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Clinical Drug Testing in Primary Care - Part 2

Chapter 4 - Drug Testing in Primary Care

1. According to this paper there are many reasons a practitioner may want to use drug testing in the primary care setting, including:

A. Evaluating patients in psychiatric care for substance abuse issues, or before prescribing psychoactive medications.

B. Identifying potential substance use problems in women who are pregnant.

C. Avoiding malpractice lawsuits.

D. Ensuring patient safety prior to surgery or other invasive procedures to prevent medication interactions

E. A, B and D above.


2. Clinical drug testing should have established collection procedures for that facility or office that follow:

A. Standards of the College of American Pathologists

B. Clinical Laboratory Improvement Amendments

C. Local and State regulations

D. All of the above


3. Some things patients may not disclose to their practitioner that drug testing can identify include:

A. Medications prescribed by other providers or over-the-counter (OTC) medications and herbal products

B. That they take medications prescribed for other people

C. Use of illicit drugs or how much alcohol they consume

D. If they have stopped taking their medications

E. All of the above


4. A positive test result for illicit drugs or non-prescribed licit medications means:

A. A substance use disorder (SUD) may exist.

B. It is highly likelyan SUD exists

C. The patient needs further screening to rule out an SUD or determine whether an SUD assessment is needed

D. A and C above.


5. When interpreting drug test results, the practitioner should know exactly what a test is—and is not—measuring.

A. True

B. False


6. Once a practitioner has made a diagnosis of SUD the practitioner has an opportunity to recommend appropriate treatment.

A. True

B. False


7. Prior to testing, the practitioner needs to do three important things, according to this paper. Which of the following is not one of these? 

A. Explain to the patient the reasons for performing drug testing,

B. Explain how the test results will be used.

C. Discuss with the patient the practitioner’s duty to maintain confidentiality.

D. Explain the drug testing technology that will be used.


8. Key things a practitioner can do that will help build a relationship of trust and openness include:

A. Communicating openly

B. Listening actively

C. Treating the patient with dignity and respect

D. Reassuring the patient that medical records are confidential

E. All of the above


9. Cultural differences between practitioner and patient can make it difficult to build and maintain a productive therapeutic relationship.

A. True

B. False


10. Federal law and regulations regarding confidentiality of alcohol and drug abuse patient records generally requires written permission from the patient to disclose any information.

A. True

B. False


11. The results of drug tests are a certain indicator of an SUD.

A. True

B. False


12. If a positive result for a drug test is surprising and the patient vehemently denies recent or current use, the practitioner should:

A. Assume the patient is telling the truth

B. Assume the patient is lying

C. Order a laboratory confirmatory test


13. A negative drug test does not necessarily mean the patient has not used a particular substance or taken the prescribed medication.

A. True

B. False


14. How often a practitioner should conduct drug testing depends on:

A. The practitioner

B. The patient

C. The diagnosis

D. The reason for testing

E. All of the above


15. Which of the following items of information does not need to be included in a patient's medical record?

A. The medical necessity for drug testing.

B. Tests performed and test results

C. Changes made to the treatment plan based on test results

D. Referrals made

E. Written procedures for performing POCTs


Chapter 5 - Urine Drug Testing for Specific Substances

16. Urine is the most rigorously evaluated and most commonly used matrix for drug testing

A. True

B. False


17. When testing for cocaine using urine, the target compound is usually

A. The metabolite, benzoylecgonine

B. The parent cocaine molecule

C. A combination of both metabolite and parent molecule


18. Using urine as a matrix is vulnerable to different forms of patient tampering:

A. Adulteration

B. Substitution

C. Dilution

D. A, B and C

E. A and C


19. This paper discusses several measures to prevent tampering with a urine sample. Which of the following is not one of these measures?

A. Directly observing the patient provide the sample

B. Video taping sample provision

C. Turning off water to the taps and adding bluing agent to the toilet water

D. Not providing soap in the restroom where sample provision is being done

E. Not allowing the patient to take coats, purses or handbags or other possessions into the restroom before or during sample provision


20. Many substances used to adulterate a urine sample can be purchased over the Internet, such as "Clean-X", "Klear", "Whizzies", and "Urine Luck".

A. True

B. False


21. This paper discusses urine testing issues for eleven specific drugs or classes of drugs. Issues covered in the paper include:

A. Cut-off concentration

B. Window of detection

C. Types of tests commonly used for each drug

D. What is usually tested for (parent drug or metabolite)

E. All of the above


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