Category: Management

Question 28
Which measurement helps clients with asthma assess the severity of their symptoms?
Breath sounds
Pulse oximetry (PO)
Respiratory rate (RR)
Peak expiratory flow (PEF)

Explain how the nurse practitioner can determine whether a patient is at risk for abuse of a controlled substance. Do you think this is an accurate process? Why or why not?
How a nurse practitioner can determine risk:
Obtain a thorough history: prior substance use disorders, psychiatric comorbidity, family history of substance misuse, and social stressors.
Use validated screening tools and questionnaires: examples include the Opioid Risk Tool (ORT), SOAPP (Screener and Opioid Assessment for Patients with Pain), COMM (Current Opioid Misuse Measure), and AUDIT/CAGE for alcohol.
Query prescription drug monitoring programs (PDMPs) to review recent controlled substance prescriptions and identify doctor shopping or overlapping prescriptions.
Perform baseline and periodic urine drug testing to confirm prescribed medications and screen for nonprescribed or illicit substances.
Assess aberrant medication-related behaviors: early refill requests, lost prescriptions, nonadherence, dose escalation without authorization, or obtaining opioids from multiple providers.
Conduct pill counts or require pharmacy verification when indicated, and use treatment agreements or informed consent outlining expectations and monitoring.
Evaluate medical indications, functional status, and treatment response; consider nonopioid and noncontrolled alternatives where appropriate.
Coordinate with interdisciplinary team members and consider referral to addiction specialists when risk is elevated.
Is this process accurate? Why or why not?
It is a risk-assessment process rather than a definitive diagnostic test. Combining history, validated tools, objective data (PDMP, urine testing), and clinical judgment improves detection of high-risk patients.
Limitations exist: screening tools have imperfect sensitivity and specificity, PDMPs may be incomplete across jurisdictions, and urine tests can yield false positives/negatives or be manipulated.
Bias and stigma can distort clinician judgment; inconsistent documentation or poor patient rapport can reduce accuracy.
Therefore, the process is reasonably accurate when used comprehensively and repeatedly, but it cannot perfectly predict individual future misuse. Best practice is ongoing monitoring, use of multiple data sources, clear agreements, and low-threshold referral to addiction services when concern persists.

Question 7: Which of the following would be considered inventory of Bright Smiles Dentistry?
Workstations
Dentists and dental hygienists
Patients
Streaming services for the TVs