utilize Motivational Interviewing techniques to encourage a patient to quit smoking is a specific learning objective for student pharmacists.
- a. True
- b. False
Answer: a. True
13. A common symptom of nicotine withdrawal is:
- a. Euphoria
- b. Increased energy
- c. Irritability and anxiety
- d. Decreased appetite
Answer: c. Irritability and anxiety
14. What is the recommended duration of therapy for a 21 mg nicotine patch for a patient who smokes >10 cigarettes per day?
- a. 2 weeks
- b. 4-6 weeks
- c. 8 weeks
- d. 12 weeks
Answer: b. 4-6 weeks
15. Acidic beverages like coffee or soda can decrease the absorption of which NRT formulation?
- a. Nicotine patch
- b. Nicotine gum and lozenge
- c. Nicotine nasal spray
- d. Nicotine inhaler
Answer: b. Nicotine gum and lozenge
16. Which of the following is an example of an “open-ended question” in motivational interviewing?
- a. “Do you want to quit smoking?”
- b. “What are some of the things you don’t like about smoking?”
- c. “Are you ready to set a quit date today?”
- d. “You know smoking is bad for you, right?”
Answer: b. “What are some of the things you don’t like about smoking?”
17. For a patient who experiences vivid dreams or sleep disturbances with the nicotine patch, what is the best recommendation?
- a. Discontinue the patch immediately.
- b. Remove the patch at bedtime.
- c. Apply two patches in the morning.
- d. Switch to a lower strength patch.
Answer: b. Remove the patch at bedtime.
18. The “Assist” step of the 5 A’s model involves:
- a. Asking the patient if they smoke.
- b. Advising the patient to quit.
- c. Providing counseling and recommending pharmacotherapy.
- d. Arranging a follow-up appointment.
Answer: c. Providing counseling and recommending pharmacotherapy.
19. What is a key counseling point for a patient using the nicotine lozenge?
- a. Chew the lozenge for best effect.
- b. Swallow the lozenge whole.
- c. Allow the lozenge to dissolve slowly in the mouth over 20-30 minutes.
- d. Use no more than 5 lozenges per day.
Answer: c. Allow the lozenge to dissolve slowly in the mouth over 20-30 minutes.
20. The “Smoking Cessation” lab session is a component of which course?
- a. PHA5164L Professional Skills Laboratory 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care 1
- d. PHA5103 Principles of Patient-Centered Care
Answer: b. PHA5163L Professional Skills Lab 3
21. Bupropion SR therapy for smoking cessation should be initiated:
- a. 1-2 weeks before the patient’s quit date.
- b. On the quit date.
- c. The day after the quit date.
- d. Only after the patient has already quit for a month.
Answer: a. 1-2 weeks before the patient’s quit date.
22. “Rolling with resistance” is a motivational interviewing technique that involves:
- a. Arguing with the patient to prove your point.
- b. Expressing agreement in a non-judgmental way and avoiding confrontation.
- c. Ignoring the patient’s resistance.
- d. Telling the patient they are wrong.
Answer: b. Expressing agreement in a non-judgmental way and avoiding confrontation.
23. Which of the following is NOT an FDA-approved first-line agent for smoking cessation?
- a. Varenicline
- b. Nicotine gum
- c. Electronic cigarettes (e-cigarettes)
- d. Bupropion SR
Answer: c. Electronic cigarettes (e-cigarettes)
24. The main reason for using combination NRT is to:
- a. Provide a steady-state level of nicotine with the patch while using a short-acting product for acute cravings.
- b. Increase the side effects of nicotine.
- c. Save the patient money.
- d. Make the therapy more complicated.
Answer: a. Provide a steady-state level of nicotine with the patch while using a short-acting product for acute cravings.
25. A patient who is pregnant should be counseled that which of the following is the first-line approach to smoking cessation?
- a. Varenicline
- b. Bupropion SR
- c. Nicotine patch
- d. Behavioral counseling without pharmacotherapy.
Answer: d. Behavioral counseling without pharmacotherapy.
26. The “5 R’s” are used to enhance motivation for patients unwilling to quit. Which of the following is NOT one of the 5 R’s?
- a. Relevance
- b. Risks
- c. Rewards
- d. Ridicule
Answer: d. Ridicule
27. What is the maximum number of pieces of 4 mg nicotine gum a patient should use per day?
- a. 12
- b. 24
- c. 30
- d. There is no maximum.
Answer: b. 24
28. A common side effect of varenicline that can be managed by taking it with food and a full glass of water is:
- a. Insomnia
- b. Dry mouth
- c. Nausea
- d. Constipation
Answer: c. Nausea
29. A patient’s readiness to quit is an important factor when selecting an appropriate smoking cessation therapy.
- a. True
- b. False
Answer: a. True
30. The “Arrange” step in the 5 A’s model involves:
- a. Arranging the pharmacy shelves.
- b. Arranging for a follow-up contact with the patient.
- c. Arranging payment for the medication.
- d. Arranging transportation for the patient.
Answer: b. Arranging for a follow-up contact with the patient.
31. The primary mechanism of action for bupropion in smoking cessation is thought to be:
- a. Antagonism of nicotinic receptors.
- b. Inhibition of dopamine and norepinephrine reuptake.
- c. MAO inhibition.
- d. Serotonin agonism.
Answer: b. Inhibition of dopamine and norepinephrine reuptake.
32. Which NRT formulation has a recommended duration of therapy that is typically longer than the others (e.g., up to 6 months)?
- a. Nicotine Patch
- b. Nicotine Gum
- c. Nicotine Inhaler
- d. Nicotine Lozenge
Answer: c. Nicotine Inhaler
33. The principle of “developing discrepancy” in motivational interviewing is intended to help the patient see the gap between:
- a. The cost of two different medications.
- b. Their current behavior (smoking) and their future goals or values.
- c. What the pharmacist recommends and what the doctor recommends.
- d. Their current health and their past health.
Answer: b. Their current behavior (smoking) and their future goals or values.
34. The “ATTAC-IT program” mentioned in the PPD 1 syllabus is a training program for:
- a. Pharmacy law.
- b. Sterile compounding.
- c. Interprofessional Tobacco Awareness and Cessation.
- d. Advanced cardiac life support.
Answer: c. Interprofessional Tobacco Awareness and Cessation.
35. A patient should be counseled to rotate the application site for the nicotine patch to avoid:
- a. Decreased absorption.
- b. Skin irritation.
- c. The patch falling off.
- d. Increased side effects.
Answer: b. Skin irritation.
36. The most common side effect of the nicotine nasal spray is:
- a. Dry mouth
- b. Cough
- c. Nasal and throat irritation.
- d. Constipation
Answer: c. Nasal and throat irritation.
37. How long after quitting smoking does the excess risk of coronary heart disease decrease by about half?
- a. 24 hours
- b. 1 year
- c. 5 years
- d. 10 years
Answer: b. 1 year
38. Which statement reflects “expressing empathy” in motivational interviewing?
- a. “You must quit now.”
- b. “I understand that quitting is difficult and you’ve had a tough time with it.”
- c. “If you don’t quit, you will get sick.”
- d. “Many people find it easy to quit.”
Answer: b. “I understand that quitting is difficult and you’ve had a tough time with it.”
39. When a patient sets a quit date, they should be advised to:
- a. Stop smoking completely on that day.
- b. Gradually reduce their smoking after that day.
- c. Choose a date far in the future.
- d. Not tell anyone about their quit date.
Answer: a. Stop smoking completely on that day.
40. The pharmacotherapy of smoking cessation is a topic covered in the Patient Care 3 course.
- a. True
- b. False
Answer: a. True
41. Which of these is a behavioral coping strategy a pharmacist can recommend?
- a. Starting varenicline.
- b. Identifying triggers and planning an alternative action, like taking a walk instead of a smoke break.
- c. Using a nicotine patch.
- d. Switching to smokeless tobacco.
Answer: b. Identifying triggers and planning an alternative action, like taking a walk instead of a smoke break.
42. The “R” in the OARS model of MI stands for:
- a. Recommendation
- b. Rationale
- c. Reflective Listening
- d. Resistance
Answer: c. Reflective Listening
43. A patient using the nicotine inhaler should be counseled to:
- a. Inhale deeply into the lungs like a cigarette.
- b. Puff frequently into the back of the throat or mouth.
- c. Use only one cartridge per day.
- d. Store the cartridges in the refrigerator.
Answer: b. Puff frequently into the back of the throat or mouth.
44. The “Assess” step in the 5 A’s model is primarily for determining:
- a. The patient’s insurance coverage.
- b. The patient’s willingness to make a quit attempt.
- c. The patient’s weight.
- d. The patient’s past medical history.
Answer: b. The patient’s willingness to make a quit attempt.
45. Which smoking cessation product has a black box warning for serious neuropsychiatric events, although subsequent studies have shown the risk to be lower than initially thought?
- a. Nicotine gum
- b. Nicotine patch
- c. Bupropion SR
- d. Varenicline
Answer: d. Varenicline
46. Supporting self-efficacy in motivational interviewing means:
- a. Telling the patient what to do.
- b. Highlighting the patient’s past successes and expressing confidence in their ability to quit.
- c. Completing the paperwork for the patient.
- d. Doubting the patient’s ability to succeed.
Answer: b. Highlighting the patient’s past successes and expressing confidence in their ability to quit.
47. A patient wants to quit smoking but is concerned about weight gain. Which medication has been shown to delay weight gain during treatment?
- a. Nicotine patch
- b. Varenicline
- c. Bupropion SR
- d. Nicotine lozenge
Answer: c. Bupropion SR
48. Identifying a patient who smokes during a routine prescription fill is an example of which step of the 5 A’s?
- a. Ask
- b. Advise
- c. Assess
- d. Assist
Answer: a. Ask
49. The PPD 1 curriculum includes performing brief tobacco interventions utilizing motivational interviewing.
- a. True
- b. False
Answer: a. True
50. The ultimate goal of a pharmacist-led smoking cessation service is to:
- a. Sell as much NRT as possible.
- b. Empower and support patients with behavioral and pharmacological tools to successfully quit smoking and improve their long-term health.
- c. Prove that pharmacists are better at counseling than physicians.
- d. Document as many interventions as possible.
Answer: b. Empower and support patients with behavioral and pharmacological tools to successfully quit smoking and improve their long-term health.