Ontario Primary Health Care Nurse Practitioner Program
Therapeutics in Primary Health Care II
Prep Guide for the Therapeutics in Primary Health Care II Final
Exam
Tuesday April 6, 2021
Information about the Final On-Line Exam
Time allowed:
The Exam is TWO and ONE HALF (2.5) hours in duration.
Start: 1000 hrs
Finish:1230 hrs
Location: This exam will be written remotely.
Weight of Exam: The Final Exam is worth 40% of the final Therapeutics II grade.
Equipment:
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Reliable internet connection, as the exam will be written via
distance technology. Connect your computer/laptop to the
internet using a cable for best connectivity or be close to your
Wi-Fi router, while ensuring privacy and a quiet space during
the exam. Ensure that others in your home are not using the
internet during the exam.
Any type of computer or a Chromebook, but must meet
“minimum system requirements” to access Proctorio, the
PHCNP online exam proctoring service https://proctorio.com/systemrequirements.
A webcam (integrated or USB)
A microphone (integrated or USB)
Ensure you have updated your operating system and your Chrome web browser.
Chrome Browser is required for Proctorio: download from
https://www.google.com/chrome/
Proctorio Chrome add-on, download from https://getproctorio.com/
Students may contact np.support@np-education.ca if they need further
information or support.
1-2 Days Before the Exam: Complete the “Student Terms of Use
Agreement” for Proctorio and the
Confidentiality Agreement for the exam, both
of which can be accessed through the same
site at
https://phcnp.instructure.com/courses/81/quiz
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zes/1048
The Student Terms of Use Agreement provides
you with relevant information regarding the
privacy and security of Student Information.
The Confidentiality Agreement is an important
piece of your professional practice—you must
agree to not disclose any information about
the exam. It is imperative that you DO NOT
discuss any exam questions or post
anything regarding the exam during or
after you have written it.
Review your university’s exam policy to ensure
compliance with all exam and academic
integrity policies
Morning of the Exam:
You need your: a) PHCNP Program user-name and password,
and
b) photo ID and your student number (student
card)
c) any other requirements specified by your
university.
Sign-in online: Access Therapeutics course in Canvas at
https://phcnp.instructure.com/courses/81 and go the
Quizzes section to access the online Exam
Exam Format:
The final exam contains 54 multiple-choice questions
and 16 short answer questions from modules 1-12.
Each multiple choice question has one answer that
is the most correct. Each question is marked
completely correct or incorrect, no partial marks are
given. Short answer questions may ask for multiple
answers that add up to 1 mark. Prescription
questions are worth 2 marks and no partial marks
are awarded.
Aids:
Normal ranges for common laboratory tests and
eTherapeutics/RxTx/ RxFiles are NOT provided.
Printed and/or electronic resources (e.g., calculator,
Google) are not allowed during the exam. You will
not need a calculator, as all calculations are
provided.
One blank sheet of paper can be used to jot down
key points or questions that you want to go back to.
If you are using this strategy, you must show both
2
sides of the blank paper to the camera at the start of
the exam and then you must show both sides of the
paper and tear it into very tiny pieces while still
connected to via video feed at the conclusion of the
exam.
Illness/Emergency: If, for some serious unforeseen circumstance,
you are unable to write the exam at the scheduled
time (e.g., severe illness, vehicle crash), you must
inform your University Site Coordinator (not the
Course Professor) as soon as possible – preferably in
advance of the exam and follow your university's
policy regarding documentation of the condition or
situation. Accommodation to complete the exam at
an alternate time/date may be made according to
your university policies and processes.
Question About an Exam Question During the Exam: Roger
Firsoff at 647-403-0265
Technical Support: Telephone is the preferred method to seek
technical support. Phone one of the numbers below, leave a message if
you get voicemail and your call will be promptly returned. Email is
provided, as a secondary, but less preferred method of seeking
support; include your telephone number if you do use email so that a
DEIT member can call you, if needed.
1.877.676.8102
Yasar <khan.yas@np-education.ca>
1.877.676.8101
Terry <ttrem@np-education.ca>
1-877-676-8105
Claude <cmorin@npeducation.ca>
If there is a power outage – immediately contact Technical Support
(see above). For a more long-lasting interruption, the alternative exam
date and time will be used. If the power remains out for the alternate
exam date and time, the exam may be rescheduled. You are required
to be available at the alternate exam time scheduled at the beginning
of the course in the NP academic calendar.
Click on Submit when you have completed the exam. Your
answers are saved automatically when you move to the next
question.
A webcam and microphone are required for the exam and they must
be turned on. Ensure your laptop or computer is on a firm surface and
that your whole face is visible in the camera field for the entire
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exam, avoid tilting the laptop screen/built-in webcam after the
camera is set-up.
Internet Connection and Power Source:
A broadband connection is required with good internet connection.
Check your network access, Wi-Fi connection, etc. If you use a
laptop, make sure it is fully charged or connected to a power outlet.
Ensure you have updated your operating system and the most recent
version of Chrome.
A reminder, accessing materials from any external source or
any form of cheating during the writing of the exam is a
violation of academic integrity according to your University
policies and can result in severe academic penalties and
potential report to the College of Nurses of Ontario regarding
professional misconduct.
Environment and Academic Integrity:
No other persons except the exam-taker are permitted in the room
during the exam. Use of telephone or other communication devices is
forbidden. The only exceptions for contacts during the exam are the
course professor to clarify an exam question or technical support for a
technical issue.
Ensure you’re in a quiet location where you won’t be interrupted. It
may help to post a sign on the door indicating “Exam in Progress” so
you are not disturbed. No food or drink or other distractions that
take your eyes away from the screen and keyboard during the exam.
It is a "closed-book" exam, no use of books, papers, module materials,
notes, recordings, websites, secondary computers/cellphones/smart
watches, or any other sources of course-related materials. Remove all
course related materials from your desk and area of vision or hearing.
Close all other programs and/or windows on the exam computer prior
to logging into the exam links. No earplugs, headsets, earphones, or
other audio devices are permitted. Turn off radio/television/other
devices.
Presence:
Stay in your seat in the room where you started the exam and keep
focused on the computer keyboard and screen for the entire time until
you have submitted the exam. Use the restroom in advance of the
exam.
Restricted Access to Course Modules During the Exam:
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Access to the course modules is restricted during the exam and
reinstated after everyone has completed the exam.
Confidentiality of the Exam:
A reminder that all PHCNP tests and exams are confidential, both
during and after the exam. Avoid posting any content specific to
an exam question in the Canvas discussion boards, or any form
of communication, including emails to the course professor. A
telephone call can be arranged to discuss a question with the
course professor.
A.
How to Prepare for the Exam
Which resources should I concentrate on?
Ontario and Canadian guidelines take precedence when you prepare
for the Therapeutics exam, followed by other provinces, then
American, and other international guidelines. Ontario and Canadian
guidelines are both accepted as correct answers. First and second-line
antibiotics are typically taken from the Anti-infective Guidelines for
Community-acquired Infections and national guidelines, e.g., STIs,
TB.
The following resources are used as references for exam items, and
they are listed in no particular order:
 Anti-infective Guidelines for Community-acquired Infections
(2019)
 e-Therapeutics (RxTx)(2020)
 Canadian Consensus Guidelines {e.g., Canadian Medical
Association Journal’s (CMAJ), Clinical Guidelines and
Supplements, Canadian Clinical Practice Guidelines, CHEP
latest version,
 Canadian STI Guidelines/Updates (2020)
 Canadian Immunization Guidelines (2020) and Ontario
Immunization Schedule (December 2016)
 RxFiles (2020)
 CNO’s Nurse Practitioner Practice Standard (2017 and updates)
 Content from all modules in Therapeutics II including “What if”
questions and answers
 Required websites
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1.
Conditions
Know the:
Management criteria for conditions listed in the module objectives,
such as:
 clinical practice guidelines
 type and frequency of laboratory and diagnostic tests
 first-line and second-line drugs and prescribing information
 teaching
 counseling
 monitoring parameters
 “red flags”
For medication:
 first and second line medications
 dose
 route
 frequency
 duration of therapy
 baseline assessment measures prior to prescribing (e.g., history,
physical exam, laboratory or diagnostic tests)
 contraindications, drug interactions, and side effects
 follow up and specific monitoring.
Information and recommendations you would give a client regarding:
 expectations for improvement of condition
 teaching, e.g., preventing spread of infection
 returning to school or work
 adverse reactions or signs of treatment failure
 signs and symptoms that would indicate a worsening condition
 action client should take if no improvement or worsening of
condition
 specific timeframe when a client should return to clinic (e.g.,
RTC in 7 days).
When and why you would consult or refer.
Health Maintenance, Health Promotion, and Disease Prevention
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Review evidence-based screening recommendations and vaccine
schedules for different ages, genders, and developmental
stages, reportable diseases, as well as the health promotion and
health education topics.
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B.
Review: working with families, groups, and communities from a
health promotion, disease prevention, and family and
community development perspective.
How to Write the Exam
1.
Multiple Choice Items
The information necessary to answer the question is provided. Use all
of the information given in the stem to critically think about the best
answer provided in the options. Avoid “reading into the question” or
adding information that is not given in the stem.
Each multiple-choice question is worth one point.
Each multiple-choice item is accompanied by four options. Only one of
these options is clearly correct, the other three options may be
plausible, but are incorrect or less adequate.
Common acronyms and abbreviations are used, e.g., CVA instead of
cerebrovascular accident.
The generic name of the drug is followed by the trade name in
parentheses, e.g., furosemide (Lasix).
Examples of terminology used in multiple choice items
Understand what the stem is asking and what information is being
prompted; then look for the best answer. For example, a stem may ask
the following:
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What action should the NP-PHC take next?
Which of the following is the most appropriate intervention?
What specific information should the NP-PHC provide?
What is the most appropriate next step the NP-PHC should take
in caring for Jane?
What health education should the NP-PHC provide?
What would be the NP-PHCs first step in managing this client?
What advice should the NP-PHC provide to Mrs. Doe?
Which one of the following should the NP-PHC prescribe?
What information should the NP-PHC include in Jane’s health
education?
How should the NP-PHC respond?
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 Which of the following statements is TRUE?
 What pharmacological intervention would be most appropriate?
 What non-pharmacological approaches would the NP-PHC
suggest?
Use your time effectively. Allow approximately 1 minute per
multiple-choice item when determining the amount of time you will
need to answer each question. Answer difficult questions by
eliminating obviously incorrect options first, and then select the best
option.
2.
Short Answer Questions
Short Answer Questions (SAQ) are presented with age-specific
situations and conditions that are commonly encountered in NP
primary care practice. If a question asks you to provide a response
that is specific to the client described in the case scenario, then you
should answer according to the information provided in the case
study. By contrast, another question may ask you to list five lifestyle
modifications that an NP would recommend to prevent a particular
condition.
Use your time wisely and effectively. Read each case study item and
accompanying questions carefully; take note of the client’s race, sex
and age, developmental stage, negative data, abnormal or relevant
findings, symptoms, allergies, and drug intolerances in the given
situation. These have been written into the SAQ to test your criticalthinking abilities.
SAMPLE CASE #1
Jane Doe, a 21 year old female, presents to the clinic with a five
day history of
a symptom. She reports another symptom that began 3 days
ago and a new symptom which started this morning. Her
examination reveals some signs of a condition. Her vital signs
are normal. The NP diagnoses Jane with a condition.
1. List THREE (3) non-pharmacological interventions the NPPHC can recommend to treat Jane’s condition? (1 pt)
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1. ___________________(one
minute)_______________________________
2. ___________________(one
minute)_______________________________
3. ___________________(one
minute)_______________________________
2. What medication should the NP-PHC prescribe to treat
Jane’s condition? Write a complete prescription. (2 pts)
The Therapeutics Clinic
123 University Avenue, Anywhere, Ontario, N0N 0N0,
(416) 567-1234
--------------------------------------------------------------------------------------------------Name:
Jane Doe
Address: 34 Main St., Anywhere, Ontario, N0N 1B0
--------------------------------------------------------------------------------------------------Rx
(3 minutes)
Please note that we don’t provide a date on the prescription template for
the exam, therefore you will have to fill in the date with all other missing
essential components of a written prescription.
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END OF CASE #1
3.
Tips for Writing SAQ Items
Keyboard your SAQ responses directly in the blank text boxes
provided in the on-line exam.
Answers should be short and concise, single words or short phrases.
Keyboard your answer into the expanding text box provided for each
answer.
Provide only one concise answer in each text box provided. If two
answers are entered into one text box, then this will be counted as
two separate answers. Responses that are separated by a semicolon
will be graded as TWO (2) responses if they are written within the
same text box.
You will be instructed to list a maximum number of responses, e.g.
"List FOUR (4) items". If more answers are given than the question
asks, the additional answers will not be counted even if they are
correct. Only the first FOUR (4) responses – to use the same example provided in the test boxes will be considered and graded.
Each question is followed by its point value.
Use Appropriate Medical Terminology.
Be specific and use appropriate medical and clinical terminology. For
example, “thyroid disease” or “heart attack” is an unacceptable
response when “hyperthyroidism” or “myocardial infarction” is the
correct response.
A vague response such as "family history" would be marked incorrect,
whereas a specific response such as "family history of CVD" that
applies to the situation will result in the response being marked
correct.
It is acceptable to write “lung cancer” or “breast cancer” when
describing cancerous conditions. Printing a general or broad response
rather than a specific response will result in the response being
marked incorrect.
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Pharmacological Interventions
These include drugs, over-the-counter
minerals, herbs and supplements.
(OTC)
drugs,
vitamins,
Non-pharmacological Interventions
Include the following:
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Counseling: e.g., supportive counseling, grief counseling,
solution-focused therapy, behavioural change therapy, cognitive
behaviour therapy, etc. Teaching is not counseling.
Health education: e.g., teaching about smoking cessation,
specific lifestyle or environmental modifications, health
promotion, illness prevention, drugs and adverse reactions;
holding a health fair or workshop; etc.
Complementary therapies: e.g., homeopathy, naturopathy,
acupuncture, therapeutic touch, healing touch, traditional
healing practices, TENS, meditation, massage, yoga, etc.
Monitoring and Follow-up
Again, include a specific time frame. For example, “RTC in 24 hours”,
or “RTC in 7 days” are examples of specific time frames. Responses
that include “RTC in the next few days” or “RTC if symptoms do not
improve” are too broad, unspecific and open to greater error; they will
be marked as incorrect.
Include instructions that require action in the event of an adverse
drug reaction, treatment failure, worsening condition or recurrence,
e.g., “RTC in 72 hours or sooner if still vomiting > 5 x daily”, or “Go
directly to ER over the weekend if the child continues to vomit or is
unable to keep down fluids”.
Rationale
Rationale may be requested for any of the responses that you provide.
We would advise you to be explicit and concise when stating your
rationale for the action that you have recommended.
Prescriptions
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If asked to write a prescription, include all ESSENTIAL prescribing
information:
Name of the clinic, address and phone number of the
provider
Client’s full name and address
Date when Rx issued (many learners forget the DATE which
results in a wrong answer)
Name of drug (spelled correctly; either the generic or trade
name of the drug is acceptable)
Drug strength if applicable
Drug dosage (number of tabs, mg, mLs etc.)
Formulation (tabs, ung, cream, gtts, elixir etc.)
Route of administration (must be indicated as PO, topical,
ophthalmic, otic, intravaginal, INH, IM etc., even though it
may be obvious i.e., if you recommend a cream, you should
also indicate the “topical” route.)
Frequency
Duration of regimen if applicable (Example: 5, 7, 10, 14
days; RANGES such as 7-10 days are incorrect)
Amount of drug to be dispensed (Mitte) (e.g., 1 pack; 14 tabs
OR 14; 72 mLs;
120 grams)
Special instructions for use if required (e.g., “apply to the
skin” or “take one hour before meals” etc. Please note that
the route of administration is listed separately from the
special instructions/directions. For example, you will not be
given credit for the route of administration if you only write,
“apply sparingly to the skin” or “instil in both eyes”. In
addition to these instructions, you must also write the
correct route beside the drug, e.g., “topical” or “ophthalmic”
to use the same examples.)
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Number of Repeats, Renewals or Refills; write “no repeats” if
none; If multiple drugs are listed on a prescription please
identify the number of allowable refills for EACH drug.
Provider’s Signature (use a fictitious name; DO NOT use
your own name on the exam).
Printed name (use a fictitious name; do NOT USE your own
name on the exam), followed by the “NP-PHC’ designation
and Registration Number.
Prescription Questions are marked as “All or None”!
1.
Examples of Terminology used in Short Answer
Questions
The following are examples of the type of wording used and the
formatting that you will encounter on the exam:
 What pharmacological interventions should the NP-PHC
recommend to Mrs. Doe? Identify TWO (2) items. (1 pt)
 What signs and symptoms would indicate Jane’s condition is
deteriorating and requires re-evaluation? List THREE (3) items.
(1 pt)
 What should the NP-PHC include in health teaching for Mrs.
Doe regarding symptom management for condition? Identify
TWO (2) items. (1 pt)
 What action should the NP-PHC take to manage Mrs. Doe’s
infection?
Identify ONE (1) item. (1 pt)
1.
___________________________________________________________
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 Should the NP-PHC prescribe (e.g., a class of drug or name of
drug) for Jane based on the current information available?
1. Indicate your response with an [ x ]. Provide ONE (1)
response. (0.50 pt)
YES [ ]
NO
[ ]
2. Give a rationale for your response. (0.50 pt)
_____________________________________________________________
_____________________________________________________________
 What non-pharmacological interventions should the NP-PHC
suggest to Mrs. Doe to assist with this condition? Identify FOUR
(4) items. (2 pts)
1.
________________________________________________________
2.
________________________________________________________
3.
________________________________________________________
4.
________________________________________________________
 What tests should the NP-PHC order before starting Jane on her
medication? Identify TWO (2) items. (1 pt)
1.
________________________________________________________
2.
________________________________________________________
 What THREE (3) contraindications should the NP-PHC rule out
prior to recommending this drug? (1 pt)
1.
________________________________________________________
2.
________________________________________________________
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 What is the most appropriate first line medication for managing
Jane’s condition? Identify ONE (1) item. (1 pt)
1.
_________________________________________________________
 How should the NP-PHC respond? List ONE (1) item. (1 pt)
1.
___________________________________________________________
 What factors should the NP-PHC consider that may be
contributing to a failed treatment OR sub-optimal results?
Identify FOUR (4) factors (2 pts).
Note: (Examples of factors could be: it may be too soon to see
treatment results yet, pharmacological agent may be too strong
or too weak, needs a different formulation for a better effect,
medication needs at least 4 weeks before positive results can be
assessed etc.
1.
________________________________________________________
2.
________________________________________________________
3.
________________________________________________________
4.
________________________________________________________
Best wishes and good luck on the exam!
Roger Firsoff, France Farley, Sylvain Grenier
Course Leads and Faculty
03/22/2021
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