Effective communication is a cornerstone of patient-centered care, and Motivational Interviewing (MI) is a powerful, evidence-based communication style designed to help patients explore and resolve their own ambivalence about behavior change. Rather than a top-down, directive approach, MI is a collaborative partnership that strengthens a person’s own motivation and commitment to change. For PharmD students, mastering the principles and techniques of MI is a critical “transcending concept” that can be applied across numerous areas of practice—from improving medication adherence and managing chronic diseases to supporting smoking cessation and other health wellness goals. This MCQ quiz will test your knowledge on the spirit, principles, and skills of Motivational Interviewing.
1. Motivational Interviewing (MI) is best described as a:
- A. Technique for confronting patients about their poor health choices.
- B. Collaborative, goal-oriented style of communication designed to strengthen a person’s own motivation for change.
- C. Rapid method for giving patients expert advice on what they should do.
- D. Standardized script to be followed with every patient.
Answer: B. Collaborative, goal-oriented style of communication designed to strengthen a person’s own motivation for change.
2. The “spirit” of Motivational Interviewing is encapsulated by the acronym PACE, which stands for:
- A. Persuasion, Authority, Correction, Expertise
- B. Partnership, Acceptance, Compassion, Evocation
- C. Planning, Action, Commitment, Evaluation
- D. Patience, Assessment, Confrontation, Education
Answer: B. Partnership, Acceptance, Compassion, Evocation
3. “Resisting the righting reflex” is a core principle of MI. This refers to the clinician’s need to avoid the natural tendency to:
- A. Immediately try to fix the patient’s problems or tell them what to do.
- B. Agree with everything the patient says.
- C. Use complex medical terminology.
- D. Document the conversation accurately.
Answer: A. Immediately try to fix the patient’s problems or tell them what to do.
4. The four core principles of MI can be remembered by the acronym RULE, which stands for: Resist the righting reflex, Understand the patient’s motivation, Listen with empathy, and:
- A. Educate the patient
- B. Evaluate the outcomes
- C. Empower the patient
- D. Enforce the plan
Answer: C. Empower the patient
5. The core communication skills in MI are known by the acronym OARS. “O” stands for:
- A. Offering advice
- B. Overcoming resistance
- C. Open-ended questions
- D. Observing behavior
Answer: C. Open-ended questions
6. Which of the following is an example of an open-ended question?
- A. “Are you taking your medication every day?”
- B. “Do you want to quit smoking?”
- C. “What are some of the challenges you face when trying to eat healthier?”
- D. “Is your blood pressure usually this high?”
Answer: C. “What are some of the challenges you face when trying to eat healthier?”
7. “Affirmations,” the “A” in OARS, are statements made by the clinician to:
- A. Praise the patient for any positive behavior or effort, building self-efficacy.
- B. Confirm that the patient understands the risks of their behavior.
- C. Assert the clinician’s authority.
- D. List all the things the patient is doing wrong.
Answer: A. Praise the patient for any positive behavior or effort, building self-efficacy.
8. The “R” in OARS stands for Reflective Listening. A “simple reflection” involves:
- A. Repeating or slightly rephrasing what the patient said.
- B. Guessing what the patient will say next.
- C. Stating the opposite of what the patient said to create discord.
- D. Offering a detailed interpretation of the patient’s feelings and thoughts.
Answer: A. Repeating or slightly rephrasing what the patient said.
9. A patient says, “I know I should exercise, but I’m just so tired after work and I have no energy.” A complex reflection would be:
- A. “So you’re saying you’re tired after work.”
- B. “It sounds like you’re feeling overwhelmed, and your fatigue makes it seem impossible to even start exercising.”
- C. “Why don’t you just exercise in the morning then?”
- D. “You should try exercising, it will give you more energy.”
Answer: B. “It sounds like you’re feeling overwhelmed, and your fatigue makes it seem impossible to even start exercising.”
10. “Summaries,” the “S” in OARS, are used to:
- A. End the conversation quickly.
- B. Demonstrate that the clinician has been listening, link together different parts of the conversation, and facilitate transitions.
- C. Correct the patient’s mistaken beliefs.
- D. List all the tasks the patient needs to complete.
Answer: B. Demonstrate that the clinician has been listening, link together different parts of the conversation, and facilitate transitions.
11. The four overlapping processes of MI are Engaging, Focusing, Evoking, and:
- A. Confronting
- B. Directing
- C. Planning
- D. Assessing
Answer: C. Planning
12. The “Engaging” process in MI is primarily focused on:
- A. Setting a clear agenda for behavior change.
- B. Building a collaborative and trusting relationship with the patient.
- C. Eliciting the patient’s own reasons for change.
- D. Developing a specific action plan.
Answer: B. Building a collaborative and trusting relationship with the patient.
13. In MI, “change talk” refers to any patient speech that favors movement toward a specific change. Which of the following is an example of change talk?
- A. “I enjoy smoking, it helps me relax.”
- B. “I know my blood pressure would be better if I could cut back on salt.”
- C. “Taking medication every day is just too much of a hassle.”
- D. “My family smokes, so I don’t see the point in quitting.”
Answer: B. “I know my blood pressure would be better if I could cut back on salt.”
14. “Sustain talk” refers to patient speech that favors the status quo. Which of the following is an example of sustain talk?
- A. “I’m worried about my health if I keep this up.”
- B. “I suppose I could try walking for 10 minutes a day.”
- C. “I’ve tried to quit smoking before and it was impossible; I don’t think I can do it.”
- D. “My life would be so much better if I could get my diabetes under control.”
Answer: C. “I’ve tried to quit smoking before and it was impossible; I don’t think I can do it.”
15. When a clinician hears change talk, the appropriate MI response is to:
- A. Ignore it and change the subject.
- B. Immediately tell the patient how to make the change.
- C. Use OARS skills to elicit more change talk and reinforce it (e.g., “Tell me more about that,” or reflect the statement).
- D. Challenge the patient on whether they are being truthful.
Answer: C. Use OARS skills to elicit more change talk and reinforce it (e.g., “Tell me more about that,” or reflect the statement).
16. “Ambivalence” is a central concept in MI. It is best understood as:
- A. A sign of resistance and unwillingness to change.
- B. A normal state of having mixed feelings or contradictory ideas about something, like wanting to change and not wanting to change at the same time.
- C. A personality flaw that cannot be addressed.
- D. A reason to stop the conversation and refer the patient to a specialist.
Answer: B. A normal state of having mixed feelings or contradictory ideas about something, like wanting to change and not wanting to change at the same time.
17. The primary goal of the “Evoking” process in MI is to:
- A. Provide education about the target behavior.
- B. Elicit and strengthen the patient’s own motivations and arguments for change (i.e., elicit change talk).
- C. Focus the conversation on a specific topic.
- D. Build initial rapport with the patient.
Answer: B. Elicit and strengthen the patient’s own motivations and arguments for change (i.e., elicit change talk).
18. Developing “discrepancy” in MI involves helping the patient see the gap between:
- A. The clinician’s opinion and the patient’s opinion.
- B. Their current behavior and their core values or goals.
- C. The cost of medication and the cost of cigarettes.
- D. Their current health and their past health.
Answer: B. Their current behavior and their core values or goals.
19. Which of the following demonstrates the MI principle of “Acceptance”?
- A. Approving of the patient’s unhealthy behavior.
- B. Honoring the patient’s autonomy and perspective without judgment, even if you don’t agree with their choices.
- C. Accepting that the patient will never change.
- D. Only accepting patients who are ready to make a change.
Answer: B. Honoring the patient’s autonomy and perspective without judgment, even if you don’t agree with their choices.
20. The “Focusing” process in MI involves:
- A. Insisting on a topic that the clinician thinks is most important.
- B. Collaboratively finding a clear direction and goal for the conversation.
- C. Focusing only on the patient’s past failures.
- D. Allowing the conversation to drift without any clear purpose.
Answer: B. Collaboratively finding a clear direction and goal for the conversation.
21. A patient says, “My doctor says I have to lose weight, but I just don’t see how.” An MI-adherent response would be:
- A. “You’re right, it’s probably too hard for you.”
- B. “Well, here is a diet plan. You need to follow it.”
- C. “Losing weight can feel like a huge challenge. What are some of your thoughts about it?”
- D. “If you don’t lose weight, you’ll get diabetes.”
Answer: C. “Losing weight can feel like a huge challenge. What are some of your thoughts about it?”
22. “Rolling with resistance” is an MI strategy for responding to patient discord or sustain talk. It involves:
- A. Arguing with the patient to prove your point.
- B. Ignoring the patient’s resistance.
- C. Acknowledging the patient’s perspective without confrontation and using reflection to explore their view further.
- D. Immediately ending the conversation when resistance appears.
Answer: C. Acknowledging the patient’s perspective without confrontation and using reflection to explore their view further.
23. “Readiness rulers” (e.g., “On a scale of 0 to 10, how important is it for you to change…?”) are tools used in MI to:
- A. Diagnose a patient’s medical condition.
- B. Assess a patient’s motivation, importance, and confidence regarding a change.
- C. Force a patient to commit to a change.
- D. Determine the patient’s IQ.
Answer: B. Assess a patient’s motivation, importance, and confidence regarding a change.
24. After a patient rates their importance for change as a “6” on a 0-10 scale, a good follow-up question in MI would be:
- A. “Why didn’t you pick a higher number like an 8 or 9?”
- B. “Why isn’t that a lower number, like a 2 or 3?”
- C. “A ‘6’ isn’t good enough, you need to be at least an ‘8’ to succeed.”
- D. “So you’re saying it’s not important at all.”
Answer: B. “Why isn’t that a lower number, like a 2 or 3?” (This is a classic MI technique to elicit change talk).
25. The final process, “Planning,” should generally begin only when:
- A. The clinician decides the patient is ready.
- B. The patient shows signs of readiness and has expressed sufficient change talk.
- C. The first 5 minutes of the appointment are over.
- D. The patient has failed to change on their own.
Answer: B. The patient shows signs of readiness and has expressed sufficient change talk.
26. Which of the following is an example of an “Affirmation”?
- A. “You did a good job taking your medication 4 days last week; that’s a tough thing to get started with.”
- B. “You need to take your medication all 7 days.”
- C. “So you took your medication 4 times last week.”
- D. “What will happen if you don’t take your medication?”
Answer: A. “You did a good job taking your medication 4 days last week; that’s a tough thing to get started with.”
27. “Elicit-Provide-Elicit” is a framework used in MI for sharing information. It involves:
- A. Providing information, then asking if the patient understands, then providing more information.
- B. Asking for permission and what the patient knows, providing information clearly, then asking for the patient’s interpretation or reaction.
- C. Eliciting all the patient’s problems, providing all possible solutions, and eliciting their final choice.
- D. Telling the patient what to do, asking if they will do it, then telling them again.
Answer: B. Asking for permission and what the patient knows, providing information clearly, then asking for the patient’s interpretation or reaction.
28. A key difference between MI and the Transtheoretical Model of Change (Stages of Change) is that:
- A. MI is a communication style to help people move through stages of change; the Transtheoretical Model describes the stages themselves.
- B. The Transtheoretical Model is a style of counseling.
- C. MI is only useful for patients in the “Action” stage.
- D. The two concepts are unrelated.
Answer: A. MI is a communication style to help people move through stages of change; the Transtheoretical Model describes the stages themselves.
29. The “righting reflex” is often counterproductive because it can:
- A. Make the clinician seem too empathetic.
- B. Elicit “sustain talk” from the patient as they defend their position against the advice.
- C. Empower the patient to make their own choices.
- D. Build rapport too quickly.
Answer: B. Elicit “sustain talk” from the patient as they defend their position against the advice.
30. Which core MI skill is being used when a pharmacist says: “So on one hand, you enjoy the social aspect of smoking with your friends, but on the other hand, you’re worried about your cough and how it affects your breathing”?
- A. Offering advice
- B. A simple reflection
- C. A complex, double-sided reflection (to highlight ambivalence)
- D. An open-ended question
Answer: C. A complex, double-sided reflection (to highlight ambivalence)
31. The “Evocation” part of the MI spirit means that the motivation for change is presumed to:
- A. Come from the clinician’s expert advice.
- B. Reside within the patient and needs to be elicited or “called forth.”
- C. Be unimportant to the process.
- D. Be created by using fear tactics.
Answer: B. Reside within the patient and needs to be elicited or “called forth.”
32. In the “Planning” phase of MI, the clinician’s role is to:
- A. Create a detailed plan and give it to the patient to follow.
- B. Help the patient consolidate commitment and collaboratively develop a specific, acceptable, and effective change plan.
- C. Determine if the patient is motivated enough to plan.
- D. Focus on why previous plans have failed.
Answer: B. Help the patient consolidate commitment and collaboratively develop a specific, acceptable, and effective change plan.
33. Which of the following is NOT consistent with the spirit of MI?
- A. “I’m here to partner with you to figure this out.”
- B. “Your health is your responsibility, but I can help you explore some options if you like.”
- C. “You really need to quit smoking immediately, or you’re going to have a heart attack.”
- D. “It sounds like you’ve been working really hard on this already.”
Answer: C. “You really need to quit smoking immediately, or you’re going to have a heart attack.” (This is confrontational and directive, not MI-adherent).
34. A patient states, “I’m not going to take that medication, the side effects sound awful.” How would you “roll with resistance”?
- A. “Yes, you are. The doctor prescribed it for a reason.”
- B. “The side effects really aren’t that bad.”
- C. “You’re concerned about how the side effects might make you feel. It makes sense to be cautious about that.”
- D. “Fine, then don’t take it.”
Answer: C. “You’re concerned about how the side effects might make you feel. It makes sense to be cautious about that.” (This is a reflection that validates the patient’s concern without confrontation).
35. A “SMART” goal, often used in the planning phase of MI, is:
- A. Simple, Meaningful, Accountable, Realistic, Timely
- B. Specific, Measurable, Achievable, Relevant, Time-bound
- C. Scientific, Motivational, Action-oriented, Researched, Tough
- D. Small, Manageable, Appreciative, Respected, Thoughtful
Answer: B. Specific, Measurable, Achievable, Relevant, Time-bound
36. A key assumption in Motivational Interviewing is that:
- A. Patients are always unmotivated and need to be directed.
- B. Ambivalence is pathological and must be confronted.
- C. The patient is the expert on their own life and possesses the resources for change.
- D. The clinician’s expertise is the most important factor in behavior change.
Answer: C. The patient is the expert on their own life and possesses the resources for change.
37. When using OARS, what is a primary goal of summarizing?
- A. To demonstrate that the clinician is the expert.
- B. To show the patient that you have been listening and to transition to the next step in the conversation.
- C. To correct the patient’s understanding.
- D. To end the appointment as quickly as possible.
Answer: B. To show the patient that you have been listening and to transition to the next step in the conversation.
38. The question “What would be some of the good things about making this change?” is designed to elicit:
- A. Sustain talk
- B. Resistance
- C. Change talk
- D. A plan of action
Answer: C. Change talk
39. MI is considered a “guiding” style of communication, which falls between:
- A. Directing and Following
- B. Questioning and Answering
- C. Listening and Talking
- D. Planning and Acting
Answer: A. Directing and Following
40. A clinician who spends most of the visit listing the reasons why a patient should change their behavior is primarily using which non-MI approach?
- A. Evocation
- B. The “righting reflex” and persuasion
- C. Empowering
- D. Reflective listening
Answer: B. The “righting reflex” and persuasion
41. In MI, “discord” in the relationship (e.g., patient arguing or becoming defensive) is seen as a signal that:
- A. The patient is not ready for change.
- B. The clinician may need to change their approach (e.g., be less directive, use more reflections).
- C. The MI session should be terminated immediately.
- D. The patient is not being truthful.
Answer: B. The clinician may need to change their approach (e.g., be less directive, use more reflections).
42. Which of the following is an example of “developing discrepancy”?
- A. “You say that your family is the most important thing to you, yet you also mentioned that your smoking prevents you from keeping up with your grandkids. How do you put those two things together?”
- B. “Your blood pressure is too high, you need to fix it.”
- C. “I disagree with your choice to continue smoking.”
- D. “Let’s focus only on the positive aspects of smoking.”
Answer: A. “You say that your family is the most important thing to you, yet you also mentioned that your smoking prevents you from keeping up with your grandkids. How do you put those two things together?”
43. MI was originally developed for use in which field?
- A. Cardiovascular medicine
- B. Diabetes education
- C. Addiction and substance use counseling
- D. Pediatric care
Answer: C. Addiction and substance use counseling
44. The “spirit” of MI is considered the foundation upon which the techniques are built. Without the spirit, the techniques can feel:
- A. More effective.
- B. Manipulative or insincere.
- C. Easier to learn.
- D. More directive.
Answer: B. Manipulative or insincere.
45. A patient says, “I don’t think I can afford to eat healthy.” A good MI-adherent open-ended question would be:
- A. “Don’t you have enough money for groceries?”
- B. “What makes healthy eating seem expensive to you?”
- C. “Have you tried shopping at a discount store?”
- D. “You can’t afford not to eat healthy.”
Answer: B. “What makes healthy eating seem expensive to you?”
46. The overall goal of using reflective listening in MI is to:
- A. Show the patient you are smarter than they are.
- B. Test the patient’s memory.
- C. Demonstrate empathy and understanding, and encourage the patient to elaborate further.
- D. Fill silences in the conversation.
Answer: C. Demonstrate empathy and understanding, and encourage the patient to elaborate further.
47. For a pharmacist, MI is a particularly useful tool for addressing:
- A. Only simple drug information questions.
- B. Medication non-adherence by exploring the patient’s own reasons for and against taking their medication.
- C. Dispensing errors.
- D. Compounding calculations.
Answer: B. Medication non-adherence by exploring the patient’s own reasons for and against taking their medication.
48. Which of the four processes of MI provides the foundation for the entire conversation?
- A. Planning
- B. Evoking
- C. Focusing
- D. Engaging
Answer: D. Engaging
49. An effective MI summary often includes:
- A. Only the clinician’s recommendations.
- B. A collection of the patient’s own statements, especially highlighting any change talk and ambivalence, followed by an open-ended question.
- C. A judgment about the patient’s progress.
- D. A list of all available medications.
Answer: B. A collection of the patient’s own statements, especially highlighting any change talk and ambivalence, followed by an open-ended question.
50. The ultimate power for change in the MI framework lies with the:
- A. Pharmacist
- B. Physician
- C. Patient
- D. Patient’s family
Answer: C. Patient
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