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NR 305
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NR 305 Week 6 Graded Discussion Topic: Providing Culturally Competent Nursing Care
NR 305 Week 6 Graded Discussion Topic: Providing Culturally Competent Nursing Care Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ... [Show More] ed.). Philadelphia, PA: Wolters Kluwer. • Chapter 11: Assessing Culture • Chapter 12: Assessing Spirituality and Religious Practices Week 6 Discussion Post: Providing Culturally Competent Nursing Care This week you have your choice of three discussion topics! Select the one that most interests you and answer the corresponding questions completely. Remember to reference both the book or lesson, and an outside scholarly source. Option #1: You are the nurse assessing an Orthodox Jewish client with peptic ulcer. The client is strictly religious and refuses to eat the food provided at the health care facility. 1. Describe how you would further assess and provide care for this client. 2. What steps could you take to increase your cultural competence, if you were not familiar with this faith? Option #2: You are the nurse caring for a client with Crohn's disease. The client believes he is being punished by God. The client is spiritually distressed and cannot come to terms with the illness. 1. How would you respond to this client? As a nurse we should avoid expressing our personal beliefs. “Spiritual distress can be as agonizing as physical pain, and unfulfilled spiritual needs can hinder a patient’s progress” (American Nurse Today, 2017). A spiritual assessment is need in order to create the proper interventions. Allow the patient to express his religious preferences and rituals. Do not feel like you have to answer all the questions they may ask you regarding their religious feelings, sometimes they just need someone to listen. Try to avoid phrases such “you’ll be fine” or “everything is going to be okay” because it can come off as you do not care about their concerns or you believe they are just overreacting. “Providing spiritual care benefits the whole patient and promotes all aspects of health and healing” (American Nurse Today, 2017). 2. What are some identified risk factors for spiritual distress, and recommended interventions? Some risk factors for spiritual distress are terminal or lifelong diagnoses, depression, death or loss of loved ones, new or worsening disabilities, anxiety and the feeling of loss of faith. “… an individual who believes that diseases are punishment from God or gods may not seek help quickly or even at all” (Kelley & Weber, 2018). Interventions for a patient with spiritual distress are to provide emotional support while maintaining a professional nurse patient relationship, actively listen to the patient, use therapeutic touch when appropriate, and if you and the patient are comfortable and it is appropriate to the patient’s religion you can pray with the patient. References Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer. American Nurse Today. (2017, October 06). Meeting your patients spiritual needs. Retrieved June 11, 2019, from https://www.americannursetoday.com/meeting-your-patients-spiritual-needs/ Option #3: Describe a time in your clinical nursing practice when you have cared for a client of cultural, religious, or spiritual practices different from your own. 1. What were some of the challenges you faced caring for this client? 2. What steps did you take (or could you have taken) to ensure the patient received culturally/spiritually competent care? [Show Less]
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NR 305 Week 6 Assignment: Physical Examination Video Demonstration Outline
NR 305 Week 6 Assignment: Physical Examination Video Demonstration Outline PHYSICAL EXAMINATION VIDEO DEMONSTRATION (200 points) This is an outline... [Show More] of techniques you must include in your physical examination video. Do not document your findings here. State your findings in your video as you complete the exam on your adult participant. Refer to the assignment guidelines and your Weber & Kelley textbook (see Chapter 28) as needed to prepare for this assignment. Remember that you may not use notes textbook, or any other study materials during the video recording. (Note: You are not required to measure vital signs as you would in an actual patient assessment.) Preparation: Be sure to check volume and ensure that the camera will be recording so that instructor can view all assessment techniques. Student states in front of camera: “My name is [First and Last Name of Student] and this is my physical examination assignment for NR 305.” Participant states in front of camera: “My name is [First and Last Name of Adult Participant] and I give my permission for this assessment to be recorded and submitted to Chamberlain College of Nursing for grading purposes.” Introductions: Student introduces self to patient; Explains purpose of the exam; Ensures comfort General Appearance: Facial expression; Body position, Level of Consciousness (LOC); Nutritional status; Hearing; Hygiene Head and Face: Inspect and palpate head. Note consistency, distribution, color of hair. Observe face for symmetry, features, expressions, condition of skin. Palpate temporomandibular joint. Eyes, Ears, Nose, Mouth: Inspect external eye. PERRLA Inspect auricle, tragus, and lobule. Inspect external nose. Palpate external nose for tenderness. Check patency of airflow through nostrils. Inspect lips teeth, gums, buccal mucosa tonsils, tongue. Neck: Inspect appearance of neck. Test ROM of neck. Palpate preauricular, postauricular, occipital, tonsillar, submandibular, and submental nodes. Upper Body: Inspect upper extremities, note condition of skin. Palpate brachial, ulnar, radial, pulses bilaterally. Assess capillary refill. Test sensation bilaterally. Posterior Chest: Auscultate posterior lung sounds and describe what you are listening for/what you hear Note: be sure the evaluator can see placement of your stethoscope at all times. Anterior Chest: Note quality and pattern of respirations, and use of accessory muscles. Auscultate lung sounds (anterior, lateral), describe what you hear and what you are listening for. Note: be sure the evaluator can see placement of your stethoscope at all times. Heart: Inspect and palpate for apical impulse. Auscultate over aortic area, pulmonic area, Erb point, tricuspid area, and apex. State the landmarks as you auscultate and remember to describe findings. Abdomen: Inspect abdomen (describe contour). Auscultate abdomen in all 4 quadrants. Percuss abdomen in 4 quadrants. Palpate abdomen in all 4 quadrants (light palpation only). Note: be sure evaluator can view assessment technique. Lower Body: Inspect lower extremities, note condition of skin. Assess capillary refill. Palpate dorsalis-pedis and posterior tibial pulses bilaterally. Test sensation bilaterally. Musculoskeletal/Neurological: Observe gait. Perform Romberg test. Perform finger-to-nose test. End of Assessment: Student states assessment has been concluded; Thanks adult participant for volunteering [Show Less]
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NR 305 Week 4 Graded Topic: Community Access to Mental Health Services
NR 305 Week 4 Graded Topic: Community Access to Mental Health Services Conduct a web search to identify health care services within your community aimed s... [Show More] pecifically at addressing this condition. Choose one: Depression, Suicidal ideation, Opioid addiction Answer the following questions in your post: 1. When reviewing a client's health history and physical examination record, what are some findings (subjective and objective) that may indicate a need for further in-depth assessment for the condition you selected above? 2. Describe a focused specialty assessment tool you could use to screen the client for this condition. 3. What resources did you find in your community that address this issue? What type of services do they provide? Were there specific resources or services you were hoping to locate, and could not? Please explain. I have chosen depression for this weeks discussion topic. ANSWER 1. When reviewing a client's health history and physical examination record, what are some findings (subjective and objective) that may indicate a need for further in-depth assessment for the condition you selected above? When completing a health history on a patient, objective findings that I may find include disheveled appearance including poorly fitting clothes (too large), unclean or poorly groomed hair and nails, poor eye contact or engagement, uncooperative or argumentative behavior, inattentive to discussion, slow speech, repeating answers (for example, I don't care when asking if they would be ok with me talking to their doctor about concerns identified during my intake), and flat affect during discussions. A few subjective findings that may be detected include patients reporting they've "had enough", "don't care", patients reporting they have lost interest in things that they normally enjoy, reporting sad mood, reporting poor appetite or weight loss, or binge eating, trouble sleeping or sleeping too much, fatigue and loss of energy. Patients may also report passive death wishes or statements such as "I wish I would just disappear; no one would notice I'm gone." 2. Describe a focused specialty assessment tool you could use to screen the client for this condition. In my current employment position, we complete a PHQ-2 assessment on every member that we meet with. If the results of the PHQ-2 are over 3, which may indicate an increased risk of depression, we then move into the PHQ-9 assessment. The first two questions assess how often the person has felt down, depressed or hopeless over the last 2 weeks, with scores from 0 (for no days) to 3 (nearly every day). The second question assesses how often the person feels a loss of pleasure or interest in things that they usually enjoy, with scores from 0 (for no days) to 3 (nearly every day). A score of three or higher flags me to proceed in the PHQ-2 assessment. "PHQ-2 is a reliable method of screening, but not diagnosing, depression" (Wilson & Agius, 2017, p. 234). Our text this week explains that "using a PHQ-2 threshold score of 2 or higher rather than 3 or higher resulted in more depressed patients being correctly identified" (Weber & Kelley, 2018, p. 87). When I complete a PHQ-9 assessment, I am then required to report the information gathered to the hospitalist or attending physician at the hospital. A score of 10 or more on the PHQ-9 may indicate a stronger indication for depression and should be evaluated by the doctor. Often, the doctor caring for the patient in the hospital will consult the behavioral health team to come and to assess the patient further to complete a formal screening. In my current position, I also work with insurance members that have complex mental health conditions. I have a partner team within the insurance company that helps to manage these cases. They are known as the "SMI Team," which stands for Serious Mental Illness. These diagnoses include bipolar disorder, schizophrenia, personality disorders, major depressive disorder, and previous suicide attempt. This team is specially trained to help our insurance members manage their mental health conditions along with their physical health issues. These case managers work with the medical and behavioral providers in coordinating care for these members that can be very vulnerable. 3. What resources did you find in your community that address this issue? What type of services do they provide? Were there specific resources or services you were hoping to locate, and could not? Please explain. I live in a more rural area of western Pennsylvania. Surprisingly, for the area that I'm in, we have several locations that can help patients manage depression. Family Counselling Center is one location that has several offices in the local area. They have multiple offices in our county and help to service the surrounding 3 counties. Family Counselling Center provides services to all patients, from children to geriatrics. They offer daily group therapies, individual counseling, family therapy, and school-based therapy. They also provide mobile psychiatric medication services, where a mental health assistant will go to your home to administer your medicine or coordinate with local pharmacies to prepackage your medications to help with compliance. This service offers many other options to help those patients deal with mental health conditions. We also have HAVIN. This stands for "Helping All Victims In Need." HAVIN helps all people that are dealing with abuse of any form. When people contact HAVIN, they are connected to a specially trained person who helps evaluate the situation, and can locate safe living arrangements, arrange for inpatient hospital care, and connect to mental health providers if needed. It is indeed a great service for my community. We also have the Armstrong Indiana BDHP (behavioral and development health program). This service offers inpatient, outpatient, partial rehab program, residential and housing services to adults in Armstrong and Indiana County. They also manage child services including Early Intervention, intellectual and mental health services. They provide a free crisis line to all residents in both counties that connects them to a trained professional to help manage the crisis and ensure the safety of the patient when they call. Weber, J.r. & Kelley, J.H. (2018). Health assessment in nursing (6thed.). Philadelphia, PA: Wolters Kluwer Wilson, R., & Agius, M. (2017). Is there good evidence that the two Questions in PHQ-2 are useful questions to use in order to screen for depression? Psychiatria Danubina, 29(Suppl 3), 232–235. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=28953768&site=eds-live&scope=site [Show Less]
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NR 305 Week 5 Graded Topic: Assessing for Family Violence
NR 305 Week 5 Graded Topic: Assessing for Family Violence • (CO #1) - Utilize prior knowledge of theories and principles of nursing and related discipl... [Show More] ines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO #1) • (CO #4) Utilize effective communication when performing a health assessment. (PO #3) A 10-year-old child named Elizabeth is brought into the emergency department by her mother. The mother appears anxious but sits quietly next to her daughter in the waiting room. When called into the triage area, the mother gives a history of coming home from work to find Elizabeth sitting on the couch watching television. Elizabeth did not go to the door to greet her or look toward her when she said hello. The mother thought the daughter's behavior was odd because she always greeted her at the door with a hug. As she approached Elizabeth, she noticed that she was clutching her right arm as if in pain. The mother asked what was wrong, but Elizabeth remained silent. Then she said "Nothing is wrong." The father is sleeping upstairs. The mother gives a family history of having an alcoholic husband who usually drinks himself to sleep. She said he has abused Elizabeth physically and psychologically in the past, and she brought her to the emergency room because she fears he has hurt her. When Elizabeth is asked about the abuse she appears scared, insecure, and withdrawn. 1. What considerations should be made by the nurse, to provide a physically and emotionally safe environment for the interview and assessment of this client who has experienced domestic abuse? 2. In your response, include some special considerations that should be taken when interviewing a child. ANSWER Weber & Kelly (2018) state regarding family violence that the nurse needs “to examine his or her own feelings and determine if there are any beliefs or biases that may interfere with the nurse’s ability to “hear” what the client is saying." (p. 168). My knee-jerk reaction to this scenario is that knowing that the father has abused Elizabeth in the past, both physically and psychologically, why would the mother leave her alone with him? There may be logical answers to my mind’s questions, and I would need to silently walk myself through those possibilities while I was attending to Elizabeth and providing the needed medical care. According to Weber & Kelley (2018) “creating a safe and confidential environment is essential to obtain concise and valid subjective data from any client who has experienced family violence.” (p 169). Moving Elizabeth to a private area and more quiet location may diffuse some of her anxiety. When I have had to assess children, I have found it helpful to sit down to talk with them, provide an explanation of what I’m going to do prior to doing it, and let them hold some of the tools I’m planning to use (i.e. stethoscope – let her listen to her own heart, hold the light pen). In an attempt to distract Elizabeth from her current situation, I would ask about any pets she has, what was her favorite cartoon, a favorite candy bar or maybe a favorite subject in school, but also respecting her need for silence if that is what is indicated. In their article, Lazoritz, Rossiter & Whiteaker (2010) say that since the child has already experienced abuse, they need “empathy, not sympathy” and that the child may feel that they did something to cause their abuse. The authors of this article reinforce that as health care professionals, we need to provide assurance to the child that they did nothing to deserve this treatment and what they have experienced is not normal. I had often thought that pediatric nursing was something I may work into. However, after reading through this material, this subject triggered a lot of emotions for me and I’m not sure pediatric nursing is for me. References, Weber, J. R., & Kelley, J. H. (2018). Health Assessment in Nursing (6th ed.). Philadelphia, PA: Wolters Kluwer. Lazoritz, S., Rossiter, K., & Whiteaker, D. (2010). What every nurse needs to know about the clinical aspects of child abuse. American Nurse Today, 5(July), 7th ser. Retrieved April 2, 2019, from https://www.americannursetoday.com/what-every-nurse-needs-to-know-about-the-clinical-aspects-of-child-abuse/. [Show Less]
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NR 305 Week 3 Graded Topic: Exploring Popular Diet Trends
NR 305 Week 3 Graded Topic: Exploring Popular Diet Trends This week's graded topics relate to the following Course Outcomes (COs). • (CO #1) - Utilize ... [Show More] prior knowledge of theories and principles of nursing and related disciplines to explain unexpected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO #1) • (CO #4) - Identify teaching/learning needs from the health history of an individual. (PO #2) • (CO #5) - Explore the professional responsibilities involved in conduction a comprehensive health assessment and provide appropriate documentation. (PO #6) A distant cousin approaches you at your family reunion and says, "Great to see you! I heard you are a nurse. My friend is having success with the (insert selection from list below) and I am wondering what you think about it? Should I give it a try?" Choose one of the following to consider in your response: • Paleo Diet • Anti-inflammatory Diet • Mediterranean Diet • Vegan Diet • Ketogenic Diet In your discussion post, please include the following information: 1. Briefly describe the diet you have selected to consider. 2. Share how you would respond to your cousin. Please include questions you would ask, and your advice/recommendations. ANSWER The Ketogenic diet is a very low-carb, high fat diet that includes foods such as: • Meats • Non starchy vegetables • Cheeses • Oils, butters, heavy creams • Eggs • Fish (preferably the fatty ones) Ketogenic diet works by using your body fat as a source of energy rather that the sugars in carbohydrates. This diet has been shown to significantly lower blood sugar and insulin levels, the main reason it is a great plan for patients with Type 2 Diabetes. People are finding more success on this diet due to the fact that they are not hungry. Many people give up due to the fact that you cannot have items such as bread, rice, pasta and potatoes. Recent studies are also showing significant improvement with diseases such as heart disease, Alzheimer’s, Epilepsy, Parkinson’s, and Polycystic Ovarian Syndrome. It is advice that you follow this diet for 3-5 months before you incorporate any “cheat” days. One cheat day can take your body out of ketosis and then you need to start all over. You need to make sure you are committed to this diet since going off one day can take your body out of the cycle. I would ask my cousin first if he has any kidney, liver or pancreatic disease. I so, this diet would not be recommended due to the high amount of fat and protein one’s body has to metabolize on this diet. Next I would inquire if he has any issues with low blood sugar, this diet drops a person’s blood sugar enough that someone with hypoglycemia could experience issues. Next I would explain that it takes 3-5 days for your body to be in ketosis. During this time some people experiences what is known as the keto-flu which can include: nausea, constipation, diarrhea, headache, muscle cramps, dizziness and sugar cravings. Last thing I would inquire amount was his alcohol consumption since there a very few drinks that are allowed on this diet because of their high sugar content or the mixers you use with them. One night drinking anything not allowed could knock your body out of ketosis and you have to start all over. Resources: Dashti, H. M., Mathew, T. C., Hussein, T., Asfar, S. K., Behbahani, A., Khoursheed, M. A., Al-Sayer, H. M., Bo-Abbas, Y. Y., … Al-Zaid, N. S. (2004). Long-term effects of a ketogenic diet in obese patients. Experimental and clinical cardiology, 9(3), 200-5. Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer. [Show Less]
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NR 305 Week 2 Graded Discussion Topic: Assessment for Health Promotion
NR 305 Week 2 Graded Discussion Topic: Assessment for Health Promotion This week's graded topics relate to the following Course Outcomes (COs). • (C... [Show More] O #1) - Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO #1) • (CO #2) - Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO #1) • (CO #4) - Identify teaching/learning needs from the health history of an individual. (PO #2) As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues. After conducting her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She attends class a total of 15 hours per week, plus she must be present for 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children. She states that she is lucky to get 5 hours of sleep per night, but that is okay with her. She drinks coffee all morning to "keep her going." She lives 1 hour from campus and commutes each day, and often drinks diet cola to "stay awake." When asked what she does to relax and de-stress, Maria states she "doesn't even have time to think about that." Maria's vitals today are as follows; T 98.6, R 20, HR 88, BP 148/90 Using the lesson and text as your guide, answer the following questions. 1. What additional assessment data (subjective and/or objective) would you like to gather from Maria? 2. What actual health concerns and risk factors have you identified? 3. What are some opportunities to promote health and wellness for Maria? 4. Write one nursing diagnosis for Maria (actual, wellness or risk), based on one of the health concerns or opportunities you have identified. (Please use one of the formulas outlined in the text and lesson!) ANSWER When reviewing the case study regarding Maria and areas for her health promotion, I would like to ask Maria: What brought you to seek healthcare at the clinic? Do you have a good support system at home? What is your medical health history and family health history? Do you have any documented illnesses like hypertension or diabetes? With the information provided by the case study, I was able to determine that her blood pressure was elevated, that she seems stressed about her recent weight gain and stressed about her lack of time for herself. I see opportunities for Maria to improve her overall health by modifying her diet and caffeine intake, setting time aside to exercise and reaching out to her family for help around the house. Exercise that is set aside for Maria’s personal well being can be beneficial at reducing stress, lowering her risk for heart disease, and managing her weight (Weber and Kelley, 2018). After assessing Maria’s objective and subjective data, as well as validating the information, I have identified an Actual Nursing Diagnosis, Anxiety. As cited by Byrd and Brook (2014) from The Corsini Encyclopedia of Psychology (Weiner, 2010), “Anxiety has been defined as “a future-oriented state characterized by a sense of apprehension and worry, and lack of control of one’s own affective response’.” Anxiety is a common and normal response to stressful situations, but for some, it can significantly affect their quality of life (Byrd and Brook, 2014). My nursing diagnosis for Maria is: Anxiety related to recent weight gain and increased personal demands as manifested by her statements about being afraid that her appearance and health will be compromised by her weight gain also her statement regarding not having time for herself to de-stress. Weber & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer p. 26 Byrd, J. & Brook, R. (2014.). Anxiety in the “Age of Hypertension” p.1, 2. Retrieved from: https://web-a-ebscohost-com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=1&sid=f7028bef-ebe6-4ab1-bf62-92f232a3c62a%40sdc-v-sessmgr05 [Show Less]
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NR 305 Week 1 Graded Topic: Exploring the Nurse’s Role in Health Assessment
NR 305 Week 1 Graded Topic: Exploring the Nurse’s Role in Health Assessment This week's graded topics relate to the following Course Outcomes (COs). �... [Show More] � (CO #1) - Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO #1) • (CO #5) - Explore the professional responsibilities involved in conducting a comprehensive health assessment and provide appropriate documentation. (PO #6) The nursing process is utilized in a variety of nursing roles and health care settings. Whether you are working in direct patient care, telehealth, or in a leadership role - the basic model is the same! Take this opportunity to share how the nursing process is utilized in your own practice settings! Hint: Your assigned readings will be helpful in formulating your answers. Please answer the following question in your initial post: Describe how you apply the first step (assessment) of the nursing process in your current practice setting. If you are not currently practicing as an RN, you may use an example from a prior clinical or work experience. Include the following information: • Briefly describe your practice setting and the typical patient population. • Provide examples of key subjective and objective data points you collect. • Describe how you document your findings. Is there technology involved? • Describe your process of data analysis. What is the end result of this process? (i.e., Do you formulate nursing diagnoses and care plans, collaborate with others and/or make referrals?) ANSWER According to Weber and Kelley (2018) “Assessment is the first and most critical phase of the nursing process. If data collection is inadequate or inaccurate, incorrect nursing judgments may be made that adversely affect the remaining phases of the process: diagnosis, planning, implementation, and evaluation.” Currently I work on a 35 bed Acute Orthopedic trauma unit. The typical patient population varies but our most prominent population is post-operative patients following trauma. Our most common trauma is motor vehicle accidents and geriatric hip fractures due to falls. Patient length of stay is usually 3-5 days. During my initial assessment my subjective data would begin with verifying my current health history data and health concern according to the patient. I would also question the patient about current concerns or goals for the day. My objective data points include current set of vital signs, laboratory/radiology results and physical appearance of the patient, as well as a comprehensive physical assessment including fall risk and Braden scale. I document my findings in an electronic health record called Cerner works. I typically do my comprehensive physical assessment at the start of shift and then a focused assessment of lines/drains, wound/incision, vascular assessment and pain every four hours. After collecting and comparing my data from all sources I would formulate nursing plans of care and interventions needed. I would spend the rest of my shift focusing on patient and plan of care goals. The video from our lesson confirms the alarming trend I see during shift work. Doctors and nurses seem to be focused on computer data rather than the patient themselves. According to Lichstein (2015) “On the typical medical service, newly admitted patients are presented in a conference room or hallway where computers are readily accessible, and visits to the bedside tend to be brief—mainly for the attending physician to meet the patient and confirm important findings.” Typically I round with my physicians to report any abnormal or new concerns with the patient present. I find all too often the art of bedside rounding and assessment is fading. I try and encourage physician conversations with the patient to promote a sense of presence of the medical team. I believe bedside assessment improves patient outcomes and relevant information for plan of care. References Lichstein, P. R. (2015). Returning to the Bedside: Notes From a Clinical Educator. North Carolina Medical Journal, 76(3), pg.174. Retrieved from https://doi-org.chamberlainuniversity.idm.oclc.org/10.18043/ncm.76.3.174 Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: pg.3 [Show Less]
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NR 305 Week 4 Assignment: Patient Teaching Project – Patient Teaching Plan Form
NR 305 Week 4 Assignment: Patient Teaching Project – Patient Teaching Plan Form Purpose: The purpose of this Patient Teaching Project is to develop a pa... [Show More] tient teaching plan and create a visual teaching tool aimed at promoting health and preventing disease for a specified patient population. Directions: • This Teaching Plan is Part 1 of the Patient Teaching Project. You will use this Patient Teaching Plan to create a Visual Teaching Tool in Part 2 of this project. • You are required to complete the form using the productivity tools required by Chamberlain University, which is Microsoft Office Word 2013 (or later version), or Windows and Office 2011 (or later version) for MAC. You must save the file in the ".docx" format. Do NOT save as Word Pad. A later version of the productivity tool includes Office 365, which is available to Chamberlain students for FREE by downloading from the student portal at http://my.chamberlain.edu. Click on the envelope at the top of the page. • Type your answers on this form. Click Save as and save the file with the assignment name and your last name, e.g., “NR305_W4_Patient Teaching Plan Form_Smith”. When you are finished, submit the form to the Drobox by the deadline indicated in your guidelines. Post questions in the Q & A Forum or contact your instructor if you have questions about this assignment. • The use of correct terminology, grammar, and spelling is important! Please write in full sentences. References should be written in APA format. Utilize in-text references when appropriate, and list all references in the space provided at the end of the worksheet. Patient Teaching Plan HEALTH TOPIC ANSWER State the topic you have selected for your Teaching Project. (Please select from the list provided in the Teaching Project guidelines located in Module 4.) For years, many workplace settings have been implementing proper measurements to prevent work related injury. However, the risk of injury is still prevalent in any workplace setting including the hospital. I choose the topic Prevention of Hazards at Work for this specific reason. According to an article published in 1985, an observation made for over 200 years even back then proved that “hospitals can be hazardous for patients” as well as the employees (Patterson, Craven, Schwartz, Nardell, Kasmer, & Noble, 1985, p. 658). Although we’ve come a long way since then, it is still important to reinforce the importance of preventing injuries related to hazards at work. Another article mentioned its importance by concluding “safety education and other injury preventive measures…will potentially reduce the number of injuries” and “promote safe working conditions” (Peled, 2005, p. 276). The purpose of this education is to focus on the preventative measures that can easily be performed but plays a crucial role in the workplace. This includes general proper body mechanics, appropriate use of personal protective equipment, and safety practices particularly with violent patients. POPULATION ANSWER Describe, in detail, the characteristics of the population you are planning to teach with the Visual Teaching Tool. The population who will be involved in this learning experience are the nurses and the patient care technicians also known as the certified nursing assistants or CNAs. The population will consist of a very diverse group with varying age and any gender they may identify but with one thing in common: they all work in the same setting which is Intensive Care Unit. BARRIERS ANSWER What are some potential learning barriers for this population of learners? (Barriers might be cultural, physical, educational, or environmental. Refer to the assigned article in the project guidelines for more information.) Potential learning barriers for this population include physical and environmental as the population involves different age groups with different experiences or expertise and the setting for this teaching would be in the hospital. As Beagley (2011) mentioned in her article, “physiological factors play a role in how” individuals receive and process new information and that environmental barriers can be anything distracting to learners and are often “difficult to control” (Beagley, 2011, pp. 334-335). Describe how you could develop your Visual Teaching Tool in a way that will address these potential barriers. With a diverse population, an excellent way to address the barriers mentioned would be utilizing the different learning styles mentioned in the article. Beagley listed three in her article: Visual, Auditory, and Kinesthetic (Beagley, 2011, p. 335). Incorporating all these styles into the Visual Teaching Tool while also focusing on the environmental factors eliminating as much distractions as possible would be beneficial to the success of this education, and one excellent tool that can be used to achieve that is the PowerPoint presentation. SETTING ANSWER Where do you plan to utilize your Visual Teaching Tool? (Examples: primary care clinic, health fair, school, etc…) The education will take place in a hospital in the Intensive Care Unit. The setting will be in an empty patient room with bed, assistive devices used for boosting a patient up in bed, and personal protective equipment (PPE). Will you be teaching one-on-one, in small groups, or to a large crowd? Small groups would best serve the purpose of this education due to the possible conflicting schedule of the population. Small group would also increase the receptibility of the learners and decrease the amount of time to evaluate the outcome. LEARNING OBJECTIVES ANSWER Write three specific learning objectives your visual teaching tool will address. Example: At the end of this education, the learner will be able to list 3 benefits of regular physical activity. 1. At the end of this education, the learner will be able to demonstrate proper body mechanics when boosting a patient up in bed. 2. At the end of this education, the learner will be able to identify what Personal Protective Equipment or PPE is required for certain situations i.e. contact/droplet/airborne isolation. 3. At the end of this education, the learner will be able to list 3 safety measures to keep in mind when taking care of violent patients. EVALUATION ANSWER Write a paragraph describing how you could evaluate whether your visual teaching tool was successful and met the learning objectives. Consider the population’s abilities and the setting. The education would prove to be successful if the learners are able to demonstrate proper body mechanics, identify the right PPEs, and list safety measures for self-protection. To evaluate the first objective, for example, two learners will stand on each side of the patient’s bed where another learner would act as the patient. The two learners on the side would demonstrate proper body mechanics as shown in the Visual Teaching Tool and boost the patient up in bed; corrections then can be made if needed. The second objective, as stated above, would be proven successful if the learners identify the appropriate PPE for a specific situation (i.e. contact isolation requires the use of gown and gloves, while droplet isolation requires the use of gloves and mask and an optional gown if exposure to secretions are expected). The third objective would be proven successful if the learner identifies 3 safety measures such as maintaining the patient’s room open, notifying another personnel that the caregiver is going into the patient’s room, or entering the patient’s room with another personnel. REFERENCES ANSWER List any references used to create this Teaching Plan in APA format. (Hanging indent not required.) Remember to also use in-text citations within this document, when appropriate (Author, year). Beagley, L. (2011). Educating patients: Understanding barriers, learning styles, and teaching techniques. Journal of Paranesthesia Nursing, 26(5), 331-337 Patterson, W. B., Craven, D. E., Schwartz, D. A., Nardell, E. A., Kasmer, J., & Noble, J. (1985). Occupational hazards to hospital personnel. Annals Of Internal Medicine, 102(5), 658-680. Peled, K. (2005). Workplace safety assessment and injury prevention in hospital settings. Work, 25(3), 273-277. [Show Less]
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NR 305 Week 2 Assignment: Lifestyle and Health Practices Profile
NR 305 Week 2 Assignment: Lifestyle and Health Practices Profile Purpose: This assignment is to help you gain insight regarding the influence of an ind... [Show More] ividual’s lifestyle and health-related practices, on their opportunities for health promotion. You are to obtain a lifestyle and health practices profile using yourself as the client, and then practice analyzing the data to formulate a health promotion nursing diagnosis. Disclaimer: When completing a Lifestyle and Health Profile on an actual client, it is essential that the information is accurate and all areas are addressed. **Please note that for this assignment, a few sections containing sensitive information have been marked optional.** This assignment will only be shared for academic-related purposes, and will not be seen by your classmates. However, if you wish to leave any of the areas marked “option to not respond” blank, points will not be deducted. All areas not marked as optional must be completed for full credit. Contact your visiting professor if you have any questions or concerns. Directions: Refer to the Personal Life and Health Practices Profile guidelines and grading rubric found in Course Resources to complete the information below. This assignment is worth 200 points. Type your answers on this form. Click Save as and save the file with the assignment name and your last name, e.g., “NR305_Week2_Personal_ Lifestyle_Form_Smith”. When you are finished, submit the form to the Life and Health Practices Profile Dropbox by the deadline indicated in your guidelines. Post questions in the Q & A Forum or contact your instructor if you have questions about this assignment. 1: Complete the Life and Health Practices Profile (130 Points) Complete the Life and Health Practices Profile below, using yourself as the client. Please document your responses professionally, as you would in a client’s actual health record. Provide enough information to have answered the questions completely. For clarity, write full sentences in your documentation. All questions in each section must be addressed, except for those indicated as optional. If a question does not apply to you, please indicate this in the findings as “N/A”. Lifestyle and Health Practices Profile Description of Typical Day Findings Briefly describe your typical daily routine from the time you wake up until bedtime. When not working, I usually wake up around 7 am in time for my girls to go to school. After they left for school, I check my emails and bills that need my attention. Me and my husband eat breakfast around 11 am and then prepare food for dinner. While cooking, I do my assignments and make my calls for medical appointments, school conferences and other business-related calls. After cooking, I take a nap (2-3 hours) and wakes up when my children arrive from school. We then eat dinner around 7 pm with the whole family where we share with each other the latest happenings in our lives. On my nights off from work, we usually watch movie before going to sleep around 11 pm. When I have work, I arrive home around 8 am, eat breakfast and prepare for bed by 10 am, sleep till 4:30 pm and be ready for dinner around 5:30 pm. My husband prepare the dinner and we eat with the kids before I go to work. Dinner is a must because that is how we connect with our kids with what is happening to them. I usually leave the house around 6 pm, then work from 7pm to 8 am (night shift). Nutrition and Weight Management Questions Findings What do you eat in a typical day? What type of foods do you prefer, how often do you eat throughout the day, and about how much do you eat? Typically, I eat late breakfast and dinner. Breakfast is usually a cup of coffee, half-cup of fried rice, an egg and some meat like bacon, hotdog or sausage. If I am working, I eat around 8 am then sleep until 5 pm. I eat dinner which is mainly comprised of a cup of rice, cup of vegetables and a portion of meat like chicken “adobo”, fried fish or baked porkchop. When not working, I usually just stay home and have some snacks like cookies (3-5 pcs) or half a bag of chips. Do you eat out frequently, or mainly prepare meals at home? If you eat out, what type of restaurants do you usually eat at? We seldom eat out because my husband is a good cook. We also find it cheaper to prepare meals at home. We only eat out when there are special occasions and we usually go for Filipino restaurants. Do you tend to eat only when hungry? Have you noticed if your eating habits change when you are stressed, bored, or depressed? Not really. When at home, I tend to munch at “junk foods” like chips especially when bored. This is the reason why I asked my husband to store more fruits and less on “junk foods”. Who typically purchase and prepares the food you eat? My husband do the grocery shopping and cooking. What type of fluids do you usually drink? How much? I drink a cup of coffee in the morning, seltzer or glass of water every meal. Activity and Exercise Questions Findings Describe your daily activity patterns. Everyday upon waking up, I spend half hour on devotion/reading the Bible. I take a shower and get dressed for work. Around 5 pm we all eat dinner and then I go to work from 7pm to 8 am in the morning. When not working, I wake-up around 7 am so I can my see my kids when they leave for school. I go back to bed until 11 am when I have finished my assignments or paying bills online, otherwise, I go online an do them. After breakfast, I usually do laundry (uniform and undergarments) and then clean the house. I also help my husband cook dinner or prepare the food for the week. When not cooking, we do errands like grocery shopping and going to appointments like doctor visits or school meetings/conferences. Do you follow an exercise plan? If yes, what types of exercise, for what duration, and how often? I don’t have an exercise plan. On warmer days, me and my husband used to walk in my campus for 30 minutes twice a week. Since the weather got cold, we haven’t done any walking at all. Do you have physical limitations that do not allow you to follow a moderately strenuous exercise program? **option to not respond** I have no physical limitations. What type of activities do you enjoy for recreation and leisure? I like to travel with my kids and husband. When not travelling, I like to watch movies in Netflix or Youtube. I also like to read a lot. Sleep and Rest Questions Findings Describe your typical sleeping patterns. When working at nights, I usually sleeps from 10 am to 4:30 pm. On my days off, I sleep from 10 pm to 10 am. Do you have trouble falling asleep? Yes, I have trouble sleeping when I have to work at nights. About how many hours of sleep do you get each night? On the average 6 to 8 hours. On my nights off, I try to sleep for 10 to 12 hours to catch up on sleep. Do you typically feel well-rested during the day? Yes during my days off but not when I have work at nights. Do you nap during the day? How often and for how long? Yes. On my days off, I usually nap for 2 to 3 hours. Do you have routine at night that helps you fall asleep? No routine at all. If I have trouble falling asleep, I apply special oil called “oil of wintergreen”. It helps me fall asleep faster and reduce back and joint pains. Substance Use Questions Findings How much alcohol do you consume on the average? **option to not respond** Not a drinker. Do you consume beverages containing caffeine? If so, how often and how much? Yes. I usually drink a cup of coffee in the morning, 3 to 4 days a week. Do you currently or have you ever smoked or used any form nicotine products? For how long? How many packs per week? Tell me about any past efforts to quit. Never smoked. Have you ever taken a medication that was not prescribed to you? If so, explain. Do you currently use, or have you ever used, recreational drugs? If so, describe. **option to not respond** Never used recreational drugs. Do you take vitamins or herbs or any other supplements? If so, what are they? No vitamins or supplements currently taking. Self-Care Questions Findings Describe your best talents and abilities? I am good with decorating, arts and crafts and flower arrangement. I am also very resourceful. How do you feel about yourself? Your appearance? I don’t have a lot of self-confidence since I gained weight. I used to be a skinny teen but since I got pregnant with my first child, I became overweight and have not lost the weight that I gained. What are some examples of activities you do to keep yourself safe and healthy? Or to prevent disease? (i.e., I apply sunscreen to prevent skin cancer.) I go to preventive screening like mammogram and Pap smear. I also do self-breast exam every month. I go for annual physical check-up with my primary care doctor and check-up with the dentist every 6 months. I also make sure that I floss daily. Do you practice safe sex? *option to not respond** Yes. I am in a monogamous relationship. How often do you schedule routine medical check-ups and screenings? I do my annual check-ups and preventive screening diligently. I have high risk for breast cancer because my mom died from it and my sister was also diagnosed with it.. How often do you visit the dentist? Every 6 months How often do you schedule a vision screening? Every 2 years Social Questions Findings What do you do to relax? Watching Netflix with my husband With whom do you socialize frequently? We are a member of a community church which we attend regularly for meetings and services. Are you involved in community activities? Yes. I serve in a local community church as a cell leader. Do you feel like you have enough time to socialize? Yes. I attend Wednesday and Friday Bible studies and Sunday worship services. What do you consider to be your contribution to society? I am a good citizen. I obey the laws and raising my children to be good citizens is my contribution to society. Relationship Questions Findings Who are the most important people in your life? Describe their relationship to you. My family (husband and children) and my siblings. They are my emotional and spiritual support. What was it like growing up in your family? A little challenging because I grew up in the province with my mom and unemployed dad. My father was also an alcoholic so it was hard for our family, especially with my half-siblings. Most of the time, my mom was the bread winner and resources were scarce. I don’t have any idea how my mom put food on the table and how we got by. She was able to send me to school and university. If applicable, describe any relationship you have with a spouse or significant other. **option to not respond** I have a good and monogamous relationship with my husband. If applicable, describe the relationship you have with your children. **option to not respond** My kids are good kids. They are very respectful of us. I try to foster open communication with them especially now that they are getting older. If applicable, describe your relationship with your in-laws. **option to not respond** My in-laws are in the Philippines. We visit them from time to time. Do you have any pets? No. Pets are not allowed in our apartment. Describe your role in your family. I am the primary caregiver. I support half of the financial obligations and serve as the executor of the rules in the house like making sure the kids made their assignment, their duties in the house and go to sleep at 10 pm. Values and Beliefs Questions Findings What is most important to you in life? Family and relationship with Jesus What do you hope to accomplish in your lifetime? I am hoping to have a nursing home for elderly. Do you currently affiliate with a religion? Is this important to you? **option to not respond** Yes. My relationship with Jesus Christ is very important for me. What gives you strength and hope? Having a personal relationship with Jesus Christ. Education and Work Questions Findings Tell me about your educational background. I have an Associate degree in Nursing. I have Master and bachelor’s degree in Agricultural Economics from the Philippines Do you have future educational goals or plans? Yes, I want to finish my Baccalaureate degree in Nursing and eventually take Masters in Public Health If applicable, tell me about your work. What are your responsibilities? I am a staff nurse in a Med-Surg floor in a public hospital in NYC. I work night shifts and responsible of taking care of 6 patients (minimum) on a Surgery floor. Do you enjoy your work? Yes, nursing is hard work, but I find it challenging and enjoyable because I get to see tangible result when our patients get better and stable enough to go back home. Describe your relationship with your co-workers. I am new in our department and I see my coworkers as my teachers and preceptors. They are very supportive and helpful of my nursing career. Do you experience work-related stress? Yes. When co-workers call out sick and we are left with only 3 nurses on the floor with 28-30 patients. Does your current income meet your needs? **option to not respond** Yes. My husband contributes to our financial obligations. Stress and Coping Questions Findings Describe what makes you feel angry. When my kids do not do their respective responsibilities like not doing homework, staying up late or lying to us. I also feel angry when I feel disrespected by somebody. How would you describe your stress level, overall? My stress is at moderate level, from work and family. What do you do to manage anger and/or stress? I read the Bible and pray everyday. I also like to talk with my friends and husband about my stressors. Where do you turn for assistance in times of crisis? I have childhood friends and church counselors whom I talk to whenever I feel stressful. Environment Questions Findings Have you identified any risks in your home or neighborhood, or at your job? Risks includes work-related violence, health risks like contracting infectious diseases, radiation and chemical exposure Are there risks associated with any of your leisure or recreational activities? None What type of precautions do you take related to potential environmental hazards? (i.e., I wear a respirator mask in the factory where I work.) I wear mask at work when I feel that my immune system is down (i.e. runny nose, feels weak or coughing), gloves and other protective devices when taking care of patients in isolation. I also wash my hands according to my hospital’s protocol (before going in and going out of the patient’s room) Do you believe you are at risk of becoming a victim of violence? If yes, please explain. **option to not respond** Not at all. End of Profile. Please continue this assignment by answering the questions below. 2. Reflect on this experience (15 points) The questions you answered in this profile are similar to those asked by nurses in practice settings every day. In 1-2 paragraphs, describe how it felt to put yourself in the client’s shoes. Did you feel vulnerable? Were some of the questions difficult to answer? Did you wonder why certain questions needed to be asked? Include some specific examples in your discussion. Answer: It is hard to answer questions regarding relationship especially the one that asks “how was it like growing in our family?”. I felt vulnerable and don’t feel like answering it honestly or answering it at all. I felt like it is a private matter, and it is nobody’s business but I saw the importance of that assessment with my mental health. 3. Analyze your responses (45 points) Carefully review your responses in the profile. In 1-2 paragraphs, provide an overall summary of the findings. Then, describe at least 2 opportunities you have identified for seeking a higher level of health. Provide some detail as to what prompted you to make your selections. Answer: Reading my responses made me realize that my life is very monotonous. It circles around work, family and church. I didn’t have much other activities that reduces my stress from work or family. Although we like to travel, we barely do it because we don’t have the resources/money to do it now. As much as we want to visit family and relatives in the Philippines, we haven’t done it in a while. I also realized that I am living a sedentary lifestyle since I got my hospital job. I didn’t do any exercise and my eating habits got worse. I would like to put a specific schedule to do walking or any activities that will make me move my body like learning to dance. I also felt that my eating habits got worse because I am not consciously looking at what kind of food I am eating. I always felt like I needed to stay home and sleep although in my assessment I have enough time to sleep and get rested. I also feel that I needed to take supplements like multivitamins and minerals especially at my age to prevent common diseases of women like osteoporosis/osteoarthritis. 4. Write one health promotion nursing diagnosis (10 points) Based on your analysis in #3, write one health promotion nursing diagnosis. (Use the formula: “Readiness for enhanced ______ related to ________.”) Answer: Readiness for enhanced nutrition and active lifestyle related to poor eating habits and sedentary daily life. [Show Less]
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NR 305 HESI Review Questions and Answers
NR 305 HESI Review Questions and Answers NR 305 HESI Review Questions and Answers (Verified & Graded A) 1. An antacid (Maalox) is prescribed for a cli... [Show More] ent with peptic ulcer disease. The nurse knows that the purpose of this medication is to A. Decrease production of gastric secretions. B. Produce an adherent barrier over the ulcer. C. Maintain a gastric pH of 3.5 or above. D. Decrease gastric motor activity. 2. In evaluating the effects of lactulose (Cephulac), which outcome would indicate that the drug is performing as intended? A. An increase in urine output. B. Two or three soft stools per day. C. Watery, diarrhea stools D. Increased serum bilirubin. 3. The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with congestive heart failure. Which intervention should the nurse implement prior to administering the digoxin? The healthcare provider prescribes digitalis (Digoxin) for a client diagnosed with congestive heart failure. Which intervention should the nurse implement prior to administering the digoxin? a. Observe respiratory rate and depth. b. Assess the serum potassium level. c. Obtain the client's blood pressure. d. Monitor the serum glucose level. 4. Following the administration of sublingual nitroglycerin to a client experiencing an acute anginal attack, which assessment finding indicates to the nurse that the desired effect has been achieved? A. Client states chest pain is relieved. B. Client's pulse decreases from 120 to 90. C. Client's systolic blood pressure decreases from 180 to 90. D. Client's SaO2 level increases from 92% to 96%. 5. A client with congestive heart failure (CHF) is being discharged with a new prescription for the angiotensin-converting enzyme (ACE) inhibitor captopril (Capoten). The nurse's discharge instruction should include reporting which problem to the healthcare provider? A. Weight loss. B. Dizziness. C. Muscle cramps. D. Dry mucous membranes. 6. A client is being treated for hyperthyroidism with propylthiouracil (PTU). The nurse knows that the action of this drug is to: A. Decrease the amount of thyroid-stimulating hormone circulating in the blood. B. Increase the amount of thyroid-stimulating hormone circulating in the blood. C. Increase the amount of T4 and decrease the amount of T3 produced by the thyroid. D. Inhibit synthesis of T3 and T4 by the thyroid gland. 7. A client with Parkinson's disease is taking carbidopa-levodopa (Sinemet). Which observation by the nurse would indicate that the desired outcome of the medication is being achieved? A. Decreased blood pressure. B. Lessening of tremors. C. Increased salivation. D. Increased attention span. 8. Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin (Coumadin). In conducting discharge teaching, the nurse advises the client to have which diagnostic test monitored regularly after discharge? A. Perfusion scan. B. Prothrombin Time (PT/INR). C. Activated partial thromboplastin (APTT). D. Serum Coumadin level (SCL). 9. A postoperative client has been receiving a continuous IV infusion of meperidine (Demerol) 35 mg/hr for four days. The client has a PRN prescription for Demerol 100 mg PO q3h. The nurse notes that the client has become increasingly restless, irritable and confused, stating that there are bugs all over the walls. What action should the nurse take first? A. Administer a PRN dose of the PO meperidine (Demerol). B. Administer naloxone (Narcan) IV per PRN protocol. C. Decrease the IV infusion rate of the meperidine (Demerol) per protocol. D. Notify the healthcare provider of the client's confusion and hallucinations. 10. A client is being treated for osteoporosis with alendronate (Fosamax), and the nurse has completed discharge teaching regarding medication administration. Which morning schedule would indicate to the nurse that the client teaching has been effective? A. Take medication, go for a 30 minute morning walk, and then eat breakfast. B. Take medication, rest in bed for 30 minutes, eat breakfast, go for morning walk. C. Take medication with breakfast, then take a 30 minute morning walk. D. Go for a 30 minute morning walk, eat breakfast, and then take medication. 11. A client is receiving metoprolol (Lopressor SR). What assessment is most important for the nurse to obtain? A. Temperature. B. Lung sounds. C. Blood pressure. D. Urinary output. 12. A client with a dysrhythmia is to receive procainamide (Pronestyl) in 4 divided doses over the next 24 hours. What dosing schedule is best for the nurse to implement? A. Q6h. B. QID. C. AC and bedtime. D. PC and bedtime. 13. Which action is most important for the nurse to implement prior to the administration of the antiarrhythmic drug adenosine (Adenocard)? A. Assess pupillary response to light. B. Instruct the client that facial flushing may occur. C. Apply continuous cardiac monitoring. D. Request that family members leave the room. 14. A client has a continuous IV infusion of dopamine (Intropin) and an IV of normal saline at 50 ml/hour. The nurse notes that the client's urinary output has been 20 ml/hour for the last two hours. Which intervention should the nurse initiate? A. Stop the infusion of dopamine. B. Change the normal saline to a keep open rate. C. Replace the urinary catheter. D. Notify the healthcare provider of the urinary output. 15. A client who was prescribed atorvastatin (Lipitor) one month ago calls the triage nurse at the clinic complaining of muscle pain and weakness in his legs. Which statement reflects the correct drug-specific teaching the nurse should provide to this client? A. Increase consumption of potassium-rich foods since low potassium levels can cause muscle spasms. B. Have serum electrolytes checked at the next scheduled appointment to assess hyponatremia, a cause of cramping. C. Make an appointment to see the healthcare provider, because muscle pain may be an indication of a serious side effect. D. Be sure to consume a low-cholesterol diet while taking the drug to enhance the effectiveness of the drug. 16. Which nursing diagnosis is important to include in the plan of care for a client receiving the angiotensin-2 receptor antagonist Irbesartan (Avapro)? A. Fluid volume deficit. B. Risk for infection. C. Risk for injury. D. Impaired sleep patterns. 17. A client is receiving clonidine (Catapres) 0.1 mg/24hr via transdermal patch. Which assessment finding indicates that the desired effect of the medication has been achieved? A. Client denies recent episodes of angina. B. Change in peripheral edema from +3 to +1. C. Client denies recent nausea or vomiting. D. Blood pressure has changed from 180/120 to 140/70. 18. A client is receiving methylprednisolone (Solu-Medrol) 40 mg IV daily. The nurse anticipates an increase in which laboratory value as the result of this medication? A. Serum glucose. B. Serum calcium. C. Red blood cells. D. Serum potassium. 19. An adult client has prescriptions for morphine sulfate 2.5 mg IV q6h and ketorolac (Toradol) 30 mg IV q6h. Which action should the nurse implement? A. Administer both medications according to the prescription. B. Hold the ketorolac to prevent an antagonistic effect. C. Hold the morphine to prevent an additive drug interaction. D. Contact the healthcare provider to clarify the prescription. 20. A client's dose of isosorbide dinitrate (Imdur) is increased from 40 mg to 60 mg PO daily. When the client reports the onset of a headache prior to the next scheduled dose, which action should the nurse implement? A. Hold the next scheduled dose of Imdur 60 mg and administer a PRN dose of acetaminophen (Tylenol). B. Administer the 40 mg of Imdur and then contact the healthcare provider. C. Administer the 60 mg dose of Imdur and a PRN dose of acetaminophen (Tylenol). D. Do not administer the next dose of Imdur or any acetaminophen until notifying the healthcare provider. 21. When assessing an adolescent who recently overdosed on acetaminophen (Tylenol), it is most important for the nurse to assess for pain in which area of the body? A. Flank. B. Abdomen. C. Chest. D. Head. 22. Which antidiarrheal agent should be used with caution in clients taking high dosages of aspirin for arthritis? A. Loperamide (Imodium). B. Probanthine (Propantheline). C. Bismuth subsalicylate (Pepto Bismol). D. Diphenoxylate hydrochloride with atropine (Lomotil). 23. The nurse is assessing the effectiveness of high dose aspirin therapy for an 88-year-old client with arthritis. The client reports that she can't hear the nurse's questions because her ears are ringing. What action should the nurse implement? A. Refer the client to an audiologist for evaluation of her hearing. B. Advise the client that this is a common side effect of aspirin therapy. C. Notify the healthcare provider of this finding immediately. D. Ask the client to turn off her hearing aid during the exam. 24. The nurse is reviewing the use of the patient-controlled analgesia (PCA) pump with a client in the immediate postoperative period. The client will receive morphine 1 mg IV per hour basal rate with 1 mg IV every 15 minutes per PCA to total 5 mg IV maximally per hour. What assessment has the highest priority before initiating the PCA pump? A. The expiration date on the morphine syringe in the pump. B The rate and depth of the client's respirations. C. The type of anesthesia used during the surgical procedure. D. The client's subjective and objective signs of pain. 25. The healthcare provider prescribes naloxone (Narcan) for a client in the emergency room. Which assessment data would indicate that the naloxone has been effective? The client's: A. Statement that the chest pain is better. B. Respiratory rate is 16 breaths/minute. C. Seizure activity has stopped temporarily. D. Pupils are constricted bilaterally. 26. A client is admitted to the hospital for diagnostic testing for possible myasthenia gravis. The nurse prepares for intravenous administration of edrophonium chloride (Tensilon). What is the expected outcome for this client following administration of this pharmacologic agent? A. Progressive difficulty with swallowing. B. Decreased respiratory effort. C. Improvement in generalized fatigue. D. Decreased muscle weakness. 27. A client who has been taking levodopa PO TID to control the symptoms of Parkinson's disease has a new prescription for sustained release levodopa/carbidopa (Sinemet 25/100) PO BID. The client took his levodopa at 0800. Which instruction should the nurse include in the teaching plan for this client? A. "Take the first dose of Sinemet today, as soon as your prescription is filled." B. "Since you already took your levodopa, wait until tomorrow to take the Sinemet." C. "Take both drugs for the first week, then switch to taking only the Sinemet." D. "You can begin taking the Sinemet this evening, but do not take any more levodopa. 28. While taking a nursing history, the client states, "I am allergic to penicillin." What related allergy to another type of antiinfective agent should the nurse ask the client about when taking the nursing history? A. Aminoglycosides. B. Cephalosporins. C. Sulfonamides. D. Tetracyclines. 29. A client is receiving ampicillin sodium (Omnipen) for a sinus infection. The nurse should instruct the client to notify the healthcare provider immediately if which symptom occurs? A. Rash. B. Nausea. C. Headache. D. Dizziness. 30. A peak and trough level must be drawn for a client receiving antibiotic therapy. What is the optimum time for the nurse to obtain the trough level? A. Sixty minutes after the antibiotic dose is administered. B. Immediately before the next antibiotic dose is given. C. When the next blood glucose level is to be checked. D. Thirty minutes before the next antibiotic dose is given. 31. A client receiving albuterol (Proventil) tablets complains of nausea every evening with her 9:00 p.m. dose. What action can the nurse take to alleviate this side effect? A. Change the time of the dose. B. Hold the 9 p.m. dose. C. Administer the dose with a snack. D. Administer an antiemetic with the dose. 32. A 43-year-old female client is receiving thyroid replacement hormone following a thyroidectomy. What adverse effects associated with thyroid hormone toxicity should the nurse instruct the client to report promptly to the healthcare provider? A. Tinnitus and dizziness. B. Tachycardia and chest pain. C. Dry skin and intolerance to cold. D. Weight gain and increased appetite 33. A client asks the nurse if glipizide (Glucotrol) is an oral insulin. Which response should the nurse provide? A. "Yes, it is an oral insulin and has the same actions and properties as intermediate insulin." B. "Yes, it is an oral insulin and is distributed, metabolized, and excreted in the same manner as insulin." C. "No, it is not an oral insulin and can be used only when some beta cell function is present." D. "No, it is not an oral insulin, but it is effective for those who are resistant to injectable insulins." 34. Which nursing intervention is most important when caring for a client receiving the antimetabolite cytosine arabinoside (Arc-C) for chemotherapy? A. Hydrate the client with IV fluids before and after infusion. B. Assess the client for numbness and tingling of extremities. C. Inspect the client's oral mucosa for ulcerations. D. Monitor the client's urine pH for increased acidity. 35. Which symptoms are serious adverse effects of beta-adrenergic blockers such as propranolol (Inderal)? A. Headache, hypertension, and blurred vision. B. Wheezing, hypotension, and AV block. C. Vomiting, dilated pupils, and papilledema. D. Tinnitus, muscle weakness, and tachypnea. 36. A client has myxedema, which results from a deficiency of thyroid hormone synthesis in adults. The nurse knows that which medication would be contraindicated for this client? A. Liothyronine (Cytomel) to replace iodine. B. Furosemide (Lasix) for relief of fluid retention. C. Pentobarbital sodium (Nembutal Sodium) for sleep. D. Nitroglycerin (Nitrostat) for angina pain. 37. The nitrate isosorbide dinitrate (Isordil) is prescribed for a client with angina. Which instruction should the nurse include in this client's discharge teaching plan? A. Quit taking the medication if dizziness occurs. B. Do not get up quickly. Always rise slowly. C. Take the medication with food only. D. Increase your intake of potassium-rich foods. 38. A client with coronary artery disease who is taking digoxin (Lanoxin) receives a new prescription for atorvastatin (Lipitor). Two weeks after initiation of the Lipitor prescription, the nurse assesses the client. Which finding requires the most immediate intervention? A. Heartburn. B. Headache. C. Constipation. D. Vomiting. 39. Which change in data indicates to the nurse that the desired effect of the angiotensin II receptor antagonist valsartan (Diovan) has been achieved? A. Dependent edema reduced from +3 to +1. B. Serum HDL increased from 35 to 55 mg/dl. C. Pulse rate reduced from 150 to 90 beats/minute. D. Blood pressure reduced from 160/90 to 130/80. 40. A client is taking hydromorphone (Dilaudid) PO q4h at home. Following surgery, Dilaudid IV q4h PRN and butorphanol tartrate (Stadol) IV q4h PRN are prescribed for pain. The client received a dose of the Dilaudid IV four hours ago, and is again requesting pain medication. What intervention should the nurse implement? A. Alternate the two medications q4h PRN for pain. B. Alternate the two medications q2h PRN for pain. C. Administer only the Dilaudid q4h PRN for pain. D. Administer only the Stadol q4h PRN for pain. 41. In teaching a client who had a liver transplant about cyclosporine (Sandimmune), the nurse should encourage the client to report which adverse response to the healthcare provider? A. Changes in urine color. B. Presence of hand tremors. C. Increasing body hirsutism. D. Nausea and vomiting. 42. A client with hyperlipidemia receives a prescription for niacin (Niaspan). Which client teaching is most important for the nurse to provide? A. Expected duration of flushing. B. Symptoms of hyperglycemia C. Diets that minimize GI irritation. D. Comfort measures for pruritis. 43. Which instruction(s) should the nurse give to a female client who just received a prescription for oral metronidazole (Flagyl) for treatment of trichomonas vaginalis? (Select all that apply.) A. Increase fluid intake, especially cranberry juice B. Do not abruptly discontinue the medication; taper use. C. Check blood pressure daily to detect hypertension D. Avoid drinking alcohol while taking this medication. E. Use condoms until treatment is completed. F. Ensure that all sexual partners are treated at the same time. 44. A client is admitted to the coronary care unit with a medical diagnosis of acute myocardial infarction. Which medication prescription decreases both preload and afterload? A. Nitroglycerin B. Propranolol C. Morphine D. Captopril 45. A client receiving Doxorubicin (Adriamycin) intravenously (IV) complains of pain at the insertion site, and the nurse notes edema at the site. Which intervention is most important for the nurse to implement? A. Assess for erythema B. Administer the antidote C. Apply warm compresses D. Discontinue the IV fluids. 46. A client with heart failure is prescribed spironolactone (Aldactone). Which information is most important for the nurse to provide to the client about diet modifications? A. Do not add salt to foods during preparation B. Refrain from eating foods high in potassium. C. Restrict fluid intake to 1000 ml per day D. Increase intake of milk and milk products. 47. After abdominal surgery, a male client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse why he is receiving this medication. Which is the best response for the nurse to provide? 48. The healthcare provider prescribes naproxen (Naproxen) twice daily for a client with osteoarthritis of the hands. The client tells the nurse that the drug does not seem to be effective after three weeks. Which is the best response for the nurse to provide? A. The frequency of the dosing is necessary to increase the effectiveness. B. Therapeutic blood levels of this drug are reached in 4 – 6 weeks. C. Another type of nonsteroidal anti-inflammatory drug may be indicated. D. Systemic corticosteroids are the next drugs of choice for pain relief. 49. Which method of medication administration provides the client with the greatest first-pass effect? A. Oral B. Sublingual C. Intravenous D. Subcutaneous. 50. A category X drug is prescribed for a young adult female client. Which instruction is most important for the nurse to teach this client? A. Use a reliable form of birth control. B. Avoid exposure to ultra violet light C. Refuse this medication if planning pregnancy. D. Abstain from intercourse while on this drug. 51. An older client with a decreased percentage of lean body mass is likely to receive a prescription that is adjusted based on which pharmacokinetic process? A. Absorption B. Metabolism C. Elimination D. Distribution 52. A medication that is classified as a beta-1 agonist is most commonly prescribed for a client with which condition? A. Glaucoma B. Hypertension C. Heart Failure D. Asthma 53. The nurse is assessing a client who is experiencing anaphylaxis from an insect sting. Which prescription should the nurse prepare to administer this client? A. Dopamine B. Ephedrine C. Epinephrine D. Diphenhydramine 54. Dobutamine (Dobutrex) is an emergency drug most commonly prescribed for a client with which condition? A. Shock B. Asthma C. Hypotension D. Heart Failure 55. Which medications should the nurse caution the client about taking while receiving an opioid analgesic? A. Antacids B. Benzodiazepines C. Antihypertensives D. Oral antidiabetics [Show Less]
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