Practice Examination (50 Questions) INSTRUCTIONS Candidates can use the practice exam to identify areas requiring further study in preparation for an official competency-based examination. The practice exam serves as an optional assessment tool, not a study guide for certification examinations. Adequate preparation for the certification examination is not limited to or reliant on taking the practice exam. It is crucial to understand that performance on a practice examination does not predict a candidate's success or failure on the competency-based NBMTM Certification Examination. Taking the practice exam is voluntary and offers no advantage over candidates who opt not to take it. Only one version of the BCMTMS practice exam is available. The exam content is derived from NBMTM's test specifications. The practice exam comprises 50 multiple-choice questions. NBMTM content experts have developed these questions. Unlike certification examination results, which use scaled scores, practice exam scores are reported as percentages. Upon completion of the practice exam, the results will be emailed to you. You may take as much time as needed for this practice exam. However, bear in mind that the actual BCMTMS exam consists of 200 questions with a four-hour time limit. After you finish the practice exam, NBMTM will email a summary of your performance, detailing correct and incorrect responses for each question. First Name*Last Name*Email* Which of the following statement is incorrect regarding Irritable bowel syndrome (IBS)?* A. IBS is more common in higher socioeconomic groups B. IBS-D is more prevalent than IBS-C C. IBS is more common in women than men D. IBS is usually diagnosed in patients What is the mechanism of action of senna?* A. It decreases the cytosolic calcium concentrations thereby allowing for a greater force of contraction by the intestinal smooth muscle B. It stimulates parasympathetic nerve endings that cause local peristalsis C. It causes local irritation of the intestinal mucosa that stimulates the Auerbach’s plexus D. It stimulates the sympathetic nervous system output on the smooth muscle of the intestine thereby increasing local peristalsis AJ is a 69-year-old man with a history of heart failure. He describes his activity level as sedentary and walking to his car causes shortness of breath. Which class of heart failure does he belong?* A. NYHA Class II B. NYHA Class I C. AHA Stage B D. AHA Stage A Which of the following is incorrect regarding Ranolazine therapy?* A. Ranolazine may increase QTc interval B. Ranolazine is contraindicated in patients taking strong CYP450 3A inhibitors and inducers C. Ranolazine is contraindicated in patients with liver cirrhosis D. Ranolazine should not be used in heart failure patients with a reduced ejection fraction Which of the following regarding MTM is true?* A. Only pharmacists are allowed to give comprehensive medication reviews B. Only members with Medicare part D are eligible to have MTM services C. Pharmacists must have National Provider Identifier (NPI) D. Telephonic medication therapy management reviews cannot be reimbursed from Medicare Which one of the following is the reason why CMS allows other professions other than pharmacists to conduct MTM reviews?* A. CMS considers MTM as “low tech” work B. Regulators wanted sponsors to have more flexibility to promote best practices C. Some patients expressed concerns that pharmacists are not clinical enough D. Pharmacists are too expensive Which of the following service elements is not required by Part D MTM programs to provide?* A. Interventions for both beneficiaries and prescribers B. Comprehensive Medication Reviews (CMRs) are performed face-to-face or by telephone C. Written summaries with medication action plans and personal medication lists D. A minimum of 60 minutes discussion time for the provider and patient Which of the following should not be included in a comprehensive medication review?* A. Rx Drugs B. OTC drugs C. Herbal Drugs D. All of the above should be included _________ is a part of the CMR specifically designed to outline the patient’s responsibility in helping to solve various identified problems* A. Medication Action Plan B. Patient Educational Inserts C. Manufacturer Package Inserts D. Comprehensive List Which one of the following does not show the positive aspects of using a telephonic model for MTM vs face-to-face model for MTM?* A. Patients are in a comfortable environment B. Some patients have difficulty hearing from the phone C. Patient has access to information such as labs and other medical history D. Consultation can be recorded for oversight and auditing ___________ was added to the drug therapy guidelines for nursing facilities residence to ensure avoidance of certain medications that are inappropriate.* A. Beer’s list criteria B. Drug Interaction Lists C. Formulary List D. FDA Safety Recommendation This system commonly referred to as plan ratings or star ratings evaluate plans in order to show beneficiary the plan’s quality and performance* A. 5 Star System B. 7 Star System C. 10 Star System D. 8 Star System Which of the following is not an appropriate entity to outsource MTM services?* A. Plan sponsored PBMs B. MTM Vendors C. Local Pharmacies D. Offshore Business Processing offices Which of the following is not one of the 5 core elements defined by the American Pharmacist Association, the National Association of Chain Drug Stores, and the Center of Medicare and Medicaid Services?* A. Comprehensive Medication Review (CMR) B. Medication Action Plan (MAP) C. Interaction with other health care professionals D. Providing financial assistance to the needy Which is true in regards to differences between medication reconciliation done at the hospital versus a comprehensive medication review (CMR)?* A. Medication reconciliation only focuses on the medication that patients would take during the hospital stay B. CMRs empower patients to engage in their own health and quality of life C. Medication Reconciliation does not involve gaps of care and adherence D. All of the above is true What information strengths do retail chain pharmacies have versus independent pharmacies?* A. Knowledge of medication of when medication is filled and when it is not picked up B. Knowledge of refill patterns C. Medication information from all pharmacies with that chain pharmacy D. Knowledge of medication dispensed Which of the following is not considered nonverbal communication?* A. Tone of voice B. Facial expressions C. Rate of Speech D. Texting During telephonic MTM reviews, what is one way you can brighten your voice?* A. Speak faster B. Smile C. Speak slowly D. Add a few jokes Which of the following is not a characteristic of an open-ended question?* A. Questions typically begin with “what” and “how” B. They can provide a wealth of unexpected and valuable info about the patient C. Open ended question generally lead patients to one direction D. It can determine how well the patient understand you and the language you are speaking Which of the following is not an indication that a patient has low health literacy?* A. Handing patient education materials to relatives or friends B. Point to the text with one finger while reading C. Identify medications by the pill color, size, and shape D. All of the above indicates low health literacy An 18 year old African American male presented to you with a past medical history of allergic rhinitis. He has been recently diagnosed with asthma and was prescribed a rescue inhaler as needed. While doing a comprehensive medication review, you noticed that he was in need of a maintenance inhaler due to the severity of his asthma. Which maintenance inhaler would you recommend as long-term therapy?* A. Qvar B. Tudorza C. Combivent D. Foradil Upon during a review for a patient, she states that she has received a prescription from her doctor for Singulair (Montelukast). The patient tells you how to take this medication? Which on one of these is considered an appropriate response?* A. It is best for her to take it in the morning B. She should take it as needed when her asthma symptoms seem to get worse C. She should take this in the evening since she has asthma D. It is best for her to take it twice daily A 30-year-old white male with a past medical history of asthma reports for a follow up at the MD office. He is currently on fluticasone 110mcg inhaler 1 puff twice a day (low-dose therapy), albuterol inhaler every 6 hours as needed, acetaminophen 500 mg tablets 1 to 2 tablets every day as needed for muscle soreness after exercise". When asked about his asthma symptoms, he reports waking up at night coughing 4 times in the last month. He experiences shortness of breath and wheezing almost every day. He also states she has been using albuterol rescue inhaler 4 to 5 times in the past week.* A. His asthma is not well controlled, increase fluticasone 100 mcg to 2 puffs twice daily and follow up after 2 weeks B. His asthma is well controlled, no action needed at this time C. His asthma is not well controlled, increase the dose of albuterol inhaler every 4 hours as needed D. His asthma is not well controlled, initiate Medrol dose pack immediately Which of the following is not considered a factor that can decrease the clearance of theophylline and require a lower dosage of medication?* A. Old age B. Pneumonia C. High Carbohydrate Diet D. Smoking Which of the following beta-blockers are approved for patients with persistent asthma who also have heart failure?* A. Propranolol B. Atenolol C. Metoprolol Succinate D. Carvedilol As you are developing the MAP (Medication Action Plan) for a patient that is taking warfarin, which of the following statements should you avoid?* A. Set up a reminder system that will ensure you will remember all your appointments to check your INR B. Immediately call the physician if you see any unusual bleeding C. Be careful not to take NSAID products, such as Advil or ibuprofen with warfarin D. Avoid foods with vitamin K due to Warfarin’s interaction with Vitamin K Which of the following is not a risk factor for atrial fibrillation?* A. Fatty Liver Disease B. European Ancestry C. Hyperthyroidism D. Heavy alcohol consumption During the MAP (Medication Action Plan), which of the following is recommended to add for a patient taking Dronedarone (Multaq)?* A. Dronedarone must be taken on an empty stomach B. Avoid grapefruit juice C. Contact MD to see if your dose of Simvastatin can be changed from 40mg to 20mg due to drug-drug interaction with Dronedarone D. None of the above Which beta blocker would you recommend for ventricular rate control in patients who have atrial fibrillation secondary to hyperthyroidism?* A. Atenolol B. Metoprolol C. Sotalol D. Propranolol A patient states that she constantly keeps skipping her bipolar medications because she states she is not sure if she took it earlier in the day and she does not want to take double the amount of medication. Which of the following would you suggest on her medication action plan?* A. Decrease the number of your medications B. Use and fill a pillbox on a weekly basis C. Use one vial to carry all of your medications D. Keep the medication inside of a cabinet Which of the following terms could be described as a mild degree of mania?* A. Depression B. Hypomania C. Major Depression D. Manic A patient with bipolar I disorder is receiving paroxetine and valproic acid after a major depressive episode 4 months ago. The use of paroxetine in this patient would be classified as which of the following medication-related problem types?* A. Need for additional monitoring B. Need for adherence C. Unnecessary Medication D. Possibility of Serotonin Syndrome Which of the following is not a common adverse effect of lithium?* A. Weight Loss B. Polyurea C. Tremor D. GI upset Which of the following is the most common cause of chronic kidney disease?* A. Hypertension B. Diabetes Mellitus C. Drug overuse D. High Sodium Diet Which of the following is NOT an appropriate counseling recommendation for a patient with chronic Kidney disease?* A. Orange juice should be avoided due to potassium content B. Acetaminophen should be used in preference instead of ibuprofen C. If you forget a dose of phosphate binder at lunch, then take it as soon as possible D. You should check your blood pressure at home in addition to having it checked at your physician’s office Which of the following phosphate binders can you give to a patient without increasing the patient's calcium levels?* A. PhosLo B. Lenal Ace C. Calcichew D. Renvela Which of the following parameters indicate that a patient is "high risk for future COPD exacerbations?* A. Daily use of both an LA beta-2 agonist and anticholinergic bronchodilator B. History of 1 COPD exacerbation in the previous 12 months C. FEV-1 (Forced expiratory volume in one second) is less than 80% but more than 50% D. Grade 2 airflow limitation When should you refer a COPD patient IMMEDIATELY to a physician?* A. When patients experience shortness of breath after climbing several flights of stairs B. Increase symptoms of coughing and shortness of breath but relieved with a short-acting inhaler C. Shortness of breath not relieved by a rescue inhaler D. Patient experiencing severe nighttime cough During an MTM review, patient states that she suffers from COPD due to long-term smoking. She states that she is on quite a few medications and would like to see if she can be eliminated from some. Which of the following is the best agent to recommend for her physician on a possible discontinuation?* A. Theophylline B. Leukotriene modifiers C. Short-acting beta-2 agonists D. Long-acting beta-2 agonists A 67-year-old Asian male with a history of allergic rhinitis, hypertension, and diabetes is currently during a CMR review. His current medications are benazepril 20 mg qd, levocetirizine 5mg qd, and metformin 500 mg bid. He continues to smoke 1 packet of cigarettes per day (15 pack-year history). Patient complains of occasional shortness of breath when he is rushing to work, however overall does not notice any breathing issues and is able to carry on normal daily activities. Which of the following would you recommend to the patient?* A. Recommend initiating furosemide due to possible heart failure symptoms B. Recommend discontinue metformin due to possible symptoms of lactic acidosis C. Recommend initiating fluticasone nasal spray for worsening allergy rhinitis D. Recommend initiating smoking cessation Which of the following counseling points should you make when noticing a patient is taking Symbicort (budesonide-formoterol) inhaler?* A. Use it immediately when feeling shortness of breath B. Rinse mouth due to small risk in developing thrush from Candida albicans C. Monitor blood pressure due to possibility of decreased blood pressure with corticosteroid inhalers D. Rinsing the mouth afterward may help prevent dry mouth side effects When using a peak flow meter, which of the following is not recommended for patients to do?* A. Place the mouthpiece into the mouth on the top of the tongue B. Breath in normally and breath out normally C. Patient should record the best of three attempts D. Patient should inhale fully and then blast Which of the following may induce an angina attack?* A. Walking upstairs B. Watching Television C. Arguing with someone D. All of the above Which of the following is appropriate counseling point for Nitroglycerin use in angina?* A. If the pain does not improve in 5 minutes after the first dose, then call 911 B. Chew nitroglycerin for faster onset C. Do not repeat dose D. Immediately store nitroglycerin in the pillbox for better accessibility When doing a CMR review, patient says he suffers from chronic stable angina. Which of the following is the best way to access whether his chronic stable angina is controlled?* A. "How does your chest pain limit you from doing the activities that you enjoy" B. "How many times do you take your nitroglycerin tablets?" C. "How many times in the past 3 months were you hospitalized from chest pains." D. "What has the doctor said about your chest pain?" Which of the following is NOT one of the comorbid conditions that may manifest from Alzheimers?* A. Depression B. Anxiety C. Insomnia D. Gout Which of the following best describes the mechanism of action of memantine (Namenda)?* A. D2 receptor agonists B. Antagonizes NMDA receptor C. Inhibits acetylcholinesterase D. Inhibits Monoamine Oxidase Enzymes Which of the following hemoglobin A1c level is considered as pre-diabetic?* A. 6.5% to 7% B. 5.7% to 6.4% C. 7% to 7.5% D. > 5% Which of the following is a symptom of both hypoglycemia and hyperglycemia?* A. Confusion B. Dizziness C. Fatigue D. Increase appetite or hunger When should we avoid duloxetine (Cymbalta) in an elderly patient?* A. Poor renal function B. History of seizure C. History of hypertension D. Concurrent use of gabapentin
