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ANCC Adult Gerontology Acute Care Exam(24 Sets) Questions with Verified Answers,100% CORRECT
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ANCC Adult Gerontology Acute Care Exam 286 Questions with Verified Answers,100% CORRECT
ANCC Adult Gerontology Acute Care Exam 286 Questions with Verified Answers
Cardiac Index - CORRECT ANSWER 2-4
SVR/Afterload - CORRECT ANSWER 800-1200... [Show More]
MAP - CORRECT ANSWER mean CVx80/CO
PA pressure - CORRECT ANSWER 15-30
Wedge PCWP pressure - CORRECT ANSWER 6-12
Hypovolemic Shock Parameters - CORRECT ANSWER Preload CVP decreased, SVR afterload increased, CI decreased, Oxygen delivery Decreased, Venous Oxygen saturation increased
Types of hypovolemic shock - CORRECT ANSWER Hemorrhage, burns, pancreatitis
Cardiogenic shock parameters - CORRECT ANSWER CVP preload increased, SVR afterload increased, CI decreased, oxygen delivery decreased, SV02 decreased
Types of cardiogenic shock - CORRECT ANSWER Post mi, malignant dysrhythmia, acute myocarditis
Obstructive shock parameters - CORRECT ANSWER Preload either, SVR increased, CI decreased, oxygen delivery decreased, SV02 decreased
Types of obstructive shock - CORRECT ANSWER Tension pneumo, cardiac tamponade, PE
Distributive shock parameters - CORRECT ANSWER Preload CVP decreased, afterload SVR decreased, CI increased, SV02 decreased, oxygen delivery increased
Types of distributive shock - CORRECT ANSWER Septic shock, anaphylaxis, neurogenic shock
CVP Preload - CORRECT ANSWER 2-8
Cardiac Output - CORRECT ANSWER 4-8
MAP - CORRECT ANSWER 70-90
Fractional Excretion of NA <1% - CORRECT ANSWER Prerenal state of kidney dysfunction (i.e. dehydration)
Fractional Excretion of NA >2% - CORRECT ANSWER ATN (acute tubular necrosis)
CPP equation - CORRECT ANSWER MAP-ICP
SIADH Hyposmolar hyponatremia "inappropriate water retention" - CORRECT ANSWER serum sodium low, serum osmo low <280, urine osmo high >100, no dehydration, tx restrict fluids
if neuro symptoms give 3%NS
DI Hyperosmolar hypernatremia dry - CORRECT ANSWER Serum sodium high, serum osmo high >290, urine osmo low <100, urine spec grave 1.005 (urine is like water), urine sodium >20, dehydration, if serum Na >150 give D5W to replace ½ volume deficit in 12-24 hours, avoid rapid lowering of Na, DDAVP for acute situations
Serum Osmo - CORRECT ANSWER 280
Urine Osmo - CORRECT ANSWER 300-800
Sodium - CORRECT ANSWER ~140
Total cholesterol - CORRECT ANSWER <200
Triglycerides - CORRECT ANSWER <150
HDL - CORRECT ANSWER >40
LDL - CORRECT ANSWER <100
Management of pulm edema - CORRECT ANSWER 02, sitting up, morphine 2-4mg, Lasix 40, another Lasix 40 if needed
Left heart failure - CORRECT ANSWER LUNGS, dyspnea at rest, rales, wheezing, generally healthy except acute event, S3, murmur of mitral regurg
Right heart failure - CORRECT ANSWER JVD, hepatomegaly, peripheral edema
MR ASS - CORRECT ANSWER Mitral regurg, aortic stenosis, systolic murmurs
MS ARD - CORRECT ANSWER Mitral Stenosis, aortic regurg, diastolic
Mitral murmur locations - CORRECT ANSWER 5th ICS, apex
Aortic murmur locations - CORRECT ANSWER 2nd or 3rd ICS, base
S1 - CORRECT ANSWER AV valves closed, SL open
S2 - CORRECT ANSWER SL closed, AV open
Cardiac blood flow - CORRECT ANSWER SVC,RA, tricuspid, RV, pulmonic valve, pulmonary artery, lungs, pulmonary veins, LA, mitral, LV, Aortic valve, aorta, body
Cushing's - CORRECT ANSWER Moon face, buffalo hump, hypertension, HYPERglycemia, HYPERnatremia, HYPOkalemia, tx depends on cause (stop meds, tumor)
Addison's ADRENOcorticoid deficiency - CORRECT ANSWER Remember: SEX, SALT, and SUGAR
Deficient cortisol, androgens, and aldosterone, hyperpigmentation in buccal mucosa, tanning, HYPOtension, scant hair, HYPOglycemia, HYPOnatremia, HYPERkalemia, cosyntropin is the rule out for addison's, manage: referral, glucorticoid, hydrocortisone, fludrocortisone inpatient: hydrocortisone and fluids
HYPERthyroidism/Grave's - CORRECT ANSWER TSH LOW, T3 High, Grave's Disease, bulgy eyes, weight loss, fine thin hair, smooth skin, a fib
Specialist referral, propranolol, methimazole, PTU, lugol's
Thyroid crisis - CORRECT ANSWER PTU or Methimazole with adjunct within 1 hour Lugol's propranolol, hydrocortisone
No ASA
Hypothyroidism - CORRECT ANSWER (TSH assay most sensitive test) TSH ELEVATED, T4 LOW
hasimototo's most common, LOW AND SLOW, cold intolerance, weight fain, brittle nails, brady, hypoactive BS, Levothyroxine 50-100mcg
Myxedema Coma - CORRECT ANSWER AIRWAY, fluid replacement PRN, levothyroxine 400mcgIVx1
Subacute thyroiditis - CORRECT ANSWER Treated symptomatically with propanonlol
Pheocromocytoma - CORRECT ANSWER Labile hypertension, TSH normal, postural hypotension, plama-free metanephrines to rule out, CT to confirm, surgical removal, postop: hypotension, adrenal insufficiency, hemorrhage
urine catecholamines, alpha blockers phentolamine
DKA - CORRECT ANSWER -intracellular dehydration, kussmaul, hyperglycemia >250, ketonemia, hyperkalemia
Management: 1L first hour>500ml/hr, 0.1/kg/hr, glucose <250 change to D51/2
when switching to subq insulin, inititate subQ insulin 2-3 hours prior to stopping insulin drip
HHNK (Hyperosmolar Hyperglycemic NON KETOSIS) - CORRECT ANSWER Type 2 DM, super elevated glucose >600, hyperosmolar >310, normal anion gap, elevated hgbA1c, normal pH
Management: massive fluid replacement, overall deficit usually 6-10L, 15U regular insulin IV followed by 10-15U subq
Dawn Phenomenon - CORRECT ANSWER "Dawn Rising", elevated glucose at night and high in AM, increase the bedtime dose of insulin
Somogyi Effect - CORRECT ANSWER Nocturnal hypoglycemia, elevated glucose at 0700 due to rebound, reduce or omit bedtime dose (need to know the glucose in the middle of the night)
Serum Cr - CORRECT ANSWER .5-1.5, most sensitive renal marker
BUN - CORRECT ANSWER 10-20, can fluctuate independent of creatinine and due to specific causes (i.e. GI bleed/dehydration)
Normal fasting glucose level - CORRECT ANSWER 60-99
Type I DM - CORRECT ANSWER HLA-DR3/DR4 association, ketone development, islet cell antibodies
Polyuria, polydipsia, polyphagia, random plasma glucose >200, impaired glucose tolerance 100-125, bring back in to repeat test
Consult dietary, if ketones present need insulin 0.5u/kg/day 2/3 AM 1/3 PM
Type II DM - CORRECT ANSWER Obesity and syndrome X, skin infections, recurrent vaginitis, no ketones present in blood/urine, start with weight control and diet
Sulfonylureas most widely prescribed stimulate pancreas to make more insulin
Biguanides- adjust for sulfonyurleas but cannot be used alone-Metformin-standard of care with diagnosis of Type 2 lactic acidosis is a side effect
Syndrome X - CORRECT ANSWER Obesity, hypertension, abnormal lipid profile
WHO ladder of pain management - CORRECT ANSWER 1. Start with non opioid
2. maintain initial + opioid,
3. don't lose the initial non-opioid and add stronger pain medication (morphine, hydromorphone, fentanyl, etc)
breakthrough pain= fentanyl patch
Non-infectious Post operative fever - CORRECT ANSWER Ask what do his lungs sound like?
Atelecatisis is most common cause, dehydration with bellies, drug reactions (ampoh, Bactrim, procainamide, isoniazide)
Fluids, pulmonary toilet
Infectious post-op fever - CORRECT ANSWER Usually seen with elevated WBC, left shift, bands
Tension Headache - CORRECT ANSWER Most common HA, generalized
Migraine Headache - CORRECT ANSWER Classic=aura
common= no aura
Related to dilation of vessels, triggers, unilateral, dull, build up gradually, visual disturbances common
New onset needs evaluation if symptoms occur 2-3x/month need prophylaxis
acute management= triptan
triptan contraindication - CORRECT ANSWER intermittent claudication
Cluster Headache - CORRECT ANSWER Severe, periorbital, unilateral
02 inhalation, triptan
Normal Albumin - CORRECT ANSWER 3.5-5
Prealbumin - CORRECT ANSWER Best indicator of early malnutrition
Hypoalbuminemia - CORRECT ANSWER <2.7 patient will look edematous, <3.5 protein malnutrition
H/H transfusion standard - CORRECT ANSWER 8 and 24
Hypotonic Hyponatremia "Water excess - CORRECT ANSWER Serum Osmo <280 (dilutes body fluids)
Assess if hypovolemic or hypervolemic (renal vs nonrenal)
Hypernatremia - CORRECT ANSWER Usually due to water loss
hypernatremia with hypovolemia - CORRECT ANSWER should be treated with 1/2NS
Hypernatremia with euvolemia - CORRECT ANSWER D5W is treatment
Hypernatremia with hypervolemia - CORRECT ANSWER Free water and loop diuretics
Hypokalemia - CORRECT ANSWER Causes include chronic diuretic use, renal loss and alkalosis, GI losses
S/S: muscle cramps in calves, constipation if severe <2.5 tetany, hyporeflexis and rhabdo
BROAD T waves, pvc's= check the k
Always check the Mg, oral replacement if K>2.5
IV at 10meq/hr if no PO
Rhabdomylosis diagnostic values - CORRECT ANSWER Serum Cr kinase and urine myoglobin are diagnostic tests
Hyperkalemia - CORRECT ANSWER if severe AmpD50 10units insulin, peaked T's but >50% of population won't show ekg changes
AIDS - CORRECT ANSWER 3 weeks-3 months for seroconversion, flu like symptoms
ELISA for initial screen
Western blot for DX
CD4>800=normal
Viral load...should be 0
CD4<200=AIDS or CD4 low with opportunistic infection
P jirovecii leading cause of death, Bactrim prophylaxis
CDC HART/AART started with CD4 no less than 350, MUST TAKE AS PRESCRIBED SAME TIME EVERY DAY
Osteoarthritis - CORRECT ANSWER Degenerative, heberdends distal and bouchards proximal nodesk, narrowing of joint space, osteophytes, ONGOING pain worse as day goes ON, NSAIDS/Tylenol, heat ice, assistive device on OPPOSITE side of affected joint
Rheumatoid Arthritis - CORRECT ANSWER Usually female, younger, autoimmune, ulnar deviation, higher up in the hands, progressive cortical thinning, osteopenia, DMARDS- steroids, methotrexate (check LFTS)
Compartment syndrome - CORRECT ANSWER Pain, paresthesias, pulses are normal, this is in the fascia, if it's not a cast cause it needs hourly tape measures, fasciotomy when critical
SLE - CORRECT ANSWER Butterfly rash, bedrest, afternoon naps, sun protection, topical steroids, NSAIDs
Drugs that can cause lupus like syndrome - CORRECT ANSWER Chlorpromazine (tHorazine), Cardizem/diltazem, isoniazid/INH, methyldopa, procainamide, quinidine
Giant cell arteritis/temporal arteritis - CORRECT ANSWER Older person with fever, normal wbc, elevated ESR, can cause blindness. Prednisone and referral
Glaucoma open angle/chronic - CORRECT ANSWER Increased ocular pressure (normal 10-20), cupping of the optic disc, constriction of visual fields, tonometry is test done starting at age 40, alpha 2 adrenergic agonists, beta-adregeneric blockers
Gluacoma/close angle/acute emergent - CORRECT ANSWER Extreme PAIN, halos on lights, dilated pupil, Diamox or mannitol immediate referral/surgery
Cataract - CORRECT ANSWER Old people, clouding, diplopia, halos around lights, no red reflex, treat with glasses and ophthalmology referral
Immunosenescence - CORRECT ANSWER Diminished function with age leads to decline in ability to fight infection
Mixed SV02 - CORRECT ANSWER Normal is 60-80
<60 patient has tapped into reserves caused by decreased 02 supply or increased 02 demand
>80 increased 02 supply , decreased 02 demand, decreased effective 02 delivery and uptake (sepsis etc)
Acute Renal /Pre Renal Disease labs - CORRECT ANSWER Serum BUN to Cr: 10:!, urine sodium <20, spec grav >1.1015, urinary sediment normal, FeNa<1
Treat with volume, dopamine for BP
Pre Renal - CORRECT ANSWER Outside kidney, typical trauma pt, prerenal only if reversed when underlying cause of hypoperfusion correted, no damage to tubules
Volume and dopamine
Intrarenal/renal/intrinsic - CORRECT ANSWER Caused by something that directly affects renal cortex, i.e. hypersensitivity rxn (contrast), nephrotoxic agents MOST COMMON, mismatched blood, damage to nephrons ACUTE TUBULAR NECROSIS most common
Stop nephrotoxic drugs, perfuse
Post renal - CORRECT ANSWER Urine flow obstruction is cause
Mechanical: Obstruction of some kind like BPH or stone
TX: remove source of problem
Criteria for Dialysis - CORRECT ANSWER AEIOU
A=acidosis
E=electrolytes
I=intoxication
O=oliguria
U=uremia
Acute Renal Insufficiency - CORRECT ANSWER Bun increased out of proportion to Cr, ATN, Obstruction, or contrast media, reversible
Chronic renal insufficiency - CORRECT ANSWER Steady increase in BUN:Cr ratio 10:1, intrinsic but progression can be slowed with tx
Stages of renal failure - CORRECT ANSWER Diminished renal reserve :50% loss of nephrons
Renal insufficiency 75% loss
End stage 90% loss
Chronic renal failure treatment - CORRECT ANSWER Control htn and DM
Reduce proten to 40g/day
Renal dose meds
CVA infarct - CORRECT ANSWER Subtle or sudden neurological deficits, visual alterations, change sin vital signs, notor weakness, changes in LOC
CVA hemorrhagic - CORRECT ANSWER Acute onset of focal neurologic deficits
Sudden increased ICP, hed and vomiting when bleed is extensive
Right (non dominant) side: left hemiparesis right visual field changes spatial disorientation
Left dominant: right hemiparesis aphasia dysrrthria difficulty writing
CVA management - CORRECT ANSWER Always head CT first if LP needed, CT first
Thromobitic- fribrinolytic therapy indicated within <3 hours-4.5 hours
Lower systemic BP but not too low MAP at 110-130 to prevent vasospasm
Nimodipine for vasospasm, maintain CPP and liit increases in CP <20
ICP monitoring indications - CORRECT ANSWER Moderate head injury but can't be serially neuro assessed
GCS <8 +abnormal CT
GCS<8 +normal CT with two of following: >40yo, BP<90, abnormal motor posturing
Simple partial seizure - CORRECT ANSWER No loss of consciousness, short, single motor group and spread to entire side of body
Complex partial seizure - CORRECT ANSWER Any simple partial followed by impaired conciousness
Generalized petit mal/absence - CORRECT ANSWER Sudden arrest of motor activity with blank stare
Tonic-clonic grand mal - CORRECT ANSWER May have aura, begins with tonic contraction, usually 2-5 minutes, may have incontinence and followed by post ictal
Seizure assessment - CORRECT ANSWER EEG is most important test in determining type of seizure
CT for all newonset
Seizure management - CORRECT ANSWER Ativan to break seizure 2-4mg IV q
Seizure prevention drugs (recognize them) - CORRECT ANSWER Carbamazepine Tegretol, phenytoin Dilantin, valproic acid depakene
Discontinuance should always be tapered never withdrawn abruptly
Myasthenia Gravis - CORRECT ANSWER Autoimmune disorder reducing acetylcholine receptor sites
Usually age 20-40
Ptosis, diplopia, extremity weakness and visual changes, DTRS ARE NORMAL
Antibodies to acetylcholine usually found AchR-ab
Anticholinesterase block synthesis of acetylchoine and usually used for symptomatic improvement
TENSILON TEST: - CORRECT ANSWER : symptoms got better?=MG symptoms got worse?=cholinergic crisis
Guillain barre - CORRECT ANSWER Progressive ascending paralysis , usually preceded by viral infection
Meningitis - CORRECT ANSWER Shoud be considered I any patient with fever and neuro symptoms
Usually s pneumoniae, h flu, or Neisseria
Fever, nuchal rigidinly, positive kernig (hamstring spasm), positive brudzinski legs flex at hips and knees in response to flexion of head and neck
Meningitis labs and dx - CORRECT ANSWER LP, CSF cloudy with elevatd protein, pressure, decreased glucose, increased WBCs bugs=protein and they eat the sugars
Viral lp=normal
Tx: pcn G, vanc with ceph until culture or fluoroquinolone
Head trauma assessment - CORRECT ANSWER usually more often in younger men
Always Asesses: time and place of injury, was there a period of LUCID INTERVAL? =epidural, seizure? LOC?
Decompensating patient may have cushings triad
Cushings triad - CORRECT ANSWER Widened pulse pressure, decreased respt rate, decreased heart rate
Signs of CSF leakage - CORRECT ANSWER Battles sign, raccoon eyes otorrhea or rhinorrhea
DX - CORRECT ANSWER Ct, skull films and head ct, cervical spinal films always a CSPINE before collar comes off
Four Ps of spinal cord injury - CORRECT ANSWER Paralysis, parasthesias, pain, position (cervical, thoracic, lumbar)
Signs and symptoms of spinal cord injury - CORRECT ANSWER C5 and higher=quadriplegia
T1-T2=paraplegia T=trunk paraplegia
L1-L2=continued bowel and bladder function
Grading strength - CORRECT ANSWER 5/5=normal moement against gravity and resistance
3/5 Full ROM against gravity but not resistance
0/5=no visible movement
Lab/dx/management spinal cord injury - CORRECT ANSWER Spinal xr series, MRI, CT, myelography
Methylprednisolone 30mg/kg IVB
Complications of spinal cord injury - CORRECT ANSWER C4 or above=respiratory
T4-T6-can lead to autonomic dysrflexia diaphoresis and flushing above level of injury chills vasoconstriction below level of injury, remove the stimulus
Brown sequard=damage to one half of spinal cord, ipsilateral upper motor neuro paralysis, contralateral loss of pain and temperature MRI steroids
Cauda equine compression of nerve roots, numbness in lower legs or sddle region , MRI steroids, sx
>T6 neurogenic shock- hypovolemia, decreased venous return, and decreased cardiac output
Parkinson's - CORRECT ANSWER Degenerative insufficient dopamine, tremor slow and at rest, rigidity, wooden facies, myerson's sign= reptive taping over bridge of nose produces sustained blink response
Parkinson's tx - CORRECT ANSWER Increasing available dopamine but be careful not to implement too early because resistance can be built up
Capidopa=levopdpa, amantadine pramiexole, ropinrole
Anticholinergics helping in alleviating tremor and rigidiy "feet dragging more" use theses benztropihne trihexypheynydyl
Alcoholism - CORRECT ANSWER CAGE= cut down
Annoyed
Guilty
Ever need a a drink in the AM EYE opener
Communicate kindly "concerned about alcoholism" not you "are an alcoholic"
AA
Delirium - CORRECT ANSWER Sudden acute onset of mental status changes
Dementia - CORRECT ANSWER Progressive gradual memory loss >60yo alzheimer's is leading cause always rule out other causes of neuro changes
Alzheimer's - CORRECT ANSWER Aphasia-speech
Apraxia-performed learned task
Agnosia-recognize objects
Acetylcholine deficiency
Tx with acetylcholinesterase inhibtors donepsezil (Aricept)
Changes in old people - CORRECT ANSWER Decreased neurons and neurotransmitters, cerebral dendrites and glial support cells, compromised thermoregulation, decreased sense of touch increased pain tolerance
Diminished DTRs, nerve conduction, muscle strength
Asthma - CORRECT ANSWER Increased responsiveness , narrowing of airways, thicking of epithelia basement membrane, plugging of airways by thick viscous mucus
Obstructive disorder Fev1, F=obstructive eval
Signs and symptoms asthma - CORRECT ANSWER Difficulty speaking in sentences, pulsus paradoxus (unique to asthma), hyperresonance to percussion
Ominous: absent breath sounds, paradoxical chest abd movement, cyanosis
Lab dx asthma - CORRECT ANSWER PFTs
Hospitalization recommended if Fev1<30% or does not improve to at least 40% after treatment
Hypercapnia omnious finding, pCO2>45 emergency
Outpatient management drugs - CORRECT ANSWER SABA>inhaled corticosteroids + SABA> increase steroids or LABA>atrovent for secretions>singulair
Inpatient management - CORRECT ANSWER 02, fluids, sympathomimetics Proventil.ventolin, alupent
Corticosteroids in those not responding to sympathomimetics methylprednisolone 60-125mg IV
Status asthmaticus - CORRECT ANSWER 02, D51/2NS, atrovent, abgs, change in behavior? Intubate them. Other drugs same as inpatient
Chronic bronchitis - CORRECT ANSWER Bronchial mucus with productive cough for >3 months in two consecutive years, usually younger person body habitus increased
Normal percussion, >35yo, HCT increased
Emphysema - CORRECT ANSWER Permanent enlargement of alveoli, usually thin older person
Hyperresonant usually >50, HCT normal
Emphysema Lab/dx - CORRECT ANSWER Low flat diaphragm CXR, FEV1 reduced
Management of emphysema - CORRECT ANSWER Outpatient: stop smoking, ipratropium bromide
Inpatient: 01, purulent sputum abx 7-10days
TB - CORRECT ANSWER Small homogenous infiltrate in upper lobes Honeycomb look, +PPD=CXR, definitive dx by culture X3
TB management - CORRECT ANSWER rifampin, INH, pyrazinamide, ethambutol
if susceptible then fourth drug can be dropped 6months, LFTS weekly
HIV+ need tx for 9 months
Ethambutol needs eye checks and red/green color vision evals
Positive skin test should get 6 months tx, hospital workers 10mm=positive
PNA - CORRECT ANSWER Strep pna is most common of CAP
S/S: lung consolidation on CXR, chills, fever, sputum
Elevated WBCs, infiltrates, GS/cx, ABG
Outpatient CAP management - CORRECT ANSWER S pneumonia m pneumoniae: Macrolide or tetracycline
Viral: oseltmavirir
MDR s pneumonia: fluorquinoloe or beta lactam+macrolide
Inpatient CAP - CORRECT ANSWER Non-ICU: fluorquinolor or beta lactam+ macrolide
ICU: betalactam+macrolide or flkuorquinolone
**Most common VAP agent*Pseudomonas? Zosyn or meropenem or cefepime +glycoside/azithromycin
MRSA above + vanc or linezolid (ID consult needed for linezolid)
HAP - CORRECT ANSWER 48 hours after admission not incubating at time of admission H flu and s pneumoniae most common
VAP - CORRECT ANSWER 48-72 hours after intubation pseudomonas most common
Pneumothorax - CORRECT ANSWER Hyperresonanace on affected side, diminished breath sounds on affected side, mediastinal shift toward unaffected side (tension)
CXR diagnostic
Emergent needle thoracostomy - CORRECT ANSWER 2nd ICS MCL up and over rib
standard Chest tube placement location - CORRECT ANSWER 4th or 5th ICS MAL up and over rib
PE - CORRECT ANSWER Unexplained dyspnea and tachy are most common symptoms, abrupt, chest pain
PE lab and dx - CORRECT ANSWER VQ scan should be performed in all clinically stable patients, AB, usually hypoxemia and hypocapnia due to hyperventilation/pain
CT, if no CT> D Dimer, pulmonary angio if VQ scan and clinical data mismatched
Pe management - CORRECT ANSWER Fluids for hypotension , worsening hypercapnia gets intubated
Heparin 80u/kg then continus 18u/kg/hr PTT 1.5-2x normal begin Coumadin simultaneously INR 2-3
ARDS - CORRECT ANSWER Refractory hypoxemia is textbook we give them more and more 02 but nothing helps
White out on CXR
Management: intubate, sedate, paralyze
tv 5-7 or 6-8 basedon IBW
PEEP about 10cmH20, treat infx
at risk for pneumo
Pleural effusion - CORRECT ANSWER Transudate (clear) vs exudate (cloudy)
Blunting of costophrenic angles on CXR
Exudate - CORRECT ANSWER Pleural fluid protein to serum protein >0.5
Pleural LDH>serum LDH
Pleural LDH >2/3 upper limit of normal serum LDH
Hypovolemic - CORRECT ANSWER CO/Ci low, CVP low, PCWP low, SVR high, SV02 low
This is the bleeder, GSW patient
Cardiogenic - CORRECT ANSWER CO/CI low, CVP high, PCWP high, SVR high, SV02 low
Think "acute pump failure" cardiac pressures high because the blood isn't pumping through
one with All cardiac indices HIGH including wedge
Obstructive - CORRECT ANSWER CO/CI low, CVP high, PCWP normal/low, SVR high, SV02 high
Think big PE
Inadequate cardiac output due to impaired ventricular filling , blood can't get in
Distributive can be called, septic, anaphylactic, or neurogenic - CORRECT ANSWER Anaphylactic and neurogenic everything is low
Septic is all over the place
Shock treatment - CORRECT ANSWER FLUIDS FIRST, then vasopressors, must have the volume/pressure to move the pressors (dopamine, dobutamine, levophed)
Anaphylactic shock - CORRECT ANSWER Massive vasodilatory response
Resp distress or stridor=intubate
Anaphylaxis with hives=Benadryl
Resp distress=epi
IVF+Benadryl+h2 blocker
Von willebrand disease - CORRECT ANSWER Lots of heavy bleeding, need fact viii, desmopressin
Leukemia - CORRECT ANSWER What is going on? Affecting the bone marrow. Tx with chemo/bone marrow transplant
Generalized lymphadenopathy
Weight loss
Bone marrow aspiration required TO CONFIRM DX
allopurinol is started in chemo/CA treatment to prevent what? - CORRECT ANSWER tumor lysis syndrome
Acute Myelogenous Leukemia - CORRECT ANSWER 80% of leukemias in adults, not the greatest survival rate
ALL - CORRECT ANSWER Pancytopenia with circulating blasts all labs are down
CLL - CORRECT ANSWER Lymphocytosis is hallmark
CML chronic myelogenous - CORRECT ANSWER Philadelphia chromosomes are hallmark
Lymphomas - CORRECT ANSWER Lymphadenopathy=it's in the lymph nodes so it needs radiation
Lymphoma staging - CORRECT ANSWER Stage I localized to 1 node
Stage 2 more than one node but on one side of node
Stage 3 both sides of the diaphragm
Stage 4 liver or bone marrow involved
Non-Hodgkins - CORRECT ANSWER Most common neoplasm between 20-40years, lymphadenopathy
radiation
Hodgkins - CORRECT ANSWER Unknown cause, average age is 32 male
Cervical adenopathy spreads in predictable fashion across lymph node groups
Reed-Sternbergs!
radiation
ITP - CORRECT ANSWER First sites ofbleeding, gums/renal
Likely doesn't need intervention until platelets <20k
High dose corticosteroids elevate platelet count in 2-3 days
Avoid constipation, shaving, flossing
HIT - CORRECT ANSWER Stop the heparin
Start argatrobran
Refludan
Continue anticoagulation and treat HIT
ITP vs SLE - CORRECT ANSWER Both ITP and SLE have thrombocytopenia and a bone marrow aspiration is required to DX
DIC - CORRECT ANSWER Both thrombin and plasmin are activated=simulatenous thrombosis and hemorrhage
DIC pathophys - CORRECT ANSWER Thrombin conversion fibrinogen to fibrin making fibrin clots in microcirc
Coag factors are reduced
Circulating plasmin activates fibrinolytic system which lyses firbin clots into fibrin degradation products
Hemoroage from antiocoagulant activitiy of FDPs and depletion of coags
DIC DX - CORRECT ANSWER Thrombocytopenia>>treat with platelets
Fibrinogen <170>> treat with cryo
Prolonged PT >>treat with FFP
Prolonged PTT >>>treat with FFP
D-dimer with increased FDPs gives predictive accuracy of 96% of DIC
Hgb - CORRECT ANSWER 12-16/14-18
HCt - CORRECT ANSWER 40-54/37-47
Everyone with anemia has low H/H - CORRECT ANSWER
MCV size - CORRECT ANSWER 80-100
MCHC olor/chromic - CORRECT ANSWER 32-36%
Iron deficiency - CORRECT ANSWER Microcytic hypochromic
Most common anemia in non-elderly
Pica is a symptom
Low mcv
Low mchc
low serum ferritin=iron stores
high TIBC= need more iron
Management: oral ferrous sulfate, no antacids with it, take it with vitamin c
Raisins, leafy greens, red meat
Thalassemia - CORRECT ANSWER Microcytic Hypochromic
Genetic
low mcv
low mchc
normal TIBC
normal ferritin
do not need iron their stores are full
doesn't usually need treatment unless severe
Folic Acid - CORRECT ANSWER Macrocytic, normochromic
Glossitis (big red tongue)
NO NEURO SYMPTOMS
MCV high
mchc normal
folate low
take folate daily
intake problem
Pernicious anemia - CORRECT ANSWER Macrocytic, normochromic
B12 deficiency
neuro symptoms
Glossitis, parasthesias, loss of fine motor control, positive Romberg, positive Babinski
intrinsic problem
MCV high
MCHC normal
serum b12 low
Anti-IF antiparietal cell test confirms deficiency
B12 cyanocobalamin 100mcg IM
Anemia of chronic disease - CORRECT ANSWER Normocytic, normochromic
Most common in elderly because they have lots of comorbidities
Usually an underlying problem
Handh low
Mcv normal
mchc normal
iron and TIBC low
No iron is needed, treat the cause
Sickle cell anemia - CORRECT ANSWER Extremely painful
Fluids before 02, pain management
morphine dilaudid
MR ASS - CORRECT ANSWER Mitral regurg, aortic stenosis Systolic
MS ARD - CORRECT ANSWER Mitral stenosis aortic regurg diastolic
Where are the murmus heard? - CORRECT ANSWER 5th ICS Apex=mitral
3rd ICS base= aortic
Acute heart failure - CORRECT ANSWER L abrupt onset usually after MI or valve rupture
Chronic heart failure - CORRECT ANSWER Right leading cause of right is left
Inadequate compensatory measures that have been employed for a long time to improve cardiac output
Left heart failure - CORRECT ANSWER Left=Lungs
S3 gallop, coarse arles, frothy cough, murmur of mitral regurg
Right heart failure - CORRECT ANSWER JVD hepatomegaly, dependent edema due to increased capillary hydrostatic pressure
Abdominal fullness S3 or S4
Diagnostics for heart failure - CORRECT ANSWER Kerley B lines on chest xry due to interstitial edema
Echocardiogram
Management of heart failure - CORRECT ANSWER No more salt, rest, weight loss
ACE -pril
Diuretics thiazides, loops
Hypertension - CORRECT ANSWER 140/90
Primary <55yo usually 95% of all cases
Secondary usually renal artery stenosis
Stop smoking, drinking, NSAIDS and obesity
s/s htn - CORRECT ANSWER Suboccipital pulsating headin early in the Am and resolving throughout the day
Epistaxis
S4 due to LVH
HTN management - CORRECT ANSWER Weight loss DASh exercise, stress management reduction or elimination of alcohol, smoking cessation, electrolyte maintenance
Thiazide diuretics first, then ace (not in pregnancy), Arb (not in pregnancy), then calcium channel blockers amil, dipine, then beta blockers (can cause wheezing)
Hypertensive urgency - CORRECT ANSWER 180/110 WITHOUT end organ dysfunction
Clonidine 0.1/0.2 up to 0.8
Hypertensive emergency - CORRECT ANSWER 180/120 impending or progressive end organ damage, BP can be lower if organ damage threatened
Nipride, aline
Malignant hypertension: flame shaped retinal hemorrhages papilledema, acte mi, aortic aneurysm, eclampsia - CORRECT ANSWER
HTN emergency management drugs - CORRECT ANSWER Aline, nipride or nicardipine
Lower bp to 160-180, 25% in minuts
Angina - CORRECT ANSWER Stable: exertional
Prinzmetal's variant- occurs at various times (usually on CCB) including rest (coronary vasospasm)
Unstable pre-infarct, rest or crescendo
Chest discomfort lasting several minutes, exertional usually with activity and goes away with rest, nitro shortens or prevents attacks
Levine's sign - CORRECT ANSWER fist clenching) squeezing
Angina diagnostics - CORRECT ANSWER Ecg may be normal, exercise ECG, serum lipid levels
Coronary angiography is definitive diagnosis
Angina management - CORRECT ANSWER Low dose ASA, nitrates, beta blockers, CCBs
MI/ACS - CORRECT ANSWER most infarcts occur at rest, nitro has little effect
Impending doom, cold sweats
3 nitros q 5" with no relief? Call 911
ACS diagnostics - CORRECT ANSWER Peaked t waves, st elevations, q waves, 30% of people have no changes
I avL=Lateral
II, III, avF= inferior
V leads= Anterior (think AV)
Troponin I, CKMB troponin I is purely cardiac I=MI
ACS management - CORRECT ANSWER ASA 325
NTG Sl every 5 minutesx 3
Begin 02
IV at KVO place 3 total
12 lead ECg after you treat the patient
Consider betablocker 5mg metoprolol IV x 3 doses
Heparin - CORRECT ANSWER Monitor coags, can cause hyperkalemia
INR (Coumadin) - CORRECT ANSWER Normal 0.8-1.2
MI 2.5-3.5x normal
Coumadin 2-3
APTT (heparin) - CORRECT ANSWER 28-38 seconds normal
1.5-2.5x normal therapeutic
PTT (heparin) - CORRECT ANSWER 60-90 normal
1.5-2.5x normal therapeutic
Pharmacologic revascularization - CORRECT ANSWER Door to fibrinolytics 30"
Unrelieved chest pain with st segment elevation in 2 or more contiguous leads
Contraindications for pharmacologic intervention - CORRECT ANSWER Prior ICh
Neoplasm
Ischemic stroke within 3 months
Aortic dissection
Active bleeding
Intracranial or intrapsinal surgery within 2 months
Closed head or facial trauma within 3 months
DVT - CORRECT ANSWER Pain or tenderness while walking
Edema distal to occlusion
Ultrasound
Bed rest with leg elevated until local tenderness is gone 7-14 days
Lovenox 1mg/kg every 12 hours or heparin infusion 7-10 days
Coumadin for 12 weeks
NSAIDs
Stop oral contraceptives
doppler
PVD (arterial disease) - CORRECT ANSWER Ateriosclerotic
Stop oral contraceptives
Hyperlipidemia, smoker, DM, 40-70yo
C/O of calf claudication
Shiny hairless skin, ,depedent rubor, pallor when elevated
Stop ALL TOBACCO, exercise to make collaterals
Chronic Venous Insufficiency - CORRECT ANSWER More common in women
Aching of lower extremities relieved with elevation
Edema after prolonged standing
Stasis leg ulcers (brown blotches)
Bed rest with legs elevated, heavy duty elastic stockins
Endocarditis - CORRECT ANSWER Diagnosis of infective endocarditis must be excluded in all patients with heart murmur
Bacterial usually
Fever, malaise, night sweats, weight loss, sick
Murmur often present
Osler's nodes distal phalanages
Splinter hemorrhages
Janeway lesions (lesions on feet)
Roth spots ( retinal infarcts)
Echocardiogram
Vancomycin
Nafcillin
PCN G with Gent
Pericarditis - CORRECT ANSWER Viral most common cause
Very localized retrosternal precordial chest pain
Pain better when sitting up leaning forward
Friction rub
ST segment elevation in all leads
Depression of PR segment highly indicative of pericarditis
NSAIDS (ibuprofren or Indocin codein for pain)
Squamous cell carcinoma - CORRECT ANSWER Kerototc easily bleed, sun exposed people
Squishy/bloody
BX and excision
Seborrheic Keratoses - CORRECT ANSWER Benign, "{STUCK ON BROWN" appearance usually pretty large
Basal Cell - CORRECT ANSWER Volcan lesion, waxy, pearly appearance, telangiectatic
Most common skin cancer
Malignant melanoma - CORRECT ANSWER Deadliest of all skin cancers, ABCDE
Asymmetry, border, color, diameter, elevation 2 yes's=97% sensitive
Actinic keratosis - CORRECT ANSWER Sun exposes small, rough flesh colored, pink
Beta blocker overdose - CORRECT ANSWER Glucagon given
Benzos overdose - CORRECT ANSWER Fluids, flumazenil is antidote
Metabolic Acidosis/Anion gap - CORRECT ANSWER (NA+K)-(HC03+Cl) 8-16
Higher the gap worse the scenario pointing towards acidosis
Hallmark sign is low serum HCO2
BUN - CORRECT ANSWER 8-20
Cr - CORRECT ANSWER .8-1.3
Mg - CORRECT ANSWER 1.5-2
Phos - CORRECT ANSWER .8-1.5
Total Ca - CORRECT ANSWER 2-2.6mmol or 8.5-10mg
TIBC - CORRECT ANSWER 45-85
Hgb - CORRECT ANSWER 12-17
Hct - CORRECT ANSWER 35-50
Mcv - CORRECT ANSWER 80-100
Albumin - CORRECT ANSWER 3.5-5
K - CORRECT ANSWER 3.5-5
Parenteral feeding - CORRECT ANSWER Complications from mechanism itself, pneumo, catheter line infection, air emboli
Dextrose increases the osmolality of the TPN
can elevate glucose
Enteral feeding - CORRECT ANSWER From the food itself
Hypernatremia, aspiration, diarrhea, emesis, GI bleed, dehydration
Hypertonic hyponatremia - CORRECT ANSWER Most common cause is hyperglycemia
Hypotonic hyponatremia hypervolemia - CORRECT ANSWER Hypervolemic- edematous patient, CHF, renal failure, etc
Restrict free water
Hypotonic hyponatremia hypovolemia - CORRECT ANSWER Look at urine sodium if <10 then it's pre renal in cause, meaning diarrhea, vomiting, dehydration and give NS
Urine sodium >20 then it's renal in nature and need to determine cause, diuretics, ACE inhibitors, SIADH
Respiratory acidosis - CORRECT ANSWER <7.35 CO2> 45
Retaining CO2, nonbreathing patient
Increase vent rate, decrease sedation, narcan
Respiratory alkalosis - CORRECT ANSWER >7.45 <35
Decrease vent rate, sedate as needed
Overbreathing patient, blowing off their c02
Metabolic acidosis - CORRECT ANSWER
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AGACNP Exam Review 909 Questions with Verified Answers,100% CORRECT
AGACNP Exam Review 909 Questions with Verified Answers Scope of Practice - CORRECT ANSWER Based on legal allowances in each state, individual state nu... [Show More] rse practice acts providing guidelines for nursing practice Key elements of the NP role include - CORRECT ANSWER integration of care across the acute illness continuum with collaboration and coordination of care; research based clinical practices, clinical leadership, family assessment, and discharge planning Standards of Advanced Practice are delineated by... - CORRECT ANSWER American Nurses Association which measure quality of practice, service, or education State Practice Acts - CORRECT ANSWER Authorize Boards of Nursing in each state to establish statutory authority for licensure of RNs State Practice Acts - authority includes: - CORRECT ANSWER use of title, authorization for scope of practice including prescriptive authority, and disciplinary grounds States vary in practice requirements, such as - CORRECT ANSWER certification Prescriptive authority - CORRECT ANSWER Ability and extent of NPs ability to prescribe meds DEA has ruled that nurses in advanced practice may obtain.. - CORRECT ANSWER registration numbers, state practice acts dictate level of prescriptive authority allowed Credentials encompass... - CORRECT ANSWER required education, licensure and certification to practice as an NP Credentials establish... - CORRECT ANSWER minimal levels of acceptable performance Credentialing is necessary to: - CORRECT ANSWER ensure that safe healthcare is provided by qualified individuals; comply with federal and state laws r/t APN Credentials also... - CORRECT ANSWER acknowledges the scope of practice of NP, mandates accountability, enforces professional standards for practice Licensure - CORRECT ANSWER establishes that a person is qualified to perform in a particular professional role Licensure is granted as defined by rules and regulations set forth by - CORRECT ANSWER a governmental regulatory body (ie. state board of nursing) Certification - CORRECT ANSWER Person has met certain standards that signify mastery of specialized knowledge Certification is granted by nongovernmental agencies such as - CORRECT ANSWER ANCC, AANP Admitting privileges to hospitals (non physican) were granted - CORRECT ANSWER 1983 by JC Credentialing and privileging - CORRECT ANSWER process which an NP is granted permission to practice in an inpt setting Credentialing with hospital privileges is granted by a - CORRECT ANSWER Hospital Credentialing Committee Pt Medical Abandoment - CORRECT ANSWER When caregiver-pt relationship is terminated w/o making reasonable arrangements w an appropriate person so that care can be continued Determination of pt abandonment depends on factors such as: - CORRECT ANSWER Whether NP accepted pt assignment, whether NP provided reasonable notice before termination, whether reasonable arrangements could have been made Following do not constitute pt abandonment - CORRECT ANSWER NP refuses to accept responsibility for pt assignment when NP has given reasonable notice to proper authority that NP lacks competence to carry out assignment; NP refuses assignment of a double shift or addtl hrs beyond posted work schedule when proper notification has been given..latter phrase can be controversial Risk Mgmt - CORRECT ANSWER Systematic effort to reduce risk begins w formal written risk mgmt plan that includes: organizations goals, delineation of program's scope, components, methods; delegating responsibility for implementation and enforcement; demonstrating commitment by the board; confidentiality and immunity from retaliation for those who report sensitive info Most common method of documentation for risk mgmt - CORRECT ANSWER incident reports Policies regarding incident reports should address: - CORRECT ANSWER ppl authorized to complete report; ppl responsible for review of a report, immediate actions needed to minimize the effects of the event; ppl responsible for follow up; plan for monitoring aftermath; security/storage of completed report Risk mgmt - Satisfaction surveys - CORRECT ANSWER Important for identifying problems before they develop into incidents or claims; for pts and employees Risk mgmt - Complaints: Risk mgmt plan should delineate tracking, analyzing, and managing complaints by clearly identifying: - CORRECT ANSWER ppl notified after receiving complaint; ppl responsible for responding; ppl responsible for monitoring follow up Action taking initiatives: - CORRECT ANSWER Prevention, correction (corrective steps must be monitored and audited), documentation, education, departmental coordination Medical Futility - CORRECT ANSWER Interventions that are unlikely to produce significant benefit for pt - "Does the intervention have any reasonable prospect of helping this pt?" Two kind of medical futility: - CORRECT ANSWER Quantitative futility: likelihood that intervention will benefit pt is extremely poor Qualitative futility: quality of benefit an intervention will produce is extremely poor Informed consent - competence (decisional capability) - CORRECT ANSWER state that pt is able to make personal decisions about their care competence implies that ability to: - CORRECT ANSWER understand, reason, differentiate good and bad, and communicate informed consent - CORRECT ANSWER pt has received adequate instruction or info regarding aspects of care to make prudent, personal choice regarding such tx Informed consent includes: - CORRECT ANSWER discussing benefits and risk consent is assumed if... - CORRECT ANSWER pt's condition is life threatening Danforth Amendment 1991 - CORRECT ANSWER pts are informed at time of admission to federally funded institution (such as hospital, nursing home, hospice, HMO, etc) that they have the right to refuse care as long as the pt has decisional capability (competence) Ethics - CORRECT ANSWER study of moral conduct and behavior protecting the rights of an individual 1st priority is the - CORRECT ANSWER most salvagable pts. Most critically injured cared for last. Key ethical principles are: - CORRECT ANSWER nonmaleficence, utilitarianism, beneficence, justice, fidelity, veracity, autonomy Nonmaleficence - CORRECT ANSWER duty to do no harm Utilitarianism - CORRECT ANSWER the right act is the one that produces the greatest good for the greatest number Beneficence - CORRECT ANSWER duty to prevent harm and promote good Justice - CORRECT ANSWER duty to be fair Fidelity - CORRECT ANSWER duty to be faithful Veracity - CORRECT ANSWER duty to be truthful (tends to be in conflict with fidelity) Autonomy - CORRECT ANSWER duty to respect an individual's thoughts and actions (tend to be in conflict with beneficence) Dismissing/discharging a pt or closing practice - CORRECT ANSWER NP cannot withdraw from caring for a pt without notification Examples of reasons for discharging a pt from practice: - CORRECT ANSWER abuse, refusal to pay, persistent non-adherence to care Steps for discharging a pt from practice: - CORRECT ANSWER send a certified letter with return receipt (copy for chart), provide general healthcare coverage for 1st 15-30 days post termination deadline, obtain release of info to provide copies of all needed records for next care provider Obligations in closing practice d/t relocation, retirement - CORRECT ANSWER give pt adequate time to find another provider, keep all files for min 5 years, provide timely notification and names of other providers and resources for future care Role of NP developed in the early... - CORRECT ANSWER 1960s as a result of physician shortages in the area of peds First NP program was peds, begun in... - CORRECT ANSWER 1964 by Dr. Loretta Ford and Dr. Henry Silver at CU Health Sciences mainly focusing on ambulatory and outpt care Historical service of NPs in primary care resulted in part from the... - CORRECT ANSWER availability of federal funding for preventive and primary care NP education Movement of NPs expanded to the... - CORRECT ANSWER inpt setting as a result of managed care, hospital restructuring, and decreases in medical residency programs 4 distinct roles for NPs: - CORRECT ANSWER clinician, consultant/collaborator, educator, researcher Crisis/Acute Grief Communication - CORRECT ANSWER Acknowledge feelings Offer self Crisis Intervention - CORRECT ANSWER Boundaries Security if necessary, NOT police Establish trust/rapport Advance Directive - CORRECT ANSWER Written statement of patient's intent regarding medical treatment The Patient Self-Determination Act of 1990 - CORRECT ANSWER All patients in a hospital setting are required to be advised of their right to execute an advance directive Living Will - CORRECT ANSWER Compilation of statements that specify which life-prolonging measures one does and does not want if they become incapacitated Durable Power of Attourney - CORRECT ANSWER Individual designated in the living will that is authorized to make medical decisions in the event patient is incapacitated Title I of HIPPA - CORRECT ANSWER Protects health insurance coverage for workers and their families in the event they change or lose their jobs COBRA COBRA - CORRECT ANSWER protects health insurance coverage for workers and their families in the event worker loses or changes jobs Who enforces HIPPA - CORRECT ANSWER Office for Civil Rights Patient Safety Rule - CORRECT ANSWER Protects patient information to analyze patient safety events and improve True or False: A patient has the right to see their medical record - CORRECT ANSWER True The Privacy Rule: Patient's Rights - CORRECT ANSWER See/have their medical record Corrections added to medical record Patient Safety and Quality Improvement Act (PSQIA) - CORRECT ANSWER Voluntary reporting system improve patient safety outcomes through anonymous reporting by providers of patient safety outcomes and events Duty to Warn - CORRECT ANSWER Patient's condition may endanger others overrides confidentiality Patient is diagnosed with HIV. Duty to Warn applies how? - CORRECT ANSWER Can notify providers not family Invasion of Privacy - CORRECT ANSWER Damaging one's reputation as a result of sharing patient information without their permission When can invasion of privacy charge not be made - CORRECT ANSWER in good faith accurate information receiver has valid reason to obtain information Initiating any change in heathcare - CORRECT ANSWER Begin at most local level and expand outward What comes first when treating a patient with a medical and psychosocial condition - CORRECT ANSWER Medical condition strongest method to evaluate teaching - CORRECT ANSWER returned demonstration when to transfer to teritary care facility - CORRECT ANSWER seriously ill or injured patients that cannot be cared for at your institution stabilize and ship Patient reluctant to undergo procedure. you should? - CORRECT ANSWER Fully educate patient and tell them why Primary care screening exams that are not emergent - CORRECT ANSWER do not delay hospital discharge refer to PCP most powerful data collected from patient - CORRECT ANSWER subjective or data you observed as the np RN calls you as the night shift NP and states patient is decompensating. You would? - CORRECT ANSWER Call primary MD when patient status changes Code goes bad and all involved are talking badly about it on the unit. You should? - CORRECT ANSWER Hold a one time debriefing with everyone invovled What is a response that would suggest admitting a patient to a SNF would be the best action? - CORRECT ANSWER Needing assistance with ADLs Goals of Healthy People 2020 - CORRECT ANSWER increase the quality and years of healthy life eliminate health disparities among americans Healthy People 2020 purpose - CORRECT ANSWER used to understand health status of the nation and plan prevention programs NP must notify department of health with what dx - CORRECT ANSWER Gonorrhea Chlamydia Syphillis HIV TB NPs must report to state - CORRECT ANSWER Criminal acts and injury from dangerous weapon (GSW) Gonorrhea Chlamydia Syphillis HIV TB Animal bites Suspected/actual child abuse Domestic violence Physical Therapy - CORRECT ANSWER Strength training coordination Occupational Therapy - CORRECT ANSWER ADLs Medicare - CORRECT ANSWER Third party payers sets the standard for reimbursement and cutting costs >65 yo. Disabled Medicaid - CORRECT ANSWER Third party payers Poverty Medicare A - CORRECT ANSWER Covers inpatient hospitalizations SNF home health hospice >65 yo. Medicare B - CORRECT ANSWER Covers physician services outpatient hospital services labs/diagnostic procedures medical equipment Pay premium NPs 85% physician scheduled fee Medicare B pays how much of bill - CORRECT ANSWER Medicare pays 80% and patient pays 20% Medicare D - CORRECT ANSWER Limited prescription drug coverage Monthly premium required Co-pay on each prescription required Incident-to-Billing - CORRECT ANSWER Services billed under MD provider number to get the full physician fee Under MD direct supervision Does direct supervision require MD to be physically in the room with NP to be eligible for incident-to-billing - CORRECT ANSWER no same office suite and easily accesible does incident-to-billing apply to the inpatient hospital setting - CORRECT ANSWER No. NP must bill under their NPI in the hospital setting Root Cause Analysis - CORRECT ANSWER Tool for identifying prevention strategies to ensure safety Culture of safety and not culture of blame Root Cause Analysis involves - CORRECT ANSWER Interdisciplinary experts those who are most familiar with the situation continually asking why at each level of cause and effect Identifying changes Impartial process Debriefing after an event is an example of - CORRECT ANSWER root cause analysis Sentinel Events - CORRECT ANSWER Unexpected occurrences involving death or serious physical injury or psychological injury or risk thereof immediate investigation and response Sentinel Event and medical error - CORRECT ANSWER not synonymous not all sentinel events occur because of an error not all medical errors result in a sentinel event Response to Sentinel Event - CORRECT ANSWER Root Cause Analysis Scope of Practice - CORRECT ANSWER Based on legal allowances in each STATE Provides guidelines for nursing practice How can the ACNP demonstrate and advocate for full scope of practice? - CORRECT ANSWER ACNP bills independently State Practice Acts - CORRECT ANSWER STATE Board of Nursing grants authority includes title, authorization of scope including prescriptive authority, disciplinary grounds What dictates the nurse practitioners prescriptive authority - CORRECT ANSWER State Nurse Practice Acts State Board of Nursing Credentials - CORRECT ANSWER Encompass required education, licensure and certification to practice as an NP Establish MINIMAL levels of acceptable performance Licensure - CORRECT ANSWER GOVERNMENT STATE BOARD OF NURSING Establishes a person is qualified to perform Certification - CORRECT ANSWER NONGOVERNMENTAL AGENCIES ANCC Establishes a person has met certain standards which signify mastery of specialized knowledge and skills Licensure vs. Certification - CORRECT ANSWER Government state board of nursing vs. nongovernmental agencies ancc Credentialing and Privileging - CORRECT ANSWER Process by which a nurse practitioner is granted permission to practice in an inpatient setting Hospital Credentialing Committee - CORRECT ANSWER Comprised of physcians Credentialing with hospital privileges grant Most common method of documentation in Risk Management - CORRECT ANSWER Incident Reports Medical Futility - CORRECT ANSWER Interventions that are unlikely to produce any significant benefit for the patient Quantitative Futility - CORRECT ANSWER Where the likelihood that an intervention will benefit the patient is extremely poor Qualitative Futility - CORRECT ANSWER Where the quality of the benefit an intervention will produce is extremely poor Competence - CORRECT ANSWER Decisional capability State in which patient can make personal decisions about their care Informed Consent - CORRECT ANSWER Patient has received adequate instruction or information regarding aspects of care to make a personal choice Informed Consent includes - CORRECT ANSWER discussing all risks and benefits Ethics - CORRECT ANSWER The study of moral conduct and behavior Nonmaleficence - CORRECT ANSWER Duty to do no harm Utilitarianism - CORRECT ANSWER Produce the greatest good for the greatest number Beneficence - CORRECT ANSWER Prevent harm and promote good Justice - CORRECT ANSWER To be fair Fidelity - CORRECT ANSWER to be faihtful Veracity - CORRECT ANSWER to be truthful autonomy - CORRECT ANSWER Respect an individuals thoughts and actions Duration of time to keep medical records after closing a practice - CORRECT ANSWER Minimum five years Reasoning for movement of NPs into inpatient setting - CORRECT ANSWER Managed care Hospital restructuring Decreases in medical residency programs Four Roles of NPs - CORRECT ANSWER Clinician Consultant/collaborator Educator Researcher Nonexperimental Research - CORRECT ANSWER No experiment design Descriptive research - CORRECT ANSWER Describe situations, experiences, and phenomena as they exist Ex Post Facto/Correlational Research - CORRECT ANSWER Examines relationships among varables Cross sectional research - CORRECT ANSWER Population with a very similar attribute but differ in one specific variable Relationships between variables at specific point in time Cohort - CORRECT ANSWER Compares one outcome in groups of individuals who are alike but differ in one characterisitc Longitudinal study - CORRECT ANSWER Multiple measures of a group over an extended period of time Experimental Research Design - CORRECT ANSWER Manipulation of variables using randomization and control groups to test the effects of an intervention or experiement Quasiexperimental Research - CORRECT ANSWER Manipulation of variable but lacks randomization and control group Qualitative Research - CORRECT ANSWER Case studies Open ended questions field study participant observations Used to explore through detailed descriptions of people, events, situations or observed behavior Drawback of qualitative research - CORRECT ANSWER researcher bias Level of significance - CORRECT ANSWER p value the probability of false rejection of the null hypothesis in a statistical test p value - CORRECT ANSWER level of significance t value - CORRECT ANSWER the mean of two groups Reliability - CORRECT ANSWER Degree to which an instrument measures the same way over time p <.05 - CORRECT ANSWER experimental and control groups are considered to be significantly different Validity - CORRECT ANSWER Degree to which a variable measures what it is intended to measure ANCC is creating questions for boards and is trying to make sure that these questions they are asking are correctly for ACNP's. Is this reliability or validity? - CORRECT ANSWER Validity. The degree to which a variable measures what it is intended to measure Liability - CORRECT ANSWER Legal responsibility that a nurse practitioner has for actions that fail to meet the standard of care Standards of care - CORRECT ANSWER criteria to measure whether negligence has occured Negligence - CORRECT ANSWER Failure of an individual to do what a REASONABLE person would do resulting in injury to the patient NP fails to do an EKG on a patient presenting with chest pain. This is an example of - CORRECT ANSWER negligence Malpractice - CORRECT ANSWER Failure to render services with the degree of care, diligence and precaution that another member of the same profession under same circumstances would do to prevent injury to patient Malpractice involves - CORRECT ANSWER professional misconduct unreasonable lack of skill illegal/immoral conduct Assault - CORRECT ANSWER threatening gesture Shaking a fist at someone or making the motion of injecting someone against their will is an example of - CORRECT ANSWER assault Battery - CORRECT ANSWER Violent contact Striking a person, pulling on clothes or anything in which they have contact is an example of - CORRECT ANSWER battery can someone commit assault on an unconscious person - CORRECT ANSWER no Defamiation - CORRECT ANSWER Communication that causes someone to suffer a damaged reputation Libel - CORRECT ANSWER defaming through written material Slander - CORRECT ANSWER spoken defamiation Can NPs order restraints? - CORRECT ANSWER Yes. Document why restraints are being ordered Degree to which an instrument works the same way over time - CORRECT ANSWER reliability How is an advanced directive different from a living will? - CORRECT ANSWER Advance directive a component of a living will Living will designates power of attourney Can you tell the wife the husband has HIV - CORRECT ANSWER no you have to say "if you were her, wouldnt you want to know" ICU patient is improving but fails the swallow evaluation. What is your next action? - CORRECT ANSWER Patient does not need ICU. Transfer to sub-actue not med-surg Hispanic M does not speak english and you are evaluating pain. What do you use? - CORRECT ANSWER Visual pain scale 25 yo. M s/p MVC and cannot feed himself. Who do you consult? - CORRECT ANSWER Occupational Therapy What is the best way for a NP to get involved with policy change? - CORRECT ANSWER Join a hospital committee Family is struggling with their father's decompensating condition. Before you consult palliative care, you should? - CORRECT ANSWER Find out if the patient has an advance directive Your patient is worried about insurance coverage. What should you do? - CORRECT ANSWER Consult case management What is the best way to ensure better outcomes for a patient? - CORRECT ANSWER Get everyone under a standardized treatment plan What is the most important variable in determining significance of research before implementing the findings? - CORRECT ANSWER Sample size Who grants a NP permission to practice in the inpatient setting? - CORRECT ANSWER Hospital Credentialing Committee An ACNP notices an MCV and stops at the scene to offer assistance. Which of the following statutes protects the CNP from malpractice in this situation? - CORRECT ANSWER Good Samaritan statute The Federal 1999 Balanced Budget Act allowed for: - CORRECT ANSWER Medicare reimbursement for advanced practice nurse services The ACNP is involved in outcomes research. All of the following are examples of patient outcomes EXCEPT: a. patient satisfaction b. length of stay c. mortality statistics d. peer review - CORRECT ANSWER D. Peer review is not a patient outcome The nurse practitioner role in research includes: - CORRECT ANSWER Utilizing research findings in implementation of guidelines for patient care The Patient Self-Determination Act: - CORRECT ANSWER assures patient's rights to participate in and direct their healthcare decisions The ethical principle of "first do no harm" is called: - CORRECT ANSWER nonmaleficence 35 yo. M is admitted to the hospital with viral PNA. During his hospitalization, a HIV test is drawn and it is positive. Pt is married with two small children and states that he will not tell his wife or you have to do it. What is the most appopriate next step in the management of his care? - CORRECT ANSWER Explain to him the importance of informing his wife and offering support. Telling the wife would be a breach of confidentiality. The Medicare program is administered by the: - CORRECT ANSWER Health Care Financing Agency A healthcare plan in which nurse practitioners and MDs are employed directly by the health plan is: - CORRECT ANSWER a staff-model health maintenance organization (HMO) Which of the following services are reimbursed by Medicare: a. home health aids b. physical therapy c. skilled nursing services d. all of the above - CORRECT ANSWER D. all of the above Health Maintenance Organizations (HMOs): - CORRECT ANSWER provide both inpatient and outpatient services through a referral system The most common mental illness in young adults: - CORRECT ANSWER schizophrenia Acute Pain - CORRECT ANSWER Pain caused by tissue damage, usually < 6 months Chronic Pain - CORRECT ANSWER Continual or episodic pain of longer duration (> 6 months); combination therapy usually needed Cutaneous Pain - CORRECT ANSWER Localized on skin or surface of body. Herpes or sunburn. Visceral Pain - CORRECT ANSWER Poorly localized such as with internal organs. Gallbladder. Somatic Pain - CORRECT ANSWER Non localized; originates in muscle, bone, nerves, blood vessels and supporting tissue. Neuropathic Pain - CORRECT ANSWER Frequently caused by a tumor; involves nerve pathway injury or compression. Sciatica Step 1 of WHO's Ladder of Pain Management - CORRECT ANSWER -ASA -APAP -NSAIDS +/- adjuvants Step 2 of WHO's Ladder of Pain Management - CORRECT ANSWER -APAP or ASA -Codeine -Hydrocodone -Oxycodone -Dihidrocodeine -Tramadol (not available with APAP or ASA) +/- Adjuvants Step 3 of WHO's Ladder of Pain Management - CORRECT ANSWER -Morphine -Dilaudid -Methadone -Levorphanol -Fentanyl -Oxycodone +- nonopioid analgesics +- Adjuvants Recommendation for breakthrough cancer pain - CORRECT ANSWER Fentanyl patches for sustained release Normal body temperature in C - CORRECT ANSWER 37 101.5 degrees F - CORRECT ANSWER 38.6 degrees C Causes of Fever - CORRECT ANSWER -Bacterial, viral, rickettsial, fungal or parasitic infection -Autoimmune disease (SLE, arteritis) -CNS disease (cerebral hemorrhage, brain tumor, MS) interference with thermoregulatory process rather than fever - Malignant neoplastic disease (primary liver metastasis of cancer) -Hematologic disease (lymphoma/leukemia) - CV disease (MI, phlebitis, PE) - GI disease (IBD, alcoholic hepatitis) - Endocrine disease (hyperthyroidism, pheochromocytoma) -Misc causes (Familial Mediterranean fever, hematoma) - Neuroleptic malignant syndrome-->caused by antipsychotics causing a serotonin like response Treatment of Fever - CORRECT ANSWER -Antimicrobials only when microbe is present -Antipyretics -Treat underlying condition NON INFECTIOUS causes of post-operative fever - CORRECT ANSWER 1. Atelectasis 2. Increased basal metabolic rate 3. Dehydration (can spike temp) 4. Drug reactions: -Amphotericin B -TMP-SMZ - often persistent, not a spike -Beta Lactams -Antibiotics -Procainamide -Isonazid -Alpha Methyldopa -Quinidine INFECTIOUS causes of post-operative fever - CORRECT ANSWER 1. Usually w/ subjective complaints, WBC elevation and left shift (bandemia) 2. WBC > 30,000 not usually from infection 3. Surgical incisions 4. IV sites 5. Point of entry for any catheter: culture? 6. UTI 7. Lungs 8. Sinusitis 9. Abscess (ie: intra-abdominal) Initial Treatment of Post-Operative Fever - CORRECT ANSWER In the absence of infection-first step is hydration and lung expansion Treatment of Infectious Post-Op Fever - CORRECT ANSWER 1. Supportive therapy and APAP 2. Treat the apparent underlying source 3. Gram stain and C&S all invasive lines or catheters, as indicated Differential Value Indicative of Allergic Reaction - CORRECT ANSWER Increased eosinophil count Components of Headache Evaluation - CORRECT ANSWER 1. Chronology **most important** 2. Location, duration and quality should also be evaluated 3. Associated activity: exercise, sleep, tension, relaxation 4. Timing of menstrual cycle 5. Presence of associated symptoms 6. Presence of "triggers" Most common type of headache - CORRECT ANSWER Tension Headache Tension Headache Signs and Symptoms - CORRECT ANSWER 1. Vise-like or tight in quality 2. Usually generalized 3. May be most intense around the back of the head 4. No associated focal or neurological symptoms 5. Usually lasts for several hours Tension Headache | Management - CORRECT ANSWER 1. OTC analgesics 2. Relaxation Migraine Headaches - CORRECT ANSWER Dilation and excessive pulsation of the branches of the external carotid artery, usually lasting 2-72 hours along the Trigeminal nerve pathway Migraine Headaches | Classifications - CORRECT ANSWER 1. Migraine with aura "classic" 2. Migraine without aura "common" Migraine Headaches | Causes/Incidence - CORRECT ANSWER 1. Onset is usually in adolescence or early adult years 2. Often + family history 3. Females > Males 4. A variety of triggers 5. Nitrate containing foods 6. Changes in the weather Migraine Headaches | Triggers - CORRECT ANSWER - Emotional/Physical stress - Lack or excess of sleep - Missed meals - Specific Foods (Nitrate containing, wines, cheeses...) - ETOH - Menstruation - oral contraceptives Migraine Headaches | Symptoms - CORRECT ANSWER - Unilateral, lateralized throbbing headache occurring episodically - Dull or throbbing - Build up gradually and last for several hours or longer - Focal neurologic disturbances may precede or accompany migraines - Visual disturbances occur commonly: visual field changes, luminous visual hallucinations - Aphasia, numbness, tingling, clumsiness or weakness may occur - Nausea and vomiting - Photophobia and phonophobia Migraine Headaches | Physical Exam Findings - CORRECT ANSWER - Often normal with the exception of neuro deficits - Appears Ill - Careful neuro exam for focal deficits or findings supportive of tumor Migraine Headaches | Laboratory & Diagnostics - CORRECT ANSWER 1. Baseline studies important to rule out other organic causes 2. Blood chemistries, BMP 3. CBC 4. VDRL (Syphilis Exam) 5. Head CT 6. Other studies indicated by physical exam or history Migraine Headaches | Management - CORRECT ANSWER 1. Avoid triggers 2. Relaxation/Stress management 3. Prophylactic Daily Therapy - Amitryptaline - Divalproex - Propanolol - Imipramine - Clonidine - Verapamil - Topiramate - Gabapentin - Methysergide - Magnesium Migraine Headaches | Management of Acute Attack - CORRECT ANSWER 1. Rest in dark, quiet room 2. Simple analgesics, ASA taken immediately to provide relief 3. Sumatriptan 6mg SQ at onset, may repeat in 1 hour 4. Sumatriptan 25mg at onset of headache Cluster Headache - CORRECT ANSWER Very painful syndromes, mostly affecting middle aged men [Show Less]
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NP board exam review: Class book 207 Questions with Verified Answers,100% CORRECT
NP board exam review: Class book 207 Questions with Verified Answers A patient has hyperactive reflexes of the lower extremities. The adult-gerontolog... [Show More] y acute care nurse practitioner assesses for ankle clonus by: - CORRECT ANSWER sharply dorsiflexing and maintaining the foot in this position, while supporting the knee. A 15-year-old patient with type 1 diabetes mellitus reports elevated blood glucose levels in the morning. The adult-gerontology acute care nurse practitioner determines that the patient's hyperglycemia is due to the dawn phenomenon and - CORRECT ANSWER increases the insulin dosage at bedtime A patient with a history of atrial fibrillation, who has maintained normal sinus rhythm with sotalol (Betapace), is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is intravenous - CORRECT ANSWER ceftriaxone A patient who has been in the intensive care unit for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. The adult-gerontology acute care nurse practitioner's initial treatment is to - CORRECT ANSWER The right answer was replenish volume by infusing a 0.9% sodium chloride solution Cytology is evaluated with - CORRECT ANSWER fine needle biopsy What is the single best predictor of one's health status? - CORRECT ANSWER health literacy Patient Health Questionnaire (PHQ-9) - CORRECT ANSWER common depression screening tool, self rank 9 signs and symptoms over last 2 weeks on scale of 0-3 CAGE-AID - CORRECT ANSWER C-have you ever felt that you ought to cut down on your drinking or drug use? A-have people annoyed you by criticizing your drinking or drug use? G-have you ever felt bad or guilty about your dirnking or drug use? E-Have you ever had a drink or used drugs first thing in the morning to steady your nerves or to get rid of a hangover? (e.g. eye opener) Ramsay Sedation scale - CORRECT ANSWER Awake: 1: anxious, agitated, restless 2: cooperative, oriented, tranquil 3: responsive to commands only Sleeping: 4:response to light glabellar tap ro loud auditory stimulus 5: sluggish response to light glabellar tap or loud auditory stimulus 6: no response to light glabellar tap or loud auditory stimulus Brief pain inventory - CORRECT ANSWER Assess impact of pain on daily life What is a good assessment tool for chronic pain such as with cancer patients? - CORRECT ANSWER Brief pain inventory Go review MMSE - CORRECT ANSWER What physical activity is good for Parkinson's patients? - CORRECT ANSWER Tai chi What is salsa dancing good for? - CORRECT ANSWER Coordination What is benchmarking? - CORRECT ANSWER Comparison and measurement of a healthcare organization's services against other national healthcare organizations HIPAA title I - CORRECT ANSWER protects health insurance coverage for workers and their families when they change or lose their jobs i.e. cobra HIPAA title II - CORRECT ANSWER administrative simplification provisions, standards for electronic healthcare transactions and national identifiers for providers, health insurance, and employers Who enforces HIPAA? - CORRECT ANSWER Office of civil rights Levels of facial fracture - CORRECT ANSWER 1. floating pallet 2. mandible 3. Face What is a tertiary facility - CORRECT ANSWER Provides specialized care i.e. level 1 trauma 2 goals of healthy people 2020 - CORRECT ANSWER increase quality and years of healthy life and eliminate health disparities among Americans Infections that require reporting to health department (5) - CORRECT ANSWER gonorrhea, chlamydia, syphilis, HIV, TB Who sets standards of coding (E&M) ? - CORRECT ANSWER medicare What are examples of 3rd party payers? - CORRECT ANSWER Medicare, Medicaid, commercial insurers, HMOs, schools providing insurance Medicare A - CORRECT ANSWER covers hospitalizations, SNFs, home health, hospice if associated with hospitalizations Medicare B - CORRECT ANSWER Covers provider services, outpatient, labs and diagnostics, supplemental requiring premium, medicare pays 80% of bill Medicare C - CORRECT ANSWER A+B = C; medicare advantage, receive services under one provider e.g. HMO, PPO Medicare D - CORRECT ANSWER limited prescription coverage, monthly premium, includes copay, need to enroll when first eligible What is required for a NP to be able to bill medicare? - CORRECT ANSWER Hold a state license, be certified by a professional body, hold at least a MSN degree What is an important goal of CQI/QA? - CORRECT ANSWER monitoring outcomes of care Who dictates the level of prescriptive authority? - CORRECT ANSWER state practice acts Who allows NPs to admit to the hospital? - CORRECT ANSWER joint comission Nonmaleficence - CORRECT ANSWER duty to do no harm utilitarianism - CORRECT ANSWER the right act is the one that produces the greatest good for the greatest number BEneficence - CORRECT ANSWER the duty to prevent harm and promote good justice - CORRECT ANSWER the duty to be fair fidelity - CORRECT ANSWER the duty to be faithful veracity - CORRECT ANSWER the duty to be truthful autonomy - CORRECT ANSWER the duty to respect the individual's thoughts and actions What two ethical principles are often in conflict? - CORRECT ANSWER Beneficence and autonomy What is a quazi experiment? - CORRECT ANSWER An experiment that lacks either a comparison group or randomization Sensitivity vs specificity - CORRECT ANSWER Sensitivity is positive and specificity is negative What lab value contraindicates use of sux? - CORRECT ANSWER Hyperkalemia What common liver met site can cause a fever? - CORRECT ANSWER Liver What is a left shift? - CORRECT ANSWER Bandemia What is the most common type of headache - CORRECT ANSWER Tension What blood test tests for syphillus? - CORRECT ANSWER VDRL What qualifies a migraine sufferer to have prophylactic therapy? - CORRECT ANSWER Attacks more than 2-3 times per month What is the black box warning on amitriptyline for? - CORRECT ANSWER QT prolongation What is a normal urine sodium? - CORRECT ANSWER 10-20 In a patient with hyponatremia, urine sodium >20 indicates - CORRECT ANSWER renal salt wasting In a patient wiht hyponatremia, urine sodiu <10 indicates - CORRECT ANSWER renal retention of sodium to compensate for loss Common causes of isotonic hyponatremia - CORRECT ANSWER hyperlipidemia, hyperproteinemia Edema, CHF, liver disease, and advanced renal failure can contribute to what kind of hyponatremia? - CORRECT ANSWER Hypervolemic, hypotonic hyponatremia Hypertonic hyponatremia - CORRECT ANSWER usually from HHNK, somolality is high and the Na is low Potassium in acid/base imbalances - CORRECT ANSWER acidosis => increased K alkalosis => decreased K Treatment (IV fluids) of hyopvolemic hypernatremia - CORRECT ANSWER NS followed by 1/2 saline What does hypokalemia look like on an EKG? - CORRECT ANSWER decreased amplitude, broad T waves, PVCs, V tach, or V-fib What is a normal calcium? Normal ionized? - CORRECT ANSWER 8.5-10.5 mg/dl; 4.5-5.5 What is different about an ionized cal from a regular cal? - CORRECT ANSWER ionized is not effected by albumin level Does acedemia increase or decrease calcium? - CORRECT ANSWER increase What causes hypocalcemia? - CORRECT ANSWER hypoparathyroidism, hypomagnesmia, pancreatitis, renal filure, severe trauma, multiple blood transfusions What ECG change can be caused by hyperthyroidism - CORRECT ANSWER a fib What electrolyte imbalance can vitamin D intoxication cause? - CORRECT ANSWER hypercalcemia What do you do if a patient's calcium level is >12? - CORRECT ANSWER NS infusion with loop diuretics what does respiratory acidosis result from? - CORRECT ANSWER decreased alveolar ventilation Anion gap equation - CORRECT ANSWER NA - (Chloride + bicarb) Normal anion gap - CORRECT ANSWER 12+/- 5 Clinical symptoms in respiratory alkalosis are related to what physiological process? - CORRECT ANSWER decreased cerebral blood flow What is the hallmark sign of metabolic acidosis? - CORRECT ANSWER Low HCO3 Examples of causes for metabolic acidosis with increased anion gap - CORRECT ANSWER DKA, alkoholic KA, lactic acidosis, drug or chemical anion Examples of causes for metabolic acidosis with normal anion gap - CORRECT ANSWER diarrhea, illeostomy, renal tubular acidosis, recovery from DKA When is giving HCO3 indicated in metabolic acidosis? - CORRECT ANSWER When significant hyperkalemia is present Common causes of metabolic acidosis - CORRECT ANSWER NG suctioning, vomitting Rule of 9's - CORRECT ANSWER arm = 9 leg = 9 thorax = 18 head=9 peri=1 Equation for burn fluid resuscitation - CORRECT ANSWER 4 ml x kg x TBSA Examples of crystalloid fluids - CORRECT ANSWER NS D5 LR Example of common colloid - CORRECT ANSWER albumin In burn patients, when do you prophylactically intubate? - CORRECT ANSWER Facial burns singed nares or eyebrows dark soot/mucous from nares and/or mouth What acid/base imbalance is expected during resuscitation from burns? - CORRECT ANSWER metabolic acidosis What electrolyte abnormality should be monitored for 24-48 hrs after burn injury - CORRECT ANSWER hyperkalemia What electrolyte abnormality should be monitored for at 72 hrs post burn injury? - CORRECT ANSWER hypokalemia In a human bite, what do you cover for and what is a common abx to use? - CORRECT ANSWER staph and anaerobes, augmentin, 3-7 days Most common cause of cellulitis - CORRECT ANSWER strep A Abx for CA-MRSA - CORRECT ANSWER bactrim, doxy, clinda Abx for A strep - CORRECT ANSWER bactrim + beta lactam Doxy + beta lactam clinda Examples of beta lactams - CORRECT ANSWER amoxicillin, keflex, cephelosporin Alternative to narcan? - CORRECT ANSWER Stadol What overdose is tinnitus a symptom of? - CORRECT ANSWER ASA What is the drug of choice in organophosphate toxicity? - CORRECT ANSWER atropine Treatment of serotonin syndrome - CORRECT ANSWER dantrolene sodium, clonazepam, cooling blankets Does cocaine cause mydriasis or miosis? - CORRECT ANSWER mydriasis - dilated Does heroin cause mydriasis or miosis? - CORRECT ANSWER miosis - pinpoint Standard transplant therapy - CORRECT ANSWER CNI + antimetabolite + steroid Calcineurin inhibitor examples - CORRECT ANSWER tacrolimus, cyclosporine antimetabolite examples - CORRECT ANSWER azathioprine, cellcept MTOR inhibitor - CORRECT ANSWER sirolimus Actinic keratosis (picture) and treatment - CORRECT ANSWER liquid nitrogen Squamous cell carcinoma (picture) and treatment - CORRECT ANSWER biopsy and surgical excision (Mohs) Seborrheic keratosis (picture) and treatment - CORRECT ANSWER benign, liquid nitrogen Basal cell carcinoma (picture) treatment - CORRECT ANSWER most common, shave/punch bx and surgical excision Malignant melanoma (picture) and treatment - CORRECT ANSWER biopsy and surgical excision ABCDE of malignant melanoma - CORRECT ANSWER Asymetry Border irregularity color variation diameter >6 cm elevation, enlargement How does SIADAH work? - CORRECT ANSWER ADH is released independent of osmolality or volume dependent stimulation causing inappropriate water retention. It is hyponatremic euvolemia. How does diabetes insipidus work? - CORRECT ANSWER ADH deficiency causes pituitary or hypothalamus damage In SIADH, what would you expect serum osmo, urine osmo, urine sodium to be? - CORRECT ANSWER serum osmo: low <280 urine osmo: up >100 urine sodium: >20 What is a pheochromocytoma? - CORRECT ANSWER excess catecholamine (epi and norepi) release characterized by paroxysmal or sustained HTN. Almost always related to tumor in adrenal medulla S/s of phenochromocytoma - CORRECT ANSWER HTN labile diaphoresis hyperglycemia severe HA palpitations sweating tremor tachycardia weight loss postural hypotension How do you confirm a pheochromocytoma - CORRECT ANSWER assay of urine catecholamines and CT of adrenals Medication given perioperatively while removing phnochromocytoma - CORRECT ANSWER phentolamine IV What are you hearing in S1? - CORRECT ANSWER Mitral/tricuspid valves close, A/P open What are you hearing in S2? - CORRECT ANSWER Aortic/pulmonic closure, M/t open S3 is heard in? Sounds like? - CORRECT ANSWER CHF, pregnancy, fluid overload Ken-tuck-y S4 is heard in? Sounds like? - CORRECT ANSWER MI, left ventricular hypertrophy, chronic HTN, stiff entricular states; Ten-ne-ssee Describe a grade III/VI murmur - CORRECT ANSWER moderately loud, easily heard Descrive a graDE IV/VI murmur - CORRECT ANSWER loud, associated with thrill Is mitral stenosis a systolic or diastolic murmur? - CORRECT ANSWER diastolic Is aortic regurg a systolic or diastolic murmur - CORRECT ANSWER diastolic is mitral regurg a systolic or diastolic murmur - CORRECT ANSWER systolic is aortic stenosis a systolic or diastolic murmur - CORRECT ANSWER systolic Where is the apex of the heart? - CORRECT ANSWER 5th ICS where is the base of the heart? - CORRECT ANSWER 2nd-3rd ICS What causes dependent edema? - CORRECT ANSWER Increased capillary hydrostatic pressure How do you rule out cushing's syndrome? - CORRECT ANSWER AM/PM cotisol levels What are the criteria of metabolic syndrome? - CORRECT ANSWER at least 3 of the following: 1. Waist >=40 or 35 2. BP >=130/85 3. Triglycerides >=150 4. FBG >=100 5. HDL <40/<50 Top 4 killers in adults (in order) - CORRECT ANSWER CAD Cancer lower respiratory CVA What is a normal AOC - CORRECT ANSWER 5.5-7% Metformin can cause which acid/base inbalance - CORRECT ANSWER metabolic acidosis Starting insulin dose - CORRECT ANSWER 0.1u/kg/day giving 2/3 in AM and 1/3 at night Somogyi efect - CORRECT ANSWER hypo overnight and hyper in AM - treat by omitting bedtime dose dawn phenomenon - CORRECT ANSWER progressively higher overnight - increase at bedtime dose Hyperthyroid - CORRECT ANSWER grave's disease overdrive test TSH first TSH low T3 high methimazole or propylthiouracil Hypothyroid - CORRECT ANSWER hashimoto's thyroiditis sluggish TSH elevated T4 low or low normal hyponatremia hypoglycemia What can exacerbate a thyroid storm - CORRECT ANSWER ASA Cushing's syndrome - CORRECT ANSWER ACTH hypersecretion by the pituitary adrenal tumor chronic steroids central obesity, moon face, etc hyper-glycemia, natremia hypo kalemia treat-underlying cause, surgical Addison's disease - CORRECT ANSWER Deficient in cortisol, androgens, and aldosterone autoimmune destruction of the adrenal gland hyperpigmentation of buccal mucosa hypo-glycemia, natremia hyperkalemia steroid replacement Gluco and mineral ocorticoids - CORRECT ANSWER hydrocortisone fludrocortisone JNC8 recommendations for medications in HTN non african americans - CORRECT ANSWER thiazide CCB ACEI ARB JNC8 recommendations for medications in HTN african americans - CORRECT ANSWER thiazide (unless DM, then get ACEI or ARB) CCB JNC8 recommendations for meds in HTN in adults with CKD - CORRECT ANSWER ACEI ARB What is the difference between SVT and ST on an EKG - CORRECT ANSWER no p wave in SVT First degree block strip - CORRECT ANSWER Second degree block strip - CORRECT ANSWER What kind of allergy do you screen for before giving a thiazide? - CORRECT ANSWER Sulfa What do ACEI and ARBs do besides cause lower BP? - CORRECT ANSWER vasodilation and block sodium and water retention What is malignant hypertension - CORRECT ANSWER fundoscopic chnages including flame shaped retinal hemorrhages, soft exudates and papilledema Treatment of prinzmetals - CORRECT ANSWER CCB, vasospastic so give CCB becaue related to calcium influx Goals for LDL, HDL and TG in DM and/or CAD patients? - CORRECT ANSWER LDL <70 HDL >40 TG <150 Common pharmacotherapy for angina - CORRECT ANSWER nitrates, BB, CCBs Normal lipid profile - CORRECT ANSWER Adults with a LDL of what should get statin therapy - CORRECT ANSWER >=190 Where is a lateral MI shown on the ECG? - CORRECT ANSWER I,aVL Where is an inferior MI shown on the ECG? - CORRECT ANSWER II, III, aVF Where is an anterior MI shown on an ECG? - CORRECT ANSWER V leads or V3 and V4 Where is a septal infart seen on ECG? - CORRECT ANSWER V1, V2 Which troponin is cardioselective? - CORRECT ANSWER Troponin I When do you see leukocytosis in a MI? - CORRECT ANSWER second day Drug therapy in acute MI - CORRECT ANSWER ASA, NTG, morphine, lasix, BB, ACEI Normal INR Normal APTT Normal PT Normal PTT - CORRECT ANSWER 0.8-1.2 28-38 11-16 60-90 What is the door to TPA goal? - CORRECT ANSWER 30 minutes Are legs shiny and hairless in PVD or CVI? - CORRECT ANSWER PVD ST changes in pericarditis - CORRECT ANSWER ST elevation temporary T wave inversion PR segment depression highly indicative of pericarditis What is the drug of choice for pericarditis? - CORRECT ANSWER NSAIDS, maybe steroids if NSAIDS fail How do you identify a GI bleed of an unknown cause? - CORRECT ANSWER GI angio Common causes of PUD - CORRECT ANSWER h pylori meds duodenal ulcers in young and gastric in old smoking Pain in PUD - CORRECT ANSWER relieved with eating in duodenal worse with eating gastric PUD 1st-3rd line treatment - CORRECT ANSWER HS HS BID PPI Common h pylori regimens - CORRECT ANSWER flagyl BID and/or amoxicillin, prilosec BID, clarithro BID x7 days then anti ulcer for 3-7 weeks Hepatitis A incubation period - CORRECT ANSWER 2-6 weeks Murphy's sign - CORRECT ANSWER for cholecystitis deep pain on inspiration while fingers are placed under the right rib cage Grey turner's sign cullen's sign - CORRECT ANSWER flank discoloration umbilical discoloration Where is pain generally in diverticulitis? - CORRECT ANSWER LLQ How does cholecystitis present? - CORRECT ANSWER sudden steady, severe pain in epigastrum or right hypochondrium, vomitting provides relief, precipitated from a fatty meal What imaging test is the gold standard for cholecystitis? - CORRECT ANSWER ultrasound What abnormal lab values could cause acute pancreatitis? - CORRECT ANSWER hypercalcemia, hyperlipidemia Gold standard imaging for acute pancreatitis? - CORRECT ANSWER CT scan Serum amylase and lipase in acute pancreatitis? - CORRECT ANSWER amylase 50-180 lipase 14-280 Ranson's criteria - CORRECT ANSWER prognosis of acute pancreatitis - 5-6 40% mortality >7 appx 100% mortality George washington got lazy after he broke CABE >55 yo WBC >16K glucose >200 LDH > 350 AST >250 Hct drop >10 BUN >5 increase calcium <8 arterial 02 <60 base deficit >4 est fluid sequestration >6K What is the hallmark symptom of ulcerative colitis? - CORRECT ANSWER bloody diarrhea How do you treat a UC flare? - CORRECT ANSWER mesalamine suppositories for 3-12 weeks in combo with prednisone Psoas sign obturator sign positive rovsing's sing - CORRECT ANSWER -pain with right thigh extension -pain with internal rotation of flexed right thigh -RLQ pain when pressure is applied to the LLQ What is the typical s/s of MCA infarct? - CORRECT ANSWER hemiplegia A pneumonic for cranial nerves? - CORRECT ANSWER On old olympus towering tops a fin and german viewed some hops CN 1 CN 2 CN 3 - CORRECT ANSWER olfactory-smell optic-vision oculomotor-most EOMs, opening eyelids, pupillary constriction CN IV CN V CN VI - CORRECT ANSWER T-orchlear-down and inward eye movement -trigeminal-muscles of mastication, sensation of face, scalp, cornea, mucus membranes and nose -abducens - lateral eye movement CN VII CN VIII CN IX - CORRECT ANSWER -facial-mouth, eyes, taste anterior 2/3, saliva, tears, puffing cheeks -acoustic-hearing and equilibrium -glossopharyngeal-phonation, gag reflex, carotid reflex, swallowing, taste posterior CN X CN XI CN XII - CORRECT ANSWER -vagus-talking, swallowing, general sensation fro mthe arotid body, carotid reflex -spinal accessory - movement of trapezius and sternomastoid muscles (shrug) -hypoglossal-moves the tongue Vertebrobasilar vs carotid TIA - CORRECT ANSWER -verte-vertigo, ataxia, dizziness, visual, field, deficits, weakness, confusion -aphasia, dysarthria, altered LOC, weakness, numbness, etc What are s/s of sudden increased ICP? - CORRECT ANSWER AMS, HA, vomitting Left hemisphere involvement of CVA vs Right hemisphere involvement of CVA - CORRECT ANSWER opposite hemiparesis -left: aphasia, dysarthria, difficulty reading/writing -right: right visual field changes, spatial disorientation What is a normal MAP? What MAP do you want on a CVA patient to prevent vasospasms? - CORRECT ANSWER 70-105 110-130 3 H's of increased ICP - CORRECT ANSWER hypotension hypoxemia hypercapnea What differentiates a simple partial from complex partial seizure? - CORRECT ANSWER followed by impaired level of consciousness What is CPP and what is the goal? - CORRECT ANSWER MAP-ICP; goal 70's Goal ICP in CVA? - CORRECT ANSWER <20 What are some indications for ICP monitors? - CORRECT ANSWER GSC <8 and/or a bleed What is myasthenia gravis? - CORRECT ANSWER autoimmune reduction of the number of acetylcholine receptor sites at the neuromuscular junction weakness worse after exercise and better after rest How do you differentiate between a myasthenia gravis crisis and a choinergic crisis? - CORRECT ANSWER Tensilon test In MS, what would you see in the CSF? - CORRECT ANSWER elevated IgG How do you evaluate for MS besides exam and labs? - CORRECT ANSWER MRI brain What is Guillain-Barre Syndrome - CORRECT ANSWER demyelination of peripheral nerves resulting in progressive symmetrical ascending paralysis Lab findings in GB - CORRECT ANSWER CSF protein elevated especially immunoglobulin G CBC early leukocytosis w/ left shift LP, MRI, and CT sometimes used What is the most common cause of meningitis? - CORRECT ANSWER strep pneumoniae What are the 5 most common disorders caused by strep P.? - CORRECT ANSWER meningitis sinusitis otitis media bronchitis CAP Why, in meningitis, does the CSF have an increase in pressure, protein, and WBCs but a decrease in glucose? - CORRECT ANSWER The protein eats up the glucose What abx do you give for meningitis? - CORRECT ANSWER Pen G, vanco, third gen cephalosporin or quinolone until C&S back What is cushing's triad and what does it mean? - CORRECT ANSWER Widening pulse pressure, decrease RR, decrease HR; decompensation in head trauma [Show Less]
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NPs Rosh 1 N6830 Exam 61 Questions with Verified Answers,100% CORRECT
NPs Rosh 1 N6830 Exam 61 Questions with Verified Answers What is the half life of aspirin? - CORRECT ANSWER 15-20 minutes A 24-year-old woman prese... [Show More] nts to the clinic complaining of worsening asthma symptoms. She states that she now has to use her albuterol inhaler three to four times per week and is awakened at night with symptoms about three times per month. The provider orders spirometry measurements, and her FEV1/FVC before a bronchodilator is 85%. Which of the following categories is this patient classified as in the stepwise progression of asthma? - CORRECT ANSWER Step 2, mild persistent Which of the following environments would be the most appropriate for the initial dissemination of evidence-based literature? - CORRECT ANSWER Oral presentation at your hospital's journal club When making clinical decisions about interventions based on evidence, which type of study is the highest level of evidence? - CORRECT ANSWER Systemic review Who is responsible for regulating nurse practitioner prescribing authority? - CORRECT ANSWER State Board of Nursing A 63-year-old man complains of fatigue, dyspnea on exertion, and swelling of his ankles and calves over the past two weeks. Which one of the following findings has the highest specificity for congestive heart failure? - CORRECT ANSWER Third heart sound A 14-year-old girl presents to the clinic as a new patient for a well-child visit. Her mother reports that she fears her daughter has become sexually active. Which of the following would be an effective interviewing technique to utilize with this patient? - CORRECT ANSWER Ask the patient's mother to leave the room during your interview What type of fears are common in children in their preschool years? - CORRECT ANSWER Fears of imaginary creatures, animals, and environmental elements like thunderstorms A 68-year-old woman presents to the clinic for follow-up care of her diabetes. She was diagnosed with type 2 diabetes mellitus ten years ago. Despite regular appointments with her doctor and consistent compliance with her diabetes medications, she continues to resist the recommended lifestyle changes required to control her diabetes. In the last five years, she has developed diabetic neuropathy and nephropathy. She had an amputation below the left knee two years ago, and she continues to suffer from wounds in both of her legs. She was placed on hemodialysis eight months ago due to kidney failure. However, she states that she has no desire to change her diet, citing that "food is all I can really enjoy at this point, even though it's bad for my health". She is aware that the diabetes is slowly causing her body to shut down and will most likely kill her. She asks about her options for health care once she becomes too ill to make decisions, and she expresses interest in writing up an advance directive. Which of the following types of advance directives is recognized by state law in the United States? - CORRECT ANSWER Health Care Proxy Which of the following should be included in a written report of suspected abuse in a pediatric patient? - CORRECT ANSWER The use of direct quotations from the child or parents Clinicians who employ evidence-based disease management approaches for their patients realize that appraisal of the evidence requires the reader to evaluate the level of evidence as well as the number of studies available that have examined the specific clinical issue of concern. Which of the following research designs is considered the highest level of evidence when determining cause and effect relationships? - CORRECT ANSWER Randomized control trial Which of the following can be a direct result caused by adolescents skipping meals? - CORRECT ANSWER Decreased school performance The adult-gerontology acute care nurse practitioner is providing care to a patient that becomes agitated, expresses dissatisfaction with his healthcare team, and threatens to leave against medical advice. Which of the following therapeutic communication techniques is the most appropriate to implement? - CORRECT ANSWER Acknowledging or accepting A 42-year-old man has been living in the United States for 6 years after migrating from Somalia. His medical history includes treatment for latent tuberculosis. He takes no routine medications and has no allergies. He presents to the clinic with complaints of nausea, stomach burning, bloating, and burping. He states he has had the issues for a "long time." He has not tried any medications for his reported symptoms. He does not smoke and denies use of alcohol. He denies weight loss, vomiting, diarrhea, or hematochezia. When providing culturally competent care, which of the following differential diagnoses is high on your list of concerns based on this patient's ethnicity? - CORRECT ANSWER Helicobacter pylori Who is responsible for approving credentialing and privileging of the medical staff including NPs? - CORRECT ANSWER Hospital's governing body When writing health policy, providing discussion of the consequences of action and inaction of a policy is an example of which of the following? - CORRECT ANSWER Discussing the impact Which of the following is an essential ethical principle of biomedical research? - CORRECT ANSWER Beneficence Which of the following activities for a 14-year-old child is considered a protective measure in preventing obesity? - CORRECT ANSWER Eating 1 - 2 family meals per week Which of the following would best exemplify using patient- and family-centered care when creating a care plan for an adolescent patient? - CORRECT ANSWER Recognizing the strengths of the patient and his or her family and empowering them to use those strengths A nurse practitioner-owned and run outpatient facility recently implemented an electronic medical record and electronic prescribing program. The nurse practitioner knows that the Medicare Modernization Act of 2003 supports the technology and encourages more utilization within America's health care system. Which Medicare plan supports the use of electronic prescribing? - CORRECT ANSWER Part D A 12-month-old girl presents to the clinic with her mother for a well-child visit. You review her growth charts and note that the child has increased her height and weight since her 9-month check-up and is currently at the 60th percentile of weight for length. The child has two siblings, a sister age 3 and a brother age 5. You knock, open the door, and enter the exam room. The child is standing next to a chair and taking books away from her sister. When she sees you, she holds her arms up and attempts to climb onto her mother's lap. You do a review of systems by asking the mother about the child's play routine, dietary intake, sleep habits, gross motor skills, and language development. The mother reports that the child sleeps through the night, is eating table food, tries to do everything her siblings do, responds to her name, and can say "mama" and "dada." However, the mother remarks that she thought her other two children were talking more at this age and wonders if she should be concerned about autism. While completing a head-to-toe exam, the child makes eye contact when you speak to her and smiles appropriately. She resists the ear exam and cries as the mother assists you in completing the task. The child is easily soothed by the mother once you return to the computer. Which of the following responses is the most appropriate regarding the mother's concerns with the child developing autism? - CORRECT ANSWER I believe she is developing as expected for her age A study finds that the negative predictive value of a new test for prostate cancer is 60%. Which of the following best explains this finding? - CORRECT ANSWER A total of 60% of patients who tested negative did not have prostate cancer A 68-year-old Vietnamese speaking woman presents to the clinic for a problem visit. The office has arranged for an interpreter to attend this visit, but her daughter, who speaks Vietnamese and English proficiently, is also present. In a cross-cultural interview, which of the following guidelines should be used? - CORRECT ANSWER Confirm the patient understands the meaning of what you say In the beginning of 2020, COVID-19 became a worldwide pandemic causing many countries to close borders, schools, public gatherings, and certain businesses. Public officials ordered health care facilities, pharmacies, and grocery stores to remain open to the public. What is the best way for outpatient health care facilities to reduce the spread of the COVID-19 infection? - CORRECT ANSWER Telemedicine Which component of Medicare provides coverage for prescription drugs? - CORRECT ANSWER Part D At an annual visit, a 28-year-old woman tells the nurse practitioner that she knows smoking is bad for her and is considering quitting. What stage of readiness to change is she exhibiting? - CORRECT ANSWER Contemplation Which of the following is appropriate developmental anticipatory guidance to discuss with the parents of a 4-month-old girl at her wellness exam? - CORRECT ANSWER She will start rolling back to front by her 6-month wellness exam A 33-year-old woman presents to discuss a personal health promotion plan the week before Halloween. She states she wants to lose weight. She has a body mass index (BMI) of 31 kg/m2 and is being treated for polycystic ovary syndrome (PCOS). She also has a family history of breast cancer (both her grandmother and mother have been treated for the condition). The patient is aware that it is best for her to eat a low-fat diet, but she explains, "I do want to lose weight, but I can't start my low-fat diet until after the holidays, because I love to eat Halloween candy and Christmas cookies." Her statement leads you to believe she is in which stage of the transtheoretical model? - CORRECT ANSWER Contemplation Which of the following questions asks patients about their social stressors and supports? - CORRECT ANSWER Do you ever feel that you're not able to afford food, medications, or other medical expenses? Research or clinical questions should be well focused and addressable, and they tend to be formed using the PICO method. What does PICO stand for? - CORRECT ANSWER Population, intervention, comparator, outcome Conflict of interest occurs when the validity of study results are influenced by which of the following? - CORRECT ANSWER Personal relationships A 42-year-old transgender woman presents to your office for a rash on the right lateral thorax. When addressing the patient and documenting the visit, which of the following pronouns would most likely be congruent with the patient's gender identity? - CORRECT ANSWER She, her, hers A nurse practitioner is working in a family physician's office in a state that prohibits independent practice. According to the collaboration agreement with the physician, the nurse practitioner's primary role is to follow-up with patients, review labs, order any additional testing or interventions, and manage patient calls. A 67-year-old woman following up at her physicians' office for her recently diagnosed hypertension. The family nurse practitioner sees the patient to reevaluate her blood pressure since she started taking a new angiotensin-converting enzyme (ACE) inhibitor that was prescribed by the physician. The patient's blood pressure is 120/80 mm Hg, and no new interventions are implemented. How would the physician's office bill the patient's insurance company or Medicare? - CORRECT ANSWER Incident-to billing The NP is responding to an increased incidence of extended-spectrum beta lactamase resistant Escherichia coli infections. The NP has evaluated evidence-based literature and developed a new protocol for the treatment of these infections. Implementation of this protocol is an example of which of the following steps of evidence-based practice? - CORRECT ANSWER Translation/Application You are interpreting the results of a study evaluating risk for vancomycin-induced renal toxicity. The odds ratio for acute kidney injury in patients with a vancomycin level greater than 15 mg/l was 4.0. Which of the following is an accurate interpretation of this value? - CORRECT ANSWER Patient who received vancomycin were 4 times more likely to develop renal toxicity You would like to conduct a study to correlate the results of a new rapid antigen testing kit with the standard culture for children with urinary tract infections. You plan to test all samples with a positive urinalysis and follow up the urine cultures within 48 hours. What method would best describe this study design? - CORRECT ANSWER Prospective cohort study Which of the following describes emotional development typical in early adolescence? - CORRECT ANSWER Egocentricity Which of the following state and federal programs is provided to assist people with limited income to afford medical care? - CORRECT ANSWER Medicaid A family practice office is considering implementing a new electronic medical record. Which feature of the electronic medical record most likely validates the clinician's concerns for their adolescent patients' decision-making autonomy? - CORRECT ANSWER A feature that allows the patient/guardian access to their health information A nurse practitioner is looking at research evidence to find an effective treatment plan for endometriosis. Which of the following research methods would present the strongest evidence? - CORRECT ANSWER A systematic review of randomized control studies A nurse practitioner is working an evening shift at a local urgent care facility in a state that prohibits independent practice and requires a collaboration agreement with a physician. The nurse practitioner sees a 27-year-old man for a fall and a small right ulnar fracture. The nurse practitioner reviews the X-ray and determines the fracture needs to be placed in a cast, however, the nurse practitioner is new to practice and does not feel comfortable independently completing the task. The nurse practitioner reviews the case with the attending physician who applies the cast, while the nurse practitioner observes. What would be the most appropriate way for the urgent care to bill for this encounter? - CORRECT ANSWER Shared visit A family nurse practitioner advises a 16-year-old girl to use sunscreen to prevent skin cancer. The girl responds that she sunbathes intentionally to get a tan and adds that she does not tan well with sunscreen. According to the health belief model, what chief construct does her statement demonstrate? - CORRECT ANSWER Perceived barriers A nurse practitioner is working in an emergency department fast track and is seeing an adult man for a fall. The patient was working on his house and fell off a ladder, causing him to fracture his right radius. Orthopedics was consulted, and they placed a cast on his arm. The patient was requesting something stronger than acetaminophen for his 7/10 pain. The nurse practitioner understands how the opioid epidemic is affecting the community and wants to make sure it is safe to prescribe the patient something stronger. What is the best method for the nurse practitioner to utilize in determining if it is safe to prescribe a controlled substance? - CORRECT ANSWER Review prescription drug monitoring program The extent to which an observation accurately measures what it is intended to measure describes what biostatistical term? - CORRECT ANSWER Validity A pregnant woman and her husband present to the clinic for a new obstetrical visit at 10 weeks gestation. They report that their culture is adamantly against any internal vaginal exams during pregnancy. After educating them on vaginal exams in pregnancy, the nurse practitioner goes on to communicate that it is an acceptable decision to decline the exam at this visit. Which of the following patient-centered care principles is the nurse practitioner demonstrating? - CORRECT ANSWER Respect for the patient's values and preferences Which of the following is an example of a technique used to decrease bias in a randomized control trial? - CORRECT ANSWER Placebos identical in appearance and packaging to the corresponding active drugs The NP is reviewing data comparing enoxaparin versus rivaroxaban for treatment of pulmonary embolism. A cost-benefit analysis is an example of which component of evidence-based practice change? - CORRECT ANSWER Evaluation A 61-year-old woman presents to the clinic for a colposcopy following an abnormal Pap smear. The clinic has a consent form for this procedure. Which of the following conditions must be met to fulfill legal requirements for informed consent? - CORRECT ANSWER She must demonstrate that she fully understands the procedure A nurse practitioner is evaluating a research article. Which of the following statements accurately describes the sample size of the study? - CORRECT ANSWER The sample size is the total number of participants in the study A patient presents to a cardiology clinic for an evaluation of dyspnea. After completing a comprehensive cardiac evaluation and physical examination, the NP rules out a cardiac etiology for the dyspnea. Which of the following is the most appropriate approach to refer the patient to a pulmonologist? - CORRECT ANSWER Communicate with the pulmonologist via telephone directly explaining the patient's cardiac workup and need for further evaluation of dyspnea Who is generally tasked with taking care of the emotional needs of the patient and family when working within a pediatric palliative care interdisciplinary team? - CORRECT ANSWER Child life specialists A nurse practitioner is presenting at a primary care health care provider conference in Philadelphia. The topic of the presentation is the initiation of end of life discussions with patients with end-stage organ failure. When would be the appropriate time to have an end of life discussion with this patient population? - CORRECT ANSWER Initial encounter The NP is interpreting a research article. Which value is used to determine statistical significance? - CORRECT ANSWER P-value Which of the following outpatient provider care models would lead to the greatest organizational cost savings and positive patient outcomes? - CORRECT ANSWER Nurse practitioner only full-time A 16-year-old girl presents to the clinic to obtain contraception. She is not married and is currently living with her parents. She states that she does not want her parents to find out about her decision to start birth control. Which of the following regulations would apply regarding adolescent consent and confidentiality? - CORRECT ANSWER Consent and confidentiality laws vary from state to state The D-dimer test has a sensitivity of approximately 95%. What does the sensitivity of the D-dimer test indicate? - CORRECT ANSWER The proportion of people with venous thromboembolism who test positive The nurse practitioner is providing care to a 17-year-old girl. At the end of the exam, the patient has exited the room. The patient's mother confides in the nurse practitioner, "My daughter's behavior is out of control and she is very disrespectful." Which of the following responses is the most appropriate? - CORRECT ANSWER "Teenagers can be challenging. I would encourage you to set reasonable expectations and maintain open communication." A 78-year-old man presents to the clinic for a follow-up after an emergency department visit for acute bronchitis. He reports he could not get the inhaler prescribed to him because it was too expensive. The man states, "Since my grandson started going to the bank for me, my account always runs out of money before the end of the month." Which of the following types of elder abuse might this indicate? - CORRECT ANSWER Exploitation A clinician is considering prescribing oxycodone to a patient. Which of the following are opioids appropriate to treat? - CORRECT ANSWER Kidney calculus A 4-year-old girl presents with her grandmother for her well-child visit. The child is attentive, her speech is easily understood, and she is able to talk in full, meaningful sentences. Fine motor skills are developing well, as you can see the child drawing and trying to write her own name. In order to assess her gross motor development, you ask the grandmother what sort of activities she is able to do outside at home or in the park. Which of the following activities should the child have attained since her 3-year well-child visit? - CORRECT ANSWER Kicking a ball short distances A 38-year-old woman who suffers from insomnia presents for her follow-up appointment. Today, she reports poor sleep 3 to 4 nights per week on average since her appointment last month. Considering the principles of motivational interviewing, which response would be most effective for continuing to assess her problem or providing appropriate interventions for her insomnia? - CORRECT ANSWER Can you describe a typical night? [Show Less]
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AGACNP Test Prep Barkley / Francis 48 Questions with Verified Answers,100% CORRECT
AGACNP Test Prep Barkley / Francis 48 Questions with Verified Answers 1. You want to get more funding for your hospital's Rapid Response Team. How sho... [Show More] uld you present this issue to the committee? a. Stress importance of the team (answer is worded as looking up evidence about how the team affects outcomes, like a meta-analysis) b. Describe how to improve and expand the team. - CORRECT ANSWER a. Stress importance of the team (answer is worded as looking up evidence about how the team affects outcomes, like a meta-analysis) 1. What is the best way for the AGACNP to get involved in policy making? a. Attend legislative days at the state capitol b. Join a hospital committee c. Write to your local congressman d. Review literature and give more in-services - CORRECT ANSWER b. Join a hospital committee 1. What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? a. Join a hospital committee b. Petition the government c. Bill for independent services d. Start your own practice - CORRECT ANSWER c. Bill for independent services 1. Which of the following is considered a high acuity role for the AGACNP? a. Primary care clinic b. Cardiology office c. Community health department d. Minute Clinic - CORRECT ANSWER b. Cardiology office 1. What is the best way to advocate for gay and lesbian population in your area? a. Participate at a high state or national level b. Join a non-profit advocacy group c. Consider lobbying the government d. Start at your facility (answers are worded differently. One of them is "decrease bias in healthcare" and another is something like "create inservices in healthcare" and another is "obtain funding to increase access." - CORRECT ANSWER d. Start at your facility 1. Which of the following is most important to evaluate statistical significance when reviewing the literature? a. Consider the sample size b. Make sure the confidence interval is tight c. See if the p-value is less than the α-coefficient d. Determine the error rate (Answers are worded differently. "Ensure confounding variables were eliminated" & "P value is less than null hypothesis" were two of them. - CORRECT ANSWER a. Consider the sample size 1. When closing a practice, the NP is required to do all of the following except a. Give the pt adequate time to find another provider b. Keep all of the patient's records for a minimum of five years c. Send a certified letter with a return receipt requested (this is for discharging/firing a patient from your practice) d. Provide names of other providers for future care - CORRECT ANSWER c. Send a certified letter with a return receipt requested (this is for discharging/firing a patient from your practice) 1. Which of the following components of an evidenced based research process is the most important for NP to participate in? a. Specifying methods of data collection b. Formulating the hypothesis c. Carefully reviewing the literature d. Formulating the research problem - CORRECT ANSWER d. Formulating the research problem 1. A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? a. libel b. slander - CORRECT ANSWER a. libel Can you tell the pt's wife, for her protection, that her husband has HIV? - CORRECT ANSWER No, not without his permission. How can the ANCP prepare to get involved in future mass casualty event? - CORRECT ANSWER Pre-enroll in disaster volunteer program An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? - CORRECT ANSWER Medicaid 1. Your pt is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid: - CORRECT ANSWER Pays after insurance and 3rd party payers have paid You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that works. What ethical principles does this challenge? - CORRECT ANSWER Veracity and Fidelity • Health Literacy: Average American- what grade level of education? - CORRECT ANSWER 8th grade education level Know your QA/QI/CPI basic definitions and goals - CORRECT ANSWER Know your QI basic definitions and goals - CORRECT ANSWER Know your CPI basic definitions and goals - CORRECT ANSWER • One question had Quality Assurance as one answer, then CPI as another option! It sounded more like CPI to me. - CORRECT ANSWER • Quality assurance- - CORRECT ANSWER a process for evaluating the care of pts using established standards of care to ensure quality • CPI measures what 3 measures to improve nursing? - CORRECT ANSWER Structure, processes, and outcomes • A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based polices to establish clinician-family communication standards in the unit. These policies should include: - CORRECT ANSWER guidelines for having discussions with family members that are geared toward establishing treatment goals. • Which clinical scenario does the NP evaluate for a quality improvement process change? - CORRECT ANSWER An increased incidence of postoperative sternal wound infections • Goals set forth in "Healthy People 2020" by the United States Department of Health and Human Services include: - CORRECT ANSWER elimination of health disparities. (and ↑QOL/LOL) • Based on the individual's culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership w/the patient by: - CORRECT ANSWER Tailoring his or her communication style to the patient's preference. • A 70-year-old pt with a hx of DM, HTN, OAs, and a new diagnosis of coronary artery disease, is being discharged. The adult-gerontology acute care nurse practitioner teaches the patient that the first point of contact for health care needs is the: - CORRECT ANSWER primary care provider • The NP is asked to provide evidence to the hospital administration about the safety of NP placing central lines. Which resource provides the strongest level of evidence? - CORRECT ANSWER A systematic review (meta-analysis is even stronger) • What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number? - CORRECT ANSWER Balanced Budget Act True/False: restraining an unwilling patient is grounds for malpractice? - CORRECT ANSWER False, if they are a danger you can restrain • Pt presents to the clinic for routine f/u and passes out. You revive the pt and admit overnight. Which of the following would qualify as incident-to-billing? - CORRECT ANSWER Temperature and weight recording • The NP program initiated, primarily, because of what issue in healthcare at the time? - CORRECT ANSWER Pediatric physician shortage Elderly F pt takes a turn for the worse. The husband is crying when you enter the room and begins telling you what end-of-life care he prefers. What do you do? - CORRECT ANSWER Ask him to speak candidly with you Pt calls to complain about bills and states he has Medicare, which should cover all costs. You explain: - CORRECT ANSWER • Since you are healthy, exams are not covered. • Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient... HIPPA. - CORRECT ANSWER Pt in ER not doing well, primary md calls: - CORRECT ANSWER Give him info NP working on ESRD research project . A colleague renal specialist asks for pt info on your patients: - CORRECT ANSWER • HIPPA breach. Who enforces HIPPA - CORRECT ANSWER Office of Civil Rights /Dept. Health and Human Services What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number? - CORRECT ANSWER Affordable Care Act A patient has fully recovered from septic shock due to bacteremia. The patient has been accepted to a long-term acute care facility for continuation of antibiotic therapy. The infectious disease physician has not seen the patient in two days. The adult-gerontology acute care nurse practitioner: contacts the physician to determine the appropriate duration of antibiotic therapy. notifies medical staff services that the physician has not seen the patient. waits for the physician to come see the patient. writes transfer orders for the patient. - CORRECT ANSWER contacts the physician to determine the appropriate duration of antibiotic therapy. A 70-year-old patient with a history of diabetes, hypertension, arthritis, and a new diagnosis of coronary artery disease, is being discharged. The adult-gerontology acute care nurse practitioner teaches the patient that the first point of contact for health care needs is the: cardiologist. endocrinologist. primary care provider. rheumatologist. - CORRECT ANSWER primary care provider An 80-year-old patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the adult-gerontology acute care nurse practitioner: gives the patient illustrative pictures that instruct him or her on body alignment during activity. has the patient watch a video about surgeries and preoperative care for hip fractures. provides the patient with an audio tape for care of hip fractures and range-of-motion activities. provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery. - CORRECT ANSWER provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery. When serving as a nurse researcher, the adult-gerontology acute care nurse practitioner is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? - CORRECT ANSWER Nonmaleficence The adult-gerontology acute care nurse practitioner is asked to provide evidence to the hospital administration about the safety of nurse practitioners placing central lines. Which resource provides the strongest level of evidence? - CORRECT ANSWER A systematic review. An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? American Association of Retired Persons. Medicaid. Medicare. United States Social Security Administration. - CORRECT ANSWER Medicaid. Goals set forth in Healthy People 2020 by the United States Department of Health and Human Services include the: elimination of health disparities. empowerment of health care delivery systems. increase in life span of older adults. treatment of acute diseases. - CORRECT ANSWER elimination of health disparities Based on the individual's culture, ethnicity, and personal choices, the adult-gerontology acute care nurse practitioner can optimize the therapeutic partnership with the patient by: assuming most patients want to rely on family members or care providers to make treatment decisions. communicating with the patient using minimal to no medical terminology. developing the patient's communication skills to a more advanced level. tailoring his or her communication style to the patient's preference. - CORRECT ANSWER tailoring his or her communication style to the patient's preference. Which clinical scenario does the adult-gerontology acute care nurse practitioner evaluate for a quality improvement process change? A new case of necrotizing fasciitis in an immunocompromised patient. A projected increase in the number of influenza cases requiring hospitalization An expected rate of ventilator-associated pneumonia in pulmonary disease patients An increased incidence of postoperative sternal wound infections. - CORRECT ANSWER An increased incidence of postoperative sternal wound infections. What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number? - CORRECT ANSWER Balanced Budget Act [Show Less]
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Sample Questions from ANCC 25 Questions with Verified Answers,100% CORRECT
Sample Questions from ANCC 25 Questions with Verified Answers Which factor is associated with the highest risk of falls in older persons living in the c... [Show More] ommunity? A) A history of previous falls B) Living alone C) Osteoporosis D) Use of an assistive device - CORRECT ANSWER A) A history of previous falls An older adult patient complains of recent lapses in memory and decreased alertness. The patient's laboratory test results indicate a mild, macrocytic anemia. Which additional test does the adult-gerontology acute care nurse practitioner order to confirm a diagnosis? A reticulocyte count A serum folate level An erythrocyte sedimentation rate Iron studies - CORRECT ANSWER A serum folate level An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply, after "spending down" to qualify? Medicaid Medicare The American Association of Retired Persons The United States Social Security Administration - CORRECT ANSWER Medicaid A 70-year-old patient with acute systolic heart failure denies any functional limitations, is able to walk five blocks before tiring, and is euvolemic. Which medication is the first-line therapy for this patient? Amlodipine (Norvasc) Digoxin (Lanoxin) Furosemide (Lasix) Lisinopril (Zestril) - CORRECT ANSWER Lisinopril (Zestril) A patient has hyperactive reflexes of the lower extremities. The adult-gerontology acute care nurse practitioner assesses for ankle clonus by: C) applying a low-pitched tuning fork firmly to the lateral malleolus. B) sharply dorsiflexing and maintaining the foot in this position, while supporting the knee. striking the Achilles tendon with the percussion hammer C) after flexing the leg at the knee and rotating it externally. D) stroking the lateral aspect of the sole with the sharp end of the percussion hammer from the heel to the ball of the foot. - CORRECT ANSWER B) sharply dorsiflexing and maintaining the foot in this position, while supporting the knee. A 15-year-old patient with type 1 diabetes mellitus reports elevated blood glucose levels in the morning. An adult-gerontology acute care nurse practitioner determines that the patient's hyperglycemia is due to the dawn phenomenon and: A) increases the insulin dosage at bed time. B) reduces the insulin dosage at bed time. C) tests the blood glucose level at 3:00 AM every morning. D) tests the blood glucose level in the evening. - CORRECT ANSWER A) increases the insulin dosage at bed time. A patient with profound hypotension is transferred from the medical-surgical unit to the intensive care unit. The patient is started on fluids and norepinephrine (Levophed) IV. The blood cultures that were drawn 48 hours ago from the tunneled catheter, show preliminary results of gram-negative bacilli. The patient's most recent echocardiogram report reveals an ejection fraction of 40%. The adult-gerontology acute care nurse practitioner determines that: A) a pulmonary artery catheter insertion is indicated, to manage septic shock. B) fluid resuscitation will be limited to no more than 4 L C) indwelling vancomycin (Vancocin) should be placed in the ports of the tunneled catheter. D) piperacillin-tazobactam (Zosyn) is indicated for the line-related infection. - CORRECT ANSWER D) piperacillin-tazobactam (Zosyn) is indicated for the line-related infection. Which research design has the greatest strength in determining if an intervention is effective? Case control Clinical trial Cohort Cross-sectional - CORRECT ANSWER Clinical trial A 55-year-old man who has no history of diabetes mellitus, heart disease, hypertension, or thrombotic events is diagnosed with paroxysmal atrial fibrillation. Based on national stroke prevention guidelines, the recommended antithrombotic management for this patient is: aspirin (Bayer). aspirin with dipyridamole (Aggrenox). clopidogrel (Plavix). warfarin (Coumadin). - CORRECT ANSWER aspirin (Bayer) An adult-gerontology acute care nurse practitioner who specializes in cardiology is asked to give a presentation on lipid-lowering drugs. A major drug company that markets a lipid-lowering medication plans to pay the presenter an honorarium, but asks the nurse practitioner to limit his or her remarks to its drug. This situation presents a: breach of contract. conflict of interest. personal choice. reasonable request. - CORRECT ANSWER conflict of interest 32-year-old patient who underwent an open splenectomy for a ruptured spleen, is preparing for discharge. An adult-gerontology acute care nurse practitioner reviews the potential complications with the patient. The nurse practitioner emphasizes which instruction to the patient? Continue antibiotics for 14 days Follow up with primary care provider for vaccinations No international travel for five years No weight lifting restrictions - CORRECT ANSWER Follow up with primary care provider for vaccinations A 65-year-old female patient has a confirmed diagnosis of terminal liver disease. The patient's advance directive designates comfort measures, only. An adult-gerontology acute care nurse practitioner's action is to: A) discuss the patient's decision with the patient's family members. B) persuade the patient to participate in a hepatitis clinical trial. C) reconfirm the patient's end-of-life decision. D) refer the patient for a psychological evaluation. - CORRECT ANSWER C) reconfirm the patient's end-of-life decision. A 68-year-old patient had surgery three days ago, for repair of an abdominal aortic aneurysm. The patient remains intubated, is neurologically intact, and has active bowel sounds. The patient's liver function is within normal limits and the patient has no signs or symptoms of heart failure. The patient's laboratory values are: blood urea nitrogen of 12 mg/dL, creatinine of 0.8 mg/dL, PaCO2 of 37 mm Hg. The preferred form of nutritional support for this patient is: A) enteral feeding to the duodenum via a nasogastric small-bore tube. B) enteral feeding to the stomach via a gastrostomy tube. C) peripheral parenteral nutrition via an 18-gauge IV catheter. D) total parenteral nutrition via a central venous line. - CORRECT ANSWER A) enteral feeding to the duodenum via a nasogastric small-bore tube. A hospital requires adult-gerontology acute care nurse practitioners to submit credentialing applications for the purpose of: A) authorizing clinical roles and responsibilities. B) delineating therapeutic and diagnostic services. C) monitoring the nurse practitioner's clinical activities. D) verifying education, licensure, and experience. - CORRECT ANSWER D) verifying education, licensure, and experience. Assessment of which endocrine system response to sepsis-induced hypotension is essential in guiding subsequent therapy? Adrenal Pancreatic Pituitary Thyroid - CORRECT ANSWER Adrenal A patient with a history of atrial fibrillation, who has maintained normal sinus rhythm with sotalol (Betapace) is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is parenteral:A patient with a history of atrial fibrillation, who has maintained normal sinus rhythm with sotalol (Betapace) is hospitalized for acute pyelonephritis. The appropriate antibiotic regimen for this patient is parenteral: cefoxitin (Mefoxin). ceftriaxone (Rocephin). ciprofloxacin (Proquin). levofloxacin (Levaquin). - CORRECT ANSWER ceftriaxone (Rocephin). Generally healthy patients, who are diagnosed with acute bronchitis, inappropriately ask for which category of drugs? Antibiotics Beta-agonists Corticosteroids Xanthines - CORRECT ANSWER Antibiotics What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number? The Affordable Care Act The Balanced Budget Act The Civilian Health and Medical Program of the Uniformed Services The Omnibus Budget and Reconciliation Act - CORRECT ANSWER The Balanced Budget Act A 19-year-old male patient arrives at the emergency department exhibiting symptoms of lower abdominal pain that radiates to the groin, and that the patient rates as an 8 on a scale of 1 to 10. That patient states that the pain came on suddenly, while he was playing football with friends. The patient's physical examination reveals positive bowel sounds in all quadrants; a soft, non-tender abdomen; no rebounding and no guarding; and no palpable mass in the abdomen or groin. Examination of the patient's genitalia reveals a unilateral cremasteric reflex. What is the adult-gerontology acute care nurse practitioner's leading differential diagnosis, based on the patient's presentation? Appendicitis Epididymitis Inguinal hernia Testicular torsion - CORRECT ANSWER Testicular torsion An exception to the practice of maintaining patient confidentiality is when: A) a family member of the patient gives consent. B) a family member of the patient is paying for the tx. C) the patient is unresponsive. D) the patient plans to hurt someone. - CORRECT ANSWER D) the patient plans to hurt someone. When reading a systematic review, an adult-gerontology acute care nurse practitioner ensures that the review: describes the intended audience. describes the study inclusion criteria. is published in a peer-reviewed journal. is written by experts in the field. - CORRECT ANSWER describes the study inclusion criteria. An adult-gerontology acute care nurse practitioner needs to communicate the findings of HIV to a patient. The nurse practitioner enters the patient's room and the spouse is at the bedside. To discuss the diagnosis, the nurse practitioner: asks the nurse to step into the room. asks the spouse to step out of the room. speaks with the patient and spouse together. speaks with the spouse privately. - CORRECT ANSWER asks the spouse to step out of the room. When discharging an 85-year-old patient who has a diagnosis of stasis dermatitis, an adult-gerontology acute care nurse practitioner includes instructions to: keep legs elevated while seated. maintain systolic blood pressure greater than 120 mmHg. soak legs in warm water daily. wear compression stockings of 65 mmHg below the knee. - CORRECT ANSWER keep legs elevated while seated. A patient is brought to the emergency department after being found unresponsive in a car. The patient's spouse arrives at the hospital to find the patient comatose, on mechanical ventilation, and brain death has been established. The spouse informs the staff that the patient has an advance directive and did not want to be kept alive, artificially. The spouse struggles with the decision to remove the patient from life support. The adult-gerontology acute care nurse practitioner: A) consults the ethics committee to help with the decision-making process. B) discusses with the spouse that removing the patient is the right thing to do. C) encourages the spouse to have a family meeting to make the decision as a group. D) reviews the patient's advance directive with the spouse. - CORRECT ANSWER D) reviews the patient's advance directive with the spouse. A patient with a history of heart failure arrives at the emergency department exhibiting shortness of breath and lower extremity swelling. Both of the patient's symptoms are a result of: a decrease in plasma oncotic pressure. an increase in capillary hydrostatic pressure. an increase in capillary membrane permeability. an obstruction of lymphatic drainage. - CORRECT ANSWER an increase in capillary hydrostatic pressure. [Show Less]
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ANCC AGACNP - Frances Guide Review Exam 531 Questions with Verified Answers,100% CORRECT
ANCC AGACNP - Frances Guide Review Exam 531 Questions with Verified Answers You want to get more funding for your hospital's Rapid Response Team. How sh... [Show More] ould you present this issue to the committee? a. Stress importance of the team (look up evidence about how team affects outcomes) b. Describe how to improve and expand the team - CORRECT ANSWER a. stress importance of team What is the best way for the AGACNP to get involved in policy making? a. attend legislative days at the state capitol b. join a hospital committee c. write your local congressman d. review literature and give more in-services - CORRECT ANSWER b. join a hospital committee What is the best way for the AGACNP to demonstrate and advocate for full scope of practice? a. join a hospital committee b. petition the government c. bill for independent services d. start your own practice - CORRECT ANSWER c. bill for independent services Which of the following is considered a high acuity role for the AGACNP? a. primary care clinic b. cardiology office c. community health department d. minute clinic - CORRECT ANSWER b. cardiology office What is the best way to advocate for gay and lesbian population? a. participate in a high state or national level b. join a non-profit advocacy group c. consider lobbying the government d. start at your facility - CORRECT ANSWER d. start at your facility Answers are worded differently. "decrease bias in healthcare" "create in-servises in healthcare" "obtain funding to increase access" Which of the following is most important to evaluate statistical significance when reviewing the literature? a. consider the sample size b. make sure the confidence interval is tight c. see if the p-value is less than the alpha-coefficient d. determine the error rate - CORRECT ANSWER a. consider the sample size When closing a practice, the NP is required to do all of the following except a. give the patient adequate time to find another provder b. keep all of the patient's records for a minimum of five years c. send a certified letter with a return receipt requested d. provide names of other providers for future care - CORRECT ANSWER c. send a certified letter with a return receipt requested Which of the following components of an evidenced based research process is the most important for NP to participate in? a. specifying methods of data collection b. formulating the hypothesis c. carefully reviewing the literature d. formulating the research problem - CORRECT ANSWER d. formulating the research problem A former pt of an NP is writing blog posts, sending emails, and distributing false, accusatory statements about the NP's practice. Which of the following forms of defamation is this? a. libel b. slander - CORRECT ANSWER a. libel Can you tell the patient's wife, for her protection, that her husband has HIV? - CORRECT ANSWER No, not without his permission How can the ANCP prepare to get involved in future mass casualty event? - CORRECT ANSWER Pre enroll in disaster volunteer program An 80 year old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? - CORRECT ANSWER Medicaid Your patient is worried about insurance coverage and asks you for advice on Medicaid. You instruct the patient that Medicaid: - CORRECT ANSWER Pays after insurance and 3rd party payers have paid You are giving a dinner presentation to a group. The pharmaceutical rep calls you the night before and wants you to say that their drug is the only one that workds. What ethical principles does this challenge? - CORRECT ANSWER Veracity and fidelity Health literacy - CORRECT ANSWER Average american: 8th grade level Quality assurance - CORRECT ANSWER A process for evaluating the care of patients using established standards of care to ensure quality CPI - CORRECT ANSWER Measures structure, processes, and outcomes A root cause analysis of a crisis situation in the ICU identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the NP is asked to develop evidence-based policies to establish clinician-family communication standards in the unit. These policies should include: - CORRECT ANSWER Guidelines for having discussions with family members that are geared toward establishing treatment goals Which clinical scenario does the NP evaluate for a quality improvement process change? - CORRECT ANSWER An increased incidence of postoperative sternal wound infections Goals set forth in healthy people 2020 by the US department of Health and Human services include: - CORRECT ANSWER elimination of health disparities (and increased QOL/LOL) Based on the individual's culture, ethnicity, and personal choices, the NP can optimize the therapeutic partnership with the patient by: - CORRECT ANSWER Tailoring his or her communication style to the patient's preference A 70 year old patient with a history of DM, HTN, OAs, and a new diagnosis of CAD, is being discharged. The adult-gerontology acute care NP teaches the patient that the first point of contact for health care needs is the: - CORRECT ANSWER PCP The NP is asked to provide evidence to the hospital administration about the safety of NP placing central lines. Which resource provides the strongest level of evidence? - CORRECT ANSWER A systematic review (meta analysis) What legislation allowed NPs to be recognized Medicare providers in all geographical areas with their own provider number? - CORRECT ANSWER Balanced Budget act True/false: restraining an unwilling patient is grounds for malpractice? - CORRECT ANSWER False, if they are a danger you can restrain Patient presents to the clinic for routine f/u and passes out. You revive the patient and admit overnight. Which of the following would qualify as incident to billing? - CORRECT ANSWER Temperature and weight recording The NP program initiated, primarily, because of what issue in healthcare at the time? - CORRECT ANSWER Pediatric physician shortage Elderly patient takes a turn for the worse. The husband is crying when you enter the room and begins telling you what end-of-life care he prefers. What do you do? - CORRECT ANSWER Ask him to speak candidly with you Patient calls to complain about bills and states he has Medicare, which should cover all costs. You explain: - CORRECT ANSWER Since you are healthy, exams are not covered Doc calls from another center asking if you can tell him what kind of orders he should give for maintenance of patient... - CORRECT ANSWER No, HIPPA Patient in ER not doing well, primary MD calls: - CORRECT ANSWER Give him info NP working on ESRD research project. A colleague renal specialist asks for patient info on your patients: - CORRECT ANSWER HIPAA breach Who enforces HIPAA? - CORRECT ANSWER Office of Civil Rights/Dept Health and Human Services Who isn't covered by HIPAA? - CORRECT ANSWER Law enforcment/municipal offices, CPS/Schools, employers/workman's comp, life insurance Insurance company calling to verify some patient appointments? - CORRECT ANSWER Answer by picking out that there is already a medical release signed by the patient and give the requested information to them Benchmarking - CORRECT ANSWER How institution compares with similar organizations Managed care - CORRECT ANSWER Know what this is and how it has improved costs, something about putting caps on payments Peer review - CORRECT ANSWER Timely, not anonymous, and NP knows how peer review will impact yearly evaluation Sensitivity vs specificity - CORRECT ANSWER Sensitivity: true positives, specificity: true negatives There was a question where a patient had a multinodular goiter and wanted to know why the NP was not going to do periodic US and fine needle biopsy in monitoring for some kind of cancer or complication. The answer I picked was that these tests were not very specific to detect the cancer Reliability - CORRECT ANSWER When implementing a new study, tested over and over, the consistency of a measurement or the degree to which an instrument measures the same way over time Validity of results in an article - CORRECT ANSWER P-value, probability of falsely rejecting the null hypothesis, want it to be <0.05 Statistical significance - CORRECT ANSWER Look at sample size and p value Privileging - CORRECT ANSWER May be granted in full or part by the hospital, credentialing committee is made of physicians Who determines scope of practice? - CORRECT ANSWER State practice acts but institutional bylaws may further restrict practice (facility limited scope of practice) Informed consent - CORRECT ANSWER A state indicating patient has received adequate instruction/information regarding aspects of care to make a prudent, personal choice regarding such, includes risks and benefits, competence: ability to communicate, understand, reason, differentiate good and bad Case management - CORRECT ANSWER Mobilize, mointor, and control resources that a patient uses during course of an illness while balancing quality and cost, "move patients through the system appropriately" 50-60 year old patient ith a new diagnosis of cancer. To appropriately plan for discharge, what should the NP do? a. consult CM b. Consult SW c. refer to Oncology d. refer to Hospice - CORRECT ANSWER a. consult CM Nondisclosure - CORRECT ANSWER Not disclosing patient PHI without permission Negligence - CORRECT ANSWER Failure of individual to do what any reasonable person would do, resulting in injury to the patient When serving as a nurse researcher, the NP is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? - CORRECT ANSWER Nonmaleficence Living will - CORRECT ANSWER Health care proxy/POA NP sees a patient for HF and performs an H&P. What % is expected to be paid? - CORRECT ANSWER Medicare pays 80% of the total bill, pt pays 20%, NP is reimbursed 85% of what the MD is reimbursed for physician services, and for procedure 80% of that 85% Focus of palliative care - CORRECT ANSWER Basic improvement in QOL of anyone with an illness at any stage Hospice - CORRECT ANSWER <6m to live Scope of practice: integration of care across the acute illness continuum with: a. collaboration b. coordination of care c. research based clinical practice - CORRECT ANSWER a. collaboration Collaboration - CORRECT ANSWER True partnership in which all players have the desire power, share common goals, and recognize/accept separate areas of responsibility/activity Patient is getting d/c'd and need wound care, pulmonary, and follow up. NP's role is to: - CORRECT ANSWER Coordinate services Government is moving towards being cost effective. What is the best way? - CORRECT ANSWER Allow NP to treat a wider variety of patients Protected health information: discussion between the NP and consultant on case - CORRECT ANSWER Considered clinical relevance How should the ACNP stay up to date with current information? - CORRECT ANSWER Evidence based guidelines Which medicare is Hospice covered under? - CORRECT ANSWER Medicare A A patient presents to the Er with c/o CP and SOB. The NP misinterprets the EKG and admits the patient fro further monitoring without consulting cardio. Later in the shift, the patient decompensates and goes into cardiac arrest. The patient was resuscitated but sustained permanent brain damage. What grounds of malpractice is the NP accountable for? - CORRECT ANSWER Lack of skill Healthcare exchange - CORRECT ANSWER Health insurance marketplaces, organizations in each state through which people can purchase health insurance You notice there have been less favorable outcomes and satisfaction surveys in patients treated for sickle cell anemia. How do you approach this problem? a. ask the patients treated how care can be improved b. look back at prior treatment given to see how outcomes can be improved c. form a standardized tx plan for all patients that can be used by all healthcare staff d. form individualized tx plans that can be used by all healthcare staff - CORRECT ANSWER c. form a standardized tx plan for all patients that can be used by all healthcare staff You have transferred a patient to the SNF. The MD in charge at that facility calls for info about the patient's medical care, what do you do? a. direct him to look it up in the EMR b. refuse to share protected health information c. instruct him to call the department head d. share the information he requests - CORRECT ANSWER d. share the information he requests Your patient has refused human blood products based on religious beliefs. He is now rapidly destabilizing. What do you do? a. administer PRBCs as needed b. call the ethics committee c. continue to research alternative treatments d. ask the family to give permission now that he's unconscious - CORRECT ANSWER c. continue to research alternative treatments What is the best way to make sure a patient will follow up as instructed? a. instruct the patient to schedule the appointment b. ask the patient the best time they can go to an appointment c. have the office manager to schedule the appointment d. schedule the appointment for the patient - CORRECT ANSWER d. schedule the appointment for the patient Your patient is brain dead on the ventilator. The family wants all possible treatment measures done to preserves life, but states that the patient would not want to be on a ventilator. What should you do? a. consult neurology to come interview the family b. document the situation carefully in the chart c. call a clergy member to offer support d. call the ethics committee - CORRECT ANSWER d. call the ethics committee A patient visits your clinic for sinusitis. She requests a PAP smear since she has not had one in "years". You: a. refer her to a gynecologist b. schedule her to come back next week for the PAP at another appt c. perform the pap today d. do a vaginal exam only, and refer the PAP to a gyno - CORRECT ANSWER b. schedule her to come back next week for the PAP at another appt A patient visits your cardiology clinic. She requests a PAP smear since she has not had one in "years." You: a. refer her to gynecologist b. schedule her to come back c. perform the PAP today d. do a vaginal exam only, and refer the PAP to a gyno - CORRECT ANSWER a. refer to gynecologist Discharge planning is udnerway for a patient who has been very dehabilitated after treatment for end-stage liver cancer. His wife is also debilitated and the children live out of state. What is the best choice? a. hospice b. home health care c. SNF d. private duty RN - CORRECT ANSWER c. SNF Your patient presents to ED w/ R wrist pain. She states, "it's my fault; I should have had dinner ready on time." What do you do? a. Tell her not to go home bc it's not safe b. XR the wrist c. call the police d. consult psych - CORRECT ANSWER b. XR the wrist Now the husband presents to the ED with drug overdose. What is your action? a. Hand him off to anothe rpractitioner b. call the police c. consult psych d. treat him without prejudice - CORRECT ANSWER d. treat him without prejudice The medical resident obtained consent for an operative procedure. on your visit, the patient is confused/ refusing the procedure a. cancel the surgery b. have the wife sign another consent c. call the resident to clarify the patient was not confused when he signed the first consent d. consult neurology - CORRECT ANSWER c. call the resident to clarify the patient was not confused when he signed the first consent Your HIV positive patient is preparing to discharge when he tells you not only that he has passed the virus to his wife, but also that he plans to kill her when he gets home. How do you respond? a. call the police b. consult psych c. consult social work d. document his statements - CORRECT ANSWER b. consult psych Your clinical student breaks the sterile field. HOw do you handle this situation? a. discuss it with the student b. report it to the charge nurse c. report it to the unit manager d. inform the faculty in charge of the student - CORRECT ANSWER a. discuss it with the student You are the NP on call for the night. The nurse calls you to report the patient is decompensating. Who do you direct her to call? a. the ER physician b. anesthesia c. an NP present on another unit currently d. the attending MD who is at home - CORRECT ANSWER d. the attending MD who is at home A code you are in does not go well, and staff members afterwards are criticizing each other. How do you deal with the situation? a. schedule an in service to discuss common code mistakes b. meet with each team member individually c. set up exercises to increase collaboration during a code d. meet with all who participated in the code and have a one-time briefing - CORRECT ANSWER d. meet with all who participated in the code and have a one-time briefing Your patient is not doing well and family/wife is at bedside crying. Yo are preparing to talk to the family. What do you do first? a. place a social work consult b. explicitly explain the situation, the outcomes and care involved c. ask if the patient has an advanced directive d. set up a family meeting in a room with a specific time and date - CORRECT ANSWER c. ask if the patient has an advance directive Your patient is not conscious. HIs advance directive states he wants to be a DNR, but his family says they want him to be a full code. How do you respond? a. tell her the decision goes to the next of kin b. call the ethics committee c. comply with her wishes and make him a full code d. tell her you can't go against the advance directive - CORRECT ANSWER d. tell her you can't go against the advance directive A patient comes to the ED at a community hospital who is 29 weeks pregnant. She says her water has broken. Her VS are stable. What do you do? a. transfer her to a tertiary facility b. contact her OB/GYN for treatment advice c. admit to l/d d. consult the nurse midwife - CORRECT ANSWER a. transfer her to a tertiary facility Your 51F patient is getting ready to discharge when she tells you she hasn't had a mammogram in 3 years. What do you do? - CORRECT ANSWER Refer to PCP for outpatient discharge Your patient's imaging reveals he has metastatic cancer. The family, in accordance with their culture, request that you not share the test results to spare him distress. How do you respond? - CORRECT ANSWER Ask the patient what he wants to know about his prognosis 35yo F presents with c/o bilateral wrist pain. You suspect spouse abuse. You notice a handgun in her purse. What would be your next action? - CORRECT ANSWER Call security to ensure safety Adult child of a patient reports that her father has expressed desire to commit suicide and has a hx of ETOH and depression. The best response would be to? - CORRECT ANSWER Hospitalize the patient and start pscyhotherapy You notice that another NP in your group is frequently contact by pharmacy for prescription errors. How do you handle the situation? - CORRECT ANSWER Address it directly with the NP Your patient voices concerns because he has lost his insurance and worries his children will no longer have coverage for medical expenses. What do you do? - CORRECT ANSWER Consult case management 80yo patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the NP: - CORRECT ANSWER Provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery A 40yo female patient with no PMH is admitted with bilateral PE. W/u reveals a psoitive result for lupus anticoagulant, and anticoagulant therapy is planned. The patient verbalizes concern about her ability to manage the appointments and the follow up care. The NP's most effective intervention si to: - CORRECT ANSWER Arrange follow up appointments for the patient at the warfarin (Coumadin) clinic and PCP after discharge What procedure does the AGACNP perform to evaluate cytology, only, in the tumor? - CORRECT ANSWER Fine needle biopsy A patient has fully recovered from septic shock due to bacteremia and has been accepted to a LTC facility for continuation of abx. ID has not seen the patient in two days. The NP: - CORRECT ANSWER Contacts the ID MD to determine the appropriate abx duration 32yo M presented with a gunshot wound (GSW) to the FA. Injuries are negligible and pt is stable. Pt reports the shot was an accident during hunting. What should the NP do? - CORRECT ANSWER Report to the police. All GSW must be reported What is the most important when assessing status? - CORRECT ANSWER Level of alertness or hx of symptoms A woman of child bearing age c/o abdominal pain. What level of exam do you document? - CORRECT ANSWER Detailed A diabetic patient complains of abd pain. Which type of exam do you conduct? - CORRECT ANSWER Comprehenxive What qualifies patient for HHC - CORRECT ANSWER Home bound, has a prescription, requires care services, wound care, select care Patient is refusing care? - CORRECT ANSWER Let them refuse, educate, and search for alternatives Guy in ER needs refill on ritalin - CORRECT ANSWER research alternatives Knowledge deficit in ICU, what would you do for nurses? - CORRECT ANSWER In services A patient has advanced dementia, ESRD, and HF, what do you do for him? - CORRECT ANSWER Transfer from acute to palliative care Your 24m patient has been out hiking on vacation. He shows you the following rash, and thinks he has Rocky Mountain Spotted Fever. What is his diagnoses? - CORRECT ANSWER Lyme disease (Erythema migrans/bullseye rash), both are treated with doxycycline Your patient is a Chinese female immigrant living in the US. You notice she is avoiding eye contact. What is this due to? a. shame because she feels the illness is her fault b. embarrassment from the examination c. a sign of respect d. a normal response - CORRECT ANSWER c. a sign of respect Your patient speaks only spanish and you need to evaluate his pain. What do you do? a. ask a family member to translate for you b. utilize the hospital's interpreter service c. call over the Hispanic housekeeper and ask her to translate d. Use a visual pain scale - CORRECT ANSWER D. use a visual pain scale 58yo Japanese male with CP 4/10 for 3 hours, reluctant to answer questions. Which of the following in the Ed warrant admission? a. age b. gender c. pain level d. ethnicity - CORRECT ANSWER d. ethnicity (underestimates pain, taught to be stoic, pain is probably much more severe) A 77yo male patient's wife cares for him at home .Which statement by the wife indicates a need for a SNF? a. my husband needs more help with his ADLs b. I can't lift him out of bed anymore c. he has lost 20 pounds d. he has trouble swallowing and I'm worried he will choke on his food - CORRECT ANSWER a. my husband needs more help with his ADLs Which psychiatric disorder is most commonly diagnosed, yet least commonly treated? a. bipolar disorder b. alzheimer disease c. depression d. dementia - CORRECT ANSWER c. depression Your patient with PNA is noted to have a heavy drinking habit. 2 days post admit he becomes combative/agitated. What is tx? a. IV valium b. IV ativan c. PO librium d. lasix - CORRECT ANSWER c. PO librium Your patient has developed a fever of unknown origin. What is the next step? a. PO abx b. IV abx c. do nothing until diagnosis is confirmed d. tylenol - CORRECT ANSWER c. do nothing until diagnosis is confirmed How long will it take to begin to see healing in a pressure ulcer that has a clean, well-vascularized bed? a. 7 days b. 2-4 weeks c. 2 days d. 4-6 weeks - CORRECT ANSWER c. 2 days The patient has been in a bar fight and has a human bite on his hand. What should you do next? a. order PO abx b. order wound culture c. order IV abx d. measure the wound depth and width - CORRECT ANSWER a. Order PO abx Your patient has a chronic, nonhealing decubitus ulcer. He c/o pain when he moves his leg. What is a potential complication? a. compartment syndrome b. decrease in ROM ability c. septic shock d. osteomyelitis - CORRECT ANSWER d. osteomyelitis What is the strongest predictor of functional impairment prior to discharge of the elderly patient? a. advanced age b. incontinence c. cognitive impairment d. poor balance - CORRECT ANSWER c. cognitive impairment Your patient has been taking Thorazine and now has fever, sweating, lethargy, and a temp of 39.4 (102.2) a. give IVF b. antipyretic c. abx d. ice packs to groin and axilla - CORRECT ANSWER a. give IVF (Flush it out, this is neuroleptic malignant sydnrome) You suspect your patient on TPN with a PICC has a CLABSI. What is the first intervention? a. stop the TPN, remove the line, and place a new line for TPN b. start abx c. send cx d. change the guidewire - CORRECT ANSWER a. stop the TPN, remove the line, and place a new line for TPN Your patient has a fever 3 days post op, WBC are 15k, blood cultures negative, and Eos 9%. What is the diagnosis? a. viral infection b. bacterial infection c. malignant hyperthermia d. drug fever - CORRECT ANSWER d. drug fever (eos=allergic reaction, normal is 1-4%) What are protein supplements best used for? a. eliminate the need for lipids b. prevent anasarca (peripheral edema) c. aid in post op healing - CORRECT ANSWER c. aid in post op healing Which macronutrient of TPN significantly increases the osmolality of the solution? a. lipids b. dextrose c. mutivitamin d. potassium - CORRECT ANSWER b. dextrose Protein in nutrition for what reason? - CORRECT ANSWER maintain nitrogen balance along with metabolic needs, adjust protein weekly by measuring urinary urea nitrogen Which electrolyte are you most concerned about monitoring in cachexic patient? a. mag b. ca c. na d. k - CORRECT ANSWER d. k refeeding syndrome, hypokalemia and hypophosphatemia Which electrolyte do you monitor in refeeding syndrome? - CORRECT ANSWER Phosphorous (or potassium) Which lab do you monitor daily in a patient on nutritional supplements? a. BMP b. cbc c. abg d. blood culture - CORRECT ANSWER a. BMP (and monitor LFT's weekly) What alternative therapy can you order to relax the patient prior to procedure? a. massage b. aromatherapy c. music d. muscle relaxant - CORRECT ANSWER c. music What alternative therapy can you use to help/distract them from their pain during the procedure? - CORRECT ANSWER Guided imagery Which alternative therapy helps Parkinson's patients with coordination? a. acupuncture b. tai chi c. relaxation techniques d. hypnotherapy - CORRECT ANSWER b. tai chi (also helps prevent falls in elderly) Which 2 headaches are treated with triptans? - CORRECT ANSWER Migraines and cluster What kind of dressing do you use on a decubitus ulcer with necrotic tissue? - CORRECT ANSWER Hydrocolloid 45yo s/p double mastectomy 2 months ago. Now is c/o pain at the incision site - CORRECT ANSWER Neuropathic pain What does the leg/foot look like in a hip fracture - CORRECT ANSWER Internally or externally rotated Pt has a post op fever... - CORRECT ANSWER Give fluids WHO pain ladder... - CORRECT ANSWER Fentanyl patch for breakthrough cancer pain Best pain indicator... - CORRECT ANSWER Patient self report Best alternative therapy to decrease pain in clavicle fracture: - CORRECT ANSWER Therapeutic touch/reiki (hand or palm healing that transfers 'universal energy' has been used for cancer, emotional, or physical healing) Picture of gunshot wound to the R lung area - CORRECT ANSWER The answer is to allow the dressing to be sucked to the chest wall during the negative pressure of expiration Another answer was to let air blow out during inhalation Cocaine induced psychosis - CORRECT ANSWER s/s parnoia, delusions, hallucinations, 'cocaine bugs' under skin, mydriasis Pt comes in tachycardic, hallucinating, all kinds of other crazy symptoms with dilated pupils - CORRECT ANSWER Sympathomimetic (cocaine or meth) Antidepressant OD - CORRECT ANSWER s/s hallucinations, confusion, tachy/dysrhythmias, hypothermia, blurred vision, urinary retention, hypotension (can't see, can't pee, can't spit, can't shit) Antidepressant OD treatment - CORRECT ANSWER ICU if CNS or cardio toxic, activated charcoal NaHCO3 for dysrhythmias and maintain pH, benzos (valium) for seizure (if serotonin syndrome: dantrium/dantrolene sodium) ASA overdose - CORRECT ANSWER s/s n/v, tinnitus, dehydration, hyperthermia, apnea, cyanosis, metabolic acidosis ASA overdose treatment - CORRECT ANSWER activated charcoal, NaHCO3 for severe acidosis of <7.1, monitor ABGs How do you treat group A strep on skin - CORRECT ANSWER TMP/SMX or Doxy/mino + beta lactam (1st generation cephalosporin, PCN, or amoxil) Pt has cellulitis of lower extremity with a wound, what do you treat with? - CORRECT ANSWER Based on the hospital sensitivity Mallampati grades for visualization of oral cavity: - CORRECT ANSWER 1. complete soft palate 2. complete uvula 3. uvula base only 4. none Osteomalacia - CORRECT ANSWER Softening of bones (PEDS rickets), most common cause is vitamin D deficiency (also phos, Ca, UVB light) Hospice vs palliative care - CORRECT ANSWER Pallitiatve care are still receiving treatment. Hospice is no curative treatment, has death dx, and <6m to live Venous stasis ulcer - CORRECT ANSWER Use compression stocking Indication for tetanus shot - CORRECT ANSWER Dirty wound and haven't had a tetanus shot in five years Tdap vaccine is an example of what type of immunity - CORRECT ANSWER Active immunity How often should a woman between the ages of 20-39 have a PAP with HPV - CORRECT ANSWER Q5y, PAP with cytology q3y If born on or after what year is it indicated to receive 2 doses of mumps vaccine? - CORRECT ANSWER 1957 What age does an individual receive zostavax? - CORRECT ANSWER 50 one time dose When should PSA levels be initiated and how often? - CORRECT ANSWER PSA levels every year >50y (and DRE) Annual PSA and DRE are indicated in what group? - CORRECT ANSWER African-american >40 and family hx of prostate cancer Pt has normal PAP smear and reports that she has not had an abnormal PAP for past 10 years. What is the appropriate age to DC? - CORRECT ANSWER 65-70 35yo Asian american is in good health. He is worried about life prolonging measures. What is the most likely cause of death for a man like him? - CORRECT ANSWER Unintentional injury (if he's African american, it's homicide <35 and heart disease at 35) What is the leading cause of death in African american males ages 40-59? - CORRECT ANSWER CAD What is the leading cause of deaths in hispanics in the US? - CORRECT ANSWER Heart disease The most common cause of hyponatremic hyperosmolality a. hyperglycemia b. hyperthyroidism c. adrenal insufficiency d. k sparing diuretics - CORRECT ANSWER a. hyperglycemia What method should you use to treat hyponatremia related to SIADH? a. bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200ml/hr d. 3% hypertonic saline ,calculated - CORRECT ANSWER d. 3% hypertonic saline, calculated What is a potential cause of hyperkalemia? a. carafate b. NSAIDs c. centrally acting HTN meds - CORRECT ANSWER b. NSAIDs Your patient has a Na of 128 and was treated with colloids 3 days ago. What is a treatment? - CORRECT ANSWER Restrict free water A 68yo patient had sx three days ago to repair a AAA. The patient remains intubated, is neurologically intact, and has active bowel sounds. LFT's are normal, no s/s CHF, the patient's laboratory values are: blood urea nitrogen of 12 mg/dL, creatinine of 0.8 mg/dL, PaCO2 of 37mmHg. Which is the most appropriate method to deliver nutrition? a. central line b. PIV c. G tube d. enteral feeding to the duodenum via a nasogastric small-bore tube - CORRECT ANSWER d. enteral feeding to the duodenum via a nasogastric small bore tube Your patient has a serum osmolality of 268 mOsm/kg and a serum sodium of 134 mEq/L. His urine has Na less than 10 mEq/L. You know that all of the following are possible explanations except: a. diarrhea b. diuretics c. dehydration d. vomiting - CORRECT ANSWER b. diuretics (Na<10 is nonrenal cause. Diuretics are associated with renal cause, urine na >20) A 61 year old female c/o fatigue, muscle weakness, and constipation. She adds that she had felt her heart beating 'abnormally' and she has been experiencing muscle spasms on occasion. You order and EKG and find decreased amplitude and broad T waves. Occasionally you also note prominent U waves. Of the following, which is the most likely diagnosis? a. hypokalemia b. hyperkalemia c. hypocalcemia d. hypermagnesemia - CORRECT ANSWER a. hypokalemia Your patient has complications from parenteral nutritional support. All of the following are plausible explanations except: a. hypernatremia b. pneumothorax c. HHNK d. GI bleed - CORRECT ANSWER d. GI bleed 65yo male with c/o n/v/constipation x several days and a six pound weight loss. Pt s/p TKR severral weeks ago and reports not getting off the couch. What electrolyte is altered? - CORRECT ANSWER Hypercalcemia secondary to immoblity Pt with s/s of abd distention, weakness and occasional diarrhea. Hx indicates renal failure. You conclude that the patient has a fluid and electorlyte problem. Which of the following is he most likely experiencing? - CORRECT ANSWER Hyperkalemia ABG reads high HCO3 and pCO2 55mmHg. What electrolyte abnormality is most likely associated with these values? - CORRECT ANSWER Hypokalemia r/t metabolic alkalosis Pt has a fever and tachycardia, and hx of CHF. There is a box with lab values, and the Na is high. What does it say about their hydration status - CORRECT ANSWER Extracellular dehydration deficit Low serum Na and high serum osmolality - CORRECT ANSWER Hyperglycemia (Probably HHNK) A patient with hypovolemic, hypotonic, hyponatremia and what fluids to give: - CORRECT ANSWER NS Low protein = Low BUN = - CORRECT ANSWER hypoosmolar hyponatremia (probably edematous, expect edema in Albumin <2.7) A patient who has been in ICU for 17 days develops hypernatremic hyperosmolality. The patient weighs 132 lbs (59.9kg), is intubated and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2o. Clinical signs include tachycardia and hypotension. The initial treatment is to: - CORRECT ANSWER Replenish the volume by infusing a 0.9% sodium chloride solution Which electrolyte imbalance leads to confusion and lethargy in the ETOH abuse patient? - CORRECT ANSWER Hyponatremia What electrolyte should be monitored prior to administering succinylcholine? - CORRECT ANSWER K ASA overdose, which electrolyte do you monitor? - CORRECT ANSWER K (if low will prevent hte alkalinization of urine, which is the mainstay of treatment) What sx is associated with hepatotoxicity s/p acetaminophen toxicity? - CORRECT ANSWER Delirium Patient at high risk for hyperkalemia? - CORRECT ANSWER NSAIDs then ACEi Tube feeding side effects - CORRECT ANSWER Diarrhea: decrease the osmolality of the tube feeding What patient requires labs to be monitored closely after intiating Tf? - CORRECT ANSWER Alcoholic with decreased intake over the past 2-3 weeks What disorder can be ruled out using the Cosyntropin stimulation test? a. Cushing's b. DI c. Adrenal insufficiency d. SIADH - CORRECT ANSWER c. Adrenal insufficiency What side effect of levothyroxine is most likely to lead to non-compliance when first initiated? a. alopecia b. dyspepsia c. weight loss d. nevousness - CORRECT ANSWER a. alopecia You are treating a patient for hypothyroidism. Which lab value is monitored for treatment/synthroid effectiveness? a. T3 b. T4 c. TSH d. thyroxin index - CORRECT ANSWER c. TSH What method should you use to treat hyponatremia related to SIADH? a. Bolus 500mL NS b. Bolus 3% hypertonic saline c. NS at 200mL/hr d. 3% hypertonic saline, calculated - CORRECT ANSWER d. 3% hypertonic saline, calculated For the past few months, 29yo Janine has been gaining weight while experiencing amenorrhea and increasingly severe acnes. She has gained more than 20 pounds, and you note that she is carrying her weight around her midline, with bilateral purple-ish striae across both flanks. You suspect CUshing's syndrome. Which of the following findings would not contribute to a diagnosis? a. urine free cortisol=360 ug/day (>50 abnormal) b. glycosuria c. wbc 19 d. after a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol - CORRECT ANSWER d. after a high dose of dexamethasone, there is a 90% reduction in urinary free cortisol In cushing's, pituitary does not respond to dexamethasone. Which of the following is NOT a criteria of metabolic syndrome? a. BP>140/90 b. waist >40 in c. TG>150 d. HDL <40 - CORRECT ANSWER a. BP>140/90 It's 130/85 What are Cushing's labs/symptoms? - CORRECT ANSWER Increased BG, increased Na, decreased K Central obesity, moon face with buffalo hump, purple striae, amenorrhea What are Addison's disease labs/diagnosis/tx? - CORRECT ANSWER Decreased BG, decreased Na, increased K Cosyntropin test, positive if serum cortison <18mcg/dL in the morning Tx: florinef, hydrocortisone, steroid bolus Patient is hypotensive with Addison's disease. What is the treatment? - CORRECT ANSWER IVF (D5NS), dopaine/pressors don't work What is SIADH, lab values, and treatment? - CORRECT ANSWER Inappropriate water retention Hypothermia, hyponatremia, decreased serum Osm, increased urine Osm, urine sodium >20 mEq (kidney's trying to excrete water via salt) Tx: 3% hypertonic saline calculated Urine Na 28, serum Osm 250, urine Osm 115. What is suspected dx? - CORRECT ANSWER SIADH 23 yo female presents with DKA. Abg pH 7.3, glucose 520, BP 90/65, HR 120, and she is confused. Which of the following are not included in the initial management of DKA? a. isotonic fluids b. insulin infusion c. sodium bicarbonate d. supportive care - CORRECT ANSWER c. sodium bicarbonate Only indicated for DKA if pH <7.1 24 yo male presents with DKA. He is now confused and irritable. AbgL 7.29/33/22. Received isotonic fluids x 1 hour, BP 110/70, HR 90. Blood glucose is 550. What is the best IV fluid indicated? - CORRECT ANSWER 1/2 NS because BG>500 HHNK: what fluids should you use? - CORRECT ANSWER NS for massive fluid volume deficit, then 1/2 NS to hydrate the cell, then D51/2NS if on insulin gtt What are Hyperthyroidism labs? - CORRECT ANSWER High T3, high T4, resin uptake TSH >5, low TSH What are Hypothyroidsim labs? - CORRECT ANSWER Low T4, low resin uptake (T3 is not a reliable test), high TSH What are the s/s of thyroid storm/crisis? - CORRECT ANSWER Fever, goiter, tachycardia, low TSH What is the treatment for myxedema coma? - CORRECT ANSWER Loading synthroid followed by maintenance dose Patient with BP 210/110, headache, then BP decreases below 160s, what is 1st treatment? - CORRECT ANSWER Alpha blockers preoperatively, regitine/phentolamine, likely pheochromocytoma What is the first test you run when you see s/s of pheochromocytoma? - CORRECT ANSWER TSH What diagnostic test confirms pheochromocytoma? - CORRECT ANSWER CT DKA fluids? - CORRECT ANSWER IVF first, 1L in first hour, then 500mL/hr, use 1/2 NS if BG>500 What is the Somogyi effect? - CORRECT ANSWER Hypoglycemic at 3am then rebounds to hyperglycemia at 7am 15 year old patient with DMI reports increased BG in AM. The ACNP determines hyperglycemia is d/t dawn phenomenon? What should you do to his tx regimen? - CORRECT ANSWER Increase the insulin dosage at bedtime Your patient has a history of coagulopathy and is about to go to surgery. Which order is appropriate for DVT/bleeding prophylaxis? a. Heparin gtt b. lovenox c. coumadin d. pneumatic stockings - CORRECT ANSWER d. pneumatic stockings Which of the following is least likely to experience a DVT? a. 24yo Female on oral contraceptives b. 74 yo male post hip replacement c. 58 yo male liver patient d. paraplegic - CORRECT ANSWER c. 59 yo male liver patient The nurse calls you to report low BP in a CHF patient on the unit. You have IVF ordered, and the cardiologist has ordered Lasix. a. d/c the lasix b. leave the orders as they are c. call the cardiologist to discuss d. call the ethics committee - CORRECT ANSWER a. d/c the lasix You are assessing heart sounds preoperatively and hear a classic "aortic stenosis" type murmur, as well as a carotid bruit. There are no neurological symptoms. What should you order first? a. carotid US b. consultation to cardiology c. cancellation of surgery until next week d. echocardiogram - CORRECT ANSWER d. echocardiogram Which of the following is contraindicated for a patient receiving a renal angiogram? a. beta blocker b. alpha blocker c. calcium channel blocker d. ace inhibitor - CORRECT ANSWER d. ace inhibitor Your 45 yo male patient has new onset atrial fibrillation, but no other past medical history. What should you prescribe? a. tylenol b. ASA c. coumadin d. plavix - CORRECT ANSWER b. ASA - he is young with no risk factors/history Coumadin would be used in 65y+ or with positive risk factors/history Which is best used to diagnose pulmonary HTN? a. bubble study b. presence of peripheral edema c. cardiac catheterization d. 2D echo - CORRECT ANSWER d. 2D echo used for diagnosis, cardiac cath used for confirmation [Show Less]
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AGPNP PREP Exam 58 Questions with Verified Answers,100% CORRECT
AGPNP PREP Exam 58 Questions with Verified Answers senile lentiginesCORRECT ANSWER Senile Lentigines (liver spots), which are brown macules found on th... [Show More] e backs of the hands, forearms, and face caused by localized mild epidermal hyperplasia in association with increased numbers of melanocytes and increased melanin production. Sebaceous gland hyperplasiaCORRECT ANSWER Sebaceous gland hyperplasia is found especially on the forehead and nose, with a raised area from 1 to 3 mm in size with a central pore. PetechiaeCORRECT ANSWER Petechiae are reddish, purple spots (usually 1-2 mm) of bleeding under the skin that may occur from numerous causes. Senile purpuraCORRECT ANSWER Senile purpura is commonly found, characterized by purple macules (not petechiae) appearing on the backs of the hands or on the forearms that result from blood that has extravasated through capillaries due to a loss of skin elasticity. ChloasmaCORRECT ANSWER Chloasma is hyperpigmentation occurring on the face of a pregnant woman FrailtyCORRECT ANSWER Frailty (also known as failure to thrive) is a common clinical syndrome in older adults. Common findings with the condition of frailty are low grip strength, slowed walking speed, low physical activity, unintentional weight loss, decreased lean body mass (sarcopenia), osteopenia, cognitive impairment, and anemia. Frailty can leave a patient vulnerable to falls, functional decline, disability, disease, and death. Providing a previsit screening tool or questionnaire to allow the older adolescent to identify and write down concerns prior to the start of the visit is a helpful open-ended approach to assist the adult-gerontology primary care nurse practitioner to phrase questions in an appropriate way to promote a sense of partnership that encourages communication.CORRECT ANSWER TRUE Adolescents may be reluctant to talk, and have a clear need for confidentiality.CORRECT ANSWER TRUE Use of a gentle confrontational approach when the adolescent is silent or unable to express specific words about physical changes occurring.CORRECT ANSWER FALSE A healthy adult patient should be able to repeat a series of how many numbers?CORRECT ANSWER When assessing immediate recall or new learning, a healthy adult patient without cognitive decline should be able to repeat a series of 5-8 numbers. The adult-gerontology primary care nurse practitioner selects which assessment tool to evaluate balance and gait problems in older adult patients?CORRECT ANSWER The Tinetti Balance and Gait Evaluation is an activity-based test that asks the patient to perform tasks, such as sitting and rising from a chair, turning, and bending. It requires no more than 15 to 20 minutes to perform. the timed "Up and Go" testCORRECT ANSWER assesses balance and gait speed The Instrumental Activities of Daily Living Scale assesses...CORRECT ANSWER The Instrumental Activities of Daily Living Scale assesses complex tasks such as shopping, laundry, and food preparation. The Index of Independence of Activities of Daily Living determines what?CORRECT ANSWER The Index of Independence of Activities of Daily Living helps identify daily activities with which the patient needs assistance. Katz IndexCORRECT ANSWER helps identify daily activities with which the patient needs assistance The Seven Minute Screen (7MS)CORRECT ANSWER The Seven Minute Screen (7MS) is a quick and common test used to assess temporal orientation, enhanced cued recall, clock drawing, and verbal fluency. The adult-gerontology primary care nurse practitioner is constructing a pedigree chart during a clinical visit. What is the purpose of obtaining a pedigree diagram?CORRECT ANSWER Genetic and familial health problems The following tests can be used to assess cognitive impairment and dementia:CORRECT ANSWER The Folstein Mini-Mental State Examination, the Mini-Cog screen for dementia, the Short Portable Mental Status Questionnaire, the AD8 Dementia Screening Interview, and the Montreal Cognitive Assessment (MoCa). What is a pedigree chart?CORRECT ANSWER A pedigree chart is a diagram of family information using a standardized set of symbols (squares representing males and circles females). A dark symbol is used to indicate someone affected with a genetic condition, and unfilled symbols for those who are unaffected; carriers of a condition are often indicated by a gray symbol. The pedigree chart should have at least three generations noted. The pedigree chart is an important component of a family history and can provide information regarding diseases that are transmitted or occur in family generations. It can be used as a diagnostic tool to help guide decisions about genetic testing for the patient and at-risk family members. In assessing the nutritional status of an older adult patient, the adult-gerontology primary care nurse practitioner identifies the common physiologic change in the gastrointestinal system to beCORRECT ANSWER Decreased hydrochloric acid, which occurs with aging, leads to decreased absorption of iron and vitamin B12. Excessive growth of certain bacteria (bacterial overgrowth syndrome) becomes more common with age and can lead to pain, bloating, and weight loss. Common physiologic changes in the gastrointestinal system of an older adult patient includeCORRECT ANSWER Decreased hydroelectric acid, which occurs with aging, leads to decreased absorption of iron and vitamin B12. Excessive growth of certain bacteria (bacterial overgrowth syndrome) becomes more common with age and can lead to pain, bloating, and weight loss. Bacterial overgrowth may also lead to decreased absorption of certain nutrients, such as vitamin B12, iron, and calcium. The stomach cannot accommodate as much food (because of decreased elasticity). The rate at which the stomach empties food into the small intestine decreases with aging. Fat absorption will decrease Peristalsis decreases clinical findings would indicate a deviation from the normal age-related changes in the neurologic system that may have some diagnostic significance for the older patient?CORRECT ANSWER Decreased ability to maintain balance may indicate a cerebellar complication. The other findings (decreased sense of touch, diminished ankle tendon reflex, and decreased short-term memory are normal age-related changes. myopiaCORRECT ANSWER nearsightedness hyperopiaCORRECT ANSWER farsightedness astigmatismCORRECT ANSWER distorted vision at all distances presbyopiaCORRECT ANSWER farsightedness caused by loss of elasticity of the lens of the eye, occurring typically in middle and old age. constitutional symptoms include:CORRECT ANSWER A constitutional symptom is defined as a symptom that affects the general well-being or general status of a patient. Examples include weight loss, shaking, chills, fever, pain, and vomiting. Constitutional symptoms tend to be nonspecific to a particular disease and because of this, they are not useful in diagnosis of conditions as non-constitutional symptoms. The following screening tools are available for the adult-gerontology primary care nurse practitioner to use to assess for polypharmacy in the older adult patient:CORRECT ANSWER Medication Appropriateness Index (MAI) Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) Beers List Beers' ListCORRECT ANSWER Beers' List of Inappropriate drugs for Older Adults Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP)CORRECT ANSWER to use to assess for polypharmacy in the older adult patient: Medication Appropriateness Index (MAI)CORRECT ANSWER the MAI may serve as a valuable tool for measuring potentially inappropriate prescribing in older adults. A normal physiologic change of the respiratory system that occurs with aging?CORRECT ANSWER Hyperresonance Age-related changes result in an increase in the residual lung volume (RV) and decrease in the forced vital capacityCORRECT ANSWER TRUE When assessing the dehydration status of an older adult, poor skin turgor resulting from aging may be provide unreliable physical assessment evidence because...CORRECT ANSWER changes in skin collagen and loss of skin elasticity with aging, poor skin turgor, which is often used as a sign of dehydration in younger individuals, is unreliable in older adults. Signs of dehydration in the older adult include...CORRECT ANSWER body temperature elevation due to dehydration or the elevation may be a result of an inflammatory or infectious process. Mucous membranes are often not noticeably dry until severe dehydration is present. The tongue may be swollen and furrowed in the older adult who is dehydrated. Common age-related changes in the GI system include...CORRECT ANSWER increased adipose tissue, decreased liver size, reduced motility and peristalsis, decreased acid secretions and motor activity of the stomach, and decreased glomerular filtration rate. The OARS ADL Scale is...CORRECT ANSWER The Older Americans Resources and Services (OARS) Activities of Daily Living (ADL) Scale is the more appropriate screening tool for identifying at-risk populations. What is the Bennet Social Isolation ScaleCORRECT ANSWER is used to evaluate social interactions and resources Mini-Mental State ExaminationCORRECT ANSWER The Mini-Mental State Examination is used to evaluate memory, orientation, and attention. The Norton ScaleCORRECT ANSWER The Norton Scale is used to evaluate pressure ulcer risk. Ineffective water conservation and Decreased thirst drive and the older adultCORRECT ANSWER As an individual ages, dehydration becomes a more prevalent problem because of ineffective water conservation and Decreased thirst drive and the older adult In the older adult population, which group is considered the fastest growing cohort?CORRECT ANSWER 85 years and older As an individual ages, which physiologic change would affect responses to pharmacologic agents?CORRECT ANSWER Medications are often protein bound (not fat bound); albumin decreases with age. A low albumin level decreases the number of protein-binding sites, causing an increase in the amount of free drug in the plasma. Drug overdose may occur in older adult patients. The number one cause of accidental death in patients older than 65 years of age is:CORRECT ANSWER Falls are the major cause of morbidity and mortality in the older adult. A fall is often the precipitating event for a cascade of problems leading to death. Complications from falls include ...CORRECT ANSWER Fractures, pneumonia, pressure ulcers, pain, and immobility. What are the normal physiologic changes in the thyroid gland that occur with aging?CORRECT ANSWER There is usually adequate secretion of TSH and a normal serum concentration of T4. Aging may produce fibrosis and increased nodularity, but overall the thyroid function remains within normal limits. The aging process causes what normal physiologic changes in the heart?CORRECT ANSWER Heart size stays the same, and the valves thicken and become rigid secondary to fibrosis and sclerosis. Pulmonary physiologic changes commonly associated with the aging process include ...CORRECT ANSWER A decrease in the vital capacity, along with a 50% increase in residual volume, occurs during the aging process. Other aging changes include a less effective cough, impaired ciliary action, and weaker respiratory muscles. Increased AP diameter is associated with aging and in chronic obstructive pulmonary disease. PO2 usually decreases, but PCO2 usually remains unchanged or slightly increased. As patients age, it becomes particularly important to encourage an increased intake of:CORRECT ANSWER Decreased hydrochloric acid, which occurs with aging, leads to decreased absorption of iron and vitamin B12 and is related to loss of intrinsic factor. Older adults are considered at risk for vitamin D deficiency, which contributes to osteoporosis. Bone loss that occurs with aging is related to low calcium. True or False: The senile lentigo is a gray-brown, irregular, macular lesion on sun-exposed areas of the face, arms, and hands that are normal skin lesions.CORRECT ANSWER TRUE Common abnormal skin lesions in the older adult includes...CORRECT ANSWER Seborrheic dermatitis Senile keratosis Squamous cell Normal vision changes that occur with aging include...CORRECT ANSWER Increased sensitivity to glare and sunlight, diminished color vision with colors appearing faded, difficulty in focusing on objects close-up, need for more light for reading, and decreased tear production. A sudden decrease or loss of peripheral vision can be indicative of what condition which requires immediate treatment by an ophthalmologist.CORRECT ANSWER a detached retina As an individual ages how is REM sleep affected?CORRECT ANSWER REM sleep decreases What is a general principle regarding drug absorption in the older adult?CORRECT ANSWER With aging, the rate of absorption is slowed due to delayed gastric emptying and reduced splanchnic blood flow. When treating an infection in the older adult, the adult-gerontology primary care nurse practitioner must consider that:CORRECT ANSWER Immune function declines with age. The diminished immunity of the older adult can be attributed to a decline in:CORRECT ANSWER T-cell function The adult-gerontology primary care nurse practitioner understands that as the patient ages changes occur in the cells of the immune system. Which statement reflects these changes?CORRECT ANSWER There is an increased ability to respond to infections with previously produced "remembered" antibodies. [Show Less]
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Acute Care Exam 1: Common Problems in the Older Adult Exam 47 Questions with Verified Answers
Acute Care Exam 1: Common Problems in the Older Adult Exam 47 Questions with Verified Answers What is gerontology? - CORRECT ANSWER Study of all aspec... [Show More] ts of aging and its consequences What is ageism? - CORRECT ANSWER When older adults are stereotyped Dependence Frailty Poor Always lonely Memory loss Cannot drive What is gerontologic nursing? - CORRECT ANSWER Specialized nursing with knowledge of illness and health of the aging Starts at age 65 What is young old? - CORRECT ANSWER 65-74 yo What is middle old? - CORRECT ANSWER 75-84 yo What is old old? - CORRECT ANSWER 85-99 yo→ Growing the fastest What is elite old? - CORRECT ANSWER 100+ yo What are the most common health conditions? - CORRECT ANSWER Diabetes HTN Heart disease Cancer What diseases cause the most mortality? - CORRECT ANSWER Heart disease Cancer Stroke Chronic lower respiratory disorders (COPD) Alzheimer's What can be done to improve cognition and QOL? - CORRECT ANSWER Socializing Maintain and manage chronic conditions Maintain healthy weight (eliminate salt and fat) Engage in physical activity What occurs to the body as it ages? - CORRECT ANSWER Decreased adaptability Many physiologic changes (body systems impacted) Impaired stress response (can worsen at hospitals) Greater risk for functional decline (ADLs) Critical care nurses must consider all physiologic and psychologic factors to provide the best care What is involved in adjusting to changes of aging? - CORRECT ANSWER Ageism Transitions Rest more Curtail driving Cane/walker for mobility Diet/nutritional changes→ More fiber, dentition, finances What are health promoting behaviors? - CORRECT ANSWER Vaccinations Influenza Pneumococcal Tetanus (booster every 10 yr) Shingles shot Seat belts Moderate alcohol or not at all No smoking (no smoking in bed) Smoke detectors/sprinklers in home Sun exposure for 10-15 mins 2-3x/week or vitamin supplement Herbs, supplements (as prescribed) Herb and drug effects Vitamin D and calcium Hazard-free environment→ No scatter rugs, waxed floors Stress management What is malnutrition? - CORRECT ANSWER Diminished sense of taste, smell (may be adding a lot of salt and sugar→ educate) Inappropriate/unbalanced foods → educate Ex: Lots of desserts/sweets → tooth decay, obesity Tooth decay, tooth loss, poorly fitting dentures Reduced income Chronic disease, fatigue Decreased ability to perform ADLs "Fast food" consumption that leads to obesity (convenient, no prep, cheaper) Trouble carrying heavy groceries Food banks Food stamps Loneliness Decreased hydration (vomiting, diarrhea, dry mucous membranes, dark urine) What is Geriatric Failure to Thrive (GFTT)? - CORRECT ANSWER Undernutrition Impaired physical functioning Depression Cognitive impairment What are benefits to regular exercise? - CORRECT ANSWER Prevents cardiac disease and DM Improves sleep Maintenance of weight Fewer depression symptoms Improved longevity What is the goal for homebound pt who has decreased mobility? - CORRECT ANSWER Goal is to do ADLs What is the goal for non-homebound pt who has decreased mobility? - CORRECT ANSWER Encourage activity (walking) What can cause stress and loss? - CORRECT ANSWER Rapid environmental changes Changes in lifestyle Acute or chronic illness Loss of significant other Financial hardship (cannot pay for groceries, health maintenance) Relocation What can cause accidents? - CORRECT ANSWER Common in older adults Falls most common Motor vehicle crashes increase with aging, chronic disease (Alzheimer's or arthritis) What is the assessment for fall risk? - CORRECT ANSWER Observation (gait, footwear, assistive devices) PMHx (fall hx, neuropathy) Fall Risk Get Up and Go Test What can cause a pt to become a fall risk? - CORRECT ANSWER Generalized weakness Drug assessment (pain meds, diuretics) Urinary incontinence Communication/visual impairment (are they using assistive devices? are they updating them as needed?) Alcohol/substance abuse Hazard free environment How do you improve driving safety? - CORRECT ANSWER Assess any physical/mental deficits Consult with provider to treat health problems Wear glasses/hearing aids Encourage driving refresher classes Avoid high-risk locations and conditions What cause drug use/misuse? - CORRECT ANSWER Polymedicine or polypharmacy (use of multiple drugs) Intolerance to standard drug dosages Drugs prescribed for too long period of time Physiologic changes affect absorption, distribution, metabolism, excretion "Start low and go slow" policy Drug-drug, drug-food interactions What are the effects of drugs? - CORRECT ANSWER Often intolerant of standard doses Age-related changes: Affect absorption (decreased GI motility) Affect distribution (decreased body water) Affect metabolism→ Reduce liver blood flow and serum enzyme activity Affect excretion (decreased GFR, kidney function) Changes in kidneys result in high plasma drug concentrations→ Creatinine Clearance Test What can cause issues with self-administration of drugs? - CORRECT ANSWER Poor communication with physician Take OTC drugs that interact with prescribed drugs Make errors→ Forget to take (use pill box, alarm) Discontinue drug therapy Fear of dependency/cost Side effects Use leftover drugs from previous illness Borrow from others What drugs are included in Beers criteria? - CORRECT ANSWER Meperidine (Demerol) Cyclobenzaprine (Flexeril) Digoxin (Lanoxin) (Should not exceed 0.125 mg daily except for atrial fibrillation) Ticlopidine (Ticlid) Fluoxetine (Prozac) Amitriptyline (Elavil) Diazepam (Valium) Promethazine (Phenergan) Ketorolac (Toradol) Short-acting nifedipine (e.g., Procardia) Ferrous sulfate (Iron) (Should not exceed 325 mg daily) Chlorpropamide (Diabinese) Diphenhydramine (Benadryl) What can cause safe use of meds? - CORRECT ANSWER Know the name, amount, type, frequency, purpose, and side effects of prescription/non-prescription meds Bring all meds to every MD visit Use a single pharmacy Assess client's ability to self-administer (vision, judgment, memory etc.) Simplify regimen as much as possible What is legal competence? - CORRECT ANSWER 18 yr or older Pregnant or married minor Legally emancipated Not declared incompetent by a court of law What is clinical competence? - CORRECT ANSWER Person is legally competent; can make clinical decisions What is depression? - CORRECT ANSWER Mood disorder having cognitive, affective, physical manifestations Primary: Lack of neurotransmitters Secondary or situational: Illness or loss Depression, delirium, dementia Increased risk of suicide May lead to alcohol and drug abuse Risk for physical illness Sleeping more, not eating Geriatric Depression Scale used for assessment (GDS-SF) Primary treatment includes drug therapy (SSRIs are drug of choice→ 2-3 weeks before they work), psychotherapy What is alcohol use/abuse? - CORRECT ANSWER Increase risk for falls, other accidents Affects mood, cognitive ability→ Isolation, depression, delirium can result Lead to complications of chronic diseases→ DM, HTN, GERD Recommend no more than 1 drink/day for people over 65 What is the CAGE test for alcohol abuse? - CORRECT ANSWER Cut down--Have you ever tried to cut down on drinking? Annoying--Have people annoyed you about stopping drinking? Guilt--Have you ever felt guilty about drinking? Eye opener--Have you had a drink this morning? What is neglect? - CORRECT ANSWER Failure to provide basic needs Pressure ulcers Contractures Dehydration Malnutrition Urine burns Excessive body odor What is emotional abuse? - CORRECT ANSWER Intimidation, humiliation What is financial abuse? - CORRECT ANSWER Unauthorized use of pts money whether for profit or gain What is physical/sexual abuse? - CORRECT ANSWER Hitting, biting, burns, restraining, molesting, unusual hair loss, sedating What is SPICES? - CORRECT ANSWER Focus on the special health care issues seen in the older population Six conditions that lead to: Longer hospital stays Higher medical cost Death Sleep disorders Problems with eating/feeding Incontinence Confusion and falls Skin breakdown What are the causes sleep disorders? - CORRECT ANSWER Common in older hospitalized adults Adequate rest is important for healing Attempt to keep patients awake during the day to prevent insomnia Identify contributing factors to insomnia (medication, caffeine) Postpone tx if possible to waking hours Environmental factors Manage the patient's pain by giving pain medication before bedtime What are problems with eating/feeding? - CORRECT ANSWER Perform nutritional screenings on the 1st day of pt admission (baseline) Nutritional hx, wt, ht, and BMI, albumin, prealbumin Collaborate with the RD about the patient's nutritional status Consider cultural preferences and determine what foods the patient likes Manage symptoms→ Pain and N/V What causes incontinence? - CORRECT ANSWER Caused by many factors→ Acute or chronic disease, ADL ability, and available staff Assess the pt to identify causes Place the pt on a toileting schedule or a bowel or bladder training program What can prevent confusion and falls? - CORRECT ANSWER Avoiding multiple drugs and promoting adequate sleep can help prevent acute confusion Reorient pt to reality as much as needed Most common accident among older patients in a hospital or NH setting is falling Nocturia: Pts forget to ask for assistance and subsequently fall as a result of disorientation in the darkness in an unfamiliar environment What are risk factors for falls? - CORRECT ANSWER History of falls Advanced age (>80 years) Multiple illnesses Generalized weakness or decreased mobility Gait and postural instability Disorientation or confusion Use of drugs that can cause increased confusion, mobility limitations, or orthostatic hypotension Urinary incontinence Communication impairments Major visual impairment or visual impairment without correction Alcohol or other substance abuse Location of patient's room away from the nurses' station (in the hospital or nursing home) Change of shift or mealtime (in the hospital or nursing home) What causes skin breakdown? - CORRECT ANSWER Skin breakdown (esp. pressure ulcers) is a major problem among older adults in hospitals and nursing homes Prevent agency-associated pressure ulcers by using evidence-based interventions Turning, gentle touch Skin tears are also common (especially the old-old group and those who are on chronic steroid therapy) Use a gentle touch Report any open areas Use the Braden scale Report and document Nutrition support (albumin, prealbumin) Skin protective creams What are chemical restraints? - CORRECT ANSWER Antipsychotics Antianxiety drugs Antidepressants Sedative-hypnotics What is important to know for physical restraints? - CORRECT ANSWER Used when chemical restraints and restraint alternatives fail Check pt q30-60mins Release restraints q2hr for turning, toileting and repositioning What are restraint alternatives? - CORRECT ANSWER If the patient is acutely confused, reorient him or her to reality as often as possible. If the patient has dementia, use validation to reaffirm his or her feelings and concerns. Check the patient often, at least every hour. If the patient pulls tubes and lines, cover them with roller gauze or another protective device; be sure that IV insertion sites are visible for assessment. Keep the patient busy, with an activity, pillow or apron, puzzle, or art project. Provide soft, calming music. Place the patient in an area where he or she can be supervised. (If the patient is agitated, do not place him or her in a noisy area.) Turn off the television if the patient is agitated. Ask a family member or friend to stay with the patient at night. Help the patient to toilet every 2 to 3 hours, including during the night. Be sure that the patient's needs for food, fluids, and comfort are met. If agency policy allows, provide the patient with a pet visit. Provide familiar objects or cherished items that the patient can touch. Document the use of all alternative interventions. If a restraint is applied, use the least restrictive device (e.g., mitts rather than wrist restraints, a roller belt rather than a vest). [Show Less]
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Rosh Inclusive Language Assessments 30 Questions with Verified Answers,100% CORRECT
Rosh Inclusive Language Assessments 30 Questions with Verified Answers Consider this patient summary: A 37-year-old G3P2002 woman with a history of... [Show More] substance use disorder, active HIV, hepatitis C, and previously treated tuberculosis delivered a viable male infant at 39 weeks 6 days in Detroit, Michigan. What piece of information given in this patient summary does not align with inclusive, bias-free language and should be omitted? - CORRECT ANSWER In Detroit, MI A woman presents to clinic, reporting she has lost her home. What is the best way to describe her housing situation? - CORRECT ANSWER Woman without housing Consider this initial sentence of the patient summary: A 22-year-old African American presents to the ED after his partner found him during an unsuccessful suicide. Which of the following word choices for the underlined terms uses the most inclusive language? - CORRECT ANSWER Man, Partner, during a suicide attempt A 28-year-old man with dark skin presents to the office to establish care. The physician wants to be sensitive to and inquire about the stressors the patient experiences because of his ethnicity. What is the best way to determine whether to use African American, Black, man of color, or another term to address his ethnic background? - CORRECT ANSWER the whole premise above is insensitive Consider this patient summary: A 19-year-old woman presents for an annual exam. She denies any current symptoms or complaints. She admits to being an intravenous drug abuser and being sexually active with multiple partners. Which of the following lists all the terms in the patient summary that should be replaced with more inclusive, bias-free wording? - CORRECT ANSWER Denies, complaints, admits, intravenous drug abuser Rates of tuberculosis are highest in undeveloped countries. How can the statement above be rephrased to apply the principles of inclusive language? - CORRECT ANSWER Rates of TB are highest in India, Indonesia, and China A 30-year-old asthmatic presents to the clinic complaining of disrupted sleep due to asthma symptoms almost every night. She admits to using an albuterol inhaler a few times a day with good relief. What is the most appropriate management of this patient? How can the underlined words in the above vignette be better stated? - CORRECT ANSWER Woman with asthma, reporting, uses, management of this patient's asthma A woman returns for a postpartum follow-up visit with the obstetrician and starts to cry, saying she cannot sleep and feels sad all the time. What is the best way to describe a potential diagnosis of depression? - CORRECT ANSWER she is a woman who may be experiencing depression What is the best way to determine a patient's gender? - CORRECT ANSWER let the patient report their gender A patient presents to the emergency department with a fatal self-inflicted gunshot wound. The patient's family is waiting for an update. Which of the following is the best language for the clinician to use when talking to the family? - CORRECT ANSWER died by suicide A 34-year-old patient tells the clinician they are a Jehovah's Witness while discussing an elective surgery. Which of the following can be assumed? - CORRECT ANSWER more details are needed to know how to proceed A resident is presenting the case of an 84-year-old woman with diabetes during morning rounds and refers to her as elderly. Which of the following is the preferential term when referring to a person in this age group? - CORRECT ANSWER older individual Which of the following is an important element to obtain when taking a family history on a patient with thalassemia? - CORRECT ANSWER ancestry Which of the following statements exemplifies the use of inclusive person-first language when relating information about a patient presenting to the clinic? - CORRECT ANSWER She is an 18 year old with a disability who will need accommodations in the dorm when she starts college later this year. Consider this statement from a patient's social history: The patient is an Asian man. How could this patient best be described using inclusive language? - CORRECT ANSWER The patient is a man who moved from Vietnam 3 years ago. When is it most appropriate to inquire about a patient's sexual orientation? - CORRECT ANSWER during primary care visit A patient who uses a wheelchair presents for a new patient appointment. What is the best way to document this patient's physical ability? - CORRECT ANSWER physically disabled Which of the following terms is frequently used to refer to people who have a light skin color and traditionally European origins, but the term is outdated, has a problematic history, and should not be used? - CORRECT ANSWER Caucasian You are the AG-ACNP caring for a critically ill patient in the intensive care unit who sustained a cardiac arrest. After administering CPR for 40 minutes without return of spontaneous circulation, the resuscitation was ended and the patient was declared dead. When informing the family, which of the following statements is the most appropriate example of therapeutic communication? - CORRECT ANSWER After providing CPR we were unable to resuscitate him and he has died. I am very sorry for your loss. A patient is referred by her primary care provider to an outpatient pulmonology clinic for recent shortness of breath and unintentional weight loss. CT of chest shows multiple 10 mm or larger ground-glass nodules in bilateral lungs, and a biopsy confirms malignancy. Follow-up positron emission tomography (PET) shows metastasis to brain, and the patient is diagnosed with terminal cancer. Which of the following is important to assess with the patient in order to help make appropriate decisions about the future plan of care? - CORRECT ANSWER spiritual or ethnic group values The adult-gerontology acute care nurse practitioner is evaluating a 65-year-old man with acute onset of substernal chest pain that radiates down his left arm. He endorses jaw pain, is diaphoretic, and has a new left bundle branch block on ECG. Choosing to discharge the patient with outpatient cardiology follow-up is an example of which of the following? - CORRECT ANSWER negligence The adult-gerontology acute care nurse practitioner is caring for a patient that presented for an elective procedure. During the procedure, a medication error occurred, and the patient suffered an iatrogenic cardiac arrest. Which of the following resources would be the most appropriate to contact for additional guidance? - CORRECT ANSWER risk management The adult-gerontology acute care nurse practitioner is trying to communicate the HIV status of a patient to the infectious disease physician. Which of the following methods is a violation of the Health Insurance Portability and Accountability Act (HIPAA)? - CORRECT ANSWER texting The adult-gerontology acute care nurse practitioner is evaluating a patient at a follow-up visit. The patient states they incorrectly reported a history of coronary artery disease and would like to have that diagnosis removed from their medical record. Which of the following is the appropriate action? - CORRECT ANSWER inform patient he has the right to make corrections to his medical record At what level is practice authority granted? - CORRECT ANSWER state When setting goals for a quality improvement project, the Institute for Healthcare Improvement (IHI) identifies the first priority should be focused on ensuring which of the following elements? - CORRECT ANSWER safety Which of the following best describes the medical-legal responsibility to act within the standards of care for a provider's health care specialty? - CORRECT ANSWER liability Which of the following best describes the unlawful touching of a patient by a provider without the patient's consent? - CORRECT ANSWER Battery A primary care provider is informed a patient has posted defamatory remarks on the Internet regarding the physician and his practice. The statements state the physician has been indicted for fraud and has lost his medical license, both of which are false. Which of the following is the most appropriate legal term for this form of defamation? - CORRECT ANSWER Libel A 64-year-old man is admitted to the cardiology service for acute on chronic congestive heart failure and is determined to be in New York Heart Association class 3. The patient states, "I have been so tired lately and unable to go golfing." Which of the following is an appropriate intervention? - CORRECT ANSWER refer palliative care [Show Less]
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AANP Adult gerontology primary care nurse practitioner study guide 76 Question with Verified Answer
AANP Adult gerontology primary care nurse practitioner study guide 76 Questions with Verified Answers Pheochromocytoma - CORRECT ANSWER small vascular... [Show More] tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache. Tx with Alpha blockers Rovsing's Sign - CORRECT ANSWER Palpation in LLQ ilicits pain in RLQ indicates appendicitis NYHA classes of Heart Failure - CORRECT ANSWER I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. Step-wise Approach to Asthma Diagnosis & Treatment - CORRECT ANSWER Step 1- Mild Intermitten FEV1/PEF > 80% predicted. Symptoms <2 days/week. Albuterol as needed. Step 2- Mild presistent Asthma (FEV1/PEF > 80% predicted. Symptoms > 2 days/week. Albuterol as needed. Low dose ICS ex Flovent. Alt cromolyn, montelukast, nedocromil, theophylline. Step 3- Mod presistent (FEV1 or PEF 60-80% predicted. Daily Symptoms. SABA plus low dose ICS or med dose ICS or low dose with leukotriene inhibitor (singulair, theophylline, zileuton). Step 4- Severe presistent asthma (FEV1/PEF <60% predicted. Symptoms most of day. High dose ICS plus long acting B2 agonist plus oral steroid daily (prednisone). Peak Expiratory Flow Rate (HAG): Green Yellow Red Zone: - CORRECT ANSWER PEF based on Height Age Gender. Blow hard using spirometer highest value recorded. 80-100% expected volume Green Zone maintain or reduce meds 50-80% expected volume Yellow Zone increase maintenance therapy. Or Having exacerbation. Below 50% expected volume Red Zone call 911 give epinephrine inj. PPD - CORRECT ANSWER Neg- No firm bump forms at the test site, or a bump forms that is smaller than 5 mm (0.2 in.). A firm bump that is 5 mm (0.2 in.) in size suggests a TB infection in people who are in a high-risk group. HIV, immunocompromise, exposed. A firm bump that is 10 mm (0.4 in.) in size suggests a TB infection in people who are in a moderate-risk group. healthcare workers, immigrants, homeless. A firm bump that is 15 mm (0.6 in.) in size suggests a TB infection in people who are in a low-risk group no risk for tb. Digoxin (Cardiac Glycosides) - CORRECT ANSWER Therapuetic 0.5-2.0 Overdose toxcitity GI upset, arrhythmias, confusion visual changes (yellow/green tinge vision- scotomas). Tx with digibind. order dig level, electrolytes, creatinine ekg. Thiazide Diuretics - CORRECT ANSWER Pt with both htn and osteoporosis have an extra benefit from thiazides. thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoclasts formation. Patients with serious sulfa allergies should avoid thiazide diuretics. Potassium sparing diuretics can be used as alternative. Chlorthalidone (hygroton), hydrochlororthiazide (esidrix, microzide), indapamide (lozol), metolazone (zaroxolyn); indicated for decreased fluid volume, inexpensive, effective, useful in severe hypertension, effective orally, enhances other antihypertensives; adverse reactions: hypokalemia symptoms, hyperuricemia, glucose tolerance, hypercholesterolemia, sexual dysfunction; observe for postural hypotension, caution with renal failure gout and client taking lithium; hypokalemia increases risk for digitalis toxicity, administer postassium supplements. Avoid with Gout, Best fist line for elderly w/ systolic htn. Coumadin (Warfarin) - CORRECT ANSWER an anticoagulant administered to prevent blood clots from forming or growing larger Prophylaxis and/or treatment of venous thrombosis, pulmonary embolus, a fib, valve replacement, recurrent MI, stroke; also immobile pt Afiib target INR 2-3 If INR 5-9 w/o bleeding hold 2-3 days low dose vit k avoid leafy veg, broccoli, brussels, canola oil, mayo. Aldosterone Antagonist - CORRECT ANSWER causes a decrease in potassium excretion (spares K) and decreases Na reabsorption. (spironolactone) Hirsuitism, htn, sever heart failure. exp spironolactone. Adverse effects are galactorrhea and hyperkalemia. Spironolactone is rarely used to treat htn in primary care due to adverse effects and higher risk of certain cancer. Postassium Sparing Diuretics - CORRECT ANSWER compete w/ aldosterone at receptor sites causing increase na and water excretion while conserving k and h ions Alt for Sulfa Allergy Pts to tx HTN. Triameterene (Dyrenium), Amiloride (Midamor). Combo HCTZ. Severe Hyperkalemia, Avoid renal pts, ace or arbs, do not give potassium supplement or salt subst. Monitor serum K+ 3.5-5. high risk elder, severe ill, dm. Ace Inhibitors, ACEI/ARBS - CORRECT ANSWER ACTION: prevent the conversion of angiotensin I to angiotensin II in the lungs USES: CHF, HTN , usually end in PRIL Indicated for DM, HTN, CKD pts w/ HTN. Cat C & D. dont give in preg. excereted in breast milk. Dry Cough, angioedema, hyperkalemia. Captopril causes agrunolocytosis monitor cbc. switch from ace to arb if cough persist. Beta Blockers - CORRECT ANSWER **** DO NOT give with ASTHMA, BRONCHIAL CONSTRICTIVE DISEASE!!!**** HTN, post myocardial infarction(first line), angina, arrhythmias, migraine prophylaxis. Adjunct tretment-hyperthyroidism/thyrotoxicosis (decrease HR, anxiety). Migrain prophylaxis-non-cardioselective(blocks beta 1 and beta 2) propanolo, timolol. Cardio Selective blocks beta-1 only atenolol, metoprolol. Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF; signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety) Adveser effects, ED, Depression, fatigue, bradycardia. Loop Diuretics - CORRECT ANSWER Examples a. Furosemide (Lasix) b. Bumetanide (Bumex) 2. Loop diuretics inhibit reabsorption of sodium and chloride at the proximal portion of the ascending loop of Henle, increasing water excretion. 3. Side effects / nursing care a. Hypokalemia, hypochloremic alkalosis, hyperuricemia (gout), hyperglycemia b. Teach high potassium foods to include in diet. c. Sulfonamide sensitive patients may have allergic reaction to furosemide. Ototoxicity, nephrotoxic. Hypovolemia, hypotension, pancreatitis, jaundice rash. Alpha Blockers - CORRECT ANSWER Hypertension with coexisting BPH- Hytrin- Terazosin. -blockage of alpha 1 receptor leads to vasodilation, decrease peripheral resistance and venous return. Potent Vasodialator- causes diziness and hypotension. give at beditime low dose titrate up. Careful with frail elderly risk of syncope/falls. Calcium Channel Blockers - CORRECT ANSWER Diltiazem (cardizem), nifedipine (procardia, adalat), verapamil HCL (calan, isoptin), nisoldipine (sular); inhibits calcium ion influx during cardiac depolarization; decreased SA/AV node conduction; adverse reactions: headache, hypotension, dizziness, edema, nausea, constipation, tachycardia, HF, dry cough; avoid grapefruit juice. HTN, Raynauds phenomenon(first line) Tetracylines - CORRECT ANSWER Suppress bacterial growth by inhibiting protein synthesis. Cat D, don't use < 8yrs. Skeletal defects. Causes yellow theeth discoloration. Doxycyline for chlamydia STDs, atypical pna, UTI, otitis media, PCP in AIDS, Lyme. Tetra for acne tx 13/14 y.o. S/E Photosensativity use sun block. Esophageal ulceration whole tablet drink with 8oz glass of water. Take empty stomach 1hr before or 2hrs after meal. Decrease effectiveness of oral contraceptives. Macrolides - CORRECT ANSWER Clarithromycyn (Biaxin),Erythromycin; CYP 34A inhibitors. Azithromycin (Zithromax), Indications: Biaxin (PO): URI, including strep, as adjunt treatment for H. pylori Zithromax (IV): gram-negative and gram-positive organisms; Adverse reactions: pseudo-membrane colitis, phlebitis, superinfection, dizziness, dyspnea; give biaxin XL with food, space MAO inhibitors 14 days before start and after end of Biaxin; report diarrhea, abdominal cramping; monitor liver/renal labs; PO Zithromax give on empty stomach. QT prolong, ototoxicity, choletstatic jaundice, gi distress. Ketex (Telithromycin)- tx mild-mod CAP Adults. narrow indication. C/I myestenia gravis pts. heptatis or jaundice pts. Interact with anitcoags, dig, theophylline, astimizole, carbamazepine, cisapride, triazolam, terfenade. Cephalosporins - CORRECT ANSWER Betalactam family of ABX. Interfere cell wall synthesis of bacteria. 1st gen- active gram + bacteria Keflex tx cellulitis uti in preg. 2nd gen- broad spectrum tx gram + & - bacterial infections. Cefuroxime (ceftin), Cefprozil (cefzil), Cefaclor (ceclor). Sinusitis, AOM, CAP, chronic bronchitis, skin infections. 3rd gen- treats gram - less potent towards gram +. Ceftriaxone (Rocephin) STDs gonnorrhea, PID, urethritis. Cefixime (suprax) ENT OAM in children, acute sinusitis. Cefdinir (Omnicef) pyelonephritis, CAP. Penicillins - CORRECT ANSWER beta lactams that inhibit bacterial ell wall synthesis by binding to one or more penicillin binding proteins, which in turn prevents the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls. Amoxicillin & Ampicillin extended spectrum effective against gram + and some gram - bacteria. Tx otitis media, sinusitus. Penicillin V tx strep. Benzathine Penicillin G IM for syphillis. Dicloaxacillin for cellulitis,ersipelas. Adverse effects: Diarrhea, Cdiff, Vaginitis candida. Do not treat mono with amox tx with penicillin vk causes rash. Fluoroquinolones - CORRECT ANSWER Gram - & Atypical bacteria. Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin causes tendonitis, tendon rupture, tooth damage Tx Chlamydia, Mycoplasma, Legionella, utis, pylenephritis, pna, sinusitus. High risk achilles tendon rupture. Avoid use with QT prolong drugs (amiodorone, macrolides, TCA, Antiphsycotics). Risk sudden death from arrythmia (torsa de pointes). Coadministration with antacids decreases effectiveness of drug. monitor INR on coumadin. C/I children less 18 yrs, preg, breast feeding, myasthenia gravis. Sulfonamides - CORRECT ANSWER Trimethoprim-sulfamethoxazole (TMP-SMX) Bactrim DS BID- prophylaxis treatment of PCP, MRSA cellulitis, UTIs, pyelonephritis Uses 1. Urinary tract infections. 2. Ulcerative colitis and Crohn's disease. 3. Bowel prep before colon surgery to kill intestinal bacteria. B. Examples of Drugs (Note the Sulfa and Gant) 1. Sulfisoxazole (Gantrisin) 2. Sulfasalazine (Azulfidine) a. Sulfasalazine (Azulfidine)(contains salicylate) 3. Sulfamethoxazole (Gantanol) is given primarily in combination with Trimethoprim (Proloprim) as Septra or Bactrim. C. Side effects / nursing care 1. Photosensitivity- rash 2. Nausea and vomiting 3. Kidney stones- push fluids 4. Tell patients to avoid direct sunlight while taking sulfonamides. 5. Encourage fluids to avoid crystal formation and renal dysfunction. C/I G6PD anemia causes hemolysis, newborns <2 months, preg 3rd tri causes hyperbilirubenemia/ kernicterus. hypersen to sulfa drugs. skin rash steven jhonson syndrome, interacts with warfarin increases INR. NSAIDS - CORRECT ANSWER Inhibit prostaglandin and other chemical mediator syntheses and other chemical mediator synthesis involved in pain; antipyretic activity through action on the hypothalamic heat-regulating center to reduce fever Mild/moderate pain, fever, arthritis, and blood thinner. Take with food will cause GI ulcers, Do not give this and aspirin together, stop taking 1 week before surgery. Topical Nasal Decongestants - CORRECT ANSWER Oxymetazoline Nasal Spray(Afrin), Phenylephrine(Neo-Synephrine Relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis, and allergic rhinitis Can cause rebound congestion if used longer than 3 to 4 days. Antihistamines - CORRECT ANSWER Called histamine antagonists or H1 blockers; they compete for receptor sites, thus preventing a histamine response. Benadryl avoid with elderly use claritin instead. Zyrtec more potent and long acting. Decongestants - CORRECT ANSWER pseudoephedrine and pheylephrin robitussin, sudafed, allegra, afrin, nasonex constrict blood vessels of nasal passages and limit blood flow, which causes swollen tissues to shrink so that air can pass more freely through the passageways CI with HTN, CAD (angina MI). Avoid mixing with stimulants caffeine causes elevated bp palpitations, anxiety, arrythymias. dont give within 14 days of MAOI and seligine (eldepryl). Aspirin - CORRECT ANSWER Irrevesiable supresses platelet function for 7 days. discontinue if c/o tinnitus (toxicity). 81/day for chronic use. Give post MI/Stroke considered tertiary prevention. Avoid in children with viral infections less than 16 years causes Reye's syndrome. Steroids Glucocorticoids - CORRECT ANSWER Hydrocortisone, prednisone, dexmethasone; indicated for hormone replacement, severe rheumatoid arthritis, and autoimmune disorders; , temporal arteritis uveitis. asthma exacerbation 40-60 mg/day 3-4 days. Medrol dose pack x 7 days. adverse reactions: emotional liability, impaired wound healing, skin fragility, abnormal fat disposition, hyperglycemia, hirsutism, moon face, osteoporosis; wean slowly; monitor serum potassium, glucose and sodium; weigh daily and report >5lb/week; administer with antiulcer drugs; prevent injurys; monitor BP and HR. HPA supression, cushings disease, Topical Steroids Potency - CORRECT ANSWER Class 1-7 Superpotent Class 1- Clobetasol (temovate) Potent- Halocinonide (Halog) Moderate- Triamcinolone (kenalog) Least Potent- hydrocortisone class 7. Biguanindes - CORRECT ANSWER Metformin (Glucophage) decreases gluconeogenesis, increases glycolysis and peripheral glucose uptake (increases insulin sensitivity Sulfonylureas - CORRECT ANSWER First generation: Tolbutamide (oranase), chlorpropamide (diabinase), second generation: Glyburide (micronase, diabeta), glipizide (glucotrol), glimeprode (amaryl); lowers blood sugar by stimulating the release of insulin by the beta cells of the pancreas + causes tissues to take up and store glucose more easily; first generation are low potency and short acting; second generation are high potency and longer acting; adverse reactions: first generations: hypoglycemia, nausea, heartburn, constipation, anorexia, agranulocytosis, allergic skin reactions; second generation reactions: weight gain, hypoglycemia; first generation: responsiveness may decrease over time; once daily with first meal; monitor blood sugar; hard to detect hypoglycemia; second generation: less likely to interact with other medications Thiazolidinediones - CORRECT ANSWER Rosiglitazone (avandia), pioglitazone (actos); lowers BS by decreasing insulin resistance of the tissues; adverse reactions: hypoglycemia, increased total cholesterol, weight gain, edema, anemia; skip dose if meal skipped; no known drug interactions; monitor liver function; caution with use in CAD; may precipitate HF Bile Acid Sequestrant - CORRECT ANSWER Colesevelam (Welchol) reduces hepatic glucose production and may reduce intestinal absorption of glucose. Meglintinide - CORRECT ANSWER Repaglinide (prandin) Nateglinide (starlix). Stimulates release of insulin in response to glucose load (meal) which lowers blood sugar, can cause hypoglycemia. Indicated for DM2 with posparandial hyperglycemia. Incretin Mimetic - CORRECT ANSWER Byetta Liraglutide (Victoza®) stimulate insulin secretion;also inhibits glucagon secretion & delays stomach emptying Mitral Area - CORRECT ANSWER (apex of heart)- located in the fifth left intercostal space, medial to the midclavicular line. Aortic Area - CORRECT ANSWER second ICS to the right side of the upper border of the sternum. MR ASH - CORRECT ANSWER Systolic Murmurs MITRAL REGURGITATION- radiates to axilla loud blowing high pitched. AORTIC STENOSIS- midsystolic ejection radiates to neck. harsh noisy. avoid physical exersion sudden death. serial cardiac sonogram, doppler surgical replacement. MS ART - CORRECT ANSWER Diastolic Murmurs MITRAL STENOSIS- low pitched rumbuling opening snap use bell steth. AORTIC REGURGITATION- high pitched blowing murmur. psoas/ illiopsoas - CORRECT ANSWER flex hip 90* ask pt to push agaist resistant to straighten leg pain acute appendicitis ectopic preg obturator sign - CORRECT ANSWER used for acute appendicitis or any suspected retroperitoneal area acute process. rotate right hip through full range of motion. Positive sign if pain with the movement or flexion of the hip Mcburney's point - CORRECT ANSWER 1/3 away from the iliac crest to the umbilicus and 2/3 from the umbillicus to the iliac crest, rebound pain, pressing in can releive pain,jump up worsens pain-appendix Markel Test - CORRECT ANSWER heel jar, detects appendicitis and peritonitis. stand on toes, quickly stomp on heel, it should reproduce the pain. + Murphy's Maneuver - CORRECT ANSWER Press deeply on the right uooer quadrant under the costal border during inspiration mid inspiratory arrest is positive finding : shows acute cholecystitis Cranial Nerves On Old Olympus Towering Tops A Finn And German Viewed Some Hops - CORRECT ANSWER CN 1: Olfactory: Smell CN2: Optic (vision) CN3: Oculomotor (eye movement) CN4: Trochlear (eye movement superio oblique muscle of eye) CN5: Trigeminal (Facial Sensation) opthalimic, maxillary and mandibular branches. CN6: Abducense ( lateral muscle of eye movement) CN7: Facial (expressions of face) CN8: Acoustic (hearing) CN9: Glossopharyngeal ( swallowing speech worsk with vagus) CN10: Vagus (speech, heart rate) CN 11: Spinal Accessory (shoulders shrugging together) CN12: Hypoglossal (tongue movements, speech swallowing). kernig's sign - CORRECT ANSWER This is a positive sign of meningitis that is when there is pain in the lower back or posterior(Back of) thigh that occurs when knee is extended while pt is lying in supine position and the hip is flexed at a right angle (pt can not straighten leg out if bent at knee when raised) Brudzinski's sign - CORRECT ANSWER meningeal sign- neck stiffness causes a patients hips and knees to flex when the neck is flexed Turner's Sign - CORRECT ANSWER Bruising on either flank that may indicate retroperineal bleeding into the abdominal wall Cullen's Sign - CORRECT ANSWER Ecchymosis (edema and bruising) around the umbilicus (may indicate internal bleeding or major organ injury) Tinel's Sign - CORRECT ANSWER This test is done in carpel tunnels syndrom. Tap over the median nerve and it is positive if tingling occurs Phalen's sign - CORRECT ANSWER test for carpal tunnel syndrome: flex wrists by putting hands back to back Navicular Fracture - CORRECT ANSWER fracture of navicular/scaphoid bone of the wrist. has lim blood supply so poor healing. if not diagnosed quick, arthritic changes can occur. pain over snuffbox, fell forward. original x-ray wil be wnl- do a repeat in 2 weeks to show scaphoid fracture due to callous bone formation. Splint wrist- thumb spica cast Colles fracture - CORRECT ANSWER the break of the distal end of the radius at the epiphysis often occurs when the pt has attempted to break his/her fall. fractured distal radius with dinner fork appearance. Lachman's Sign - CORRECT ANSWER knee joint laxity is positive. suggest ACL damage of the knee. More sensitive than the anterioir drawer test for ACL damage. McMurray's Test - CORRECT ANSWER knee pain and a "click" sound upon manipulation of the kneee is positive. Suggests injury to the medial meniscus. gold standard test for joint damage is the MRI Drawer Sign - CORRECT ANSWER a test for knee instability. A diagnostic sign of a torn or ruptured ligament. The positive anterior drawer sign is the test for the anterior cruciate ligament (ACLS). the posterior drawer sign is the test for the posterior cruciate ligament(PCL) Finkelstein's Test - CORRECT ANSWER De Quervains tenosynovitis is caused by an inflammation of the tendon and its sheath, which is located at the base of the thumb. The screening test is finkelsteins , which is positive if there is pain and tenderness o the wrist(thumb sign) upon ulnar deviation(abductor pollicis longus and extensore pollicis brevis tendons) Cuada Equina Syndrome - CORRECT ANSWER Signs and Symptoms: low back pain, unilateral or bilateral sciatica, saddle anesthesia with poor rectal tone, bowel/bladder incontinence, lower extremity motor and sensory loss Hyperthyroidism - CORRECT ANSWER Grave's disease Hypersecretion of thyroxine from immune system attacking thyroid gland causing anxiety, irritability, insomnia, tachycardia, tremors, diaphoresis, sensitivity to heat, weight loss, exophthalmos and photosensitivity, diarrhea, hair loss. The classic finding is a very low (or undetectable )TSH with elevations in both serum free T4(thyroxine) and T3(triiodothyronine )levels. The most common cause for hyperthyroid in the US is chronic autoimmune disorder called Graves disease Tx with PTU propylthiouracil shrinks thyroid. Methimazole decrease hormone production. S/E skin rash granulocytopenia, hepatic necrosis. monitor cbc, lfts. Betablockers propranolol for symptoms of tachycardia. Radioactive Iodine not for preg woman. Permanent destruction of thyroid gland. life long thyroid replacement therapy. Hypothyroidism - CORRECT ANSWER A disorder caused by a thyroid gland that is slower and less productive than normal The classic lab finding for hypothyroidism is a high TSH with low free T4(no not confuse with total T4) Tx with Levothyroxine (synthroid 25 mcg/day start low dose). Check TSH levels 6-8 weeks. Thyroid Cancer - CORRECT ANSWER a single large nodule(>2.5 cm)on one lobe of the thyroid gland. The 24 hour radioactive iodine uptake(RAIU) test will show a cold nodule Type 1 Diabetes - CORRECT ANSWER form of diabetes mellitus that is an autoimmune disease; results in the destruction of beta islet cells and a complete deficiency of insulin on the body; usually occurs before age 30. Type 2 Diabetes - CORRECT ANSWER Diabetes of a form that develops especially in adults and most often obese individuals and that is characterized by high blood glucose resulting from impaired insulin utilization coupled with the body's inability to compensate with increased insulin production. fasting glucose 100-125 A1C 5.7-6.4 2 hr ogtt 140-199 Dawn Phenomenon - CORRECT ANSWER A nocturnal release of growth hormone, which may cause blood glucose level elevations before breakfast in the client with diabetes mellitus. Treatment includes administering an evening dose of intermediate acting insulin at 10 pm. Somogyi Effect - CORRECT ANSWER Rebound HYPERglycemia in AM in response to counterregulatory hormone release after episode of hypoglycemia in middle of the night Insulin Categories - CORRECT ANSWER Humalog Rapid acting covers one meal at a time Short Acting Regular covers from meal to meal NPH long acting last from breakfast to dinner Lantus 24hrs. Medicare part A - CORRECT ANSWER The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care. Medicare part B - CORRECT ANSWER The part of the Medicare program that pays for physician services, outpatient hospital services, durable medical equipment, and other services and supplies. Medicare part C - CORRECT ANSWER Medicare Managed Care Plans (formally Medicare Plus (+) Choice Plan) was created to offer a # of healthcare services in addition to those available under Part A & Part B. The CMS contracts w/ managed care plans or PPO's to provide Medicare benefits. A premium similar to Part B may be required for coverage to take affect Medicare part D - CORRECT ANSWER Also known as the Medicare prescription drug benefit. Only individuals who are enrolled (or eligible) for Medicare Part A and/or Part B are eligible. One type of Part D coverage is called the Medicare Advantage plan (MA) Medicade Title 19 - CORRECT ANSWER the government insurance program for low-income individuals & familys that is funded both by the federal government & each individual state Advanced Directives - CORRECT ANSWER Communicates a client's wishes regarding and end-of-life care should the client become unable to do so. PSDA requires that all health care facilities ask if a patient has advanced directives upon admission. Living Will - CORRECT ANSWER A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes. Power of Attorney - CORRECT ANSWER Written legal document designating some other person as an attorney-in-fact. They then may bargain and sign for the person who granted the power of attorney. AOM tx - CORRECT ANSWER Pathogens: S. pneumo, H. flu (nontypeable), M. catarrhali CAD risk factors - CORRECT ANSWER HTN FAM HX DM DYSLIPIDEMIA LOW HDL AGE MEN >45 WOMEN>55 SMOKING OBESITY MICROABLUMINURIA CAROTID ARTERY DISEASE PVD [Show Less]
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NCOA - Module 1 review Exam 24 Questions with Verified Answers,100% CORRECT
NCOA - Module 1 review Exam 24 Questions with Verified Answers Older adults - CORRECT ANSWER one of the largest group of patients in acute care, long ... [Show More] term care facilities, and rehabilitation facilities. Baby boomers - CORRECT ANSWER As ___________ age and the number of people living longer increases, the need for those with an aging expertise grows The field of gerontological - CORRECT ANSWER this field of nursing has evolved over the past decades and its specialty is in greater demand more now than ever before history and evolution - CORRECT ANSWER The ______ and _______ of gerontological nursing encompasses major milestones from the day of primary care or private duty nursing to acute care and now a shift to community based care. The Nursing Competence in Aging - CORRECT ANSWER Which initiative advocated for all nurses to have greater knowledge, skills, and broader attitudes toward the older adult primarily due to the prevalence and incidence of chronic health and functional issues in older adult clientele. quality health care - CORRECT ANSWER The provision of _______ and the complexities of the older adult are ever growing challenges for the healthcare system. Gerontology - CORRECT ANSWER study of social, cultural, psychological, cognitive, economic and biological aspects of aging. Geriatrics - CORRECT ANSWER Specialty that focuses on healthcare of elderly people specific to disease and illness. Gerontological Nursing - CORRECT ANSWER Specialty that involves assessment, planning, implementing and evaluating care in older adult. When did gerontological nursing practice begin? - CORRECT ANSWER 1.Although nurses published articles about the care of older adults as early as 1904, the specialty of gerontological nursing really began to emerge beginning in the 1950s. 2.The 1960s and 1970s marked a notable recognition for the need of standards of practice in geriatric nursing, with the creation of the first Standards of Practice for Geriatric Nursing documents in 1969, an effort led by the American Nurses Association. 3.In the 1970s Medicare and Medicaid programs marked a significant growth within the healthcare industry for the older adult segment. Gerontological Nurse Roles - CORRECT ANSWER - Direct hands-on care to older adults in various settings. - Knowledge of disease processes, medical treatments, rehabilitation and end of life care. - The 21st century has provided a resurgence in interest in gerontological care. There are several types of nurses that work in this field. - Older adults often present with atypical symptoms that complicate diagnosis and their plan of care and treatments. 1.Older adults are high risk for falls. The nurse must assess if they have altered mobility, confusion, malnutrition, polypharmacy. 2.Skin breakdown - is associated with diagnoses of dementia, osteoporosis, osteomyelitis Skin breakdown - CORRECT ANSWER is associated with diagnoses of dementia, osteoporosis, osteomyelitis Falls - CORRECT ANSWER older adults are high risk for what Current American Nurses Credentialing Options: - CORRECT ANSWER 1.Gerontological Nurse(Registered Nurse Board Certified(RN-BC) 2. Adult Gerontology Acute Care Nurse Practitioner (AGACNP-BC) 3. Adult-Gerontology Primary Care Nurse Practitioner (AGAPCNP-BC) 4. Adult Gerontology Clinical Nurse Specialist Certification for Gerontological Clinical Nurse Specialist -became available in what year? - CORRECT ANSWER In the US, certification for Gerontological Clinical Nurse Specialist -became available in 1989 by the American Nurses Association 85% - CORRECT ANSWER Approximately what percent of older adults have at least one chronic health condition? What 2 diseases are most common for older adults to have? - CORRECT ANSWER 1.Arthritis and hypertension been claimed to be the most common. 2.Most deaths in the older adult population stem from heart disease, lung cancer, COPD, accidents, strokes, Alzheimer's disease, diabetes, influenza/pneumonia, kidney disease and suicide. 60% & two - CORRECT ANSWER Approximately ___ percent have at least ____ chronic conditions 1.Coping with multiple chronic conditions is a real challenge. Learning to manage a variety of treatments while maintaining quality of life can be problematic. 2.Clinicians play an important role in educating patients and families about chronic health conditions. 3.Connect clients with appropriate community resources and services. Baby boomers are born between years - CORRECT ANSWER Baby boomers are those individuals born between 1946 and 1964 and are the population most concerning within the healthcare arena. 1.Expected rises in average individual Medicare spending is relevant to the baby boomers using healthcare 2.By 2029, when all of the baby boomers will be 65 years and over, more than 20 percent of the total U.S. population will be over the age of 65. Although the number of baby boomers will decline through mortality, this shift toward an increasingly older population is expected to endure. 3.By 2056, the population 65 years and over is projected to become larger than the population under 18 years. Older Adults in the Community - CORRECT ANSWER - Older adults prefer to live in their own homes and communities. - Older adults are less likely to change residencies compared to other age groups. - Many older adults live alone or with family members or perhaps with a caregiver. - Older adults who live alone may require additional homecare and many live in assisted living communities, group homes, or long term care. Ageism - CORRECT ANSWER 1.A common term used associated with negative attitudes toward older adults. 2. The stereotyping and discrimination against individuals or groups on the basis of their age Nursing Skills - CORRECT ANSWER - The functional abilities of older adults classified as activities of daily living (ADLs) includes bathing, dressing, eating, transferring and toileting along with home management activities such as shopping, cooking, housekeeping, laundry and handling finances. - These should be assessed by the nurse under systematic assessment measurement tools... these tools are useful to indicate the older adults functional ability and overall degree of health. - Assessment of the effect of chronic disease and age related declines in functional abilities allow nurses to establish a plan of care more appropriately. It is critical as one is hospitalized to optimize functional ability and independence as much as possible. - Nurses must have effective assessment skills to recognize subtle cues. Nurses must have excellent communication skills when interacting with older adults especially with sensory deficits. Nursing Considerations - CORRECT ANSWER - To promote health and wellness of the older adult, Gerontological nurses must have effective teaching skills in order to educate the older adult, their family and/or caregivers about safe and effective health techniques, lifestyle changes, functional health, life transitions and as well as disease processes, community and service resources. - Psychological, social, environmental and economic needs of the older adult client must be given equal consideration to presenting physical needs as well - Gerontological nurses must strengthen their delegation skills as unlicensed Assistive Personnel (UAP) are used in select settings to assist with the high demands associated with older adult care. - The ideal environment for living is the older adults own home. Recent economic, governmental and technological advancements have enabled more acutely ill clients to be discharged sooner and monitored at home. - Fundamental knowledge and skills related to nursing older patients: 60% of older adults & 2 chronic conditions - CORRECT ANSWER Appx. ___% of older adults have at least ___ chronic conditions. [Show Less]
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Gerontology HESI Practice Exam 99 Questions with Verified Answers,100% CORRECT
Gerontology HESI Practice Exam 99 Questions with Verified Answers An older resident is newly admitted to an assisted living community. Which action sh... [Show More] ould the registered nurse (RN) implement to provide the resident to maintain safe medication administration? [select all that apply] a. locked medication storage in the client's room b. medication administration record (MAR) c. payment forms for prescribed medications d. delivery of adequate supply of medication e. list of findings indicating medication effectiveness - CORRECT ANSWER a. locked medication storage in the client's room b. medication administration record (MAR) d. delivery of adequate supply of medication e. list of findings indicating medication effectiveness When assessing an older client, which age-related changes in the cardiovascular system should the registered nurse (RN) document? [select all that apply] a. dyspnea b. chest pain c. cardiac murmurs d. widening pulse pressure e. irregular heart rate - CORRECT ANSWER c. cardiac murmurs d. widening pulse pressure An older client who recently moved into an assisted living community refuses to eat or join any activities. When evaluating the client further, what should the registered nurse (RN) focus on during next examination? a. anxiety b. depression c. exhaustion d. confusion - CORRECT ANSWER b. depression Depression is a symptom that an older client is likely to experience with a sudden change in living accommodations when a loss of personal identity can create low self-esteem. The registered nurse (RN) is caring for an elderly client with functional incontinence who lives in an assisted living community. The client is alert and mildly confused and can self ambulate. Which nursing intervention should the RN implement? a. offer assistance with toileting Q2 hours b. use protective disposal undergarment instead of underwear c. ask if the client has attempted to void Q2 hours d. obtain a prescription for intermittent catheterization - CORRECT ANSWER a. offer assistance with toileting Q2 hours Toileting assistance maintains independence and self-esteem which are important for an older client with incontinence. A toileting schedule also decreases the clients chances of accidents and embarrassment. The healthcare provider prescribes a new medication, atorvastatin (Lipitor), for an older client who arrives at the clinic for an annual physical examination. What common side effect should the registered nurse (RN) advise the client to observe for with this medication? a. constipation b. headaches c. muscle weakness d. nausea and vomiting - CORRECT ANSWER b. headaches Headaches are the most common side effect of atorvastatin (Lipitor). The registered nurse (RN) is re-enforcing discharge instructions with the family of an older client who was recently admitted for an intestinal obstruction. Which statement indicates that the family understands the instructions? a. increase protein and carbohydrates in the daily diet b. limit activity to bed rest for the first week and increase mobility incrementally each week c. report abdominal distention, constipation, or any nausea and vomiting to the healthcare provider d. drink liquids 2 hours after meals instead of during meals - CORRECT ANSWER c. report abdominal distention, constipation, or any nausea and vomiting to the healthcare provider These symptoms occur with intestinal obstruction and should be addressed immediately. An older male client asks the registered nurse (RN) how he can reduce his incidents of hemorrhoidal flare ups. What information should the RN offer the client about how to prevent rectal discomfort? [select all that apply] a. increase fiber and liquids in the diet to help prevent constipation and straining b. change exercise program to reflect less cardio-exercise and more weight training c. use a therapeutic cushion or frequent repositioning for periods of prolonged sitting d. take frequent warm sitz baths and do not use abrasive paper that can traumatize tissues e. establish bowel habits by scheduling daily time to defecate when the client is not rushed - CORRECT ANSWER a. increase fiber and liquids in the diet to help prevent constipation and straining c. use a therapeutic cushion or frequent repositioning for periods of prolonged sitting d. take frequent warm sitz baths and do not use abrasive paper that can traumatize tissues e. establish bowel habits by scheduling daily time to defecate when the client is not rushed Fluids, comfort measures, and establishment of a regular bowel pattern help reduce incidents of hemorrhoid inflammation. An older male client is seeking counseling about his recent sexual issues with his partner. What issue should the registered nurse (RN) explore in this discussion? a. certain medications may impact sexual function b. normal aging affects sexual function in male clients c. safe sex is not necessary with older sexually active elders d. sexual interest usually declines with aging in male clients - CORRECT ANSWER a. certain medications may impact sexual function During the quarterly evaluations of the clients in the assisted living community, the registered nurse (RN) assesses for findings of failure to thrive in the older population. Which findings should the RN document and report as manifestations related to failure to thrive? [select all that apply] a. unintentional weight loss b. increased weakness c. increased amounts of sleep d. irritation and agitation e. seeking constant attention from caregiver - CORRECT ANSWER a. unintentional weight loss b. increased weakness c. increased amounts of sleep Symptoms of failure to thrive in the older population include weight loss, weakness, and excessive sleep, which should be documented and evaluated by a healthcare provider immediately. The registered nurse (RN) is reinforcing discharge instructions to the family of an older client with failure to thrive. What information should the RN include to promote nutritional intake for the client? [select all that apply] a. minimize stress level by providing the client with a quiet environment during meals b. provide food variations that the client can manage without assistance c. assist the client with eating meals in bed in a semi Fowler's position d. encourage fluid intake before melas to decrease dehydration e. offer any type of food to the client as long as calories are consumed - CORRECT ANSWER a. minimize stress level by providing the client with a quiet environment during meals b. provide food variations that the client can manage without assistance A and B continue to promote independence and decreased stress for the client, which will increase the opportunity for nutritional intake An older woman asks the registered nurse (RN) how she can decrease her chances of getting cystitis. What information should the RN provide? a. void and empty the bladder completely every 2 to 3 hours b. take warm sitz baths with bubble bath to cleanse the vulva c. decrease fluid volume intake to reduce urgency d. test urine pH daily using over-the-counter (OTC) dipsticks - CORRECT ANSWER a. void and empty the bladder completely every 2 to 3 hours An older male with Parkinson's disease (PD) is discharged home with levopoda-carbidopa (Sinemet) and instructions to this wife for his care. Which statement best indicates to the registered nurse (RN) that the wife understands her husband's needs? a. "It is important to keep my husband in a chair or in bed as much as possible and prevent him from falling." b. "I will notify the healthcare provider if my husband has increasing involuntary movement of his extremities." c. "Since it is difficult for my husband to eat, we should stay in the house instead of going out to dine." d. "I should expect that my husband be incontinent of bowel and bladder as his disease advances." - CORRECT ANSWER b. "I will notify the healthcare provider if my husband has increasing involuntary movement of his extremities." The home health registered nurse (RN) visits an older women with heart failure (HF) who is on complete bed rest. Which intervention is most important for the RN to suggest to the client to prevent complications related to immobility? a. get as much sleep as possible b. perform leg exercises while in bed c. increase protein intake to combat fatigue d. invite friends to visit to decrease risk for depression - CORRECT ANSWER b. perform leg exercises while in bed This client is at risk for complications related to immobility. Active leg exercises should be performed frequently to decrease the risk for thrombophlebitis. An older male client is admitted to the hospital with left-sided heart failure (HF). Which finding should the registered nurse (RN) document that is consistent with HF? a. ascites b. pitting edema c. jugular distention d. course and fine crackles - CORRECT ANSWER d. course and fine crackles An older female client who has been taking hydrocodone/acetaminophen (Lortab) Q4 hours for chronic back pain for the past 5 years tells the registered nurse (RN) that she cannot live without her pain pills. When asked if she is addicted, the client states that she is not an addict because the healthcare provider prescribed the pain pills. Which coping mechanism should the RN determine the client is using about her addiction? a. lack of knowledge about narcotic medications b. rationalization to support narcotic use c. transfer of blame to healthcare provider d. justification of narcotic use due to chronic pain - CORRECT ANSWER b. rationalization to support narcotic use The client is using rationalization to maintain self-esteem when she is questioned by stating that she is not addicted because she is taking medication prescribed by a healthcare provider. An older male client with heart failure (HF) complains of chronic constipation and wants to retrain his bowel. Which information should the registered nurse (RN) offer the client for establishing regular bowel habits? a. add whole grain foods and fibrous vegetables to diet b. drink water and fluids up to 3,000 mL daily c. use a stool softener or glycerin suppository PRN d. plan daily exercise based on fatigue level - CORRECT ANSWER a. add whole grain foods and fibrous vegetables to diet Increasing daily fiber with increasing fluid intake are the best tools to use when retraining bowel habits. The home health registered nurse (RN) is visiting an older client with chronic hypertension. What evaluation is most important for the RN to complete with each visit? a. effectiveness of medication b. ability to ambulate c. signs of dehydration d. familial support - CORRECT ANSWER a. effectiveness of medication An older male client is admitted for emergency treatment of acute closed-angle glaucoma. The registered nurse (RN) begins administering the prescribed biotic medications and glycerin (Glycol) therapy. Which intervention is most important for the RN to maintain during the client's therapy? a. maintain lighting control in the room during therapy b. monitor intake and output Q2 hours for 24 hours c. place an eye patch over the affected eye during sleep d. administer the eye drops at the scheduled intervals - CORRECT ANSWER b. monitor intake and output Q2 hours for 24 hours Monitoring I&O is most important during the administration of glycerin (Glycol) due to the rapid acting osmotic diuretic effect of glycerin therapy. The registered nurse (RN) is assigned the care of an older client who returns to the unit after surgery for closed angle glaucoma. Which intervention in the plan of care should the RN bring to the attention of the healthcare team? a. assist with ambulating to the commode b. monitor intake and output Q8 hours c. administer morphine 4 mg IM Q2 hour PRN pain d. place an eye patch on operative eye during sleep - CORRECT ANSWER c. administer morphine 4 mg IM Q2 hour PRN pain Morphine side effects include nausea, vomiting, and constipation, causing straining on stool, all of which can increase intraocular pressure and cause intraocular bleeding during the postoperative period. The home health registered nurse (RN) is reinforcing instructions to the family about how to prevent pressure ulcers for their older family member who is bedridden. Which measure should the RN discuss? a. lift the client when turning instead of sliding b. massage directly over reddened sites c. change client's position ever 4 hours d. place pillows under both the knees - CORRECT ANSWER a. lift the client when turning instead of sliding Decreasing the chances of friction and shearing while moving the client. The home health registered nurse (RN) is changing an older client's wet to dry dressing. Which observation should the RN evaluate as a therapeutic response with the removal of the dry dressing? a. debridement and removal of slough and eschar b. drainage of purulent exudate from the wound c. moist skin edges around the wound field d. presence of capillary growth in the wound - CORRECT ANSWER a. debridement and removal of slough and eschar Wet to dry dressings begin with a wet packing inside of the wound, and then a dry gauze is used to cover the wet packing to wick drainage and bacteria away from the wound to promote healing. The home health registered nurse (RN) is assessing an older client for a pressure ulcer. Which finding should the RN observe the area for a Stage I pressure ulcer? a. superficial skin breakdown and flaking b. deep pink, red, or mottled skin c. subcutaneous damage or necrosis d. skin that blanches pink when pressed - CORRECT ANSWER b. deep pink, red, or mottled skin Temporary blanching of the area can last for over a minute due to poor circulation. Deep pink, red, or mottled skin is a finding consistent with a Stage 1 pressure ulcer. A frail elderly woman visits the healthcare provider because she has been getting out of breath easily when walking long distances. Which pulmonary function change should the registered nurse (RN) expect to commonly occur with aging? a. decreased residual volume b. mild respiratory acidosis c. reduced vital capacity d. increased alveoli function - CORRECT ANSWER c. reduced vital capacity An older female client arrives for an annual visit by the urologist due to a history of changes in serum values related to renal function. What changes should the registered nurse (RN) expect for an older client due to normal aging? a. decrease in glomerular filtration rate (GFR) b. hematuria during urinalysis c. chronic bladder infections d. urinary incontinence - CORRECT ANSWER a. decrease in glomerular filtration rate (GFR) A frail elderly couple ask the registered nurse (RN) if they have to watch their salt intake because food does not taste as good as it used to so they have to season most foods. What information should the RN offer the couple? a. boredom may influence how the taste of food is perceived, and different seasonings can stimulate taste b. with age, an increase in sodium intake is needed to compensate for a decrease in renal function c. short-term memory loss and confusion may be the reason they want to over-season their food d. taste buds often are dull due to atrophy so older clients should use other seasonings instead of salt - CORRECT ANSWER d. taste buds often are dull due to atrophy so older clients should use other seasonings instead of salt An older client who is unconscious is admitted after experiencing a head injury from a fall. Glasgow Coma Scale (GCS) is prescribed to evaluate the client. Which focused assessments should the registered nurse (RN) use to determine the client's GCS score? [select all that apply] a. verbal response b. motor response c. eye opening d. pupillary reaction e. hearing - CORRECT ANSWER a. verbal response b. motor response c. eye opening The registered nurse (RN) is assigned to the care of an older client with venous stasis ulcers. A primary goal in the client's plan of care is to decrease swelling in the extremities. What action should the RN take to meet this goal? a. elevate the legs on pillows b. decrease fluid intake c. decrease salt intake in diet d. increase protein intake in diet - CORRECT ANSWER a. elevate the legs on pillows After taking a 10-day course of an antibiotic that was ineffective, a frail, elderly client with chronic obstructive pulmonary disease (COPD) is admitted with pneumonia. The client has a long history of smoking and still smokes a pack of cigarettes a day. Which finding should the registered nurse (RN) report to the healthcare provider? a. barrel chest with increased chest diameter b. crackles and pulse oximetry level of 88% c. low hemoglobin and hematocrit levels d. arterial blood gases indicating respiratory acidosis - CORRECT ANSWER b. crackles and pulse oximetry level of 88% The home health registered nurse (RN) visits an older female client with an ideal conduit who has been experiencing chronic urinary tract infections (UTI). Which intervention should the RN recommend to the client to manage the frequency of UTIs? a. force fluid intake to 1,000 mL daily b. change appliance every 4 hours c. attach a larger drainage bag while sleeping d. allow bag to fill completely before emptying - CORRECT ANSWER c. attach a larger drainage bag while sleeping An older male client returns to the hospital after discharge 4 days ago for a transurethral resection of the prostate (TURP). The registered nurse (RN) evaluates the function of the 3-way indwelling urinary catheter and the continuous bladder irrigation system. Which finding should the RN report to the healthcare provider? a. irrigation bag of normal saline is hanging at the level of the client's head b. the urinary output is greater than the amount of irrigation fluid instilled c. the irrigation turbine is attached to the irrigation port on the 3-way catheter d. the tubing that drains the urinary bladder has bright red urine with clots - CORRECT ANSWER d. the tubing that drains the urinary bladder has bright red urine with clots An older client with chronic kidney disease (CKD) has an arteriovenous fistula (AV) in the left forearm for hemodialysis. After palpating the AV fistula, which finding is an indication that the AV fistula is functioning properly? a. enlarged veins b. redness around the site c. decreased pulses below fistula d. marked ecchymotic areas - CORRECT ANSWER a. enlarged veins After a transurethral resection of the prostate (TURP), an older man returns to the medical surgical floor with a 3-way indwelling urinary catheter. The registered nurse (RN) observes the catheter's tubing for drainage when the client states that he needs to void. What should the RN implement based on this finding? a. irrigate the bladder through the catheter port b. remove the indwelling catheter c. explain that urgency is expected d. notify the healthcare provider of the symptom - CORRECT ANSWER a. irrigate the bladder through the catheter port The feeling of urgency can be caused by blood clots that can occlude drainage of the catheter, which is a common occurrence in the first 72 hours after a TURP. The urgency indication that the client's bladder is not emptying, and the RN should irrigate catheter to relieve the symptoms caused by a clot. The registered nurse (RN) is caring for an older female with a 20 year history of rheumatoid arthritis (RA), who is admitted for carpel tunnel release. Which finding associated with RA should the RN document? a. asymmetrical joint deformity b. small joint involvement in fingers c. crepitation or grating sensation in joints d. weight bearing joint involvement - CORRECT ANSWER b. small joint involvement in fingers Small joint involvement is common in rheumatoid arthritis. A 64-year-old client is admitted to the hospital with a fractured right hip. One of the concerns following surgical repair is to promote dorsiflexion. Which intervention would a nurse implement? a. begin early ambulation b. monitor pain level c. provide PCA instructions d. provide a foot board - CORRECT ANSWER d. provide a foot board A footboard supports the feet in dorsiflexion and helps prevent foot drop throughout the recovery. After a recent total hip replacement, an older female client, who transferred to a rehabilitation facility placement, asks the registered nurse (RN) if she broke her hip because she is old. How should the RN best respond? a. hip fractures can occur in any age group and require strength conditioning b. with aging, everything tends to break down more easily the older one gets c. older people tend to look down instead of ahead, increasing the risk of falls d. older women commonly lose bone calcium which increases the risk of fracture - CORRECT ANSWER d. older women commonly lose bone calcium which increases the risk of fracture An older client is admitted with a preliminary diagnosis of Addison's disease. Which skin finding should the registered nurse (RN) document that is typical with Addison's disease? a. moon face b. hyperpigmentation c. excessive acne d. multiple skin tags - CORRECT ANSWER b. hyperpigmentation An older female client recently moved to an assisted living facility. The family explains to the registered nurse (RN) that the client is unmanageable and always confused, disoriented, and depressed. The client asks the RN repeatedly, "Where am I?" How should the RN respond? a. explain that she is in a new home called an assisted living community b. question the client about her perception of where she might be now c. distract the client with a scenario that she is on an outing with her family d. reassure the client not to worry because she will meet new friends - CORRECT ANSWER a. explain that she is in a new home called an assisted living community An older female client who is a new resident at an assisted living facility cannot remember how to get to her room. What action should the registered nurse (RN) implement? a. schedule therapy and social activities in her room b. ask another resident to help the client c. show client how to follow hallway signs to her room d. move the client to a room close to the nurses station - CORRECT ANSWER c. show client how to follow hallway signs to her room A new resident in an assisted living facility is an older client who is experiencing short-term memory loss and confusion. Which activity should the registered nurse (RN) schedule the client to do during the day? a. arts and crafts b. current events discussion group c. group sing-along d. daily exercise group - CORRECT ANSWER d. daily exercise group A daily exercise group allows the client to mirror the leader and minimizes the client's stress to remember. Since his arrival in an assisted living community, an older male client is having difficulty going to sleep. Which intervention should the registered nurse (RN) implement first? a. encourage client to take a warm bath at night b. ask the client what has helped him in the past c. recommend that the client not take daytime naps d. offer the client a glass of warm milk before bedtime - CORRECT ANSWER b. ask the client what has helped him in the past An older male client arrives at the clinic for an annual physical examination. While the nurse assesses the client, the client states that he is having intimacy problems with his wife. Which information should the nurse provide to elicit more information from the client? a. query client to clarify the client's idea of an intimacy problem b. discuss benign prostatic hypertrophy (BPH) and ejaculation c. explore frequency that he experiences erectile dysfunction (ED) d. determine if the client's wife is young enough to get pregnant - CORRECT ANSWER a. query client to clarify the client's idea of an intimacy problem An older client who is a resident in a long-term care facility is receiving medications through a gastric tube (GT). After interrupting the continuous GT feeding in which sequence should the nurse implement these actions for administration of crushed medications? (arrange in the order from first step to last step) - Flush the feeding tube of feeding solution - Crush the medication into a powder or fine granules - Administer each medication separately - Dissolve each crushed medication in a medicine cup - Flush GT to clear the medication from the tubing - Reconnect the gastric feeding tube - CORRECT ANSWER 1. Crush the medication into a powder or fine granules 2. Dissolve each crushed medication in a medicine cup 3. Flush the feeding tube of feeding solution 4. Administer each medication separately 5. Flush GT to clear the medication from the tubing 6. Reconnect the gastric feeding tube The hospice nurse is completing a focused assessment of an older female client with end stage Alzheimer's disease, who recently fractured her hip. What technique should the registered nurse (RN) use to determine the client's pain? a. use the FACES pain scale b. ask client to rate pain on a scale of 1 to 10 c. observe for facial grimacing d. review documentation of recent eating habits - CORRECT ANSWER c. observe for facial grimacing Older clients are at highest risk for abuse and neglect due to which factors? [select all that apply] a. needs are greater than the caretaker's abilities b. client's declining strength c. fixed income d. longer life expectancy e. lack of exposure to technology and trends - CORRECT ANSWER a. needs are greater than the caretaker's abilities b. client's declining strength A frail, elderly client is admitted to the unit with a diagnosis of pneumonia. Which finding is most important for the registered nurse (RN) to report to the healthcare provider? a. fever and chills b. confusion and dehydration c. crackles in lung fields d. nausea and vomiting - CORRECT ANSWER b. confusion and dehydration Confusion and dehydration are findings of inadequate oxygenation and perfusion in this frail elderly client. The registered nurse (RN) is observing the skin of an older client. Which finding should the RN document as consistent with the normal aging process? a. decreased elasticity b. tough and leathery texture c. shiny and edematous d. excessive hair growth on the head - CORRECT ANSWER a. decreased elasticity An older client is transferred to a telemetry unit after placement of a pacemaker. What action should the registered nurse (RN) take first? a. view the incision site b. obtain a blood pressure c. establish telemetry monitoring d. evaluate client for pain - CORRECT ANSWER c. establish telemetry monitoring The first action is to establish telemetry monitoring to ensure the pacemaker is functioning properly. The nursing assessment of an older female elicits information that the client is diagnosed with Raynaud's phenomenon. Which exposure should the nurse instruct the client to avoid? a. alcohol consumption b. warm climates c. cold climates d. active exercise - CORRECT ANSWER c. cold climates A family member brings their aging father to the clinic because he has been alert and oriented during the day but agitated and disoriented in the evening. The registered nurse (RN) reviews the client's list of current medications with the client and family. Which action taken by the RN is most important? a. medication review with the family caregivers is the RN's responsibility b. multiple medications can contribute to sundowner like symptoms c. medication recall is the best way to evaluate the client's memory d. reviewing medication actions is a component of effective client care - CORRECT ANSWER c. medication recall is the best way to evaluate the client's memory Older clients may see a variety of healthcare providers which can increase the chance of poly pharmacy that compounds the workload of metabolic pathways that may be less efficient due to the aging process. Multiple medication interactions may contribute to sundowner like symptoms. Osteoporosis increase the risk for a hip fracture in older adults, and women are more likely to have osteoporosis than men. Women of which ethnic group have the highest risk for a hip fracture? (arrange with the highest risk first and lowest risk last) - African American - Caucasian - Asian - Hispanic - CORRECT ANSWER 1. Caucasian 2. Asian 3. Hispanic 4. African American Which ethical principle underlies nursing actions respecting each patient's values and beliefs? a. autonomy b. beneficence c. justice d. responsibility - CORRECT ANSWER a. autonomy [Show Less]
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Acute Care Exam 2|116 Questions with Verified Answers,100% CORRECT
Acute Care Exam 2|116 Questions with Verified Answers The nurse prepares to conduct a general survey on an adult patient. Which assessment is performed ... [Show More] first while the nurse initiates the nurse-patient relationship? 1) Appearance and behavior 2) Measurement of vital signs 3) Observing specific body systems 4) Conducting a detailed health history - CORRECT ANSWER 1) Appearance and behavior Correct The nurse is teaching a young mother to palpate her 8-year-old child to quickly evaluate if the child has a fever. Which information is important for the nurse to include? 1) Place the palm of the hand on the child's back. 2) Lightly touch the child's forehead with the fingertips. 3) Place the back of your hand against the child's forehead and then on the back of the neck. 4) Use the pads of your fingers and press against the child's neck and over the thorax. - CORRECT ANSWER 3) Place the back of your hand against the child's forehead and then on the back of the neck. While assessing the adult patient's lungs, the nurse identifies the following assessment findings. Which finding should be reported to the health care provider? 1) Respiratory rate: 14 2) Pain reported when palpating posterior lower thorax 3) Thorax rising and falling symmetrically for right and left lungs 4) Vesicular breath sounds heard with auscultation of peripheral lung fields - CORRECT ANSWER 2) Pain reported when palpating posterior lower thorax The nurse is teaching a young female patient to practice good skin health. Which information is important for the nurse to include? 1) Avoid sunbathing between 3 PM and 7 PM. 2) Oral contraceptives and antiinflammatories make the skin more sensitive to the sun. 3) Call the health care provider for the presence of a mole on an arm or leg that appears uniformly brown. 4) Wear sunscreen with an SPF of 30 or greater if using a sunlamp or tanning parlor. - CORRECT ANSWER 2) Oral contraceptives and antiinflammatories make the skin more sensitive to the sun. As a nurse prepares to provide morning care and treatments, it is important to question a patient about a latex allergy before which intervention? (Select all that apply.) 1) Applying adhesive tape to anchor a nasogastric tube 2) Inserting a rubber Foley catheter into the patient's bladder 3) Providing oral hygiene using a standard toothbrush and toothpaste 4) Giving an injection using plastic syringes with rubbercoated plungers 5) Applying a transparent wound dressing - CORRECT ANSWER 1) Applying adhesive tape to anchor a nasogastric tube 2) Inserting a rubber Foley catheter into the patient's bladder 4) Giving an injection using plastic syringes with rubbercoated plungers The nurse is assessing a patient who returned 3 hours ago from a cardiac catheterization, during which the large catheter was inserted into the patient's femoral artery in the right groin. Which assessment finding would require immediate follow-up? 1) Palpation of a femoral pulse with a heart rate of 76 2) Auscultation of a heart murmur over the left thorax 3) Identification of mild bruising at the catheter insertion site 4) Palpation of a right dorsalis pedis pulse with strength of +1 - CORRECT ANSWER 4) Palpation of a right dorsalis pedis pulse with strength of +1 The patient reports having a sore throat, coughing, and sneezing. While performing a focused assessment, which finding supports the patient's reported symptoms related to upper respiratory infection? 1) Buccal mucosa is moist and dark pink. 2) Respiratory rate is 18, rhythm is even. 3) Retropharyngeal lymph nodes are enlarged and firm. 4) Inspection with a tongue depressor on the posterior tongue causes gagging. - CORRECT ANSWER 3) Retropharyngeal lymph nodes are enlarged and firm. The nurse is teaching a patient with poor arterial circulation about checking blood flow in the legs. Which information should the nurse include? (Select all that apply.) 1) A normal pulse on the top of the foot indicates adequate blood flow to the foot. 2) To locate the dorsalis pedis pulse, take the fingers and palpate behind the knee 3) When there is poor arterial blood flow, the leg is generally warm to the touch. 4) Loss of hair on the lower leg indicates a long-term problem with arterial blood flow. - CORRECT ANSWER 1) A normal pulse on the top of the foot indicates adequate blood flow to the foot. 4) Loss of hair on the lower leg indicates a long-term problem with arterial blood flow. How should the patient be positioned to best palpate for lumps or tumors during an examination of the right breast? 1) Supine with both arms overhead with palms upward 2) Sitting with hands clasped just above the umbilicus 3) Supine with the right arm abducted and hand under the head and neck 4) Lying on the right side, adducting the right arm on the side of the body - CORRECT ANSWER 3) Supine with the right arm abducted and hand under the head and neck The nurse is planning a staff education conference about abdominal assessment. Which point is important for the nurse to include? 1) The aorta can be felt using deep palpation in the upper abdomen near the midline 2) The patient should be sitting to best determine the contour and shape of the abdomen. 3) Always wear gloves when palpating the skin on the patient's abdomen. 4) Avoid palpating the abdomen if the patient reports any discomfort or feelings of fullness. - CORRECT ANSWER 1) The aorta can be felt using deep palpation in the upper abdomen near the midline The nurse is teaching a patient how to perform a testicular self-examination. Which statement by the nurse is correct? 1) "The testes are normally round and feel smooth and rubbery." 2) "The best time to do a testicular self-examination is before your bath or shower." 3) "Perform a testicular self-examination weekly to detect signs of testicular cancer." 4) "Since you are over 40 years old, you are in the highest risk group for testicular cancer." - CORRECT ANSWER 1) "The testes are normally round and feel smooth and rubbery." The patient is assessed for range of joint movement. He or she is unable to move the right arm above the shoulder. How should the nurse document this finding? 1) Patient was not able to flex arm at shoulder. 2) Extension of right arm is limited. 3) Patient's abduction of right arm was limited to 100 degrees. 4) Internal rotation of right arm is limited to less than 90 degrees. - CORRECT ANSWER 3) Patient's abduction of right arm was limited to 100 degrees. ID: 41140170 The nurse plans to assess the patient's abstract reasoning. Which task should the nurse ask the patient to perform? 1) "Tell me where you are." 2) "What can you tell me about your illness?" 3) "Repeat these numbers back to me: 7...5...8." 4) "What does this mean: 'A stitch in time saves nine? ' " - CORRECT ANSWER 4) "What does this mean: 'A stitch in time saves nine? ' " The nurse teaches a patient about cranial nerves to help explain why the patient's right side of the mouth droops instead of moving up into a smile. What nerve does the nurse explain to the patient? 1) VII — Facial 2) V — Trigeminal 3) XII — Hypoglossal 4) XI— Spinal accessory - CORRECT ANSWER 1) VII — Facial The nurse is planning to teach the student nurse how to assess the hydration status of an older adult. Which techniques are appropriate for this situation? (Select all that apply.) 1) Inspect the lips and mucous membranes to determine if they are moist. 2) Pinch the skin on the back of the hand to see if the skin tents. 3)Check the patient's pulse and blood pressure. 4) Weigh the patient daily. - CORRECT ANSWER 1) Inspect the lips and mucous membranes to determine if they are moist 3)Check the patient's pulse and blood pressure 4) Weigh the patient daily The nurse is having difficulty reading a physician's order for a medication. He or she knows that the physician is very busy and does not like to be called. What is the most appropriate next step for the nurse to take? 1) Call a pharmacist to interpret the order 2) Call the physician to have the order clarified 3) Consult the unit manager to help interpret the order 4) Ask the unit secretary to interpret the physician's handwriting - CORRECT ANSWER 2) Call the physician to have the order clarified The patient has an order for 2 tablespoons of Milk of Magnesia. How much medication does the nurse give him or her? 2 mL 5 mL 16 mL 30 mL - CORRECT ANSWER 30 mL A nurse is administering eardrops to an 8-year-old patient with an ear infection. How does the nurse pull the patient's ear when administering the medication? 1) Outward 2) Back 3) Upward and back 4) Upward and outward - CORRECT ANSWER 4) Upward and outward A patient is to receive cephalexin (Kefl ex) 500 mg PO. The pharmacy has sent 250-mg tablets. How many tablets does the nurse administer? ½ tablet 1 tablet 1 ½ tablets 2 tablets - CORRECT ANSWER 2 tablets A nurse is administering medications to a 4-year-old patient. After he or she explains which medications are being given, the mother states, "I don't remember my child having that medication before." What is the nurse's next action? 1) Give the medications 2) Identify the patient using two patient 3) Withhold the medications and verify the medication orders 4) Provide medication education to the mother to help her better understand her child's medications - CORRECT ANSWER 3) Withhold the medications and verify the medication orders A patient is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority in relation to safe medication administration for the discharge nurse? 1) Set up the follow-up appointments with the physician for the patient. 2) Ensure that someone will provide housekeeping for the patient at home. 3) Ensure that the home care agency is aware of medication and health teaching needs. 4) Make sure that the patient's family knows how to safely bathe him or her and provide mouth care. - CORRECT ANSWER 3) Ensure that the home care agency is aware of medication and health teaching needs. A nursing student takes a patient's antibiotic to his room. The patient asks the nursing student what it is and why he should take it. Which information does the nursing student include when replying to the patient? 1) Only the patient's physician can give this information. 2) The student provides the name of the medication and a description of its desired effect. 3) Information about medications is confidential and cannot be shared. 4) He has to speak with his assigned nurse about this. - CORRECT ANSWER 2) The student provides the name of the medication and a description of its desired effect. The nurse is administering a sustained-release capsule to a new patient. The patient insists that he cannot swallow pills. What is the nurse's next best course of action? 1) Ask the prescriber to change the order 2) Crush the pill with a mortar and pestle 3) Hide the capsule in a piece of solid food 4) Open the capsule and sprinkle it over pudding - CORRECT ANSWER 1) Ask the prescriber to change the order The nurse takes a medication to a patient, and the patient tells him or her to take it away because she is not going to take it. What is the nurse's next action? 1) Ask the patient's reason for refusal 2) Explain that she must take the medication 3) Take the medication away and chart the patient's refusal 4) Tell the patient that her physician knows what is best for her - CORRECT ANSWER 1) Ask the patient's reason for refusal The nurse receives an order to start giving a loop diuretic to a patient to help lower his or her blood pressure. The nurse determines the appropriate route for administering the diuretic according to: 1) Hospital policy. 2) The prescriber's orders. 3) The type of medication ordered. 4) The patient's size and muscle mass. - CORRECT ANSWER 2) The prescriber's orders. A patient is receiving an intravenous (IV) push medication. If the drug infiltrates into the outer tissues, the nurse: 1) Continues to let the IV run. 2) Applies a warm compress to the infiltrated site. 3) Stops the administration of the medication and follows agency policy. 4) Should not worry about this because vesicant filtration is not a problem. - CORRECT ANSWER 3) Stops the administration of the medication and follows agency policy. If a patient who is receiving intravenous (IV) fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects: Sepsis. Phlebitis. Infiltration. Fluid overload. - CORRECT ANSWER Phlebitis. After seeing a patient, the physician gives a nursing student a verbal order for a new medication. The nursing student first needs to: 1) Follow ISMP guidelines for safe medication abbreviations. 2) Explain to the physician that the order needs to be given to a registered nurse. 3) Write down the order on the patient's order sheet and read it back to the physician. 4) Ensure that the six rights of medication administration are followed when giving the medication. - CORRECT ANSWER 2) Explain to the physician that the order needs to be given to a registered nurse. A nurse accidentally gives a patient a medication at the wrong time. The nurse's first priority is to: 1) Complete an occurrence report. 2) Notify the health care provider. 3) Inform the charge nurse of the error. 4) Assess the patient for adverse effects. - CORRECT ANSWER 4) Assess the patient for adverse effects. Review the following nursing diagnoses and identify the diagnoses that are stated correctly. (Select all that apply.) 1) Anxiety related to fear of dying 2) Fatigue related to chronic emphysema 3) Need for mouth care related to inflamed mucosa 4) Risk for infection - CORRECT ANSWER 1) Anxiety related to fear of dying 4) Risk for infection A nurse reviews data gathered regarding a patient's pain symptoms. The nurse compares the defining characteristics for acute pain with those for chronic pain and in the end selects acute pain as the correct diagnosis. This is an example of the nurse avoiding an error in: 1) Data collection. 2) Data clustering. 3) Data interpretation. 4) Making a diagnostic statement. - CORRECT ANSWER 3) Data interpretation. The nursing diagnosis readiness for enhanced communication is an example of a(n): 1) Risk nursing diagnosis. 2) Actual nursing diagnosis. 3) Health promotion nursing diagnosis 4) Wellness nursing diagnosis. - CORRECT ANSWER 3) Health promotion nursing diagnosis In the following examples, which nurses are making nursing diagnostic errors? (Select all that apply.) 1) The nurse who listens to lung sounds after a patient reports "difficulty breathing" 2) The nurse who considers conflicting cues in deciding which diagnostic label to choose 3) The nurse assessing the edema in a patient's lower leg who is unsure how to assess the severity of edema 4) The nurse who identifies a diagnosis on the basis of a single defining characteristic - CORRECT ANSWER 3) The nurse assessing the edema in a patient's lower leg who is unsure how to assess the severity of edema 4) The nurse who identifies a diagnosis on the basis of a single defining characteristic A nurse is reviewing a patient's list of nursing diagnoses in the medical record. The most recent nursing diagnosis is diarrhea related to intestinal colitis. This is an incorrectly stated diagnostic statement, best described as: 1) Identifying the clinical sign instead of an etiology. 2) Identifying a diagnosis based on prejudicial judgment. 3) Identifying the diagnostic study rather than a problem caused by the diagnostic study. 4) Identifying the medical diagnosis instead of the patient's response to the diagnosis. - CORRECT ANSWER 4) Identifying the medical diagnosis instead of the patient's response to the diagnosis. Review the following list of nursing diagnoses and identify those stated incorrectly. (Select all that apply.) 1) Acute pain related to lumbar disk repair 2) Sleep deprivation related to difficulty falling asleep 3) Constipation related to inadequate intake of liquids 4) Potential nausea related to nasogastric tube insertion - CORRECT ANSWER 1) Acute pain related to lumbar disk repair 2) Sleep deprivation related to difficulty falling asleep 4) Potential nausea related to nasogastric tube insertion The nurse completed the following assessment: 63-year-old female patient has had abdominal pain for 6 days. She reports not having a bowel movement for 4 days, whereas she normally has a bowel movement every 2 to 3 days. She has not been hospitalized in the past. Her abdomen is distended. She reports being anxious about upcoming tests. Her temperature was 37° C, pulse 82 and regular, blood pressure 128/72. Which of the following data form a cluster, showing a relevant pattern? (Select all that apply.) 1) Vital sign results 2) Abdominal distention 3) Age of patient 4) Change in bowel elimination pattern 5) Abdominal pain 6) No past history of hospitalization - CORRECT ANSWER 2) Abdominal distention 4) Change in bowel elimination pattern 5) Abdominal pain The nurse in a geriatric clinic collects the following information from an 82-year-old patient and her daughter, the family caregiver. The daughter explains that the patient is "always getting lost." The patient sits in the chair but gets up frequently and paces back and forth in the examination room. The daughter says, "I just don't know what to do because I worry she will fall or hurt herself." The daughter states that, when she took her mother to the store, they became separated, and the mother couldn't find the front entrance. The daughter works part time and has no one to help watch her mother. Which of the data form a cluster, showing a relevant pattern? (Select all that apply.) 1) Daughter's concern of mother's risk for injury 2) Pacing 3) Patient getting lost easily 4) Daughter working part time 5) Getting up frequently - CORRECT ANSWER 2) Pacing 3) Patient getting lost easily 5) Getting up frequently Which of the following are examples of collaborative problems? (Select all that apply.) 1) Nausea 2) Hemorrhage 3) Wound infection 4) Fear - CORRECT ANSWER 2) Hemorrhage 3) Wound infection Two nurses are having a discussion at the nurses' station. One nurse is a new graduate who added, "Patient needs improved bowel function related to constipation" to a patient's care plan. The nurse's colleague, the charge nurse says, "I think your diagnosis is possibly worded incorrectly. Let's go over it together." A correctly worded diagnostic statement is: 1) Need for improved bowel function related to change in diet. 2) Patient needs improved bowel function related to alteration in elimination. 3) Constipation related to inadequate fluid intake. 4) Constipation related to hard infrequent stools. - CORRECT ANSWER 3) Constipation related to inadequate fluid intake. The following nursing diagnoses all apply to one patient. As the nurse adds these diagnoses to the care plan, which diagnoses will not include defining characteristics? 1) Risk for aspiration 2) Acute confusion 3) Readiness for enhanced coping 4) Sedentary lifestyle - CORRECT ANSWER 1) Risk for aspiration A female patient reports that she is experiencing burning on urination, frequency, and urgency. The nurse notes that a clean-voided urine specimen is markedly cloudy. The probable cause of these symptoms and findings is: Cystitis. Hematuria. Pyelonephritis. Dysuria. - CORRECT ANSWER Cystitis. A male patient returned from the operating room 6 hours ago with a cast on his right arm. He has not yet voided. Which action would be the most beneficial in assisting the patient to void? 1) Suggest he stand at the bedside 2) Stay with the patient 3) Give him the urinal to use in bed 4) Tell him that, if he doesn't urinate, he will be catheterized - CORRECT ANSWER 1) Suggest he stand at the bedside Elimination changes that result from inability of the bladder to empty properly may cause which of the following? (Select all that apply.) 1) Incontinence 2) Frequency 3) Urgency 4) Urinary retention 5) Urinary tract infection - CORRECT ANSWER 1) Incontinence 2) Frequency 3) Urgency 4) Urinary retention 5) Urinary tract infection An older male patient states that he is having problems starting and stopping his stream of urine and he feels the urgency to void. The best way to assist this patient is to: 1) Help him stand to void. 2) Place a condom catheter. 3) Have him practice Credé's method. 4) Initiate Kegel exercises. - CORRECT ANSWER 4) Initiate Kegel exercises. Since removal of the patient's Foley catheter, the patient has voided 50 to 100 mL every 2 to 3 hours. Which action should the nurse take first? 1) Check for bladder distention 2) Encourage fluid intake 3) Obtain an order to recatheterize the patient 4) Document the amount of each voiding for 24 hours - CORRECT ANSWER 1) Check for bladder distention To minimize the patient experiencing nocturia, the nurse would teach him or her to: 1) Perform perineal hygiene after urinating. 2) Set up a toileting schedule. 3) Double void. 4) Limit fluids before bedtime. - CORRECT ANSWER 4) Limit fluids before bedtime. A patient with a Foley catheter carries the collection bag at waist level when ambulating. The nurse tells the patient that he or she is at risk for: (Select all that apply.) 1) Infection. 2) Retention. 3) Stagnant urine. 4) Reflux of urine. - CORRECT ANSWER 1) Infection. 4) Reflux of urine. The patient is incontinent, and a condom catheter is placed. The nurse should take which action? 1) Secure the condom with adhesive tape 2) Change the condom every 48 hours 3) Assess the patient for skin irritation 4) Use sterile technique for placement - CORRECT ANSWER 3) Assess the patient for skin irritation The nurse directs the NAP to remove a Foley catheter at 1300. The nurse would check if the patient has voided by: 1400. 1600 1700. 2300. - CORRECT ANSWER 1700. The postoperative patient has difficulty voiding after surgery and is feeling "uncomfortable" in the lower abdomen. Which action should the nurse implement first? 1) Encourage fluid intake 2) Administer pain medication 3) Catheterize the patient 4) Turn on the bathroom faucet as he tries to void - CORRECT ANSWER 4) Turn on the bathroom faucet as he tries to void The patient is to have an intravenous pyelogram (IVP). Which of the following apply to this procedure? (Select all that apply.) 1) Note any allergies. 2) Monitor intake and output. 3) Provide for perineal hygiene. 4) Assess vital signs. 5) Encourage fluids after the procedure. - CORRECT ANSWER 1) Note any allergies. 5) Encourage fluids after the procedure. The nurse assesses that the patient has a full bladder, and the patient states that he or she is having difficulty voiding. The nurse would teach the patient to: 1) Use the double-voiding technique. 2) Perform Kegel exercises. 3) Use Credé's method. 4) Keep a voiding diary. - CORRECT ANSWER 3) Use Credé's method. The patient states that she "loses urine" every time she laughs or coughs. The nurse teaches the patient measures to regain urinary control. The nurse recognizes the need for further teaching when the patient states: 1) "I will perform my Kegel exercises every day." 2) "I joined weight watchers." 3) "I drink two glasses of wine with dinner." 4) "I have tried urinating every 3 hours." - CORRECT ANSWER 3) "I drink two glasses of wine with dinner." [Show Less]
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N421: The Gerontological Nurse Exam 54 Questions with Verified Answers,100% CORRECT
N421: The Gerontological Nurse Exam 54 Questions with Verified Answers Scope of Practice - CORRECT ANSWER 1) Defined by the ANA → assessment, diagno... [Show More] sis, planning, implementation, and evaluation 2) Key elements = quality, evidence, and safety Major Professional Standards - CORRECT ANSWER 1) ANA Scope and Standards of Practice 2) ANA Guide to Ethics 3) ANA Guide to Social Policy Statement What guides nursing practice at the state level? - CORRECT ANSWER State board of nursing exam (NCLEX) Gerontological Nursing Standards - CORRECT ANSWER 1) Standards = nursing process (ADPIE) 2) Practice = address issues of access to healthcare services, quality and affordability of health care, and coordination of services by an interdisciplinary team 3) Role = patient advocate, nurse educator, nurse manager, nurse consultant, and nurse researcher Gerontology Advanced Practice Nurse positions - CORRECT ANSWER 1) Adult Gerontology Clinical Nurse Specialist (AGCNS-BC) 2) Geriatric Nurse Practitioner (GNP-BC) 3) Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC) 4) Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP-BC) Quality and Safety Education for Nurses (QSEN) - CORRECT ANSWER 1) Purpose = meet the challenges of preparing future nurses who will have the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare system QSEN: Key Components - CORRECT ANSWER 1) Patient-centered care 2) Teamwork (communication and collaboration) 3) EBP 4) Quality initiatives 5) Safety 6) Informatics Functional Ability and the Older Adult - CORRECT ANSWER 1) Primary focus when caring for the older adult is FUNCTIONAL ABILITY 2) Want to maximize their strengths and add patient teaching or support to their weaknesses 3) If there are issues with functional ability then there may be issues with any of the blue bubbles Functional Ability - CORRECT ANSWER 1) Functional ability is located on a continuum from fully independent to complete dependence 2) Independence and dependence vary depending on location and different areas 3) Basic activities of daily living (BADLs) 4) Instrumental activities of daily living (IADLs) BADLs - CORRECT ANSWER 1) Dressing 2) Personal hygiene 3) Cooking and eating 4) Using the toilet IADLs - CORRECT ANSWER 1) More complex set of skills that allow you to live independently 2) Paying bills 3) Cooking healthy meals 4) Cleaning your home 5) Being able to dial a telephone 6) Take prescribed medication correctly Capacity vs. Actual Performance - CORRECT ANSWER 1) Capacity = ability to perform a task 2) Actual performance = amount of assistance needed, amount of time needed, level of performance 3) Eg. Hand-off report: "Will need two assists, level of performance is poor because you have to keep repeating yourself, and it will take twice the amount of time" Diminishing Functional Ability: Risk Factors - CORRECT ANSWER 1) Developmental abnormalities 2) Age 3) Cognitive function 4) Mental health issues (substance abuse issues) 5) Physical or psychological trauma (including PTSD, interpersonal violence) 6) Illness (acute or chronic) Functional Assessment - CORRECT ANSWER 1) Comprehensive functional assessment is time-intensive and should be an interprofessional effort Functional Assessment: Indications - CORRECT ANSWER 1) Children with delays in developmental milestones 2) Adults with loss of functional ability, change in mental status, multiple health conditions, or frail elderly person living in a community setting Functional Assessment Components - CORRECT ANSWER 1) Vision 2) Hearing 3) Mobility 4) Falls 5) Continence 6) Nutrition 7) Cognition 8) Affect 9) Home environment 10) Social participation 11) BADLs, IADLs Functional Assessment: Level of Assistance/Dependency - CORRECT ANSWER 1) No assistance 2) Partial assistance 3) Total assistance Functional Assessment: Level of Difficulty - CORRECT ANSWER 1) No difficulty 2) Some difficulty 3) Unable to perform Goal of Care Delivery - CORRECT ANSWER 1) Maintain optimal independent function and prevent functional decline for health-related quality of life 2) Reduce risk 3) Early detection and screening 4) Management of functional activity impairment, involving multidisciplinary approach Reducing Risk - CORRECT ANSWER NB. Regular lifestyle interventions 1) Well-balanced nutrition 2) Regular physical activity 3) Routine health checkups (covered by medicare) 4) Stress managment 5) Regular participation in meaningful activity 6) Fall prevention measures 7) Avoidance of tobacco and other substances associated with abuse Functional Impairment: Interventions - CORRECT ANSWER 1) Multidisciplinary approach 2) Interventions depend on the underlying cause of impairment (eg. visual, mobility, cognitive, mental health, etc.) 3) Self-care assistance for BADLs and IADLs 4) Fall prevention 5) Exercise therapy 6) Teaching safe use of assistive devices Implementation of Nursing Care Plan (NCP): Nursing Role - CORRECT ANSWER 1) Considers information from physical, cognitive, social, psychological, and functional assessment of the patient 2) Considers patient ability for BADLs and IADLs 3) Works in collaboration with the patient to choose appropriate interventions 4) Evaluation! Regulations and Laws - CORRECT ANSWER 1) Standards of Care 2) Joint Commission (JC) 3) Social Security Amendments of 1965 4) HIPAA 5) OBRA = Federal Nursing Home Reform → protects resident rights, restraints, etc. Skilled Nursing Facilities (SNF)/LTC - CORRECT ANSWER 1) For residents who need some skilled services, usually after a hospital stay (prepare them to go home) 2) LTC facilities have services with OT, PT, etc. on site Continuing Care Retirement Communities - CORRECT ANSWER 1) Aging in place 2) Older adult enters very functionally independent 3) Should their functional ability change, they are moved into assisted living 4) Very expensive ~$68,000/year Assisted Living - CORRECT ANSWER 1) Assistance with ADLs 2) Eating in dining room with other residents 3) Have to have some level of competence 4) For individuals who have trouble with IADLs Residential Care/Rest Homes - CORRECT ANSWER 1) Getting a room and not much else assistance 2) May get some help with laundry but very limited oversight Adult Day Care - CORRECT ANSWER 1) Come into the home to provide assistance 2) Older adult can be dropped off while adult family member goes to work Stay in Own Home with support - CORRECT ANSWER 1) Most older adults will stay in their own home with support 2) Least expensive option Special Care Needs for Older Adults - CORRECT ANSWER 1) Functional ability (assistance with ADLs) 2) Cognitively impaired 3) Homebound 4) No longer able to live at home and/or homeless Risks Related to Hospitalization - CORRECT ANSWER 1) NB. WORST PLACE FOR AN OLDER ADULT 2) Adverse drug reactions 3) Changes in cognitive status = delirium, dementia, depression (3 D's) 4) Infection, immobility, incontinence 5) Skin breakdown 6) Sleep disorders 7) Problems with eating and feeding 8) Falls ACE unit - CORRECT ANSWER 1) Acute Care for Elderly 2) Nurses in this unit have specialties for caring for the elderly Long-term Care (LTC) - CORRECT ANSWER 1) Minimum data set (MDS) required for LTC admission 2) Staffing standards mandate that long-term care facility residents receive at least 4.13 hours of direct nursing care each day 3) Reality = 3.5 hours/resident/day LTC: Goals - CORRECT ANSWER 1) Preserve quality of life 2) Preserve dignity 3) Satisfaction of lifestyle preferences Restraints - CORRECT ANSWER 1) Physical = devices that inhibit movement 2) Chemical = antipsychotics, benzodiazepines, anti-anxiety → LAST RESORT, cannot use this to control behavior, restlessness, insomnia, yelling, or screaming 3) Use of restraints requires physician order 4) Strict parameters = initiation, evaluation, continuance, and documentation Home Care Services: Medicare Requirements - CORRECT ANSWER 1) Skilled care needed 2) Homebound 3) Unable or unwilling or have no one in the home available to provide care 4) Requires intermittent care 5) Nurse or physical therapist acts as case manager 6) Evaluation = on admission, change of status, prior to discharge Community-based Services - CORRECT ANSWER 1) Multipurpose senior centers 2) Adult Day Care Services 3) Respite Care 4) Homemaker services 5) Nutrition services 6) Transportation services 7) Telephone monitoring/friendly visitors 8) Personal emergency response systems 9) Home health care 10) Hospice Medicare - CORRECT ANSWER 1) Federally funded 2) Age years 65+, individuals with a disability, or end-stage renal failure 3) In order to benefit, must have paid in Medicare Part A - CORRECT ANSWER 1) In-patient, hospital care, skilled nursing facility, hospice, and home health Medicare Part B - CORRECT ANSWER 1) Partial out-patient visits, some preventative services 2) Have to pay an annual premium and deductible 3) Only pays 80%, but people can buy supplemental insurance Medicare Part C - CORRECT ANSWER 1) Medicare Advantage Plans Medicare Part D - CORRECT ANSWER 1) Prescription drug coverage 2) Doesn't cover the whole thing 3) "Donut hole" = lack in coverage after you hit your prescription coverage ceiling 4) Patients can lack the personal funds where they cannot afford meds that fall in the donut hole → will cut meds/doses in half in order to get by until covered again Medicaid - CORRECT ANSWER 1) For people living below the poverty line or disabled 2) State-administered and pulls from Federal funds Life Changes with Aging - CORRECT ANSWER 1) Retirement 2) Role change 3) Life review 4) Widowhood 5) Fixed income 6) Health changes Communication - CORRECT ANSWER 1) Ongoing, continuous, dynamic process that includes verbal and nonverbal signals Communication Barriers - CORRECT ANSWER 1) Fear of one's own aging 2) Fear of showing emotion or being around emotional patients 3) Feeling the need to write down every detail of the encounter 4) Lack of knowledge about the patient's culture, goals, and values 5) Unresolved issues with aging relatives in the nurse's own family 6) Feeling that professional distance must be maintained at all cost 7) Being overworked or overscheduled Patient and Family Teaching - CORRECT ANSWER 1) Older adults often underreport their symptoms 2) Rather than asking them if they are in pain, ask them in they are in any discomfort 3) Cascade of events for older adults → benign issue becomes worst issue Beneficence/nonmaleficence - CORRECT ANSWER To do good and not harm patients Justice - CORRECT ANSWER To be fair and distribute scarce resources equally to all in need Autonomy - CORRECT ANSWER To respect patients' needs for self-determination, freedom, and patient rights Veracity - CORRECT ANSWER 1) Truthfulness (within the confines of what the patient wants to know) Important Aspects of Ethical Decision Making - CORRECT ANSWER 1) Assessment 2) Relevant contextual factors 3) Capability of the patient to make decisions 4) Patient preferences 5) Needs of the patient as a person 6) Preferences of the family 7) Issues of power or conflict 8) Opportunity for all involved to speak and be heard Leading Causes of Death >65 yo - CORRECT ANSWER 1) Heart disease 2) Malignant neoplasms 3) Cerebrovascular 4) Bronchitis/emphysema/asthma 5) Diabetes mellitus 6) NB. people are living longer and are surviving chronic conditions Most Common Causes of Disability in the US - CORRECT ANSWER 1) Degenerative join disease 2) Chronic back pain 3) Atherosclerosis 4) Lung or respiratory problems 5) Deafness or hearing problems 6) Mental or emotional problems 7) **Diabetes mellitus 8) Blindness or vision problems 9) Stroke [Show Less]
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ANCC study guide: legal/ethical/policy 100 Questions with Verified Answers,100% CORRECT
ANCC study guide: legal/ethical/policy 100 Questions with Verified Answers what legal document governs the practice of a NP - CORRECT ANSWER the state... [Show More] nurse practice act What are the 4 ethical principles? (and define) - CORRECT ANSWER 1. beneficence (promoting well being for pt. and society) 2. nonmalefecience - "above all, do no harm" 2. autonomy (person acts intentionally after being given informed consent) 4. justice (equitable distribution of social benefits What is he difference between an ethical dilemma and an ethical conflict? - CORRECT ANSWER ethical dilemma = when asked to choose between two ethically legitimate alternatives (e.g. preserving pt. confidentiality or protecting endangered third parties) ethical conflict = involves the compromise of an ethical principle (usually bc of self interest like pt-therapist sexual relations) YES or NO if ethical below: a. sex with a family member of pt. b. discussing cases with spouse c. confidentiality must be maintained after death of pt. d. Psych provider can make determination of suicide as a result of mental illness for insurance purposes solely from reading the patients records e. Dating a pt. one year after discharge - CORRECT ANSWER a. NO (especially with child/ad) b. NO (even saying pt name is breach of confidentiality) c. YES (only exceptions are legally and protecting others from harm) d. YES (calles psychological autopsy) e. NO (1-2 years maybe.. currently "unethical") f. YES Describe what an assessment of environmental maintenance is? - CORRECT ANSWER assessing for risk of injury, violence, and possession of weapons biggest risk factor for a parent abusing a child? - CORRECT ANSWER past abuse of the parent A group of nursing students at Nurseslabs University is currently learning about family violence. Which of the following is true about the topic mentioned? a. Family violence affects every socioeconomic level. b. Family violence is caused by drugs and alcohol abuse. c. Family violence predominantly occurs in lower socioeconomic levels. d. Family violence rarely occurs during pregnancy. - CORRECT ANSWER a. Family violence affects every socioeconomic level. Family violence occurs in all socioeconomic levels, races, religions, and cultural groups. Although violence is associated with substance abuse, it is not the singular cause. The statement that the family violence predominantly occurs in lower socioeconomic levels is false. Abuse often occurs during pregnancy; about 23% of all pregnant women seeking prenatal care are victims of abuse. What describes reasonable and prudent practice for a NP? - CORRECT ANSWER - professional standards and scope of practice document What determines what is acceptable education prep for practice? - CORRECT ANSWER professional nursing organizations What determines the legal boundaries of practice? - CORRECT ANSWER state legislation statutes - specifically the Nurse Practice act. . REMEMBER!! determines LEGAL practice What grants legal authority for NP practice? - CORRECT ANSWER state legislative statutes (e.g. nurse practice act) What does the state practice act do? - CORRECT ANSWER - defines the scope of practice of NP - protects the title of NP - Has required educational components and certifications - determines collaborative agreement - what can be prescribe by nurse and physician oversight - places restrictions on practice - disciplines -NPA accompanies the Board of Nursing (created by state legislature) that develops further rules and regulations What is the umbrella term for the regulations of NPs? define it - CORRECT ANSWER credentialing - process used to protect the public by ensuring minimal level professional competency What is credentialing? - CORRECT ANSWER process used to protect the public that determines the minimum level of professional competency - it is the umbrella term for certification and licensure What is licensure - CORRECT ANSWER process by which an agency of the STATE grants permission to practice in the profession What is certification? - CORRECT ANSWER It is a NONGOVERNMENTAL body that is voluntary. - It gives out a credential (giving title protect) - determines scope - profesional nursing organization certifies someone to practice as a professional - The person meet preset standards showing a mastery of a specific body of knowledge (has the skills to function in that field) EXAMPLE: For psych NP's the ANCC is the ONLY certifying body What is the manual used to determine Scopes and Standards of Practice for Pscyh NP's - CORRECT ANSWER Psychiatric-Mental Health Nursing: Scopes and Standards of Practice What federal statute protects the confidentiality (right to assume that information given to the healthcare provider will not be disclosed) ? - CORRECT ANSWER The Medical Record Confidentiality Act of 1995 (pertaining to both verbal and written info) - also need medical authorization and consent form to release medical records and information when requested by client or another healthcare provider What 4 rights does HIPPA guarantee - CORRECT ANSWER Health Insurance Portability and Accountability Act 1. To be educated about HIPPA 2.. To have access to their own medical records 3. TO request amendment of their health information to which they object, and 4. To require permission for disclosure of their personal information What does the HITECH do? - health information technology for economic and clinical health act do? - CORRECT ANSWER - showed that EMR can improve outcomes (safety, quality, efficiency) - incentive payments for sharing EMR's meaningful use incentives When can confidentiality be broken? - CORRECT ANSWER - harm to self or others (duty to warn from Tarasoff principle) - giving information to insurance companies - ansering court orders, subpoenas, summons - information given to attorneys involved in litigation - meeting state requirements for mandatory reporting of disease and conditions - elder or child abuse what is fidelity - CORRECT ANSWER keeping with promise; being true and loyal What is the first code of ethics principle in the ANA - CORRECT ANSWER nurse practice with compassion and respect What is an ethical dilemma - CORRECT ANSWER issue when there are two "right or justifiable choices" one must choose between Describe a. teleological theory b. deontological theory c. virtue ethics - CORRECT ANSWER a. the ends justify the means. an action is judged good or bad based on the consequences/outcomes b. the action is not judged by outcomes but by the action itself c. do things based on moral virtues - compassion, honor, respect, wisdom, honesty, courage or the character of the person making the decision What does the Americans with Disabilities Act do? - CORRECT ANSWER it requires the business of 15 or more employees must not discriminate based on disability (like depression) against qualified persons in hiring, firing, advancement, job training, compensation, and workplace conditions - grants employment with equal basis to others without disability - employers re REQUIRED to make reasonable accommodations (e.g. can have job coach What is competency - CORRECT ANSWER a LEGAL, not a medical concept - a determination that a client can make reasonable judgements and decisions regarding treatment and other health concerns - court rules if a person incompetent What re the four element son negligence to prove malpractice - CORRECT ANSWER 1. Duty: Np should have given reasonable care for tx 2. Breech of Duty: NP violated standard of care of tx 3. Proximate Cause: Causal relationship between the breach and client's injuries 4. Damages: The client experiences permanent and substantial damages as a result What is case management a. define b. overall goal - CORRECT ANSWER a. a system of controlled OVERSIGHT and authorization of SERVICES and benefits provided to clients consisting of coordinating care, ensuring quality outcomes, monitoring plan of care, and doing advocacy b. Overall goal is to promote quality, cost effective outcomes What can be used when a client has severe mental disease and prevent relapse - CORRECT ANSWER durable power of attorney what percentage of homeless has a. substance use b. SCZ - CORRECT ANSWER a. 50% b. 15-45% hoe many migrants and farm workers are there? - CORRECT ANSWER 3 million what is most important when treating those in prisons? - CORRECT ANSWER self-reflection what does forensics do? specifically nurses - CORRECT ANSWER apply science to the knowledge of legal issues - makes relationship for investigation based on crime committed Which is an accurate statement regarding the formal evaluation of quality of care? a. Continuous quality improvement (CQI) programs focus on individual incidents. b. Health care regulatory agencies have not identified an effective means to measure quality. c. Hospitals do not receive payment for services if quality of care evaluations are not performed. d. The Joint Commission mandates that hospitals implement CQI programs - CORRECT ANSWER d. The Joint Commission mandates that hospitals implement CQI programs 20. While providing a history, a patient requests that an acute care nurse practitioner disclose the information gathered with no one but the patient's spouse. By respecting this request, the nurse practitioner demonstrates which component of a therapeutic relationship? a. Autonomy b. Beneficence c. Confidentiality d. Empathy - CORRECT ANSWER c confidentiality An adult nurse practitioner evaluates a patient who has been a victim of domestic violence. After the office visit, law enforcement authorities contact the nurse practitioner, requesting information regarding any visible injuries observed during the visit. The nurse practitioner's response is to: a. call the patient to obtain consent. b. provide the written record, as requested. c. refer the request to the office manager. d. require a court order for release. - CORRECT ANSWER b. provide the written record, as requested. An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply, after "spending down" to qualify? a. Medicaid b. Medicare c. The American Association of Retired Persons d.The United States Social Security Administration - CORRECT ANSWER Medicaid An adult-gerontology acute care nurse practitioner who specializes in cardiology is asked to give a presentation on lipid-lowering drugs. A major drug company that markets a lipid-lowering medication plans to pay the presenter an honorarium, but asks the nurse practitioner to limit his or her remarks to its drug. This situation presents a: breach of contract. conflict of interest. personal choice. reasonable request. - CORRECT ANSWER conflict of interest A hospital requires adult-gerontology acute care nurse practitioners to submit credentialing applications for the purpose of: - authorizing clinical roles and responsibilities. - delineating therapeutic and diagnostic services. - monitoring the nurse practitioner's clinical activities. - verifying education, licensure, and experience. - CORRECT ANSWER - verifying education, licensure, and experience. What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number? a. The Affordable Care Act b. The Balanced Budget Act c. The Civilian Health and Medical Program of the Uniformed Services d. The Omnibus Budget and Reconciliation Act - CORRECT ANSWER balanced budget act (bc they were able to reimburse less to NP's and thus save money for the budget of the US) the adult-gerontology primary care nurse practitioner treats several patients for biological exposure. In the patients' records, the nurse practitioner documents which epidemiological factors for each exposure? Comorbidities and length of exposure. Location and event intensity. Mode of transmission and incubation. Premorbid conditions and surveillance rates. - CORRECT ANSWER Mode of transmission and incubation. 7. When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary care nurse practitioner: concludes that the study proves the hypothesis. excludes the discussion section, because the conclusion contains this information. recommends incorporating the results directly into clinical practice. uses the methodology section to support the validity of the study. - CORRECT ANSWER uses the methodology section to support the validity of the study. A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner: a. asks the child to provide a copy of the patient's advance directive document. b. assures the child that the nurse practitioner can disclose requested information. c. informs the child that he or she must come to the clinic to discuss the parent's case. d. tells the child that the nurse practitioner can discuss the information only with the patient. - CORRECT ANSWER tells the child that the nurse practitioner can discuss the information only with the patient. The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to: evaluate standards, risks, benefits, and outcomes. identify how to anticipate and resolve similar future situations. investigate the need for disciplinary action. obtain agreement of all parties with a chosen solution. - CORRECT ANSWER evaluate standards, risks, benefits, and outcomes. To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner: A. charges a fee for patients who arrive late to clinic appointments. B. disseminates research study results to colleagues. C. expresses opinions about alternative therapies with patients who consider such treatments. D. schedules time during clinic hours to meet with pharmaceutical representatives. - CORRECT ANSWER disseminates research study results to colleagues. are cohort or case studies higher level of evidence? - CORRECT ANSWER cohort A patient who sustained a myocardial infarction comes to the clinic for a refill of atorvastatin (Lipitor). The family nurse practitioner explains that the medication is prescribed for: cancer prevention. primary prevention. secondary prevention. tertiary prevention. - CORRECT ANSWER tertiary prevention. what is tertiary prevention - CORRECT ANSWER Tertiary prevention generally consists of the prevention of disease progression and attendant suffering after it is clinically obvious and a diagnosis established. This activity also includes the rehabilitation of disabling conditions. Examples include eliminating offending allergens from asthmatic patients; routine screening for and management of early renal, eye, and foot problems among diabetics; and preventing reoccurrence of heart attack with anticlotting medications and physical modalities to regain function among stroke patients A 42-year-old patient with epistaxis, dilated pupils, tachycardia, and mild euphoria shows symptoms associated with the use of: benzodiazepine (Alprazolam). cocaine. morphine (MS Contin). oxycodone (OxyContin). - CORRECT ANSWER coaine Which symptom requires immediate medical attention for a 16-year-old female patient who recently started using oral contraceptives? Increasing breast tenderness. Increasing emotional lability. Spotting between periods. Worsening headaches. - CORRECT ANSWER Worsening headaches. The pediatric primary care nurse practitioner obtains a sexual history from a 15-year-old female patient. The patient reports that her boyfriend has recently been pressuring her to agree to engage in sexual intercourse. The nurse practitioner: explains the risks of having unprotected sexual intercourse. explores the patient's feelings about consenting to sexual intercourse. offers the patient oral or transdermal birth control medications. performs a gynecologic examination to obtain a baseline Pap test. - CORRECT ANSWER explores the patient's feelings about consenting to sexual intercourse. . In reacting to parental divorce, a child between the ages of 9 and 12 differs from a younger child in his or her: a. acceptance of the family's dissolution. b. experience of grief and intense anger. c. positive reaction to the departure of a parent. d. tendency toward emotional decompensation. - CORRECT ANSWER b. experience of grief and intense anger. Evidence-based practice in clinical management is grounded in: clinical practice guidelines. cohort studies. expert opinions. systematic reviews. - CORRECT ANSWER systematic reviews. Statements that define the core knowledge of a pediatric primary care nurse practitioner's care are contained within the professional: accreditation standards. certification requirements. licensure application. scope of practice. - CORRECT ANSWER scope of practice. When does the pediatric primary care nurse practitioner administer the first hepatitis B immunization to an infant born to a mother with an unknown hepatitis B status? Within 12 hours of birth. At two weeks of age. At one month of age. At two months of age. - CORRECT ANSWER Within 12 hours of birth. Which behavior reflects existentially oriented therapy? Attempting to understand a patient's subjective world Challenging a patient's irrational beliefs Developing specific plans for change Establishing general group goals - CORRECT ANSWER Attempting to understand a patient's subjective world Which statement by a male patient who has posttraumatic stress disorder (PTSD) and chronic persistent suicidal ideation indicates a need for hospital assessment? "I feel so bad all the time. I wish I were dead." "My wife is so scared that she has taken all my guns out of the house." "My wife just left with the children. I have no one left and no future." "Those medications you gave me make me feel worse. I stopped taking them." - CORRECT ANSWER "My wife is so scared that she has taken all my guns out of the house." According to current clinical guidelines for treating a patient with bipolar I disorder mania with psychotic features, an adult psychiatric and mental health nurse practitioner prescribes: alprazolam (Xanax). citalopram (Celexa). lamotrigine (Lamictal). quetiapine (Seroquel). - CORRECT ANSWER quetiapine (Seroquel). Which nonpharmacologic treatment modality is recommended for depression? Biofeedback Dialectical behavioral therapy Eye movement desensitization and reprocessing therapy Supportive group therapy - CORRECT ANSWER Supportive group therapy The psychiatric-mental health nurse practitioner is responsible for initiating quality improvement at a community mental health clinic. The effective strategy for evaluating the clinic's services is to: - analyze the data from epidemiological studies. - conduct a root cause analysis. - interview patient families. - use a survey to elicit patient satisfaction responses. - CORRECT ANSWER - use a survey to elicit patient satisfaction responses. The psychiatric-mental health nurse practitioner is employed in a newly created attending role on a psychiatric inpatient unit. To promote an interprofessional environment, the nurse practitioner: - discusses the resistance directly with the physicians. - assigns a role for all staff members in improving patient outcomes. - educates staff members on the role of a psychiatric-mental health nurse practitioner. - works with the nurse manager to organize all levels of nursing staff. - CORRECT ANSWER - assigns a role for all staff members in improving patient outcomes. What are the components of negligence that proves malpractice? - CORRECT ANSWER 1. Duty 2. Breech of Duty - deviates from standard of practice 3. Direct/Proximate Cause - deviation directly caused outcome 4. Damages What are the 5 elements of informed consent - CORRECT ANSWER 1. Informing of diagnosis 2. Explaining risks/beenfits of treatment 3. Explaining risks and benefits of NOT having treatment 4. Alternate treatments 5. Prognosis/consequences What is managed care - CORRECT ANSWER a system is which the insurer is not only the payer but also the provider of health care (insurers monitor costs and will only pay for certain things) - incentivizes everyone to provide quality in care what two components are a part of the advanced directive and define - CORRECT ANSWER living will (designates preferences for care if patient becomes incompetent or terminally ill; specific instructions) durable power of attorney (healthcare proxy that selects and= agent to act of behalf of person should he or she become unable to make their own healthcare decisions. it also covers finances) What is health production function - CORRECT ANSWER a mathematical expression that shows the relationship between a persons health and a number of other factors including the amount of health care consumed define health care system - CORRECT ANSWER organizational and institutional structures through which an economy makes choices regarding production, consumption, and distribution of medical services define health alliance - CORRECT ANSWER public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market whats the difference between grassroots lobbying and special interest group - CORRECT ANSWER special interest group is a collection of individuals who coordinate lobbying efforts around a common interest and seek to influence policy makers grassroots lobbying occurs when non paid individuals contact their legislatures to influence policy what is a caucas - CORRECT ANSWER congress members or political party that comes together to support a defined political ideology outcomes management uses variance data to change a system of health care practice. All of the following are sources of variance except: a. patient survey b. practitioner competency c. severity of patient illness d. practice patterns of care delivery - CORRECT ANSWER a. patient survey outcomes management is the use of variance data to change system of health care practice. VARIANCE IS ANY EVENT THAT ALTERS PATIENT PROGRESS TOWARD THEIR EXPECTED OUTCOMES. Sources of variance include practitioner behavior (competency), severity of illness (with high risk), and practice patterns that inhibit or expedite care What are some of the roles of the FDA? - CORRECT ANSWER regulates the intro of new drugs tot he US, protects consumers from the risks associated with drug purchases, approve new drugs before they can be sole, determine which drugs can be OTC or prescription status they DO NOT accept or deny new drug patents what is an insurance "benefit" vs a claim vs pre approval vs denying - CORRECT ANSWER benefit = the amount the insurance pays when the insured suffers a loss claim = request o insurance company to pay benefits for a loss pre-approval = insurance will approve certain claim before it is provided denying a claim = insurance company does not pay a bill bc certain required conditions were not met what is nursing informatics - CORRECT ANSWER integration of nursing knowledge with info processing and communication technology to support health crossing the quality chasm a. who wrote it b what issues contribute to bad quality care c. main point d. six goals of quality care - CORRECT ANSWER a. institute of medicine b. - complexity of knowledge, skills, interventions - increase in chronic conditions - insufficient and disorganized healthcare system - challenge to implement info technology c healthcare professional need to COLLABORATE d. safe, effective, efficient, patient-centered, timely, equitable What is it called when medicare enrollees can purchase private insurance to cover additional medical expenses not covered by medicare? - CORRECT ANSWER medicare + choice Part C 2010 future of nursing:leading change, advancing health a. writer b. what it said - CORRECT ANSWER a. IOM b. nurses should practice to full extent of knowledge, seek higher levels of education, full/equal partners to docs,improved information infrastructure needed what have managed care organizations done to reduce costs - CORRECT ANSWER - enroll employees by offering premiums LESS than traditional insurers - decrease ER visits - decrease # hospital stays - decrease LOS at hospitals - bargain with medical practices for reduced rates on visits of organizations iddim't adopt meaningful use by 2015 what penalty was faced? - CORRECT ANSWER reduced medicare reimbursement rates What are some of the system organization of healtcare - CORRECT ANSWER microsystem = direct pt. care ( macrosystem = hospital, skilled nursing facility megasystem = american healthcare system metasystem = something at societal level of economy, political, social (e.g. global economy) who is eligible for medicaid? - CORRECT ANSWER low income children, low income pregnant women, elderly and disabled that qualify for supplemental security income program who is eligible for medicare? - CORRECT ANSWER elderly over the age of 65 who have worked 40 quarters and paid medicare taxes certain you're ppl with disabilities ppl with end stage renal disease ppl who need a kidney transplant individuals receiving social security disability who have amyotrophic later sclerosis Explain the different parts of Medicare - CORRECT ANSWER Part A = hospitalizations (up to 90 days), skilled nursing facility (up to 100 days), hospice (up to 6 months), some home healthcare Part B = Ambulatory practitioner service, physical, occupational, speech therapy, medical equipment, diagnostic tests, preventative care Part C = OPTIONAL coverage for beneficiaries who can choose to receive all of their health care services through one of the provider organizations covered under the medicare advantage plan Part D = OPTIONAL coverage for outpatient pharmaceuticals to establish a living will one must: - CORRECT ANSWER comprehend the act of wrong and signing the will know the potential heirs understand the extent of ones assets han no undue influence absence of delusions compromising rational thought what are the covered tests within medicare part b - CORRECT ANSWER pap smears, mamagromas, screening for colorectal cancer, prostate cancer, screening for CV dz, screening for diabetes, glaucoma screening, influenza vaccines, PNA vaccines LIVER AND SKIN CANCER NOT COVERED when can you have romantic relationship with client? - CORRECT ANSWER NEVER!! minimum level of professional competence is called - CORRECT ANSWER credentialing what is translational research? - CORRECT ANSWER hows studies can best be translated into practice what act incentivizes physicians to find drugs for rare diseases? - CORRECT ANSWER orphan drug act what rule prohibits NPs from discussing alternative treatments not covered by the managed care organization? - CORRECT ANSWER gag rule what law says that patients can refuse treatment but a guardian may authorize treatment? - CORRECT ANSWER Roger vs Oken for an act to be consider criminal it has to have actus reus and mens rea - CORRECT ANSWER actus = voluntary conduct mens= evil intent describe the differences of: a. conflict resolution b. negotiation c. mediation d. professional civility - CORRECT ANSWER a. 2 or more parties come together to find a peaceful solution to a disagreement (negotiation or mediation is a way of getting conflict resolution done) b. searching for an agreement that satisfies both parties c. uses a trained, impartial third party to help reach consensus on substantive issues at disagreement (usually employed later on than negotiation..) - helps people to see each others perspective d. treating others with respect and dignity what is transformational leadership? - CORRECT ANSWER leader and follower find purpose and meaning because of the growth of their relationship Foundation of leadership - CORRECT ANSWER trust describe kurt lewis's theory of change - CORRECT ANSWER unfreezing = challenging the status quo to make sure ppl are ready for change change freezing = solidifying the change what is complexity science? - CORRECT ANSWER things are interconnected not linearly but holistically - focuses on the connections that can make the changes what are some the steps for change? - CORRECT ANSWER Unfreezing - need widespread discussion serve on inter professional team team has vision and identifies forces implements change evaluates outcomes Freezing do you want people on an interporfessional team to have distinct roles or similar roles? - CORRECT ANSWER DISTINCT [Show Less]
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ACNP BOARD REVIEW Exam 39 Questions with Verified Answers,100% CORRECT
ACNP BOARD REVIEW Exam 39 Questions with Verified Answers To improve the health of a population, an acute care nurse practitioner's intervention is to... [Show More] : -join a professional nursing organization and run for an organizational office. -maintain current certification as an acute care nurse practitioner. -participate in hospital grand rounds. -report any unusual pattern of infections to the local health department. - CORRECT ANSWER report any unusual pattern of infections to the local health department. A patient, who is allergic to penicillin, requires antibiotic treatment for community-acquired pneumonia. The patient has a limited income, lacks health insurance, and is about to be discharged from the hospital. An acute care nurse practitioner's intervention is to: -consult social services for assistance. -order an aerosol antibiotic. -transfer the patient to an extended care facility. -write a prescription for an antibiotic. - CORRECT ANSWER consult social services for assistance. A patient is scheduled for elective orthopedic surgery. During the preadmission physical examination, the acute care nurse practitioner detects an asymptomatic pulsatile mass in the middle upper abdomen. The nurse practitioner's most appropriate action is to: obtain a kidney-urethra-bladder x-ray. obtain a renal arteriogram. obtain an abdominal ultrasound. proceed with the patient's elective surgery. - CORRECT ANSWER obtain an abdominal ultrasound. Abdominal Aortic aneurysm Which musculoskeletal disease primarily involves the distal joints, hips, knees, and spine, and is characterized by the development of Heberden and Bouchard nodes? Gout Osteoarthritis Osteoporosis Rheumatoid arthritis - CORRECT ANSWER Osteoarthritis Heberden: distal phalanges Bouchard: proximal phalanges Difference between OA and RA: Heberden and Bouchard nodes are often seen in digits, they are bony round growth near the joints, while rheumatoid nodules are more common with arms and elbows underneath the skin, people with RA later develop curving and bending of fingers. An acute care nurse practitioner is deciding whether to recommend a long-term medication regimen that will help a patient manage disease symptoms but may also introduce problematic side effects. This decision reflects which ethical principle? Autonomy Beneficence Fidelity Justice - CORRECT ANSWER beneficence A patient, who has been in the intensive care unit for 17 days, develops hypernatremic hyperosmolality. The patient weighs 132 lb (59.9 kg), is intubated, and is receiving mechanical ventilation. The serum osmolality is 320 mOsm/L kg H2O. Clinical signs include tachycardia and hypotension. An acute care nurse practitioner's initial treatment is to: reduce serum osmolality by infusing a 5% dextrose in 0.2% sodium chloride solution. reduce serum sodium concentration by infusing a 0.45% sodium chloride solution. replenish volume by infusing a 0.9% sodium chloride solution. replenish volume by infusing a 5% dextrose in water solution. - CORRECT ANSWER replenish volume by infusing a 0.9% sodium chloride solution. priority is to replenish the volume and the fix the osmolality A 78-year-old male patient with heart failure develops a bacterial urinary tract infection secondary to an indwelling Foley catheter. The patient has a known history of allergy to penicillin and sulfonamides. The appropriate choice for antimicrobial therapy is: cephalexin (Keflex). ciprofloxacin (Cipro). doxycycline (Vibramycin). tetracycline (Sumycin). - CORRECT ANSWER ciprofloxacin (Cipro) Cephalosporin (ceph) are "cousins" with penicillin (cross-allergy). Tetracyclines can cause severe side effects and are not recommended for elderly. An acute care nurse practitioner is evaluating a 78-year-old patient for an aortic valve replacement. Laboratory results indicate a low serum albumin level. The nurse practitioner prescribes a high-protein diet and evaluates the patient's response by: assessing the total serum protein level. calculating the body fat percentage. obtaining a complete blood count. obtaining a serum prealbumin level. - CORRECT ANSWER obtaining a serum prealbumin level. Albumin is relatively insensitive to change of nutritional status. Our body has a large pool of albumin and it could take up to 14 days for albumin to come back to normal once the pool is depleted. Albumin level could also be affected by one's renal function and hydration state. Prealbumin is one of the earliest indicator for nutritional status now. Normal level 16-35 mg/dL A 42-year-old patient with metastatic lung cancer is admitted with severe intractable pain related to a pathologic fracture of the left femur. The plan is to stabilize the fracture surgically, and begin local radiation therapy to the site. For this patient, the most appropriate analgesic regimen is: -fentanyl (Duragesic) transdermal system applied every 72 hours. -meperidine (Demerol) 50 mg intramuscularly every three hours around the clock. -morphine sulfate (Avinza) IV via a patient-controlled analgesia pump with a basal rate. -oxycodone/acetaminophen (Percocet) orally every six hours around the clock. - CORRECT ANSWER morphine sulfate (Avinza) IV via a patient-controlled analgesia pump with a basal rate. A female patient is receiving adjuvant chemotherapy for breast cancer and has been given information about her treatment regimen, expected side effects, and symptom management. Which symptom, if occurring two weeks after treatment, warrants a prompt call to the acute care nurse practitioner? Alopecia Fatigue Fever Nausea - CORRECT ANSWER fever - infection A patient with hydrocephalus secondary to a subarachnoid hemorrhage has developed an intracranial pressure of 25 mm Hg. The acute care nurse practitioner's intervention is to: -hyperventilate to reach a PCO2 of 30 mm Hg. -order dexamethasone (Decadron) 4 mg IV. -perform a ventriculostomy and drainage of cerebrospinal fluid. -prescribe mannitol (Osmitrol) 100 g IV. - CORRECT ANSWER perform a ventriculostomy and drainage of cerebrospinal fluid. Usual treatment are: mannitol and sedatives, surgery due to acute elevation of ICP, surgery is preferred. Which medication is used with caution in older adults due to the potential for confusion and delirium? Fluoxetine (Prozac) Haloperidol (Haldol) Lorazepam (Ativan) Phenelzine (Nardil) - CORRECT ANSWER Lorazepam (Ativan) A 45-year-old patient, who is on mechanical ventilatory support in the intensive care unit, is receiving a neuromuscular blockade for respiratory control related to acute respiratory failure. To prevent keratoconjunctivitis sicca, the acute care nurse practitioner prescribes: artificial tears preparations. IV antibiotic administration. local sulfonamide therapy. topical steroid administration. - CORRECT ANSWER artificial tears preparations After undergoing a successful autologous bone marrow transplant for multiple myeloma, a 55-year-old male patient comes to the clinic for his followup appointment. The patient reports that a skin lesion has changed in appearance. The acute care nurse practitioner responds by: -consulting dermatology to evaluate the lesion. -inspecting and excising the lesion. -prescribing a topical steroid preparation. -recommending reevaluation in two weeks - CORRECT ANSWER consulting dermatology to evaluate the lesion. An 83-year-old patient arrives in the emergency department in severe respiratory distress. The patient verbalizes a desire not to be intubated nor to have cardiopulmonary resuscitation performed. The patient states that a neighbor has a copy of the patient's recently signed living will. The acute care nurse practitioner leaves the bedside momentarily and returns to find the physician preparing to intubate. The nurse practitioner's initial action is to: -assist the physician with intubation. -call the patient's neighbor to deliver a copy of the living will. -locate a previous patient record to find a copy of the living will. -notify the physician of the conversation with the patient. - CORRECT ANSWER notify the physician of the conversation with the patient. let them make the decision A 24-year-old male patient with a closed head injury has been intubated for 12 days. The patient's parents have repeatedly refused consent for a tracheostomy and long-term care placement. On multiple occasions, the surgeon has discussed the risks and benefits of the surgery with them. Addressing the parents, the acute care nurse practitioner states: "I understand you have reservations about the placement of a tracheostomy." "Please know that not many patients die while undergoing a tracheostomy." "Without a tracheostomy, we can't transfer your son to another facility." "You know, your son will die if a tracheostomy is not placed." - CORRECT ANSWER "I understand you have reservations about the placement of a tracheostomy." Before initiating a new antihypertensive drug therapy, an acute care nurse practitioner uses which evidence-based practice approach? Discussing the medication choices with a collaborating physician Discussing the medication's side effects with a colleague Reviewing the confidence intervals of related research Reviewing the institutional formulary - CORRECT ANSWER Reviewing the confidence intervals of related research During a clinic appointment, an acute care nurse practitioner sees a 56-year-old male patient with a history of hypertension, metabolic syndrome, and hyperlipidemia. A review of the patient's symptoms reveals nocturia, occasional heartburn, and transient rhinitis. The patient asks about the appropriate interval of certain screening tests for someone his age. The nurse practitioner responds that a: digital prostate examination should be performed monthly. prostate-specific antigen should be performed annually. sigmoidoscopy should be performed every 10 years. testicular examination should be performed every two years. - CORRECT ANSWER prostate-specific antigen should be performed annually. digital prostate exam: every 4 years sigmoidoscopy: every 5 years testicular exam: every month Which is an accurate statement regarding the formal evaluation of quality of care? -Continuous quality improvement (CQI) programs focus on individual incidents. -Health care regulatory agencies have not identified an effective means to measure quality. -Hospitals do not receive payment for services if quality of care evaluations are not performed. -The Joint Commission mandates that hospitals implement CQI programs. - CORRECT ANSWER The Joint Commission mandates that hospitals implement CQI programs. While providing a history, a patient requests that an acute care nurse practitioner disclose the information gathered with no one but the patient's spouse. By respecting this request, the nurse practitioner demonstrates which component of a therapeutic relationship? Autonomy Beneficence Confidentiality Empathy - CORRECT ANSWER Confidentiality A 57-year-old male patient arrives at the emergency department with substernal chest pain. An electrocardiogram reveals ST segment depression in leads V3 and V4. Before administering nitrates, an acute care nurse practitioner assesses the patient's use of: angiotensin-converting enzyme inhibitors. aspirin. beta-blockers. phosphodiesterase inhibitors. - CORRECT ANSWER phosphodiesterase inhibitors PDE 5 is for ED, and it could interact with nitrates to further vasodilate causing severe hypotension and death. For an 84-year-old patient who undergoes surgery, the most accurate predictor of mortality and patient outcome is: a low score on a Mini-Mental State Examination. an impaired functional status. the availability of social support. the patient's chronological age. - CORRECT ANSWER an impaired functional status. An acute care nurse practitioner performs a cardiac assessment on a patient with a confirmed mitral valve prolapse. During which activity does the nurse practitioner expect the patient's murmur to diminish? Inhaling Sitting Squatting Standing - CORRECT ANSWER squatting increases peripheral vascular resistance and preload as there are more blood flows through the valve. Squatting decreases the murmur in hypertrophic cardiomyopathy (HCM) and mitral valve prolapse (MVP) A 21-year-old patient is admitted to the intensive care unit with a severe closed head injury. The patient's family is becoming louder and more insistent about seeing the patient. To establish a therapeutic relationship with the family, an acute care nurse practitioner's initial action is to: -acknowledge the family's anxiety. -arrange for a meeting with a social worker. -escort the family to a conference room. -gently direct the family to maintain composure. - CORRECT ANSWER acknowledge the family's anxiety. An acute care nurse practitioner is called to the medical intensive care unit to evaluate a patient who is intubated for mechanical ventilation. The patient's arterial blood gas results are: pH-7.35; PCO2-44 mm Hg; HCO3-22 mEq/L; and PO2-52 mm Hg. The current ventilator settings are: Assist control; Respiratory rate-14 breaths/min; Tidal volume (TV)-400 mL; Fraction of inspired O2-100%; and positive-end expiratory pressure (PEEP)-5 cm H2O. The nurse practitioner's next action is to increase the: -peak pressure alarm to 40 mm Hg. -PEEP to 10 cm H2O. -respiratory rate to 18 breaths/min. -TV to 500 mL. - CORRECT ANSWER The right answer was PEEP to 10 cm H2O. Lung is not adequately ventilated leading to hypoxia. 1. In the early stages of iron deficient anemias, blood studies show: macrocytic normochromic. microcytic hypochromic. normochromic normocytic. pancytopenic hypocytic. - CORRECT ANSWER normochromic normocytic. 3. A patient has hyperactive reflexes of the lower extremities. The adult-gerontology primary care nurse practitioner assesses for ankle clonus by: firmly applying a low-pitched tuning fork to the lateral malleolus. flexing the leg at the knee, rotating it externally, and striking the Achilles tendon with the percussion hammer. sharply dorsiflexing the foot and maintaining this position while supporting the knee. stroking the lateral aspect of the sole from the heel to the ball of the foot with the sharp end of the percussion hammer. - CORRECT ANSWER sharply dorsiflexing the foot and maintaining this position while supporting the knee. 5. The adult-gerontology primary care nurse practitioner reminds a 16-year-old, male patient who just received his driver's license to wear a seat belt at all times when in a car. The patient replies that he does not need to wear a seat belt, because nothing will happen to him if he is involved in an automobile collision. According to the health belief model, what chief component does the patient lack? Enabling factors. Motivation. Perceived role conflict. Perceived severity. - CORRECT ANSWER Perceived severity. 7. When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary care nurse practitioner: -concludes that the study proves the hypothesis. -excludes the discussion section, because the conclusion contains this information. recommends incorporating the results -directly into clinical practice. -uses the methodology section to support the validity of the study. - CORRECT ANSWER uses the methodology section to support the validity of the study. 12. The adult-gerontology primary care nurse practitioner evaluates an 80-year-old patient with cognitive deficits, who is unaccompanied by the adult child who typically is present. The patient has urinary symptoms, for which the nurse practitioner considers ordering sulfamethoxazole-trimethoprim (Bactrim). The patient's previous medical record is unavailable. Before prescribing the medication, the nurse practitioner: contacts the patient's adult child. queries the other staff members. relies on the patient's self-report. waits until the patient's chart is available. - CORRECT ANSWER contacts the patient's adult child. 21. A 68-year-old patient has sustained an unintended weight loss of 15 lb (6.8 kg) over the last two months but reports feeling well. The patient's problems include depression, tobacco abuse, obesity, and dyslipidemia. His or her medications are sertralizine (Zoloft), simvastatin (Zocor), and famotidine (Pepcid). The adult-gerontology primary care nurse practitioner performs which three actions? Adds a probiotic. Conducts a depression screening. Decreases the dosage of the statin medication. Obtains a chest x-ray. Orders a thyroid-stimulating hormone. - CORRECT ANSWER Conducts a depression screening. Obtains a chest x-ray. Orders a thyroid-stimulating hormone. 23. The adult-gerontology primary care nurse practitioner conducts a research study to evaluate a new method for non-pharmaceutical pain control. After making a statistically significant finding, the nurse practitioner informs and consults his or her research colleagues. The nurse practitioner's next action is to: critique and determine the applicability of these research findings to practice. incorporate the information gleaned from the research findings into patient care. offer the research findings as a treatment option to future patients. publish the information in a widely read journal on pain management. - CORRECT ANSWER was critique and determine the applicability of these research findings to practice 19. A 30-year-old, female patient has a two-week history of nausea, vomiting, decreased weight, abdominal pain, and a long-term history of multiple sexual partners. The patient's physical examination reveals abdominal tenderness with icteric sclerae and skin. Which laboratory test confirms active hepatitis B? Antibody. Enzyme-linked immunosorbent assay. Immune globulin G. Surface antigen. - CORRECT ANSWER Surface antigen. 16. An 84-year-old patient arrives at the office for an initial visit. The patient questions the need for colorectal screening, since 10 years have passed since the last colonoscopy. The adult-gerontology primary care nurse practitioner recommends: a colonoscopy. a fecal DNA test. flexible sigmoidoscopy. watchful waiting. - CORRECT ANSWER watchful waiting. 15. The adult-gerontology primary care nurse practitioner plans to provide smoking cessation education at a community center to older adults and their families. The nurse practitioner designs the program based on knowledge that older adult smokers: are likely to be optimistic about their ability to quit. are more likely to be successful at quitting than younger smokers. have a decreased risk of morbidity and mortality than do younger smokers. receive more instruction to quit from health care providers than younger smokers. - CORRECT ANSWER are more likely to be successful at quitting than younger smokers. 14. The adult-gerontology primary care nurse practitioner evaluates a patient with cold symptoms who reports smoking half a pack of cigarettes a day and shows no interest in quitting. The nurse practitioner's most appropriate approach is to treat the cold symptoms and: advise the patient to stop smoking. prescribe bupropion (Zyban). raise the issue of smoking cessation at the next visit. recommend that the patient select a low nicotine cigarette. - CORRECT ANSWER advise the patient to stop smoking. prescribe bupropion (Zyban). 13. The adult-gerontology primary care nurse practitioner conducts a small group class on weight management. The nurse practitioner anticipates that the patient who may have the greatest difficulty implementing the counseling is the: extroverted patient raising his or her grandchildren. introverted patient who does not speak in the group. personable patient who lives with his or her children. worried patient whose son is serving in military conflict. - CORRECT ANSWER worried patient whose son is serving in military conflict. 10. To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner: charges a fee for patients who arrive late to clinic appointments. disseminates research study results to colleagues. expresses opinions about alternative therapies with patients who consider such treatments. schedules time during clinic hours to meet with pharmaceutical representatives. - CORRECT ANSWER disseminates research study results to colleagues. 6. The adult-gerontology primary care nurse practitioner treats several patients for biological exposure. In the patients' records, the nurse practitioner documents which epidemiological factors for each exposure? Comorbidities and length of exposure. Location and event intensity. Mode of transmission and incubation. Premorbid conditions and surveillance rates. - CORRECT ANSWER Mode of transmission and incubation. [Show Less]
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Nursing 418 exam 1|35 Questions with Verified Answers,100% CORRECT
Nursing 418 exam 1|35 Questions with Verified Answers Critical care units - CORRECT ANSWER Designed to meet the special needs of acutely and criticall... [Show More] y ill patients minimum of every 2 hours - CORRECT ANSWER how often are assessments and vital signs done in the CCU? Critical care nursing - CORRECT ANSWER Specialty dealing with human responses to life-threatening problems - AACN definition CCRN - CORRECT ANSWER Adult, pediatric, or neonatal critical care certification CCRN-K (knowledge) - CORRECT ANSWER for adult pediatric and neonatal critical care nurses who do not provide direct care but whose specialized knowledge influences the care delivered to the acute and critically ill patients PCCN - CORRECT ANSWER progressive care certification CCRN-E - CORRECT ANSWER tele ICU certification 1. CMC 2. CSC - CORRECT ANSWER 1. cardiac medicine certification 2. cardiac surgery certification clinical nurse specialist - CORRECT ANSWER Provides advanced nursing care to meet the needs of adult gerontology, pediatric, or neonatal patient populations acute care nurse practitioner - CORRECT ANSWER Comprehensive assessments, orders, and interprets diagnostic test, manages health problems and disease-related symptoms, prescribes treatments, and coordinates care during transitions in settings delirium - CORRECT ANSWER alterations in: - mentation (delusions, short attention span, loss of recent memory) - psychomotor behavior (restlessness, lethargy) - sleep-wake cycle (e.g., daytime sleepiness, nighttime agitation) preexisting dementia hx of baseline hypertension or alcohol abuse severe illness on admission sleep deprivation annxiety hemodynamic instability hypoxemia hypercarbia electrolyte disturbances drugs - sedatives, analgesics, antimicrobials - CORRECT ANSWER delirium risk factors: dementia - CORRECT ANSWER Slow, progressive, irreversible loss of intellectual or cognitive abilities like abstract thinking, reasoning delirium - CORRECT ANSWER patients with dementia are high risk for developing _______ confusion assessment method (CAM) confusion assessment method ICU (CAM-ICU) intensive care delirium screening checklist (ICDSC) - CORRECT ANSWER assessment/diagnosis of delirium (3) D - Dementia, dehydration E - Electrolyte imbalances, emotional stress L - Lung, liver, heart, kidney, brain I - infection, intensive care unit R - rx drugs I - injury U - untreated pain, unfamiliar environment M - metabolic disorders - CORRECT ANSWER mnemonic for causes of delirium: Dexmedetomidine Low-dose antipsychotics (Haloperidol, Risperidone, Olanzapine, Quetiapine) Short acting benzodiazepines - CORRECT ANSWER drug therapy for delirium ICU setting only for agitation associated w/ delirium - CORRECT ANSWER when is dexmedetomidine used? when delirium is associated w/ sedative and alcohol withdrawal or in conjunction w/ antipsychotics to reduce extrapyramidal side effects - CORRECT ANSWER when are short acting benzodiazepines used in r/t delirium? albumin, BUN, glucose, electrolytes - CORRECT ANSWER labs to monitor for nutrition (4) infection (UTIs, electrolyte imbalances) dementia - CORRECT ANSWER Critically Ill Elderly Symptoms atypical Confusion may be sign of ______ Depression often misdiagnosed as ________ RRT - CORRECT ANSWER Bring rapid and immediate care to an unstable patient in noncritical settings prevent patient from coding - CORRECT ANSWER purpose of RRT Critical care RN Critical care physician Advanced practice RN (APRN) Respiratory therapist - CORRECT ANSWER RRT members RR: <8 or >28 O2 Sat: <90% Threatened airway - CORRECT ANSWER RRT triggers: Respiratory RR: ____ or ___ O2 sat: _____ Threatened ______ <90 Increase, >110 <50 or >120 Chest pain - CORRECT ANSWER RRT triggers: Cardiovascular Acute change in systolic BP to _____ Acute sustained ________ in diastolic BP to _______ Acute change in HR to _____ or ______ Onset of ________ Acutely cold, pulseless, or cyanotic extremity Arouse Speaking or swallowing Pupillary - CORRECT ANSWER RRT triggers: Neurological Confusion, agitation, delirium Unexplained difficulty to ______ Difficulty ______ or ______ Changes in ________ responses Seizure 30-45 Sedation Extubate Peptic ulcer DVT - CORRECT ANSWER Ventilator Bundle (VAP) HOB up ______ degrees Take breaks from _____ Daily readiness to _______ ________ prophylaxis ________ prophylaxis ventilator bundle - CORRECT ANSWER VAP bundle central line - CORRECT ANSWER CLABSI bundle Urinary catheter - CORRECT ANSWER CAUTI bundle ABCDE bundle - CORRECT ANSWER Bundle to prevent the unintended consequences of critical illness such as delirium, prolonged ventilation and excessive muscular deterioration Awaken Breathe Choose medication/coordinate care Delirium Early ambulation - CORRECT ANSWER ABCDE bundle A: Awakening trials for ventilated patients B: Spontaneous breathing trials C: Coordinated effort b/t RN and RT to perform the spontaneous breathing trial when patient is awakened by reducing or stopping patient's sedation D: A standardized delirium assessment program, including treatment and prevention options E: Early mobilization and ambulation - CORRECT ANSWER ABCDE bundle (in depth) ST elevation myocardial infarction Stroke alert - CORRECT ANSWER Codes for acute issues: Code STEMI = _______ Code Trauma Code FAST = ________ [Show Less]
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ANCC Risk mgt / ethics / research Exam 93 Questions with Verified Answers,100% CORRECT
ANCC Risk mgt / ethics / research Exam 93 Questions with Verified Answers What are some systematic components to reducing risk? What does it begin w... [Show More] ith? - CORRECT ANSWER Begins with a formal written plan -organizational goals -delineation of program scope, components, methods -delegating responsibility for implementation and enforcement -commitment of the board -guarantees of confidentiality and immunity for those who squeal goals -> scope/methods -> delegation -> board buy in -> protect squealers What is the most common method of documentation of risk mgt? And what should be delineated in it? - CORRECT ANSWER Incident report -who is authorized to write it -who is responsible for review -what do you do once you've had mtg -who is responsible for follow up -plan for monitoring aftermath -security and storage of completed forms Why are satisfaction forms an important part of risk mgt? - CORRECT ANSWER B/C they help to identify a problem before it happens; they should be tracked and analyzed just like incident reports -employee and patient surveys complaints are a key source of potential risk mgt what 3 things should they identify - CORRECT ANSWER they identify: -person notified after recieveing complaint -person responsible for responding -person responsible for follow up monitoring of resolution - What are 5 action taking initiatives - CORRECT ANSWER -Prevention: risk awareness and safety programs -Correction: remediation to mitigate impact and prevent future occurrences (must be monitored and audited) -Documentation: important for legal defense, good records and institituional policies -Education: in-services at orientation and annually -Dept. Coordination: enc. dept and mgrs to work together for common goal of improved safety for pt and staff what is Medical futility - CORRECT ANSWER unlikely to produce any significant benefit What question can you ask yourself to determine medical futility - CORRECT ANSWER "does the intervention have any reasonable prospect of helping this pt?" what are the 2 types of medical futility - CORRECT ANSWER -Quantative: likelihood of intervention will benefit is extremely poor -Qualitative: the quality of benefit an intervention will produce is extremely poor What must a pt possess to sign an informed consent - CORRECT ANSWER Competence (decisional capability) -implies ability to understand, reason, and differentiate b/w good and bad AND bea ble to communicate What does informed consent mean? what must it include? - CORRECT ANSWER the pt has rcvd ADEQUATE instruction or info re. aspects of care to make a PRUDENT, PERSONAL choice re. treatment -discussion of ALL risks/benefits -GENERALLY consent is assumed if the pt/s condition is life-threatening Describe the right to refuse care what ruling says they have this right - CORRECT ANSWER pt must be advised at time of admission to a hospital, nsg home, hospice, HMO that they have this right (DANFORTH AMENDMENT) and that this can include ANY, SOME or ALL of care as long as they have decisional capability expect 2-3 ethics questions - CORRECT ANSWER Nonmaleficence - CORRECT ANSWER the duty to do no harm utilitarianism - CORRECT ANSWER right to act is the one that produces the greatest good for the greatest number beneficence - CORRECT ANSWER duty to prevent harm and promote good justice - CORRECT ANSWER duty to be fair fidelity - CORRECT ANSWER duty to be faithful veracity - CORRECT ANSWER duty to be truthful autonomy - CORRECT ANSWER duty to respect and individuals thoughts and actions what is often in conflict with veracity? - CORRECT ANSWER fidelity what is often in conflict with beneficence? - CORRECT ANSWER autonomy How to dismiss a pt or close a practice how long should you cover them what do you need to obtain from the pt how long do you keep records - CORRECT ANSWER -MUST have NOTIFICATION -send a certififed letter with return reciept, copy for chart -content in letter should be general not specific -establish there will be SOMEONE ELSE to assume care -provide general coverage within reason , at least 30days -obtain release of info to get records for subsequent provider -keep files for 5 yrs what are 3 examples of reasons to d/c a pt? - CORRECT ANSWER abuse, refusal to pay, pt persistent non-adherence to care History of NP - when was role first developed, and what led to the development? In what area? - CORRECT ANSWER 1960's as a result of physician shortage, pediatrics what 3 problems led to the beginning of acnp's - CORRECT ANSWER result of managed care, hospital restructuring, and decreases in medical residency programs where was first NP program, by whom and where - CORRECT ANSWER Peds NP in 1964, by Dr. Loretta Ford and Dr Henry Silver at U of Colorado Health sciences center Initial NP programs focused in what speciaties - CORRECT ANSWER ambulatory and outpt How did primary care NP programs come about - CORRECT ANSWER as the result of federal funding for preventative and primary are NP education What are the 4 distinct roles of NP - CORRECT ANSWER clinician, consultant/collaborator, educator, researcher know about EBP and research methods - CORRECT ANSWER What are major steps in research process and where does acnp participate - CORRECT ANSWER -formulate problem -literature review -formulate hypothesis -select design -ID population to study -specify methods to collect data -design study -conduct the study -analyze data -interpret results -communicate findings nonnexperimental research - CORRECT ANSWER -involves 2 broad categories: DESCRIPTIVE -aims to describe situations, experiences, pheomena as they EXIST EX-POST FACTO (aka CORRELATIONAL) - examines relationships b/w variables in the PAST ex. sepsis rates over last 6 months in OR could ID a certain MD with higher rates despite same OR's and same staff Others (not always nonexperimental): -CROSS SECTIONAL - looks at ***pops. with A similar attribute*** but differ in some other way in a specific time (ex. asthmatics of various ages)(ex. SURVEY where pt documents severity of asthma at a particular time) -COHORT - study a group and an outcome (ex. how many ppl pass boards first time, alumni surveys)(compares an outcome "lung CA" within ***groups of ppl who are alike in MANY ways ***but differ by a characteristic e.g. female nurses who smoke compared with those who do not smoke) -LONGITUDINAL - taking MULTIPLE MEASURES of a group or pop. over a long period of time to find relationships b/w variables. (1 or 5 or 10 yr follow ups)(Framingham study over multiple generations) what is design of research study? what is methodology? what is approach? - CORRECT ANSWER these questions are all asking the same thing 3 broad headings of types of research - CORRECT ANSWER experimental, nonexperimental, qualitative Experimental study what happens if no randomization or control -in the above instance what is manipulated in the study - CORRECT ANSWER must have RANDOMIZATION and CONTROL -can be done without them but will be quasi -RCT: control is what's alike or different -quasi - manipulates variables without randomization or controls Qualitative research 5 examples - CORRECT ANSWER -case studies, ethnography, field studies, observation, open-ended questions -phenomena is explored via detailed descriptions or observed behavior -ex. whats it liek to be a 49 yr old dying of lung ca what are 2 cons to qualitative research - CORRECT ANSWER bias (requires you to interpret what they are saying) are the findings generalizable (small pt population) what are pros to qualitative research - CORRECT ANSWER produces very rich data through no other means of research What is a confidence interval? compare small and large. - CORRECT ANSWER a range with limit with specified probability of including the parameter being estimated -small means VERY PRECISE -large means less precise which of these is most important for you to focus on changing your practice after reading a publication: a)level of signaifcance b)confidence interval c) p value - CORRECT ANSWER both a and c interpret this CI: 2.8 -3.2 - CORRECT ANSWER terminally ill bone ca patients in the final stage of illness have between 2.8 and 3.2 episodes of nausea every 24 hours What is standard deviation what percent fall within one SD what percent fall within 2 SD - CORRECT ANSWER the avg amt of deviation from mean - bell curve -means that 68% or 2/3 of the population fall within one SD of the mean -95% of sample falls within two SD of mean Level of significance **** - CORRECT ANSWER If there is a P value in the article it's significant. If there's no numerical P value in the article it means it was not significant. -this means the results are statistically significant -probability of false rejection of null hypothesis in a statistical tese -p<0.5 is significant difference b/w experiment and control What is perfect correlation - CORRECT ANSWER a measure of interdependence of 2 random variables that range in value from -1 to +1 - -1 means perfect negative correlation (as one goes up the other goes down) - +1 means perfect positive correlation (both go together in same directions) - 0 means absence of correlation does not indicate causation because of confounding variables what is a t-test - CORRECT ANSWER statistical test to eval difference in means between groups what is reliability - CORRECT ANSWER consistency of measurement -degree to which a test measures the same way OVER TIME with same subjects -reflects estimated repeatability - tells you where a person is doing well (ex. looking at test questions on ACNP exam, 66% miss questions about HIPPA but 84% get right a clinical question) what are 3 ways to establish reliability of a test - CORRECT ANSWER -test/retest: the more CONSERVATIVE method a person should get the same score on exam 1 and 2. ***INVOLVES 2 ADMINISTRATIONs OF THE TEST -Internal consistency: done by grouping questions in a questionairre that measure the same concept ex. one could write 2 sets of 3 questions that measure the same concept (knowledge of lipid panels) and then after responses run a correlation b/w these 2 groups to see if test is reliably measuring ) ***INVOLVES ONLY 1 ADMINISTRATION of the test - Cronbachs Alpha: computes correlation values among questions of tests. CLOSER TO 1 is better optimal is >.70 Liability - CORRECT ANSWER legal obligation we have for actions that FAIL to meet STANDARDs of CARE --> ACTUAL of POTENTIAL pt harm How is it determined that negligence has occurred? - CORRECT ANSWER Standards of Care Negligence - CORRECT ANSWER neglecting to do what a reasonable person would do leading to harm Malpractice what wrongdoing is included in this umbrella term - CORRECT ANSWER BROADER UMBRELLA term. Covers: -professional misconduct -unreasonable lack of skill -illegal or immoral conduct (ex. giving a n'bor opiate scripts to sell on black market) -practicing medicine without a license -practicing outside your scope of practice -allegations resulting in pt harm Assault - CORRECT ANSWER INTENTIONAL THREAT which creates fear of imminent harm -ex. holding fist up like you're gonna hit someone Battery - CORRECT ANSWER actually hurting someone -hitting them or their clothes ***An unconscious person - can you commit assault or battery upon an unconscious person - CORRECT ANSWER Battery NOT assault (they would have to be awake to feel threatened) Defamation ant the 2 types - CORRECT ANSWER Communication --> damaged reputation -libel: written -slander: spoken Is an NP liable if a pt is discharged while in danger of hurting himself or others? - CORRECT ANSWER Yes Restraints documentation requirements - CORRECT ANSWER the exact reason Can an NP be liable if bedside nurse doesn't document properly on restraints? - CORRECT ANSWER yes - we are supposed to be ensuring that the nurse documents checks and such What is the NP liable for in regards to restraints? - CORRECT ANSWER -excessive use of restraints -exact reason is not charted -safety checks are not charted What are good samaritan statutes? - CORRECT ANSWER protects hc providers from law suits if they aid at the scene of an accident and render reasonable, emergency care, within their scope of practice What are the 12 standards of practice for Culturally and Linguistically appropriate services? - CORRECT ANSWER Aim is to: contribute to elimination to racial and ethnic health disparities and to improve the health of everybody -social justice -critical reflection -EBP and research -Language assistance services at no cost to pt -verbal and written notices must be provided to them in their preferred language that they have the right to recieve language assistance -friends and family should not be used to provide interpretation services unless requested by pt The adult-gerontology primary care nurse practitioner evaluates an 80-year-old patient with cognitive deficits, who is unaccompanied by the adult child who typically is present. The patient has urinary symptoms, for which the nurse practitioner considers ordering sulfamethoxazole-trimethoprim (Bactrim). The patient's previous medical record is unavailable. Before prescribing the medication, the nurse practitioner: contacts the patient's adult child. queries the other staff members. relies on the patient's self-report. waits until the patient's chart is available. - CORRECT ANSWER waits till chart available To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner: charges a fee for patients who arrive late to clinic appointments. disseminates research study results to colleagues. expresses opinions about alternative therapies with patients who consider such treatments. schedules time during clinic hours to meet with pharmaceutical representatives. - CORRECT ANSWER disseminates research The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to: evaluate standards, risks, benefits, and outcomes. identify how to anticipate and resolve similar future situations. investigate the need for disciplinary action. obtain agreement of all parties with a chosen solution. - CORRECT ANSWER evaluate standards... A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner: asks the child to provide a copy of the patient's advance directive document. assures the child that the nurse practitioner can disclose requested information. informs the child that he or she must come to the clinic to discuss the parent's case. tells the child that the nurse practitioner can discuss the information only with the patient. - CORRECT ANSWER tells the child that the nurse practitioner can discuss the info with only the pt When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary care nurse practitioner: concludes that the study proves the hypothesis. excludes the discussion section, because the conclusion contains this information. recommends incorporating the results directly into clinical practice. uses the methodology section to support the validity of the study. - CORRECT ANSWER use method section Preparing to implement an incontinence reduction program at a nursing home, the adult-gerontology primary care nurse practitioner reviews several studies. Place the studies in sequential order of the strength of evidence for this population from strongest to weakest. (Fill in your answer by providing a numerical value to each letter with no spaces eg. A1B2C3) A: a case report of an experimental incontinence reduction program in older adults B: A concensus statement from the urologic association regarding the use of scheduled toileting C: a systematic review of nonrandomiized trails concerning the use of vaginal estrogen - CORRECT ANSWER c b a A patient has fully recovered from septic shock due to bacteremia. The patient has been accepted to a long-term acute care facility for continuation of antibiotic therapy. The infectious disease physician has not seen the patient in two days. The adult-gerontology acute care nurse practitioner: contacts the physician to determine the appropriate duration of antibiotic therapy. notifies medical staff services that the physician has not seen the patient. waits for the physician to come see the patient. writes transfer orders for the patient. - CORRECT ANSWER conyacts An 80-year-old patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the adult-gerontology acute care nurse practitioner: gives illustrative pictures that instruct the patient on body alignment during activity. has the patient watch a video about surgeries and pre-operative care for hip fractures. provides the patient with an audio tape for care of hip fractures and range-of-motion activities. provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery. - CORRECT ANSWER provides verbal reinforcement When serving as a nurse researcher, the adult-gerontology acute care nurse practitioner is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? Confidentiality. Justice. Nonmaleficence. Right to self-determination. - CORRECT ANSWER nonmaleficence The adult-gerontology acute care nurse practitioner is asked to provide evidence to the hospital administration about the safety of nurse practitioners placing central lines. Which resource provides the strongest level of evidence? A nurse practitioner's journal editorial. A randomized control trial. A systematic review. The American Association of Colleges of Nursing's Nurse Practitioner Competencies. - CORRECT ANSWER An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? American Association of Retired Persons. Medicaid. Medicare. United States Social Security Administration. - CORRECT ANSWER aid Which clinical scenario does the adult-gerontology acute care nurse practitioner evaluate for a quality improvement process change? A new case of necrotizing fasciitis in an immunocompromised patient. A projected increase in the number of influenza cases requiring hospitalization. An expected rate of ventilator-associated pneumonia in pulmonary disease patients. An increased incidence of postoperative sternal wound infections. - CORRECT ANSWER sternal wound infections A root cause analysis of a crisis situation in the intensive care unit identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the adult-gerontology acute care nurse practitioner is asked to develop evidence-based polices to establish clinician-family communication standards in the unit. These policies should include: an evaluation tool to assess the health care surrogate's decision-making ability and anxiety level. guidelines for having discussions with family members that are geared toward establishing treatment goals. limits on the number of consulting services utilized to prevent sending mixed messages. requirements for a formal family conference within 12 hours of a patient's admission to the intensive care unit. - CORRECT ANSWER guidelines A patient is brought to the emergency department after being found unresponsive in a car. The patient's spouse arrives at the hospital to find the patient comatose, on mechanical ventilation, and brain death has been established. The spouse informs the staff that the patient has an advance directive and did not want to be kept alive, artificially. The spouse struggles with the decision to remove the patient from life support. The adult-gerontology acute care nurse practitioner: consults the ethics committee to help with the decision-making process. discusses with the spouse that removing the patient is the right thing to do. encourages the spouse to have a family meeting to make the decision as a group. r eviews the patients advance directive with the spouse. - CORRECT ANSWER reviews An adult-gerontology acute care nurse practitioner needs to communicate the findings of HIV to a patient. The nurse practitioner enters the patient's room and the spouse is at the bedside. To discuss the diagnosis, the nurse practitioner: asks the nurse to step into the room. asks the spouse to step out of the room. speaks with the patient and spouse together. speaks with the spouse privately. - CORRECT ANSWER speak with spouse privately When reading a systematic review, an adult-gerontology acute care nurse practitioner ensures that the review: describes the intended audience. describes the study inclusion criteria. is published in a peer-reviewed journal. is written by experts in the field. - CORRECT ANSWER describes inclusion criteria An exception to the practice of maintaining patient confidentiality is when: a family member of the patient gives consent. a family member of the patient is paying for the treatment. the patient is unresponsive. the patient plans to hurt someone. - CORRECT ANSWER plans to hurt someone A 65-year-old female patient has a confirmed diagnosis of terminal liver disease. The patient's advance directive designates comfort measures, only. An adult-gerontology acute care nurse practitioner's action is to: discuss the patient's decision with the patient's family members. persuade the patient to participate in a hepatitis clinical trial. reconfirm the patient's end-of-life decision. refer the patient for a psychological evaluation. - CORRECT ANSWER reconfirm Which research design has the greatest strength in determining if an intervention is effective? Case control Clinical trial Cohort Cross-sectional - CORRECT ANSWER trial describe levels of evidence - CORRECT ANSWER 1) Systematic Reviews | 2)Clinical trials | 3)Observational studies -cohort -cross sectional -case control | 4)Case reports, case series | 5)anecdotal, opinions describe prevention as a part of action taking initiatives in risk mgt - CORRECT ANSWER proactive risk awareness and safety programs in place describe correction as a part of action taking initiatives in risk mgt what 2 factors must be included in this - CORRECT ANSWER post incident remediation to minimize impact and prevent future occurrences these steps must be monitored and audited describe documentation as a part of action taking initiatives in risk mgt - CORRECT ANSWER essential for legal defense thorough medical records and institutional policies describe education as a part of action taking initiatives in risk mgt - CORRECT ANSWER in services of all staff at orientation and annually (minimally) describe departmental coordination as a part of action taking initiatives in risk mgt - CORRECT ANSWER encouraging departments and managers to work together for the common goal of improved pt and staff safety describe correlational research - CORRECT ANSWER examines relationships among variables types: natural observation survey research archival research correlational research can be used as the first step before an experiment begins. It can also be used if experiments cannot be conducted. It determines if a relationship exists between two or more variables, and if so, to what degree the relationship occurs. describe ex post facto research - CORRECT ANSWER x post facto experiment begins with groups that are already different in some respect and searches in retrospect for factors that brought about those differences describe cross sectional research - CORRECT ANSWER usually non experimental -examines a pop with a similar attribute (asthma) but different in one particualar way (age) purpose: to find relationships between variables at a specific time ex. surveys mostly used to determine PREVALANCE by public health departments pro: short, cheap con: can't make causal relationships and thus often form a foundation for a hypothesis describe a cohort study - CORRECT ANSWER compares a particular outcome (lung cancer) in groups that are alike mostly but differ by a particular characterestic (female nurse who smoke compared with those who do not smoke) follow a group of people who do not have the disease for a period of time and see who develops the disease (new INCIDENCE). Can't have already developed the disease (as opposed to a cross sectional) cons: attrition, takes a long time describe a longitudinal study - CORRECT ANSWER Framingham is the famous one how does a longitudinal study vary from a cohort - CORRECT ANSWER In Cohort studies, subjects are asembled on the basis of some common experience (such as attendinding medical school) and are then monitored for a specified amount of time at regular intervals (e.g., taking Step 1, 2, and 3) until they develop the outcome of interest (they become practicing physicians) or the follow up time ends. The cohort stydy minimizes many of the biases evident in case-control designs and is the definitive observational clinical study. Cohort allows researchers to compute a relative risk. Longitudinal Studies identify individual subjects and follow them over a given period of time. For example, the study of cholesterol-lowering drugs on cardiovascular events requires that the same subject is observed over a significant period of time. what are 5 examples of qualitative studies - CORRECT ANSWER case studies open ended questions field studies paricipant observation ethnographic studies [Show Less]
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Cardiac Exam 88 Questions with Verified Answers,100% CORRECT
Cardiac Exam 88 Questions with Verified Answers Discuss the clinical risks associated with atrial fibrillation: - CORRECT ANSWER 5-fold increased risk o... [Show More] f stroke 3-fold increased risk of HF 2-fold increased risk of dementia For patients at high risk of HF, what medication should be used for prevention? - CORRECT ANSWER ACEi & Beta-blockers (ACEi are recommended in patients at high risk. Beta blockers are recommended in all patient with prior MI) Explain blood pressure goals in hypertensive emergencies: - CORRECT ANSWER Decrease the MAP by 15-25% over several minutes to an hour Discuss the types of atrial fibrillation - CORRECT ANSWER Acute: Lasts 24-48 hours Chronic paroxysmal: Recurrent afib that resolves within 7 days Chronic: Persistent afib Long-standing persistent: Continuous >12 months Permanent: When decision is made to stop attempts to restore NSR Post-operative atrial fibrillation: New onset afib within 30 days of surgery Discus the role of BNP in diagnosis of heart failure - CORRECT ANSWER >NT-BNP is able to be used for -Diagnosis -Prognosis >Though it declines with effective therapy, GDMT is not recommended based off BNP (GUIDE-IT Trial). >BNP is higher in renal disease, women, COPD. Define white coat hypertension - CORRECT ANSWER BP difference between home and office of 20/10 mm Hg Discuss the diagnostic work-up for atrial fibrillation: - CORRECT ANSWER -2D echo or TEE ==> Assess VHD ==> Assess heart chambers size/function ==> Assess pulmonary pressure ==> LA thrombus -Telemetry/event recorder ==> Verify AF ==> Assess LVH ==> Assess pre-excitation ==> Assess prior MI -Thyroid profile ==> Indicated when ventricular rate is difficult to control BNP should not be measured when taking what medication? - CORRECT ANSWER Sacubitril valsartan (neprilysin inhibitor) BNP is falsely increased by this medication. NT-proBNP remains reliable Masked hypertension should be considered in what groups? - CORRECT ANSWER Diabetics (43%) Blacks (59%) CKD (60-70%) List medications that may be used to treat general hypertensive emergencies: - CORRECT ANSWER Clevidipine: -Dihydropyridine calcium channel blocker. -Not effective in patients with renal/hepatic disease. -Contraindicated in aortic stenosis (due to risk of hypotension) or in lipid disorders (administered in lipid emulsion). -Contains soy and eggs Esmolol: -Beta-blocker. -Not dependent on renal/hepatic function. -Best option for tachycardia associated hypertensive crisis Labetalol: -Alpha/Beta blocker. -Decreases SVR and prevents reflex tachycardia. -Unlike other beta blockers, it does not induce heart failure. -Nicardipine: Calcium channel blocker. Decreases SVR without decreasing CO. It is metabolized by the liver to inactive metabolites. It should be avoided in aortic stenosis, cardiomyopathy, impaired liver function. -Nitroprusside: (Not typically used) Arterial/venous dilator. Potential toxicities: Cyanide (evidence by lactic acidosis, AMS, hypotension); cyanide toxicity may be reduced by hydroxocobalamin. Thiocyanate toxicity (evidenced by delirium, headaches, nausea, abdominal pain, muscular spasms).may be decreased with thiosulfate. What is the most reliable physical sign of volume overload? - CORRECT ANSWER Jugular Venous Distention Post-surgical atrial fibrillation is most likely to occur on which day? - CORRECT ANSWER Post-op day 2 (~38%) Discuss the etiologies and treatment of post-operative atrial fibrillation - CORRECT ANSWER Cause: Excessive adrenergic tone -Treatment: Beta-blockers Cause: Pericarditis/inflammation -Treatment: Steroid, Omega-3, Acellular matrix Cause: Atrial myopathy/fibrosis-reentry -Treatment: Antiarrhythmic agents, Pacing Cause: Ischemia -Treatment: Beta blocker and CCB, nitrates Cause: Electrolyte imbalance -Treatment: Magnesium & potassium Guidelines: -Preoperative amiodarone or colchicine for prophylaxis. (Per Scordo, preoperative BB preferred) -BB is first line. CCB if ineffective -Reasonable to administer antiarrhythmic medication/restore NSR What is first line treatment for HF? - CORRECT ANSWER ACE Inhibitors or Beta-blockers >Either may be started first (CIBIS III Trial) ACEi -Better tolerated when patient is still congested -Recommended when LVEF <40% -Increased risk of hypotension when NA <130, Cr 1.5-4 -S/E: Neutropenia/agranulocytosis Beat blockers -Better tolerated with less congestion -Recommended in stable HF due to LVSD -Must be on diuretic if HX of fluid retention -Used in HFpEJ to decrease HR Discuss what medications should be used/avoided in hypertensive emergency associated with: Myocardial ischemia - CORRECT ANSWER Use: Nicardipine & esmolol; Nitroglycerin & labetalol; Nitroglycerin & esmolol Avoid: Hydralazine, Diazoxide, Minoxidil, Nitroprusside Discuss the use of cardioversion in the treatment of atrial fibrillation: - CORRECT ANSWER Indications: Hemodynamic instability -Decompensated HF -Active ischemia -Organ hypoperfusion Note: Stabilization outweighs anticoagulation Guidelines: -Recommended when RVR is presents and contributing to MI, hypotension, HF -Recommended with pre-excitation when tachycardia is associated with HD instability Discuss alternative therapy in ACEi intolerance - CORRECT ANSWER ARBs are recommended as alternative treatment -May continue to have same symptoms as on ACEi -Effective in neurohormonal escape Hydralazine and nitrate may also be considered -Good for AA Discuss what medications should be used/avoided in hypertensive emergency associated with: Acute kidney injury - CORRECT ANSWER Use: Fenoldopam, Nicardipine, Clevidipine Avoid: N/A Discuss treatment for rate control in atrial fibrillation in the hemodynamically stable patient: - CORRECT ANSWER Rate control: Rate control was proven superior in HDS patients per the AFFIRM trial -At 3.5 years, mortality was greater in rhythm vs rate control group Rate Goal: 100 BPM -60-85 bpm if symptomatic Agents: -Calcium Channel blockers ==>Diltiazem, Verapamil ==> Dihydropyridine blockers not effective (nifedipine, amlodipine) ==> Contraindicated in HF (negative inotrope) -Beta-blockers ==>Metoprolol, Esmolol ==> Esmolol has short duration; easy to titrate -Amiodarone ==> Preferred agent in WPW (per scordo) ==> May promote CV- may nee to be on ACT -Digoxin ==> Note effective, days to reach therapeutic levels ==> Rarely used as monotherapy ==> Caution in elderly ==> Avoid in WPW ==> No significant difference compared to placebo ==> Increased All-Cause mortality Discuss combination therapy with Sacubitril and Valsartan (ARNI) - CORRECT ANSWER ARB and Neprilysin inhibitor -Recommended for patients who continue to be symptomatic on ACEi/ARB/Aldosterone agonist -Reduce mortality by 20% (PARADIGM-HF Trial) -Neprilysin inactivate vasoactive peptides -Neprilysin increases angiotensin II levels requiring use of ARB -Do not with with aliskiren in patients with DM -Requires 36hr washout of ACEi Discuss what medications should be used/avoided in hypertensive emergency associated with: Aortic dissection - CORRECT ANSWER Use: Esmolol & nicardipine; Esmolol & Clevidipine; Labetalol; Esmolol & Nitroprusside Avoid: Hydralazine, Diazoxide, Minoxidil Discuss what medications should be used/avoided in hypertensive emergency associated with: Pulmonary edema/LV Systolic dysfunction - CORRECT ANSWER Use: Esmolol or Labetalol & Nitroglycerin & Loop diuretic What is the indication for diuretic use in HF? - CORRECT ANSWER HF Stage C (Symptomatic) -ACEi and Diuretic should be used for for symptomatic patients Discuss assessment for need for anticoagulation therapy in atrial fibrillation - CORRECT ANSWER Assess CHA2DS2-VASc - CHF 1 -HTN 1 - >75 yo 1 -DM 1 -Stroke/TIA 2 -Vascular disease 1 -Age 65-74 1 -Female 1 ==> Score 1+, indication for ACT Assess HAS-BLED -Hypertension 1 -Abnormal Liver (1) or Renal (1) function - Stroke (1) - Bleeding (1) - Labile INR (1) - Elderly >65 (1) - Drugs (1) or Alcohol (1) When choosing a diuretic in HF, what are your options and when should they be used? - CORRECT ANSWER Loop Diuretic -Used in volume overload -Usually used in decreased renal function Thiazide Diuretic -Used in hypertension -Not effective if GFR <30 Aldosterone Antagonist - Cr <2.5 (M), <2 (Women); eGFR>30, K <5 -May decrease hypokalemia effects when combined with LD -Post MI with LVEF <40% - EF <35% - 30% decrease in mortality (RALES Trial) Discuss what medications should be avoided in hypertensive emergency associated with: Ischemic stroke (SBP >180-200 mm Hg) - CORRECT ANSWER Nitroprusside, Methyldopa, Clonidine, Nitroglycerin (Use: Nicardipine, Clevidipine, Labetalol ) Discuss agents that can be used for anticoagulation in atrial fibrillation - CORRECT ANSWER Indication: CHADVASC 2+ CHADVASC 1, may use ASA -Warfarin ==> Required in mechanical valve ==> Advanced kidney disease (Clcr <15) ==> INR goal 2.0-3.0 or 2.5-3.5 based on type and location of prosthesis ==> CYP 2C9, 3A4 DOACs Antithrombin -Dabigatran (Pradaxa) ==> CYP None ==> Superior to Warfarin in RE-LY trial; ==> Though decreased stroke, increased GI bleeding (RE-LY) ==> Reversal: idarucizumab ==> Dose adjustment for CrCl 15-30 mL/min) Factor Xa inhibitor -Apixaban (Eliquis) ==> Monitor renal function ==> CYP 3A4 ==> Superior to warfarin in stroke prevention, lower risk of bleeding (ARISTOLE) -Rivaroxaban (Xarelto) ==> Monitor renal function, adjust dose if CrCl <50 mL/min ==> CYP 3A4, 2J2 ==> Non-inferior to warfarin (ROCKET-AF); less intracranial hemorrhage ==> Take with food -Edoxaban (Lixiana/Savaysa) ==> Monitor renal function ==> CYP 3A4 ==> Non-inferior to warfarin with decreased rates of bleeding/hemorrhagic stroke (ENGAGE-AF) Discuss antiarrhythmic therapy in atrial fibrillation - CORRECT ANSWER -Indications ==> Following 1 month of ACT ==> Underlying cause is determined/reversible ==> Remain symptomatic despite rate control Agnets -Amiodarone ==> Increases effect of warfarin and digoxin ==> Side effects: Hypotension, bradycardia, QT prolongation, Torsade de pointes -Dofetilide ==> Initiate in hopsital ==> Downward dosing in renal disease ==> Side effects: QT prolongation, Torsade de pointes -Flecainide ==> Use with AV nodal blocker in history of aflutter; may cause rapidly conducting atrial flutter ==> Avoid in structural heart disease ==> Side effect: Hypotension, aflutter -Ibutilide ==> Side effects: QT prolongation, torsade de pointes -Propafenone ==> Avoid in structural heart disease ==> Side effects: Hypotension, rapidly conducting aflutter -Quinidine ==> Side effects: QT prolongation, hypotension Discuss management of diuretic tolerance (refractory edema) - CORRECT ANSWER Use combination LD and TZD -Metolazone is usually first line; remains active at lower GFR Discuss what medications should be used/avoided in hypertensive emergency associated with: Intracerebral hemorrhage (SBP >140-160) - CORRECT ANSWER Use: Nicardipine, Clevidipine, Labetalol Avoid: Nitroprusside, Methyldopa, Clonidine, Nitroglycerin Discuss the algorithm for choice of antiarrhythmic in atrial fibrillation - CORRECT ANSWER Normal Heart: Flecainide, Propafenone, Sotalol ==Failed==> Amiodarone, Dofetilide Hypertension: Left ventricular hypertrophy? ==Yes==>Amiodarone. ==No==> Flecainide, Propafenone, Sotalol ==Failed ==> Amiodarone, Dofetilide CAD: Dofetilide, Sotalol ==Failed==> Amiodarone Heart failure Amiodarone or Dofetilide In heart failure, heart rate may independently predict outcome. _________ is indicated for resting HR >70 when already on optimal beta blocker therapy. This medication acts by slowly SA node, but does not decrease inotropy - CORRECT ANSWER Ivabradine Discuss what medications should be used/avoided in hypertensive emergency associated with: Hyperadrenergic states (e.g. cocaine use) - CORRECT ANSWER Use: Nicardipine or Clevidipine & benzo; Phentolamine; Labetalol Avoid: Beta-blockers Discuss what medications should be used/avoided in hypertensive emergency associated with: Preeclampsia/eclampsia - CORRECT ANSWER Use: Labetalol, Nicardipine Avoid: Diuretics, ACEi Discuss pill in pocket therapy: - CORRECT ANSWER Indications: ==> Recognize onset ==> No Acute aortic dissection risk Step 1: ==>Rate control with BB or CCB ==> Prevent aflutter Step 2: ==> Use propafenone or flecainide Step 3: ==> Observe for effect and tolerance on first episode ==> Treat continued events at home Discuss use of Calcium Channel Blockers in HF - CORRECT ANSWER -Considered in HR and preserved LVEF and: >AFib Use diltiazem or verapamil Angina: use amlodipine and felodipine Discuss recommendations for atrial fibrillation and hypertrophic obstructive cardiomyopathy - CORRECT ANSWER -ACT is indicated despite CHADVASC -Amiodarone or Disopyramide combined with BB or CCB is reasonable -Ablation can be beneficial in those whom rhythm control is desired and medical intervention is no effective/tolerated -Sotalol, dofetilide, or dronedarone may be considered for rhythm control Discuss treatment of HFpEF - CORRECT ANSWER -ACEi or ARB to decrease remodeling -Aldosterone receptor antagonists Describe the blood pressure categories: - CORRECT ANSWER Normal: <120 / <80 Elevated: 120-129 / <80 HTN Stage 1: 130-139 / 80-90 HTN stage 2: >140 / >90 Discuss recommendations for atrial fibrillation complicating acute coronary syndromes - CORRECT ANSWER -Urgent cardioversion is recommended or are 1) HD unstable, 2) Ongoing ischemia, or 3) Inadequate rate control -Beta blockers are recommended to slow ventricular rate in the absence of HF, HD instability, or bronchospasm -Amiodarone or digoxin are recommended to slow ventricular rate if AF is associated with LV dysfunction or HD instability -CCB might be considered to slow ventricular rate only in the absence of significant HF or HD instability Discuss Biventricular pacing in heart failure - CORRECT ANSWER Use if: -NRS -Widen QRS -LVEF <35% with NYHA III-IV Discuss the 2017 ACC/AHA recommendations for blood pressure management thresholds - CORRECT ANSWER Non elevated CVD risk -Treat >140/90 -Goal <130/80 Elevated CVD risk -Treat >130/80 -Goal <130/80 Discuss recommendations for atrial fibrillation and hyperthyroidism - CORRECT ANSWER -Beta blockers are first line therapy -CCD may be used is BB are contraindicated Define treatment resistant hypertension - CORRECT ANSWER Hypertension despite treatment with 3+ medications in which one medication is a diuretic Discuss recommendations for atrial fibrillation and pulmonary disease (COPD) - CORRECT ANSWER -CCB are recommended to control ventricular rate Discuss treatment of treatment resistant hypertension: - CORRECT ANSWER -Confirm compliance -Identify secondary cause -Pharm: CCB, RAAS inhibitors, Chlorthalidone. *PATHWAY-2 study demonstrated superiority of addition of Spirolactone compared to alpha/beta blockers Discuss recommendations for atrial fibrillation and WPW with pre-excitation - CORRECT ANSWER -Intravenous procainamide or ibutilide is recommended if hemodynamically stable Discuss blood pressure treatment for diabetics - CORRECT ANSWER -Goal: BP <130/80 -Due to renal protection, ACEi or ARBs should be used Discuss recommendations for atrial fibrillation and heart failure - CORRECT ANSWER -BB or CCB is recommended in compensated HFpEF -In absence of pre-excitation, Digoxin or Amiodarone is recommended to control heart rate acutely -Combination of digoxin and BB is reasonable to control resting and exercise heart rate -AV node ablation is reasonable if medical therapy is insufficient -For patients with tachycardia induced cardiomyopathy, AV node ablation or rhythm-control is reasonable When assessing for secondary hypertension, when should you suspect: Pheochromocytoma? Cushing's syndrome? Aortic coarctation? - CORRECT ANSWER Pheochromocytoma: -Episodic hypertension, -Palpitation, -Diaphoresis -Head ache ==>S/S d/t increased catecholamine Cushing's syndrome: -Moon facies -Central obesity, -Abdominal striae -Inter-scapular fat deposition Aortic coarctation: -Differential in brachial/femoral pulses -Systolic bruit When screening for secondary hypertension, what would lead you to suspect primary aldosteronism? - CORRECT ANSWER -Elevated aldosterone/renin ratio (>30) -Hypokalemia When should you suspect primary aldosteronism? - CORRECT ANSWER Resistant HTN <30 yo Hypokalemia BP >160/100 Adrenal mass Discuss PAC/PRA screening for primary aldosteronism - CORRECT ANSWER Primary aldosteronism is present if: -PAC >15 -PRA <1 -PAC/PRA ratio >20 What test is used for renal artery stenosis? - CORRECT ANSWER MRA renal arteries Discuss typical causes for renovascular hypertension - CORRECT ANSWER Fibromuscular dysplasia - Young females -Respondes to percutaneous transluminal renal angioplasty Atherosclerosis -Hypokalemia -Abdominal bruits When should you be suspicious of renovascular hypertension? - CORRECT ANSWER Onset of HTN before 30yo Sudden onset of HTN in men >50 Keith-Wagener-Baker retinopathy What medication reduce LV fibrosis in hypertension? - CORRECT ANSWER ARB ACEi Aldosterone antagonists A 50-year-old White male with a history of hypertension, smoking (60 pack-years), angina, and chronic bronchitis (COPD) presents with 3 hours of substernal chest pain with diaphoresis. He is anxious, diaphoretic, and nauseous. His blood pressure is 90/70 mm, pulse 50per minute, respirations 24 per minute. His lungs are clear, heart is bradycardic with no murmurs, and there is ~10 cm of jugular venous distension (estimated jugular venous pressure 15 cm). His ECG is shown in the following figure (ST elevation in II, III, aVL. ST depression in I, aVL, V2, V3, V4, V5) . Based on these findings, which of the following diagnoses is most likely? a.Inferior myocardial infarction with evidence of right ventricular involvement b.Anterior myocardial infarction with lateral extension c.Anterior myocardial infarction with aneurysm formation d.Posterior myocardial infarction with lateral extension Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 61). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER What populations require statin therapy? - CORRECT ANSWER 1) Clinical atherosclerotic disease 2) LDL >190 mg/dL 3) Diabetics 40-75 yo 4) Estimated 10-year atherosclerotic risk of 7.5% or greater aged 40-75 yo Define Metabolic Syndrome - CORRECT ANSWER 3 or more of: 1) Abdominal obesity 2) Triglycerides >150 3) Low HDL ==> Men <40 and women <50 4) Hyper tension 5) Fasting glucose >110 (DROP: Dyslipidemia, Insulin resistance, obesity, high blood pressure) A 65-year-old male presents to the ED with new-onset chest pain. During the examination, a grade II/VI systolic murmur is auscultated, best heard at the second ICS, right sternal border. The differential diagnosis is: a.Mitral stenosis b.Pulmonic insufficiency c.Aortic stenosis d.Mitral insufficiency Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 62). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER Discuss options for statin therapy and goals - CORRECT ANSWER High-intensity statin -Atorvastatin -Rosuvastatin Moderate-intensity statin -Atorvastatin -Rosuvastatin -Simvastatin -Pravastatin -Lovastatin -Fluvastatin Low-intensity statin -Simvastatin -Pravastatin -Lovastatin A 67-year-old male presents with a history of aphasia and right-sided hemiparesis which has now resolved. He has 80% blockage of both carotids. The AG-ACNP understands the treatment for this patient will be: a.Right carotid endarterectomy followed by a left cardioid endarterectomy b.Left carotid endarterectomy followed by a right carotid endarterectomy c.Maintenance with antiplatelet therapy d.No treatment at this time, a repeat carotid ultrasound in 6 months Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 62). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER What are the goals for patients receiving statin therapy for CAD? - CORRECT ANSWER Goals: High risk -LDL <100 mg/dL if tg >200 mg/dL Very high rick -LDL <70 mg/dL A 45-year-old female with a 20-pack-year smoking history recently returned from Europe with her husband. She developed pain and swelling in her right calf 8 hours into the return flight. She denies fever, chest pain, shortness of breath, abdominal pain, nausea, or vomiting. She has no bleeding conditions. She has no drug allergies but is allergic to seafood and certain types of nuts. The most appropriate next step is: a.Administration of warfarin (Coumadin) with a target INR of 2 to 3 b.Lower extremity Doppler ultrasound study c.Obtain ABGs and ventilation-perfusion scan d.Administration of enoxaparin sodium (Lovenox) Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 62). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A 24-year-old male presents to the ED with a cocaine overdose. He is awake, with tachycardia, anxiety, diaphoresis, headache, confusion, and a blood pressure of 230/120. Which of the following is the most appropriate medication to treat his hypertension? a.Isoproterenol (Isuprel) b.Esmolol (Brevibloc) c.N-Acetlylcysteine (Mucomyst) d.Phentolamine (OraVerse) Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 62). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER What monitoring is required for statin therapy? - CORRECT ANSWER Monitoring -LFT -Report muscle aches -CPK (Baseline, and when warranted) A 62-year-old male is 1 day postoperative cardiac bypass surgery. He suddenly develops hypotension with pulsus paradoxus and has no urinary output for the past 2 hours. Point of care two-dimensional echocardiogram demonstrates right systolic collapse. The AG-ACNP's diagnosis is which of the following? a.Cardiac tamponade b.Dissecting thoracic aortic aneurysm c.Hemorrhage d.Barotrauma Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 63). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER Discuss clinical findings in chronic stable angina pectoris - CORRECT ANSWER Manifestation: -Chest pain -Typical -Atypical -Non-cardiac chest pain Physical findings: -S4 gallop -Transient apical systolic murmur (MVR) -Arrhythmia A patient is transferred to the ICU with a blood pressure of 90/60 mmHg, oxygen saturation of 85%, oliguria, and diffuse crackles. Pulmonary artery catheter readings reveal a cardiac output of 1.9 L/min. and a wedge pressure of 24 mmHg. Which IV medication does the AG-ACNP prescribe? a.Nesiritide (Natrecor) b.Nitroglycerin c.Dopamine d.Nitroprusside (Nipride) Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 63). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER What diagnostic testing is required for stable angina? - CORRECT ANSWER -Risk factors and co-morbidities ==> Lipids, T4, TSH, anemia, diabetes -Resting EKG (Usually normal) -Stress imaging ==> Radionuclide imaging ==> Images in which radionuclide uptake is proportionate to blood flow ==> Radionuclide angiography ==> Radionuclide tracers to image the LV and measure EF and wall motion. Resting abnormalities indicate infarction ==> Stress echocardiography ==> Exercise-induced segmental wall motion abnormalities indicate ischemia A 32-year-old female 3 months pregnant presents to the ED with worsening dyspnea, bilateral ankle edema, and bibasilar crackles. A two-dimensional echocardiogram demonstrates a reduced ejection fraction. Which of the following medications are initially appropriate to prescribe? a.Lisinopril (Prinivil) b.Diltiazem (Cardizem) c.Metoprolol (Lopressor) d.Methyldopa (Aldomet) Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 63). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER Discuss medical therapy for chronic stable angina pectoris - CORRECT ANSWER >Beta blockers -Clinical indications: Start for all MI, ACS, LVDF RAAS blockers >Ace inhibitors -Clinical indications: ==> Use in all patients with LVEF <40%, diabetes, CKD ==> Consider for all ACS patients >ARBs -Clinical indications: ==> Use in patients who are intolerant to ACEi >Aldosterone antagonist -Clinical indications: Post MI without renal d/f or hyperkalemia and already on therapeutic ACEi and BB and have either 1) HFrEF or DM >Calcium channel blockers -Combined with BB if initial BB therapy is not successful -CCB and long-acting nitrates as BB alternative >Plavix & ASA -BMS, 1 month - Sirolimus (DES), 3 months - Taxus (DES), 6 months -May be up to 1 year The AG-ACNP is asked to see a patient in the postanesthesia care unit who is postop thoracotomy for coronary artery bypass surgery. The patient becomes hypotensive with a blood pressure of 90/70, pulse 120/regular, with cool clammy skin. The AG-ACNP initially prescribes: a.Dopamine b.IV fluids c.Digoxin (Lanoxin) d.Norepinephrine (Levophed) Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 63). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A 68-year-old female cigarette smoker complains of fatigue and dyspnea. The most specific evidence for CHF in this patient would be a.Ankle edema b.Wheezes c.S3 gallop d.Weight gain Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 63). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER The AG-ACNP is making rounds in the ICU, when suddenly a postcardiac transplant patient develops symptomatic bradycardia. The AG-ACNP orders which of the following medications? a.Atropine b.Epinephrine (adrenaline) c.Isoproterenol (Isuprel) d.Aminophylline Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 64). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A 56-year-old male presents to the ED with substernal chest pain, pain with inspiration, systolic apical murmur, and fever. His ECG demonstrates ST segment elevation in all leads. The AG-ACNP recognizes this as: a.Endocarditis b.Acute myocardial infarction c.Pleurisy d.Pericarditis Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 64). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A 38-year-old female patient presents to the ED with fever 100.4 and sharp left chest pain. The pain is exacerbated when she lies flat, and lessened with sitting upright and leaning forward. Her heart rate is 106 beats per minute at rest and blood pressure is 116/72. An ECG shows diffuse ST elevation without troponin elevation. The most likely diagnosis is? a.Acute myocardial infarction b.Acutely decompensated heart failure c.Acute mitral chordae rupture d.Acute pericarditis Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 64). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A 48-year-old female patient presents to the ED with complaints of palpitations and dyspnea for the past 6 hours. Upon triage, her pulse is found to be irregular with a rate of 146 beats per minute. Her blood pressure is 114/68. She is alert and oriented and denies chest pain. ECG demonstrates an irregular, narrow complex tachycardia. Which intervention is most appropriate for the AG-ACNP to order first? a.Order STAT transthoracic echocardiogram. b.Perform synchronized cardioversion immediately. c.Order metoprolol (Lopressor) 5 mg to be given slow IV push now. d.Administer adenosine (Adenocard) 6 mg rapid IV push now. Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 64). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER The AG-ACNP is providing discharge education for a 56-year-old male client with a new diagnosis of systolic heart failure related to dilated cardiomyopathy. The patient has history of heavy alcohol consumption daily for the past 8 years. Which topic is most important in the pre-discharge counselling for the client and his family? a.Aerobic exercise may worsen his heart function. b.Sexual activity is contraindicated due to his heart function. c.Cessation of alcohol may improve his heart function. d.Following a low-sodium diet will improve his heart function. Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 64). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A 57-year-old male with a history of smoking presents to the ED with complaints of sudden, severe chest pain radiating down his back and associated dizziness. His blood pressure is 208/116. An ECG demonstrates LV hypertrophy without ischemic changes. Which initial intervention is appropriate? a.Chest CT with IV contrast b.Urgent surgical consultation c.Aggressive blood pressure control d.Transesophageal echocardiogram Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 64). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER The NP is caring for a 38-year-old African American male patient who has no known medical history, was admitted to the hospital for management of newly diagnosed type II DM and renal dysfunction with proteinuria. Throughout the hospitalization, the patient has been noted to be persistently hypertensive, with blood pressure readings in the general range of 160/90. The most appropriate first-line medication for this client would include: a.Metoprolol succinate (Toprol XL) 25 mg orally twice per day b.Amlodipine (Norvasc) 10 mg orally once per day c.Hydrochlorothiazide (Microzide) 25 mg orally once per day d.Lisinopril (Prinivil) 20 mg orally once per day Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 65). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER The AG-ACNP is caring for a 58-year-old male patient who was recently diagnosed with CAD after having an ST-segment myocardial infarction. Based on the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol, which option for statin therapy would be most appropriate for this client when planning for hospital discharge? a.Atorvastatin (Lipitor) 40 mg orally once per day b.Lovastatin (Mevacor) 40 mg orally once per day c.Pravastatin (Pravachol) 40 mg orally once per day d.Simvastatin (Zocor) 40 mg orally once per day Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 65). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A 48-year-old patient underwent PCI with a DES. Which antiplatelet regimen would be most appropriate for the continuing management of this patient? a.Aspirin 81 mg and Clopidogrel (Plavix) 75 mg orally daily for at least 12 months b.Clopidogrel (Plavix) 75 mg orally daily alone for the next 6 months c.Aspirin 81 mg orally daily alone for the next 6 months d.Aspirin 81 mg and Clopidogrel (Plavix) 75 mg orally daily for the next 1 month Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 65). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER An NP is called to assess a 76-year-old female patient who has a known history of systolic heart failure. The patient is being admitted to the hospital with complaints of couch orthopnea and declining activity tolerance. Oxygen saturations are lower than her usual baseline and a chest x-ray demonstrates pulmonary venous hypertension. Which is the initial intervention in the treatment of this patient? a.Referral to the cardiac catheterization lab b.Intravenous loop diuretic therapy c.Electrocardiography d.Intensify home dose of beta-blocker therapy Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 65). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER An AG-ACNP is caring for a male client in the ED with dull precordial chest pain and headache. He denies known past medical problems and is on no routine medications. The client is found to have a blood pressure of 240/130 and nicardipine (Cardene) infusion has been ordered. Which potential adverse effect might necessitate the addition of an esmolol (Brevibloc) infusion? a.Neurological changes b.Intensifying chest pain c.Reflex tachycardia d.Rebound hypertension Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 65). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A 54-year-old client is being managed in the cardiac-surgical ICU, and is currently 14 hours post coronary artery bypass surgery. For the past 2 hours, the patient complains of progressive dyspnea at rest. Upon assessment, the NP notes markedly distant heart tones, diminished peripheral pulses during inspiration, and JVD to the angle of the jaw. The AG-ACNP recognizes this as: a.Cardiac tamponade b.Acute respiratory failure c.Fluid volume overload d.Recurrent myocardial ischemia Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 66). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER A critically ill client becomes hemodynamically unstable. Exam reveals muffled heart sounds and JVD. Blood pressure shows a narrowed pulse pressure with pulsus paradoxus. Which intervention is most important for the NP to urgently facilitate in the care of this client? a.Aggressive intravenous diuresis b.STAT cardiac MRI c.Emergent intravenous vasodilators d.Immediate cardiac surgical consultation Adult-Gerontology Acute Care Nurse Practitioner Q&A Review (p. 66). Springer Publishing Company. Kindle Edition. - CORRECT ANSWER [Show Less]
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Joel Essentials in role development Exam 41 Questions with Verified Answers ,100% CORRECT
Joel Essentials in role development Exam 41 Questions with Verified Answers 3. Which type of grant proposal does the advanced practice nurse (APN) su... [Show More] bmit when completing a doctor of philosophy (PhD) residency? 1. Practice 2. Business 3. Research 4. Leadership - CORRECT ANSWER 3. research 1.Which change represents the primary impetus for the end of the era of the female lay healer? 1. Perception of health promotion as an obligation 2. Development of a clinical nurse specialist position statement 3. Foundation of the American Association of Nurse-Midwives 4. Emergence of a medical establishment - CORRECT ANSWER 4. The emergence of a male medical establishment represents the primary impetus for the end of the era of the female lay healer. Whereas lay healers viewed their role as being a function of their community obligations, the emerging medical establishment viewed healing as a commodity. The era of the female lay healer began and ended in the 19th century. The American Association of Nurse-Midwives (AANM) was founded in 1928. The American Nurses Association (ANA) position statement on educational requirements for the clinical nurse specialist (CNS) was developed in 1965; the ANA's position statement on the role of the CNS was issued in 1976. The beginning of modern nursing is traditionally considered to have begun with which event? 1. Establishment of the first school of nursing 2. Incorporation of midwifery by the lay healer 3. Establishment of the Frontier Nursing Service (FNS) 4. Creation of the American Association of Nurse-Midwives (AANM) - CORRECT ANSWER 1. Traditionally, modern nursing is considered to have begun in 1873, when the first three U.S. training schools for nurses opened. The role of the lay healer as a midwife is documented to have occurred in the 19th century, before the establishment of schools of nursing. The Frontier Nursing Service (FNS), which provided nurse-midwifery services, was established in 1925. In 1928, the Kentucky State Association of Midwives, which was an outgrowth of the FNS, became the American Association of Nurse-Midwives (AANM). 3. In 1910, which factors most significantly influenced the midwifery profession? Select all that apply. 1. Strict licensing requirements 2. Negative public perception 3. Dedicated funding for training 4. Poor maternal-child outcomes 5. Mandatory professional supervision - CORRECT ANSWER 2. & 4 In 1910, the midwifery profession was significantly influenced by poor maternal-child outcomes and a public perception as unprofessional. 4. Which advanced practice nursing role is unique in that the practitioners view their role as comprising a combination of two distinct disciplines? 1. Nurse practitioner 2. Certified registered nurse anesthetist 3. Clinical nurse specialist 4. Certified nurse-midwife - CORRECT ANSWER 4. The role of the certified nurse-midwife (CNM) is unique in that the CNM views the practice role as combining two disciplines: nursing and midwifery. In the 19th century, which factors led to the administration of anesthesia by nurses? Select all that apply. 1. Surgeon entitlement to collecting anesthesia fees 2. Collaborative practice between physician-anesthetists and nurses 3. Lack of recognition of anesthesiology as a medical specialty 4. Opposition to anesthesia administration by physicians 5. Formation of a national organization by nurse anesthetists - CORRECT ANSWER 1 & 3 Because of a lack of recognition as a medical specialty and the surgeon's entitlement to collecting anesthesia fees, other physicians had little to no interest in anesthesia administration Which factor contributed to expansion of the role of the clinical nurse specialist (CNS) during the 1960s? 1. Increased numbers of practicing physicians 2. Tightening of female role definitions 3. Return of nurses from military conflict 4. Lack of medical specialization - CORRECT ANSWER 3. return of nurse veterans from the Vietnam War who sought to increase their knowledge and skills, and to work in advanced roles and nontraditional fields, such as anesthesia and trauma. 7. Differentiation between the role of the clinical nurse specialist (CNS) and the nurse practitioner (NP) is primarily based on which premise? . Designation as an advanced practice nurse 2. Diagnosis of patient health conditions 3. Nature of practice setting environments 4. Authority to prescribe medications - CORRECT ANSWER 3. the nature of the practice setting. Although the CNS most often practices in a secondary or tertiary care setting, the NP often practices in a primary care setting. The National Council of State Boards of Nursing's Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation prompted gains related to which aspects of the role and function of the nurse practitioner (NP)? Select all that apply. 1. Legal authority 2. Reimbursement 3. Consumer recognition 4. Prescriptive privilege 5. Autonomy - CORRECT ANSWER 1, 2& 4 The 2008 adoption of the Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation by the National Council of State Boards of Nursing prompted gains related to several aspects of the role and function of the nurse practitioner (NP), including legal authority, reimbursement mechanisms in the United States, and prescriptive privilege. 9. The doctor of nursing practice (DNP) degree was developed to support the achievement of which goal related to advanced practice nursing education? 1. Eliminating master's degree programs 2. Promoting excellence in clinical practice 3. Replacing doctor of philosophy programs 4. Emphasizing nursing research - CORRECT ANSWER 2 Promoting excellence in clinical practice 10. Among national nursing leaders, which argument serves as a basis for opposition to the requirement that advanced practice nurses (APNs) earn a doctor of nursing practice (DNP) degree? 1. Greater professionalization is needed among advanced practice nurses. 2. The number of graduate nursing programs should be limited. 3. Advanced practice nursing certification should not require a doctoral degree. 4. The need for care providers should be prioritized. - CORRECT ANSWER 4. The need for care providers should be prioritized. 2. According to the Consensus Model for APRN Regulation, advanced practice nursing should abide by which recommendation? 1. Emphasizing state-based regulation of advanced practice nursing standards 2. Ensuring regulation of advanced practice registered nurses (APRNs) as a unified, collective group 3. Preparing clinical nurse specialists (CNSs) to function primarily in acute care 4. Changing the population focus of adult nurse practitioners to adult gerontology - CORRECT ANSWER 4. Per the Consensus Model, the population focus of adult nurse practitioners (NPs) has shifted to adult gerontology. As opposed to emphasizing state-based regulation of advanced practice nursing, broad goals of the Consensus Model include developing more consistent standards for advanced practice nurses (APNs) that promote eligibility for interstate licensure reciprocity. Instead of ensuring regulation of advanced practice registered nurses (APRNs) as a collective group, the Consensus Model recommends regulation of APRNs in one of four accepted roles. The Consensus Model describes the practice of clinical nurse specialists (CNSs) as including both acute and primary care settings. 4. For nurse practitioners (NPs), which issue represents a current barrier to autonomy. 1. Restrictions on reimbursement for services 2. Absence of state-based prescriptive authority 3. Limited ability to serve in acute care settings 4. Lack of authority to manage medical problems - CORRECT ANSWER 1. Restrictions on reimbursement for services 5. Which changes have contributed to the evolution of the present-day nurse practitioner (NP)'s role? Select all that apply. 1. Focus on delivering care to low-income patients 2.Development of retail patient care clinics 3. Increased access to Medicaid recipients 4. Inclusion of patients from suburban areas 5. Emphasis on serving uninsured immigrants - CORRECT ANSWER 2. Development of retail patient care clinics 4. Inclusion of patients from suburban areas Which consideration led to designation of the nurse practitioner (NP) rather than the clinical nurse specialist (CNS) as the advanced practice nurse (APN) who would deliver care related to psychiatric or mental health services? 1. Level of educational preparation 2. Eligibility for prescriptive authority 3. Ability to serve in community settings 4. Practice based on core competencies - CORRECT ANSWER 2. A heightened emphasis on a biopsychological approach to treating clients with psychiatric/mental health needs has underscored the importance of prescriptive authority for this advanced practice nursing role. Which of the following defines the current practice of the acute care nurse practitioner (NP)? 1. Unit-based versus practice-based assignment 2. Participation on a specialty care team 3. Geographical setting 4. Patient population - CORRECT ANSWER 4. Patient population Which activity does the advanced practice nurse (APN) complete when participating in a doctor of nursing practice (DNP) residency? 1. Participate in quality improvement 2. Present at research conferences 3. Pilot research projects for dissertation 4. Submit research grant proposals - CORRECT ANSWER 3. Pilot research projects for dissertation 1. Which activity does the advanced practice nurse (APN) anticipate when completing a doctor of philosophy (PhD) research residency? 1. Literature review in nursing science 2. Participation in quality improvement 3. Presentation at practice conferences 4. Development of capstone with mentors - CORRECT ANSWER 1. Literature review in nursing science 2. According to the Consensus Model for APRN Regulation, advanced practice nursing should abide by which recommendation? 1. Emphasizing state-based regulation of advanced practice nursing standards 2. Ensuring regulation of advanced practice registered nurses (APRNs) as a unified, collective group 3. Preparing clinical nurse specialists (CNSs) to function primarily in acute care 4. Changing the population focus of adult nurse practitioners to adult gerontology - CORRECT ANSWER The following are: The government is responsible for public health activities• A population-based focus is assumed• Public health addresses relationships between the state and the population• Population-based services are delivered grounded in science• Public health officers have the power to coerce individuals and businesses into actions that protect the health of the population - CORRECT ANSWER Characteristics of Public Health Law the legal powers and duties of the state that assure conditions of health for the people and limit the use of state powers to constrain autonomy, privacy, liberty, proprietary, or other legal protected rights" - CORRECT ANSWER Public Health Law Definition Foundation U.S. Constitution Treaties and federal statutes Federal regulations State constitutions State statutes State regulations Local authority Common Law - CORRECT ANSWER Heirarchy 1. Which of the following changed the ability of all advanced practice nurses (APNs) to prescribe medications? 1. Risk of harm to patients 2. Lack of a physician on site 3. Nurse practitioner (NP) practice in primary care 4. Interruption of patient flow - CORRECT ANSWER 3. Nurse practitioner (NP) practice in primary care 2. Which of the following has been the main source of barriers limiting advanced practice registered nurses' (APRNs') prescriptive authority? 1. Limitations in state legislation and regulations 2. Concerns about patient safety and quality of care 3. Requirement for Drug Enforcement (DEA) number 4. Organized lobbying by medical organization - CORRECT ANSWER 4. The majority of barriers to practice have roots in organized lobbying by certain parts of the medical community to limit the autonomy of advanced practice registered nurses (APRNs) 3. Which of the following was found to be the most practical formulary for regulating prescriptive authority? 1. Open 2. Exclusionary 3. Collaborative 4. Regulator established - CORRECT ANSWER 2. Exclusionary formularies were found to be a more practical approach to regulation of prescriptive authority. 6. Which of the following describes the historical progression of advanced practice registered nurses' (APRNs') attainment of prescriptive authority? Select all that apply. 1. Standardization of educational programs 2. Lack of primary care in underserved areas 3. Complexity of the federal legislation process 4. Persuasion of legislators and state governors 5. Lack of title recognition in nurse practice acts - CORRECT ANSWER 1,2,4,5 Which of the following contributes to the increase in the likelihood of advanced practice registered nurses (APRNs) attaining nationwide prescriptive authority? 1. Quality of care 2. Cost-effectiveness 3. Uniform nurse practice acts 4. Designation as a midlevel practitioner 5. Endorsement of APRN Consensus Model - CORRECT ANSWER 1.quality of Care 2. Cost - effectiveness 5. Endorsement of APRN Consensus Model- Though totally unfettered authority by all advanced practice registered nurses (APRNs) has not yet been achieved, the experience of prescribing medications for patients under the care of these providers has been found to be safe and beneficial. The practicality, the enhancement of quality of care, and the cost-effectiveness of the practice of these groups has enhanced the logic and desirability of giving prescriptive authority to APRNs nationwide. 9. The primary document that supports advance practice registered nurses' (APRNs') unrestricted prescriptive authority and provides recommendations for APRNs' education and certification is _______________. - CORRECT ANSWER APRN Consensus Model Reorder the steps for changing a state's nurse practice act (first to last). 1. Hearing to give testimony 2. Introduction of legislation 3. Sent to floor of both chambers 4. Referral to committee of jurisdiction 5. Passage through appropriate committees - CORRECT ANSWER 2. Legislation must be introduced that amends or adds to current law. 4. Once legislation is introduced, it is referred to a committee of jurisdiction (usually a professional licensure committee) for consideration. 1. Once the legislation is in committee, the chair of that committee generally calls for a hearing to allow proponents and opponents of the legislation to give testimony regarding the introduced legislation. 5. After passing through all appropriate committees, the legislation, at the discretion of the majority party leadership, is taken to the floor of the voting chamber for a vote. In some states, proposed legislation must also go through the appropriations committee of at least one of the voting chambers to determine cost and evaluate fiscal impact on the state. 3. After passing through all appropriate committees, the legislation is taken to the floor of the voting chambers. Sometimes this is done simultaneously in both chambers of the state legislature; in others, the legislation passes through one chamber at a time Nurses working in a Magnet facility have low staff turnover rates and report high job satisfaction, making others aspire to have the longevity in employment experienced by those at the Magnet facility. Which of the following reference groups is this an example of? 1. Evaluative 2. Normative 3. Comparison 4. Audience - CORRECT ANSWER 3. Comparison 2. Which action should the advanced practice nurse (APN) take to be successful in socialization? 1. Be better at multitasking. 2. Develop a rapport with colleagues. 3. Develop skills in empathic communication. 4. Practice sympathetic listening - CORRECT ANSWER 3. Develop skills in empathic communication. An advanced practice nurse (APN) consistently identifies each client by the five rights upon every encounter. This behavior is an example of which of the following? 1. First-order change 2. Second-order change 3. Role-making 4. Subrole internalization - CORRECT ANSWER 2. Second-order change 4. Which action by the advanced practice nurse (APN) demonstrates role-making? 1. Practicing autonomy when working in a busy practice 2. Suggesting a change in treatment to the supervising physician 3. Changing a client's medication to a lower dosage 4. Teaching a client how to self-administer insulin - CORRECT ANSWER 2. Suggesting a change in treatment to the supervising physician 5. The advanced practice nurse (APN) is mentoring an APN student. The APN recognizes that the student is having a hard time adjusting to the new role. Which action should the mentor take? 1. Allow the student to work through the process. 2. Listen sympathetically to the student. 3. Refer the student to a colleague with similar experiences. 4. Treat each failure as a learning opportunity. - CORRECT ANSWER 4. Treat each failure as a learning opportunity. 6. The advanced practice nurse (APN) is working with a colleague in a busy surgical center and becomes concerned with the colleague's change in behavior. Which sign indicates that the colleague might be experiencing burnout? 1. Empathic behavior 2. Short attention span 3. Sensitivity 4. Intolerance - CORRECT ANSWER 4. Intolerance The advanced practice nurse (APN) is working in a busy emergency room. Which action can the APN take to reduce role strain? 1. Own the problem and work through it. 2. Find a quiet place to retreat. 3. Focus on helping others. 4. Become more involved in the work environment. - CORRECT ANSWER 2. Find a quiet place to retreat. The advanced practice nurse (APN) is experiencing burnout and recognizes the need for self-care. Which action should the APN avoid? 1. Work through stressful situations and then take a break. 2. Plan self-care as seriously as client care. 3. Determine who owns each problem. 4. Examine the quality of peer support. - CORRECT ANSWER 1. Work through stressful situations and then take a break. 9. The advanced practice nurse (APN) is working with a new nurse. Which action by the nurse does the APN interpret as the social integration phase of resocialization? 1. Working well with others in the profession 2. Mastering skills 3. Integrating values into work setting 4. Displaying competency in routine - CORRECT ANSWER 1. Working well with others in the profession 10. Which action should the advanced practice nurse (APN) avoid when attempting to resolve role strain? 1. Using alcohol to escape stress 2. Taking meditation breaks during a shift 3. Talking with coworkers 4. Voicing opinions at a staff meeting - CORRECT ANSWER 1. Using alcohol to escape stress 1• Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death. 2• Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. 3• Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all. 4• Promote healthy development, healthy behaviors, and well-being across all life stages. 5• Engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all." - CORRECT ANSWER Healthy People 2030Overarching Goals• Social deterrents to health - Ethical Considerations - Culture Care Theory - CORRECT ANSWER .Principle of justice- Fair and equitable access to high-quality health-care services • Integration of cultural competence into all care roles .Culturally congruent care to patients from diverse populations • Both universal and culture-specific care patterns acknowledged [Show Less]
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Professionalism Exam 29 Questions with Verified Answers,100% CORRECT
Professionalism Exam 29 Questions with Verified Answers Discuss the role of the APRN and PA. - CORRECT ANSWER In addition to the role of the RN, the APR... [Show More] N is able to assess patients as well as initiate diagnostic tests and procedures to improve patient outcomes. APRN's are also able to make diagnoses and provide patients with therapeutic interventions (they have prescribing capabilities) through evidence-based practices and knowledge (American Nurses Association, 2015). Health promotion, education and research are in the scope of practice of both APRNs and PAs. PAs are able to conduct physical exams, diagnose and treat illnesses, order and interpret tests, develop specific treatment plans, prescribe medication, perform procedures and assist in surgeries What are the differences (APRN vs PA)? - CORRECT ANSWER One benefit of being a nurse practitioner is the autonomy that the profession allows. Nurse practitioners have full practice in some states, and full prescription privileges in all 50 states. In non-full practice states, APRNs must have a collaborative agreement with a physician (McCleery, 2014). Unfortunately, PAs must work under the license and agreement of a physician. APRNs follow the nursing model which is focused on holistic and population based patient care and PAs follow the medical model (American Academy of PAs, 2021). Nurse practitioners can practice in primary care settings, pediatrics, gerontology, mental health and women's health facilities (American Nurses Association, 2015). PAs concentrate in a specific area such as the ER, surgery, women's health and internal medicine Examine the education requirements for each. - CORRECT ANSWER PAs are required to obtain a bachelor's degree in any health related field (with the required program prerequisites) and APRNs are required to have completed a BSN RN degree. Both then require the completion of a masters program and sometimes a doctorate degree (Florida Board of Nursing, 2021). PAs complete 1000 group didactic hours and 2000 clinical hours and sit for the PANCE board exam (American Academy of PAs, 2021). Nurse practitioners are required to have undergone 500 didactic hours and 500 clinical hours to sit for the board exam (Florida Board of Nursing, 2021). The board exam for APRNs is the AANP or ANCCE Explore the current evidence regarding how the APRNs contribute to healthcare. - CORRECT ANSWER According to AANP, 75% of APRN practice in primary care. They are a vital part of the primary care workforce in the United States(AANP,2018). Research shows that Nurse practitioners are able to provide high quality care while being cost effective. Nurse Practitioners are able to provide care of equal or sometimes better quality care at a lower cost compared to other providers. One Study even showed that APRN services in emergency room settings showed reduced waiting time as well as provide care that can be compared to a midgrade physician (Woo, 2017). When there are APRNs in healthcare this can lead to the population to have greater access to emergency, critical care as well as primary care which can strengthen the healthcare team in order to meet the increased demands of healthcare. The value of the APRN is seen because they are helping with patient care across the board when it comes to communication, discharge planning, follow-up care as well as administrative work(Woo, 2017). While patients see NP it shows decrease patient's length of stay was shortened. In conclusion, APRN shows that they reduce cost of care, nursing management shows that they deliver 23% below average cost. They save money for patients, tax payers and it helps patients prevent loss of time and income from work. Research shows that their outcome of care is similar if not the same as doctors and are seen more in underserved rural areas. Describe any barriers that APRNs may encounter working as an APRN - CORRECT ANSWER Working as an APRN could come with several barriers when it comes to the workplace environment. The first barrier can be the regulations that the state enforces. Even though there is evidence showing data and evidence in support of full practice authority many states continue to deny APRN the right to practice to the full extent of the license they carry(Kleinpell, et al.., 2014). Some of the barriers include poor role clarification, proliferation of APRN titles, differing educational requirements and degrees, scope of practice issues, and fragmentation/ variability in standards and quality of educational programs (Kleinpell, et al.., 2014). Some of the other barriers are lack of public awareness on APRN roles meaning that many patients do not know what APRN do. Another issue is that Physicians themselves are not completely aware of what an APRN can do during a clinic. Also, the physicians think they are more valuable when compared to APRN because they consider themselves to have more education compared to APRN. Another issue is the reimbursement issue they are facing. In conclusion, there is a federal, state as well as institutional limit to APRN practice and in turn creates delays when it comes to care, raises the cost of care and can make it harder for patients to get services such as primary care etc. What is the consensus model - CORRECT ANSWER The consensus model provides guidance for states to adopt uniformity in the regulation of APRN roles. This includes licensure, accreditation, certification and education (LACE). The model allows for the facilitation & regulation of safe and competent advanced practice registered nurses (APRNs) in every state. Unfortunately, this model is not binding to the 50 states. It is just a guideline for states to follow (American Nurses Association, 2015). This model could apply/be beneficial to APRNs who are traveling across state lines to provide care in emergency situations. For example, to provide care to covid patients in other states, in which the nurse is not licensed. What can or can't I do in practice? For example, can I perform I&D's - CORRECT ANSWER An APRN in practice can do the following but are not limited to: ordering, conducting and interpreting diagnostic and laboratory tests; prescribing pharmacologic agents and non-pharmacologic therapies; and teaching and counseling (ANA,2015). APRN usually do not perform complex surgical procedures, they can perform some invasive treatment procedures. Performing or ordering preventative and diagnostic procedures based on the patient's age and history ARNP can perform I&D, respiratory procedure, microscopy, as well as do feral monitoring. Always take into consideration that the APRN scope of practice is dependent on age of foci. Depending on where the APRN works they can do intubations, pap smears, venous access placements. Suturing, prostate exams to name a few. In conclusion, what APRN can or cannot do is depending on the scope of practice dictated by the state. What do I need to obtain a license to practice in FL - CORRECT ANSWER For Licensure as an Advanced Practice Registered Nurse, the requirements are as follows and can be found in Section 464.012, F.S ( Florida Board of Nursing, 2021). Hold a valid Registered Nurse License from any US jurisdiction (at initial APRN licensure). Education Requirements: Applicants who graduated on or after October 1, 1998, must have completed requirements for a master's degree or post-master's degree certification. Certified Registered Nurse Anesthetist applicants who graduated on or after October 1, 2001, must have completed requirements for a master's degree program. Applicants who graduated prior to the applicable date are exempt from this requirement. Graduates from either a certificate or currently closed program should submit supporting documentation that demonstrates program compliance with Board guidelines. After July 1, 2006, applicants for licensure as an Advanced Practice Registered Nurse pursuant to section 464.012(1), F.S., shall submit proof of national advanced practice certification from an approved nursing specialty board. And, proof of malpractice insurance or exemption. What do I need to sit for national boards - CORRECT ANSWER According to the American Nurses Credentialing Center (ANCC), the requirements to sit for national boards are as follows. Hold a current, active RN license in a state or territory of the United States or hold the professional, legally recognized equivalent in another country. Hold a master's, post-graduate, or doctoral degree from a family nurse practitioner program accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN) (formerly NLNAC | National League for Nursing Accrediting Commission). A minimum of 500 faculty-supervised clinical hours must be included in your family nurse practitioner program. Three separate, comprehensive graduate-level courses in: advanced physiology/pathophysiology, including general principles that apply across the life span; advanced health assessment, which includes assessment of all human systems, advanced assessment techniques, concepts, and approaches; advanced pharmacology, which includes pharmacodynamics, pharmacokinetics, and pharmacotherapeutics of all broad categories of agents. What are the different boards? Which should I choose and why? - CORRECT ANSWER After completing graduate education, NPs are eligible to sit for national certification examinations (NCE) in their specialty areas. Certification examinations are offered by a variety of bodies: the American Nurses Credentialing Center (ANCC), the American Academy of Nurse Practitioners Certification Board (AANPCB), the Pediatric Nursing Certification Board (PNCB), the American Association of Critical Nurses Certification Corporation (AACNCC), and the National Certification Corporation (NCC) for the obstetric, gynecologic, and neonatal specialties (Blair, 2018). I would choose the ANCC because this certification aligns with the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Once you complete eligibility requirements to take the certification examination and successfully pass the exam, you are awarded the credential: Adult-Gerontology Primary Care Nurse Practitioner-Board Certified Nursing - CORRECT ANSWER •The importance of the word "nursing" in advanced practice registered nurse (APRN). •Advanced education enables APRNs to be differentiated from other educationally prepared nurses and other health care professionals. •Advanced practice nursing is moving towards the practice doctorate as entry into practice. Florence Nightingale - CORRECT ANSWER •To put the person in the BEST possible condition so nature can act on the person. Virginia Henderson - CORRECT ANSWER nurse collaborates with an individual to enhance the health status including health promotion and patient independence. Art & Science of Nursing - CORRECT ANSWER •The APRN supports and assists holistic patient care. •Presence, empowerment, reflection, listening, touch, empathy, humor, knowing the community, accessing care and directly providing care ensures patient satisfaction and quality evidence-based outcomes. Heuristic caring - technique- any approach to problem solve that employs a practical method that is sufficient for reaching a short term goal. Negotiable with the patient, problem solve & provide self discovery. Touch, listening, assessing and providing care, etc. •Patient care is the priority of the APRN: Direct Care - CORRECT ANSWER -Patient advocate -Educator to the patient and family -Case manager -Consultant -Collaborator Educator - CORRECT ANSWER •Most printed educational content should be constructed at a fifth- to eighth-grade reading level. ethics - CORRECT ANSWER •what one ought to do bioethics - CORRECT ANSWER •when the moral choice involves health care. ex. Abortion dilemma - CORRECT ANSWER •a situation where there are several unequally satisfying solutions, or when there is a conflict between one's values. Utilitarianism - CORRECT ANSWER •the right act is the one which produces the "most good for the greatest number". •Example: universal health insurance, where everyone has access, but perhaps the critically ill or those who require more resources do not get help because more resources could be given to more people who require less. Liver for patient: kid, athlete, or 90 yo •Offers an explanation of the consequences of action or inaction. Deontology - CORRECT ANSWER •Emphasizes duty, obligation, rule-based ethics. •Focus is on the rightness or wrongness of actions (under a series of rules) versus the consequences of those actions. •Obligation to act in a way that is prudent or right. •The means justify the ends. •Example: removing life support from someone who has little chance of recovery because this is what a reasonable person would want, yet there is no way of really knowing what the person actually desired. Ex. Patient stole shoes bcuz siblings cant go to school because they don't have shoes Teleology - CORRECT ANSWER •Virtue ethics (focus on person's moral character rather than rules). •The greatest amount of happiness and the least amount of harm. •The end justifies the means. •Examples: A nurse speaks to his/her director about someone engaging in illegal. behavior (stealing items) in the department or a person is unwilling to sacrifice their moral beliefs for personal advancement. •Autonomy - CORRECT ANSWER •Self-determination •Respect for all persons •Must respect an individual's thoughts and actions •Restricted by paternalism •Example: informed consent, respect for privacy, helping with decision making when asked. Nonmaleficence - CORRECT ANSWER •Duty not to cause harm. •This is the only principle NOT contained in the Belmont Report. •The foundation of health care. •Does not require taking positive action. •Example: coercing a patient to participate in unwanted chemotherapy or assisting someone in ending their life. Beneficence - CORRECT ANSWER Duty to prevent harm and promote good. Benefits should outweigh the risks when providing care. Actions should promote good. Uses the principle of proportionality. Example: performing CPR, keeping side rails up to prevent patient falls, administering pain medication in a timely manner when clinically indicated. Justice - CORRECT ANSWER •The duty to be fair & equitable. •Fairness, individual rights. •Complex and difficult to apply in health care. •Healthy People 2020: eliminate health disparities (vulnerable individuals). •Examples: Who should get the heart transplant? Who should get the remaining ventilator? Charlie Gard case. Veracity - CORRECT ANSWER •The duty to tell the truth •Truth-telling •Must use language that the patient understands (all patient education materials should be written at the 5th grade level). •Example: honestly explaining an advance directive. Confidentiality - CORRECT ANSWER •Respect for privileged information. •Crucial in the provider-patient relationship. •HIPAA •Breach of confidentiality can be a reason for disciplinary action or even termination (reviewing EHR of patient that you are not caring for). •Another example: not sharing patient's condition with visitors, family or friends. Fidelity - CORRECT ANSWER •Keep promises •Duty to be faithful •Avoid false expectations •Example: telling the patient you will request a consultation, and then following up on it [Show Less]
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NP Role Final Exam 159 Questions with Verified Answers,100% CORRECT
NP Role Final Exam 159 Questions with Verified Answers In which specialty are most nurse practitioners educated? Peds Primary care Family Adult g... [Show More] erontology - CORRECT ANSWER primary care Which factor represents a potential barrier to Nurse Practitioner's practice in a primary care setting? Cost effectiveness Professional growth Aging baby boomers Collaboration agreements - CORRECT ANSWER Collaboration agreements Distinguish among the advanced practice registered nursing (APRN) roles recognized by the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education. - CORRECT ANSWER Under the APRN model of regulation, the 4 roles recognized are Certified registered nurse anesthetist Certified nurse midwife Clinical nurse specialist Certified nurse practitioner APRNs are certified in one of the 4 roles and at least one of the six population foci: family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women's health, and/or psych Which topic is specifically addressed in outcomes designated by the AACN essentials for Master's education in nursing? physical assessment pathophysiology population health pharmacology - CORRECT ANSWER population health Which organization outlined core competencies for nurse practitioners in all tracks and specialties? American Association of Nurse Practitioners (AANP) National Organization for Nurse Practitioner Faculties (NONPF) American Association of Colleges of Nursing (AACN) National Council of State Boards of Nursing (NCSBN) - CORRECT ANSWER NONPF Differentiate between the focus of the doctor of nursing practice (DNP) and the doctor of philosophy (PhD) in nursing. - CORRECT ANSWER DNP's educational focus is on clinical practice and the PhD is more specific for research Which American Association of Colleges of Nursing (AACN) essential is unique to the doctor of nursing practice (DNP) program? a. Background for practice from sciences and humanities b. Advanced nursing practice c. Healthcare policy for advocacy in health care d. Organizational and systems leadership - CORRECT ANSWER Advanced nursing practice Describe the components of the DNP Scholarly Project as designated by the American Association of Colleges of Nursing (AACN) - CORRECT ANSWER As per the AACN, the DNP Scholarly Project must meet the following criteria: (a) focus on a change that impacts healthcare outcomes either through direct or indirect care; (b) have a systems (micro-, meso-, or macro-level) or population/aggregate focus; (c) demonstrate implementation in the appropriate arena or area of practice; (d) include a plan for sustainability (e.g. financial, systems or political realities, not only theoretical abstractions); (e) include an evaluation of processes and/or outcomes (formative or summative); (f) be designed so that processes and/or outcomes will be evaluated to guide practice and policy; and (g) provide a foundation for future practice scholarship. Discuss the scope of practice and expanded opportunities made available to the nurse practitioner who earns a doctor of nursing practice (DNP) degree - CORRECT ANSWER For the nurse practitioner who earns a DNP, the scope of practice does not change. However, by way of knowledge and skills gained in a DNP program, the nurse practitioner (NP) may have a greater impact on health outcomes for patients and populations. In addition, the DNP/NP may clinically practice in nearly any setting; including in a community health center leadership role, in larger acute care facilities, as a solo practitioner, and in nurse-managed health centers. The DNP/NP also may perform and apply research. For the DNP/NP, opportunities also include obtaining joint appointments with educational institutions and healthcare facilities, as well as serving as a leader in disease management. Explain the relevance of nursing philosophies and theories to the nurse practitioner's delivery of patient care. - CORRECT ANSWER Nursing philosophies and theories serve as the foundation for delivery of patient care by the nurse practitioner (NP). Concepts described in nursing philosophies and theories form the basis for excellence in nursing practice and serve to illustrate the NP's distinctive qualities. Nursing philosophies and theories conceptualize unique qualities; including the NP's ability to build trust, instill confidence, and create a positive patient-NP relationship. Discuss the relationship between a microsystem and a macrosystem in the context of a family unit. - CORRECT ANSWER The family microsystem comprises the nuclear family and extended family members, as well as the roles and expectations for each family member. The macrosystem represents the larger world in which the family lives and interacts, and serves as a social framework that has unintentional influences on values, attitudes, and behaviors through time. The macrosystem may impact the family's overall development and well-being across the family lifespan. Components of the macrosystem include social expectations, legal and moral perspectives, and cultural traditions that affect the ways individuals treat and are treated by others. Which step does the nurse practitioner include when applying the structural approach to family unit assessment? a. Consider normal family changes and experiences over the family members' lifetime b. Assess both individual family members and families as a whole unit c. Emphasize dimensions of time and change in the family's membership structure d. Recognize the cluster of expectations or norms for any family member's status position - CORRECT ANSWER Recognize the cluster of expectations or norms for any family member's status position The nurse practitioner considers the combined effects of both normative events and unexpected events on the family unit's health. Which family theory is most congruent with the nurse practitioner's assessment approach? a. Family stress theory b. Individual life span theory c. Family development theory d. Life course theory - CORRECT ANSWER Family stress theory Summarize the basic nature of resilience including behaviors demonstrated by resilient individuals. - CORRECT ANSWER Resilience is defined as the ability of an individual or family to function well and attain life goals despite overbearing stressors or challenges that might easily impair the person or family unit. Primary desired outcomes associated with resilience include moderating the negative effects of stress and promoting adaptation. While resilience is sometimes conceptualized as the ability to withstand a crisis that is brief in nature, in most cases, resilience is associated with how an individual or family manages a pervasive social condition such as poverty, a devastating illness, or a critical injury. Behaviors that are reflective of resilience include preserving hope;constructing a meaningful account of life events or situations; reaching out to others for help as needed; and identifying or developing resources and strengths to manage stressors flexibly and gain a positive outcome. Individual, family, and social factors that promote resilience include which characteristic? a. External locus of control b. Dependency c. Spirituality d. Upward social comparison - CORRECT ANSWER Spirituality When collecting data related to family structure, which information is needed for assessment of the family constellation? a. Identification of immediate family members b. Current level of financial support c. Strategies used for stress management d. Eligibility for financial assistance - CORRECT ANSWER Identification of immediate family members Describe family capacity including strategies that support family capacity-building. - CORRECT ANSWER Family capacity is the extent to which a family's needs, goals, strengths, capabilities, and aspirations can meet the family's ability to function to its fullest potential. Similar to resilience, family capacity may be reflective of the family's ability to adapt and change. Family capacity-building involves increasing the family members' competence in implementing strategies to enhance their development and build their problem-solving skills while increasing their confidence that they are able to do so. Which factor represents a limitation associated with use of a genogram for family health assessment? a. Data collection requires extensive interviewing b. Family members tend to be disengaged from the process. c. All information must be obtained in one sitting. d. Cultural assessment data is not included. - CORRECT ANSWER Cultural assessment data is not included. Compare and contrast the genogram and the family pedigree. - CORRECT ANSWER A genogram is an assessment tool or clinical method of taking, storing, and processing family information for the benefit of the patient and the family. Information collected for use in agenogram is displayed as a graphic representation of family members and their relations over three generations. The information collected for the genogram may include genetic, medical, social, behavioral, and cultural aspects of the family. Similar to a genogram, a family pedigree is a graphic representation of a person's medical and biological history and is often referred to as the "family tree." Like the genogram, the pedigree is a family history assessment tool developed in an interview with a patient and is displayed as a graphic representation. A pedigree can be a powerful tool for use in health risk identification, diagnosis, and intervention. However, the pedigree provides little insight into family dynamics or the complex context of the patient and family in the community. While the genogram focuses on family relationships and communication patterns, the pedigree is a collection of the family health history and an assessment of disease risk factors. Summarize the three general components of a comprehensive prioritized problem list. - CORRECT ANSWER Contents of the problem list may vary based on healthcare organizational requirements and healthcare provider preferences. In general, main components of a comprehensive prioritized problem list include (a) a list of chronic diseases or illnesses; (b) an ongoing or active problem that you are working on with the patient; and (c) a summarization of the most important things about a patient. Explain the impact of healthcare disparities and vulnerability on health outcomes. - CORRECT ANSWER Healthcare disparities comprise differences in healthcare quality among individuals or groups with regard to access, treatment options, and preventative services. Segments of the global population experience social inequalities and are at risk for poor health outcomes. While any individual can become vulnerable at any point in their life, as documented in the literature, health outcomes and vulnerability fall along a social gradient and poorer people experience poorer health. For the culturally competent nurse practitioner, the delivery of patient care is influenced by which principle? a. High-income countries are not subject to health disparities. b. Access to primary health care services is a human right. c. Gaps in health outcomes between different groups of people are inevitable. d. Certain forms of health inequities are considered to be fair and just. - CORRECT ANSWER Access to primary health care services is a human right. The nurse practitioner explores a patient's social determinants of health. When assessing GRADESLAB.COM lifestyle and behaviors, which question does the nurse practitioner ask the patient? a. "Do you use tobacco products?" b. "Are you currently employed?" c. "Do you have sufficient food?" d. "What is your level of education?" - CORRECT ANSWER "Do you use tobacco products?" The nurse practitioner plans to advocate for improving access to health care among all populations. Which strategy does the nurse practitioner implement to advocate at the macrosystem level? a. Becoming motivated to act on the behalf of other individuals b. Developing cultural skills c. Working through the chain of command of a healthcare organization d. Gaining insight into self - CORRECT ANSWER Working through the chain of command of a healthcare organization Describe key social and environmental factors that coexist with poverty. - CORRECT ANSWER Beyond representing strictly a socioeconomic issue, poverty impacts health, well-being, and quality of life for generations to come. Key social and environmental factors that coexist with poverty include poor housing; inadequate nutrition; lack of clean water; increased exposure to violence; fragmented health care; and a higher prevalence of physical illness, mental health issues, and disabilities. Discuss factors that contribute to financial insecurity among the elderly. - CORRECT ANSWER While social security income is often identified as a protective factor against elderly poverty, increases in the life expectancy of the elderly over time mean that financial resources have to last longer. Simultaneously, healthcare and housing costs are rising and employer benefit pension plans have decreased. As a result, elderly individuals face significant insecurity about whether or not their resources are sufficient to cover the duration of their lives after retirement. Discuss transgenerational trauma and its impact on disease development. - CORRECT ANSWER Transgenerational or intergenerational trauma comprises wounding from a traumatic event that produces effects upon generations after the initial trauma. Transgenerational trauma may occur in individual families. In addition, transgenerational trauma may occur among groups who have experienced various traumatic events (such as genocide, terrorism, and natural disasters) as collective trauma. For both individuals and groups, long-lasting harmful effects on physiological processes in the body may lead to the development of chronic disease Describe the nurse practitioner's approach to assessing and assisting an individual who may be subject to human trafficking. - CORRECT ANSWER The NP must be educated on identifying victims of human trafficking, developing culturally appropriate caring patient/provider relationships, becoming knowledgeable on reporting laws, and assisting colleagues to better identify and refer potential victims. Potential indicators of trafficking include (a) being accompanied by someone who appears to be controlling the individual and the scenario; (b) fear; (c) sadness; (d) bruises and other traumatic injuries; (e) lack of documentation; (f) discrepancy of behavior and reported age; and (g) generally poor health. Recommended approaches to assessment of individuals who may be subject to human trafficking include (a) assuring safety and confidentiality as a primary step; (b) asking about the individual's living arrangements and freedom to come and go at will; (c) asking if the individual is subject to threats or harm; and (d) asking if the individual has been forced to have sex or perform sex acts. Useful laboratory testing includes complete blood count, STD testing (including HIV), ova and parasites, hepatitis B and C, and tuberculosis. By working as a team with social services and law enforcement, the NP can help get the victim to safety and into services to assist transitioning to safe housing with long-term treatment for psychological and medical issues. When discussing gender and sexuality, a patient identifies as being "gender fluid." The nurse practitioner understands the patient's gender identification to be reflective of which self- perception? a. The patient does not identify with any gender. b. The patient identifies as mixed or neutral gender. c. The patient identifies with the gender assigned at birth. d. The patient's gender is not static but shifts. - CORRECT ANSWER The patient's gender is not static but shifts. When discussing sexual orientation, the patient tells the nurse practitioner, "I view myself as being female, but I am attracted to other people regardless of how they view their gender or gender identity." Which sexual preference best describes the patient's perspective? a. Pansexual b. Homosexual c. Asexual d. Bisexual - CORRECT ANSWER Pansexual Research suggests the delivery of disparate health services is most prevalent among patients who receive mental health treatment in which setting? a. Primary care b. Psychiatric c. Community health d. Pediatric - CORRECT ANSWER Primary care The term "co-occurring diagnosis" best describes a patient who is diagnosed with which concurrent health alterations? a. Schizophrenia and opioid abuse disorder b. Emphysema and chronic bronchitis c. Hypertension and borderline personality disorder d. Bipolar depression and conduct disorder - CORRECT ANSWER Schizophrenia and opioid abuse disorder Which disorder most significantly impacts out-of-home placement for children? a. Conduct disorder b. Autism spectrum disorder c. Post-traumatic stress disorder d. Substance use disorder - CORRECT ANSWER Substance use disorder Which single intervention is most appropriate for the nurse practitioner to consider including in the plan of care for a patient who is struggling with opioid and marijuana dependencies? a. Buprenorphine b. Motivational interviewing c. Naltrexone d. Family psychotherapy - CORRECT ANSWER Motivational interviewing Discuss health outcomes associated with alterations in cortisol release secondary to chronic stress and traumatic events. - CORRECT ANSWER Systemic cortisol release enables the body to respond to stressful stimuli. However, stress and traumatic events may lead to alterations in the hypothalamic-pituitary-adrenal (HPA) axis. For example, individuals who experience chronic stress may be subject to excessive cortisol production or to cortisol release in response to nonthreatening stimuli. In animal studies, researchers found that excessive cortisol release and increased HPA axis reactivity may be linked to an increased risk for developing depression. Decreased HPA reactivity and an associated blunted cortisol response also have health implications. Lower HPA reactivity is associated with social and behavioral challenges during both childhood and adulthood. Blunted cortisol release has been studied with childhood victims of abuse and bullying. Indirect victims of trauma, such as children who witness interpersonal conflict between caregivers, have also been observed to demonstrate a low cortisol response rate. Discuss the relationship between housing instability among women and intimate partner violence. - CORRECT ANSWER Women are especially vulnerable to issues related to housing instability. A bidirectional relationship exists between housing instability and intimate partner violence. For women who are financially dependent on an abusive partner, lack of housing options represents a significant barrier to leaving the abusive relationship. In turn, future housing instability can be predicted based on having experienced intimate partner violence. The nurse practitioner (NP) identifies which personal characteristic as a potential manifestation of vicarious traumatization (VT)? a. Scheduling time off work b. Seeking peer socialization c. Empathizing with clients d. Experiencing somatization - CORRECT ANSWER Experiencing somatization Explain the bidirectional nature of dual diagnosis. - CORRECT ANSWER General risk factors are often present for both mental illness and substance use. Substance use may be secondary to a psychiatric disorder; however, a psychiatric disorder may also develop secondary to substance abuse. Commonly, dual-diagnosis is bidirectional, meaning the conditions contribute to one other. Explain the importance of including suicide screening during risk assessment for members of the general, adolescent, and geriatric populations. - CORRECT ANSWER For all risk assessments, suicide screening is a key component. In the United States, according to the Centers for Disease Control and Prevention (CDC), suicide is the 10th leading cause of death and is responsible for 1% of fatalities. The primary care setting provides the greatest opportunity for suicide screening. Recent research indicated individuals who committed suicide visited their primary care provider within a month of the suicidal act. Members of the adolescent and geriatric populations are at high risk for suicidality. Because adolescents and geriatric patients typicallysee their primary care provider at least once per year, suicide screening should be included as part of routine office visits for members of these populations. Describe two key factors that contribute to misdiagnosis of bipolar depression as unipolar depression. - CORRECT ANSWER Key factors that contribute to misdiagnosis of bipolar depression as unipolar depression include that depression is a common symptom of bipolar disorder. Without more extensive patient reporting, misdiagnosis of bipolar depression as unipolar depression is likely to occur. Additionally, patients often fail to recall manic episodes. Explain how delivering patient care based on the Golden Rule may impede cultural competence. - CORRECT ANSWER In Western culture, the Golden Rule is one of the most familiar moral values. The Golden Rule is "Do unto others as you would have them do unto you." While the Golden Rule is rooted in good intentions, in health care, this value presumes that all individuals prefer to be treated in a manner that is congruent with the healthcare provider's personal standards and beliefs without consideration of individual preferences. Beyond following the Golden rule, culturally competent care requires the nurse practitioner (NP) to consider the patient's individual preferences. Which concept centers on a belief that the culture with which the individual is most familiar represents the cultural standard? a. Polarization b. Ethnocentrism c. Acculturation d. Stereotyping - CORRECT ANSWER Ethnocentrism Differentiate between the "melting pot" and the "tossed salad" perspectives in application to cultural awareness in the United States. - CORRECT ANSWER Considering the United States as a "melting pot," or the blending together of various cultures to form one, does not take into account the unique qualities of the various cultures that form the population. By contrast, perceiving the United States as a "tossed salad" represents a more culturally aware perspective through which the diversity of the culture is valued for what it contributes to the whole. The nurse practitioner (NP) applies Giger and Davidhizar's "transcultural assessment model" during patient assessment. Which statement by the patient is most useful for determining the patient's perception of environmental control? a. "God will decide whether or not I get well." b. "Several of my relatives have sickle cell anemia." c. "My parents think I need to drink more water." d. "I am not comfortable with strangers touching me." - CORRECT ANSWER "God will decide whether or not I get well." Which action by the nurse practitioner is most reflective of cultural humility? a. Developing competence regarding all cultures served in a specific setting b. Acknowledging limitations in understanding a patient's cultural background c. Viewing the patient's circumstances from the NP's perspective d. Learning about a specific cultural group's beliefs and preferences - CORRECT ANSWER Acknowledging limitations in understanding a patient's cultural background The nurse practitioner (NP) is preparing to assess a Native American patient. Which strategy demonstrates cultural sensitivity by the NP? a. Understanding the patient may avoid eye contact b. Anticipating that the patient may be quiet until trust is established c. Desiring to learn about the patient's use of herbal remedies d. Recognizing the patient may prefer to collaborate with a folk healer - CORRECT ANSWER Desiring to learn about the patient's use of herbal remedies Summarize the impact of cultural immersion experiences on cultural competency. - CORRECT ANSWER Research indicates cultural immersion experiences enhance cultural awareness and sensitivity. In addition, research suggests an individual's beliefs regarding a cultural group are affected by interacting with various culturally diverse groups, which prevents stereotyping. Discuss the importance of combining cultural awareness training with nurse practitioner-client partnerships to impact health outcomes for disparate populations. - CORRECT ANSWER Cultural awareness training may be helpful in increasing cultural awareness. However, simply completing cultural awareness training is not a guaranteed means by which to improve health outcomes for disparate populations. Cultural awareness becomes significant when the healthcare provider recognizes the influence of culture on a person's existence. Partnership between the NP and the client can help the NP gain a better understanding and appreciation of the client's culturally specific needs in the context of the client's population. Summarize the purpose and goals of the Office of Minority Health (OMH) Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS standards). - CORRECT ANSWER The Office of Minority Health (OMH) Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS standards) were developed for use by healthcare systems to promote delivery of the best possible care for the diverse patient populations who seek care in the United States. Goals of the CLAS standards include (a) advancing health equity; (b) improving quality; and (c) helping eliminate healthcare disparities. The 14 CLAS standards guide the nurse practitioner (NP) and other healthcare providers to the recommended language and communication processes in healthcare settings that will enhance patient care outcomes. The nurse practitioner's demonstration of cultural competence includes which intervention? a. Achieving consensus on differing values b. Using colloquial expressions when speaking c. Identifying stereotypes held by others d. Establishing boundaries for acceptable behaviors - CORRECT ANSWER Establishing boundaries for acceptable behaviors Unique aspects of a nurse practitioner (NP) preceptorship in an acute care setting include which consideration? a. Cultural competence b. Credentialing c. Clinical experience d. Collaboration - CORRECT ANSWER Credentialing Explain the role of the clinical advisor in relationship to the nurse practitioner (NP) student and the preceptor. - CORRECT ANSWER Clinical advisors are either full-time faculty or adjunct faculty who are NPs that are responsible for overseeing the clinical experiences of up to six NP students. The clinical advisor is the link for the student and the preceptor, visiting the student onsite to determine that the student is progressing in a supportive learning environment, in addition to getting to know the preceptor. This role provides the student and preceptor with someone knowledgeable about the course objectives and someone who can troubleshoot any issues that may arise. Despite excellent academic performance and favorable clinical evaluations, the nurse practitioner (NP) student thinks, "I feel like I am fooling everyone. My good grades and positive evaluations are based on luck." Which term best describes the NP student's perceptions? a. Identity crisis b. Role confusion c. Resocialization process d. Imposter phenomenon - CORRECT ANSWER Imposter phenomenon Which activity comprises a complementary form of clinical education? a. Evaluating the clinical site b. Performing a student self-evaluation c. Documenting the number of clinical hours completed d. Researching current information about a disease state - CORRECT ANSWER Researching current information about a disease state Discuss current pathways to earning a doctor of nursing practice (DNP) degree. - CORRECT ANSWER At present, several paths to the DNP are available. These academic paths include ADN to DNP, nonnursing baccalaureate degree to DNP, BSN to DNP, postmaster's DNP, and even postdoctorate DNP. Students may enter a program with experiences ranging from little to no nursing experience, several years of nursing experience, some years of nurse practitioner experience, to several years of nurse practitioner experience. According to the American Association of Colleges of Nursing (AACN), all final projects completed during the course of a doctor of nursing practice (DNP) nurse practitioner program should incorporate which component? a. Developing and implementing a research utilization project b. Evaluating a new practice model c. Using evidence to improve practice or patient outcomes d. Completing a pilot study - CORRECT ANSWER Using evidence to improve practice or patient outcomes Discuss the oral case study presentation, including its relevance to the nurse practitioner's practice and main components of the presentation. - CORRECT ANSWER The oral case presentation skill is central to healthcare providers' communication. It allows the nurse practitioner to succinctly convey a clear, organized analysis of a patient's health problem(s) to another provider in order to develop an effective management plan. The case presentation also serves as a method for clinical preceptors and peers to assess the level of expertise a practitioner has regarding a particular problem and to evaluate the assessment and management portion of that patient's care. Lastly, a clearly communicated case presentation enables the nurse practitioner to get a more experienced clinician's opinion about a patient in an efficient, cost-effective manner. The main components of an effective oral case study presentation include (1) introduction or chief complaint; (2) history of present illness; (3) physical examination; (4) diagnostic tests; (5) differential diagnosis; (6) management plan; and (7) summary. The cardiothoracic nurse practitioner (NP) is providing care to a patient who recently sustained a myocardial infarction (MI) and who may require surgical intervention. Which action by the NP best illustrates consultation? a. Asking another healthcare provider for direction on the patient's treatment plan for coronary artery disease b. Jointly communicating with another healthcare provider about the patient's ethical concerns related to blood transfusion c. Requesting that another healthcare provider accept the patient's ongoing treatment following surgery d. Working with another healthcare professional to determine the patient's need for postoperative home care - CORRECT ANSWER Asking another healthcare provider for direction on the patient's treatment plan for coronary artery disease Distinguish among collaboration, consultation, and referral of patients by the nurse practitioner. - CORRECT ANSWER Collaboration can be defined as a joint communication and decision-making process between healthcare professionals working toward a mutual goal of addressing a patient and family's medical, social, and ethical problems. Consultation can be defined as a request for direction or assistance on a diagnosis or treatment plan from another provider. Referral can be defined as another provider accepting the ongoing treatment of a patient for a specific problem and often for a limited amount of time. Explain how individual professions' isolated evidence base may create barriers for the nurse practitioner (NP) who seeks to implement effective collaborative teams. - CORRECT ANSWER When seeking to implement effective collaborative teams, barriers faced by the NP can be based on the individual professions' isolated evidence base, which results in a foundation of decision making and distinct communication patterns that can result in role confusion and turf battles. Each discipline perceives itself as having sole expertise, power, and leadership in one care aspect over the discipline. Describe the evolution of the definition of evidence-based medicine (EBM) to include patient values and preferences. - CORRECT ANSWER In the early published definitions of EBM, the areas of foci included identifying, critically appraising, and summarizing best current evidence. However, it became clear that evidence alone was not sufficient to make clinical decisions, so in 2000 the Evidence-Based Medicine Working Group presented the second fundamental principle of EBM. This principle specified that clinical decisions, recommendations, and practice guidelines must not only focus on the best available evidence, but they also must include the values and preferences of the informed patient. Summarize the four key assumptions of evidence-based practice (EBP) in nursing. - CORRECT ANSWER Key assumptions of EBP in nursing practice include (1) nursing is both a science and an applied profession; (2) knowledge is important to professional practice, and there are limits to knowledge that must be identified; (3) not all evidence is created equal, and there is a need to use the best available evidence; and (4) evidence-based practice contributes to improved outcomes When completing Step 1 of Melnyk and Fineout-Overholt's evidence-based practice (EBP) process, which action does the NP student implement? a. Cultivating a spirit of inquiry b. Formulating a clinical question c. Creating a culture of evidence-based practice d. Searching for high-quality research evidence - CORRECT ANSWER Formulating a clinical question Explain the purpose of the PICOT method. - CORRECT ANSWER Prior to finding the best current evidence for clinical decision making, the clinical problem must be identified and translated into a searchable, answerable question. The PICOT method is a widely accepted format for creating clinical questions. Discuss the primary components of a PICOT question. - CORRECT ANSWER The primary components of a PICOT question include P: Population/disease (age, gender, ethnicity, with a certain disorder); I: Intervention or variable of interest (therapy, exposure to a disease, risk behavior, prognostic factor); C: Comparison (alternate therapy, placebo or usual practice, absence of risk factor); O: Outcome (risk of disease, accuracy of a diagnosis, rate of occurrence of adverse outcome); and T: Time, which is the time it takes to demonstrate an outcome (i.e., the time required for the intervention to achieve an outcome or time populations are observed for outcome). When searching for the best research evidence, which step does the nurse practitioner (NP) student complete first? a. Expand the search using the explode option. b. Combine searches generated from PICOT key words. c. Establish inclusion and exclusion criteria. d. Use tools to limit the search to the topic of interest. - CORRECT ANSWER Establish inclusion and exclusion criteria. Based on the American Association of Critical Care Nurses (AACN) evidence-leveling system, which type of evidence demonstrates the greatest strength? a. Meta-analysis of multiple controlled trials b. Well-designed controlled studies c. Peer-reviewed organizational standards d. Theory-based evidence from multiple case reports - CORRECT ANSWER Meta-analysis of multiple controlled trials The nurse practitioner (NP) student is seeking to learn more about palliative care patients' perceptions of the meaning of quality of life. Based on the Oxford Centre for Evidence-Based Medicine (OCEB) 2011 Levels of Evidence, which type of evidence will be most useful to the NP student's search? a. Case-control studies b. Nonrandomized controlled trials c. Meta-synthesis of descriptive studies d. Systematic review of randomized controlled trials - CORRECT ANSWER Meta-synthesis of descriptive studies . During critical appraisal of the credibility of a research study, the nurse practitioner (NP) student considers which information? a. Evidence of conflict of interest b. Control of extraneous variables c. Clarity of reported results d. Selection of sampling procedure - CORRECT ANSWER Evidence of conflict of interest Discuss three categories of barriers to implementation of evidence-based practice (EBP) in nursing - CORRECT ANSWER Three categories of barriers to using evidence in clinical practice include limitations in EBP systems, human factors, and lack of support for clinicians who use EBP. Limitations in EBP systems may result from an overwhelming amount of evidence and sometimes contradictory findings in the research. Human factors that create barriers include lack of knowledge about EBP and skills needed to conduct EBP, nurses' negative attitudes toward research and evidence-based care, nurses' perception that research is only for medicine and is a cookbook approach, and patient expectations. Another barrier to EBP involves lack of organizational systems or infrastructure to support clinicians using EBP. Causes for barriers in this category include lack of authority for clinicians to make changes in practice, peer emphasis on practicing the way they always have practiced, lack of time during the workday, lack of administrative support or incentives, and conflicting priorities between unit work and research. [Show Less]
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