A patient comes to the clinic reporting dizziness and fatigue ...

[bucstennis@aim.com]

A patient comes to the clinic reporting dizziness and fatigue associated with nausea and vomiting. The primary care NP suspects anemia and orders a complete blood count. The patient's hemoglobin is elevated.
 
  The NP correctly concludes that the patient is not anemic. The NP has made an error in: a. context formulation.
  b. inappropriate knowledge base.
  c. cost-versus-benefit analysis.
  d. hypothesis triggering and information processing.

Question 2

A patient takes a cardiac medication that has a very narrow therapeutic range. The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient's medical plan.
 
  The NP knows that the bioavailability of the drug varies from brand to brand. The NP should: a. contact the insurance provider to explain why this particular formulation is necessary.
  b. change the patient's medication to a different drug class that doesn't have these bioavailability variations.
  c. accept the situation and monitor the patient closely for drug effects with each prescription refill.
  d. ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense.

[joshraies]

Answer to Question 1

D
Faulty hypothesis triggering occurs when the clinician fails to consider appropriate initial hypotheses. The patient had nausea and vomiting, which can cause dehydration, leading to orthostatic hypotension and dizziness. The NP made an assumption that the dizziness was caused by anemia and ordered a complete blood count. Faulty information gathering occurs when clinicians fail to order appropriate tests. An error in context formulation occurs when clinicians and patients have different goals. Errors in knowledge base would occur if the practitioner did not perform a complete history and physical, missing important information. An error in cost-versus-benefit analysis could occur if the clinician ordered expensive tests that were not necessary for diagnosis and treatment.

Answer to Question 2

A
In this case, the NP should advocate for the desired drug because changing the drug can have life-threatening consequences. If this fails, other options may have to be explored.

[bucstennis@aim.com]

Thanks for the timely response, appreciate it

[T4T]

TYSM