Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013).
Pharmacotherapeutics for advanced practice: A practical approach
(3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 2, “Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles” (pp. 15–29)This chapter examines concepts related to pharmacokinetics and pharmacodynamics. It also explores patient factors that health care providers consider when prescribing drug therapy to patients.
Chapter 3, “Impact of Drug Interactions and Adverse Events on Therapeutics” (pp. 30–48)This chapter explains drug-drug, drug-food, drug-herb, and drug-disease interactions. Nurs 6521 Week 1 Discussion Question It also reviews patient factors that influence drug interactions and then covers adverse drug reactions.
Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 49–59)
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This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.
Chapter 6, “Principles of Pharmacotherapy in Elderly Patients” (pp. 66–78)This chapter describes issues and factors that affect drug therapy for elderly patients. It then explores concepts relating to drug selection, administration, and management for elderly patients.
Hilmer, S. N., McLachlan, A. J., & Le Couteur, D. G. (2007). Clinical pharmacology in the geriatric patient.
Fundamental & Clinical Pharmacology
,
21
(3), 217–230. Nurs 6521 Week 1 Discussion Question.
Retrieved from the Walden Library databases.This article explores issues that health care providers consider when prescribing drug treatment to geriatric patients. It also examines the role of polypharmacy in adverse drug reactions and the importance of managing patient response to drug treatment.
Scott, S. A. (2011). Personalizing medicine with clinical pharmacogenetics.
Genetics in Medicine
,
13
(12), 987–995. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290900/
This article examines pharmacogenetic testing in relation to personalized drug therapy plans and explores evidence-based guidelines and recommendations on pharmacogenetic testing.
Drugs.com. (2012). Retrieved August 22, 2012, from
http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Media
Laureate Education, Inc. (Executive Producer). (2012).
Introduction to advanced pharmacology
. Baltimore, MD: Author. Nurs 6521 Week 1 Discussion Question.
NURS 6521 WK11 QUIZ – Exam study guide questions and answers
.
Question 1
A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?
A.
That the infant’s skin has greater permeability than that of an adult
B.
That there is less body surface area to be concerned about. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
C.
That there is decreased absorption rates of topical drugs in infants
D.
That there is a lower concentration of water in an infant’s body compared with an adult
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1 points
Question 2
A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
Monophasic
B.
Triphasic OC
C.
Ortho Tri-Cyclen
D.
Biphasic OC
1 points
Question 3
A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
“Take this drug once each day on an empty stomach.”
B.
“It’s best to take a dose of sibutramine after each meal.”
C.
“This drug will help you to lose weight without having to exercise or change your normal diet.”
D.
“Take a dose when you feel like you are tempted to binge on food.”
1 points
Question 4
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
Increased intranodal conduction time
B.
Increased cardiac conduction
C.
Decreased heart rate
D.
Decreased myocardial contraction
1 points
Question 5
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using
A.
body surface area.
B.
age in months.
C.
age in years.
D.
weight.
1 points
Question 6
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
A.
Nephrotoxicity
B.
Hypokalemia
C.
Hypertensive crisis
D.
Cardiac dysrhythmia
1 points
Question 7
A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The nurse will inform the patient that during sibutramine therapy she should
A.
abstain from sex.
B.
use adequate contraception.
C.
obtain a pap smear .
D.
take a pregnancy test every month.
1 points
Question 8
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be
A.
body temperature.
B.
blood pressure.
C.
Vision.
D.
height and weight.
1 points
Question 9
A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
ADHD
B.
Anxiety
C.
Respiratory depression
D.
Obesity
1 points
Question 10
The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. What measure addresses the most common cause of incorrect doses in the care of infants and children?
A.
Having nurses check their math calculations with a colleague before administering a drug
.
B.
Recording drug administration in both the nurse’s notes and the medication administration record (MAR)
C.
Avoiding intravenous administration of drugs whenever possible.
D.
Ensuring that a full assessment takes place no more than 30 minutes before giving a drug.
1 points
Question 11
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
A.
A child has an erratic blood flow from an immature peripheral circulation, which increases drug absorption, causing an increase in adverse effects.
B.
A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects.
C.
A child’s gastric pH is decreased, causing less of the drug to be absorbed from the subcutaneous skin, therefore producing more adverse effects. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
D.
A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects.
1 points
Question 12
A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of
A.
trans fat.
B.
grapefruit juice.
C.
caffeine.
D.
alcohol.
1 points
Question 13
A patient asks the nurse practitioner about food sources such as soybeans and soy products. The nurse practitioner understands that these foods are considered
A.
monotherapy.
B.
taboo.
C.
inappropriate.
D.
phytoestrogens.
1 points
Question 14
A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should.NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
use clean technique only when applying the medication.
B.
use sterile technique when applying the medication.
C.
cool the medication prior to administration.
D.
allow the child to apply the medication if possible.
1 points
Question 15
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should
A.
offer a choice between liquid and chewable medications, if possible.
B.
insert a central intravenous line.
C.
have the mother hold the child firmly and sooth him while the drugs are administered.
D.
teach the boy about the fact that he will feel much better after he takes his medications.
1 points
Question 16
A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?
A.
“How much do you weigh?”
B.
“On a scale of zero to ten, what level of pain is acceptable to you?”
C.
“Did Tylenol or other over-the-counter pain remedies ever relieve your pain?” NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
D.
“Do you ever use alcohol or drugs?”
1 points
Question 17
A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to
A.
the mother and be sure to reinforce the need to force the medications, if her son does not want to take them.
B.
the mother regarding why the boy needs to take the medications.
C.
the boy by telling him not to worry about the medications and to take them as directed.
D.
both the boy and his mother regarding all medication issued.
1 points
Question 18
A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. The breast tenderness occurs primarily during her menstrual cycle. NURS 6521 WK11 QUIZ – Exam study guide questions and answers The nurse practitioner probably suspects
A.
PMS.
B.
breast cancer.
C.
pain in the heart.
D.
cancerous breast tenderness.
1 points
Question 19
A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication
A.
for 20 days.
B.
once a day.
C.
every day until the infection is gone.
D.
for 30 days.
1 points
Question 20
The recommended treatment for trichomoniasis is
A.
Flagyl.
B.
Diflucan.
C.
Meclizine.
D.
Amoxicillan.
1 points
Question 21
A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the
A.
rectus femoris muscle.
B.
ventrogluteal muscle.
C.
dorsogluteal muscle.
D.
deltoid muscle.
1 points
Question 22
A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.) NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
Diet
B.
Route of administration
C.
Age
D.
Weight
E.
Disease process
1 points
Question 23
An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation?
A.
Ineffective Family Therapeutic Regimen Management
B.
Caregiver Role Strain
C.
Delayed Growth and Development
D.
Knowledge Deficit
1 points
Question 24
A preterm neonate received caffeine for the treatment of apnea. The nurse should monitor the neonate for which of the following? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
Constipation
B.
Bloody stools
C.
Hypoglycemia
D.
Bradycardia
1 points
Question 25
A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should
A.
give the drug in a pill form.
B.
have the parent gently force the child’s mouth open.
C.
offer the child a flavored ice chip or ice pop prior to administering the drug.
D.
involve the child in a play therapy session, and then tell the child that the medicine is candy.
1 points
Question 26
A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment?
A.
The health status of the other children
B.
Where the medications will be stored
C.
The mother and grandmother’s understanding about the drugs
D.
How clean the house is
1 points
Question 27
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
staining of permanent teeth.
B.
sleep deprivation.
C.
orange-tinged urine.
D.
deep muscle pain.
1 points
Question 28
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
A.
“Marijuana can easily interact with other drugs and cause potentially fatal reactions.”
B.
“Every year, thousands of Americans end up in emergency departments with marijuana overdoses.”
C.
“Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes.”
D.
“Most people don’t know that marijuana can be just as addictive as heroin or cocaine over time.”
1 points
Question 29
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?
A.
Hypoxia as a result of a prolonged second stage of labor
B.
Changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity
C.
Impaired maternal nutrition as a result of drug use
D.
Vasoconstriction leading to reduced placental blood flow
1 points
Question 30
A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The nurse practitioner is aware that
A.
trichomoniasis discharge is typically thin and clear.
B.
it is unusual to have an odor with trichomoniasis.
C.
trichomoniasis is an incurable disease.
D.
asymptomatic women are diagnosed with trichomoniasis by a routine pap smear.
1 points
Question 31
A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to
A.
increased heart rate and subsequently rapid drug distribution among infants and children.
B.
increased body surface area relative to body volume in infants and children.
C.
the inability of infants and children and describe symptoms of adverse drug reactions.
D.
immature liver and kidney function in infants and children.
1 points
Question 32
A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops
A.
at the back of the mouth.
B.
on top of the tongue.
C.
in the buccal pouch.
D.
under the tongue.
1 points
Question 33
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The most likely cause of this response is
A.
a paradoxical response.
B.
an allergic response.
C.
a hepatotoxic response.
D.
an idiosyncratic response.
1 points
Question 34
A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose?
A.
1000 mg
B.
2000 mg
C.
3000 mg
D.
4000 mg
1 points
Question 35
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?
A.
Take the drug for one full week before coming in contact with allergens
B.
Drink plenty of fluids.
C.
Avoid high noise levels
D.
Take the drug on a full stomach
1 points
Question 36
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
A.
electroencephalogram (EEG).
B.
electrocardiogram (ECG).
C.
electromyelogram (EMG).
D.
electrophysiologic study (EPS).
1 points
Question 37
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
“I am on the middle school track team.”
B.
“My mother is going to give me my insulin.”
C.
“I walk two blocks to school every day.”
D.
“We live in a two-story house.”
1 points
Question 38
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate?
A.
Cardiac function
B.
Hepatic function
C.
Respiratory function
D.
Renal function
1 points
Question 39
To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
A preterm neonate who has apnea
B.
A 52-year-old man with narcolepsy
C.
A school-age child with severe ADHD
D.
A 34-year-old woman with a diagnosis of gastric ulcerations
1 points
Question 40
A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?
A.
A 48-year-old Caucasian man who has adult-onset diabetes
B.
A 28-year-old African-American woman with hyperthyroidism
C.
A 60-year-old African-American man who experiences angina
Please answer each question below and click Submit when you have completed the Quiz.
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Question 1
1 out of 1 points
A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
Compared to adult skin, infants’ skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult patient. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults.
Question 2
1 out of 1 points
A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs.
Question 3
1 out of 1 points
A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
Patients should take sibutramine on an empty stomach to maximize peak concentration levels. They should take it only once a day. It is important to remember that sibutramine should be used in conjunction with a low-calorie diet and daily exercise routine for maximum results. It is not taken on an “ass-needed” basis to control food cravings.
Question 4
1 out of 1 points
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?
Question 5
1 out of 1 points
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using
Response Feedback:
Body surface area is the external surface of the body expressed in square meters. The ratio of body surface area to weight is inversely proportional to length. Drug calculation using body surface area is more accurate than using the weight of the child alone. The methods of using the child’s age in months and years are no longer recommended to calculate drug dosages for pediatric patients.
Question 6
1 out of 1 points
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
Response Feedback:
Because of its pressor effects, dextroamphetamine is contraindicated during the first 14 days after discontinuing monoamine oxidase inhibitor (MAOI) therapy, because MAOI therapy itself may predispose the patient toward elevated blood pressure. Therefore, this 14-day washout period for MAOIs must be observed to prevent hypertensive crisis. This particular combination of drugs does not constitute a risk for a dysrhythmias, kidney damage, or electrolyte imbalances.
Question 7
1 out of 1 points
NURS 6521 WK11 QUIZ – Exam study guide questions and answers
A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. The nurse will inform the patient that during sibutramine therapy she should
Response Feedback:
Before sibutramine therapy is started, the nurse should assess the female patient for pregnancy or the intention to become pregnant. This drug is classified as pregnancy category C. Patients should be told to use adequate contraception and to advise their physician if they become or intend to become pregnant during sibutramine therapy. It would not be appropriate to tell the patient to abstain from sex, and a pregnancy test would not be necessary once a month. However, it would be advisable to have a pregnancy test before therapy begins if the patient is unsure if she is pregnant or if the patient has irregular menstrual periods. A pap smear is not necessarily related to the use of sibutramine but should be done on a regular basis as a normal disease-prevention measure for women.
Question 8
1 out of 1 points
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be
Response Feedback:
The nurse should assess blood pressure, body temperature, and vision at each clinic visit as routine nursing measures in caring for a pediatric patient. However, the priority assessment would be of height and weight. Monitoring the growth and development of children taking amphetamines is extremely important because these drugs have been associated with growth suppression.
Question 9
1 out of 1 points
A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
Methylphenidate is clinically used to treat ADHD and narcolepsy. The drug is not indicated in the treatment of obesity, respiratory depression, or anxiety.
Question 10
1 out of 1 points
The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?
Response Feedback:
Of all the problems that may contribute to an incorrect dose, the most common involve errors in math during dosage calculation. Dosage calculation can involve several steps, and a mathematical error can occur at each step. Documentation in multiple locations, rigorous assessment, and avoidance of IV administration are not practices that appreciably reduce the potential for incorrect doses.
Question 11
1 out of 1 points
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
Response Feedback:
Increased absorption of topical drugs is common in pediatric patients because children have a greater body surface area and a child’s skin exhibits greater permeability. Increased absorption of topical drugs can result in adverse effects that do not occur in adult patients. Erratic blood flow would affect an intramuscular or subcutaneous route of drug administration. Gastric pH would not affect topical absorption.
Question 12
1 out of 1 points
A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of
Response Feedback:
Caffeine-containing drinks such as tea, coffee, and cola may increase the adverse effects associated with dextroamphetamine. Intake of trans fat and grapefruit does not impact the use of dextroamphetamine. A history of drug and alcohol abuse may contribute a risk of dextroamphetamine abuse, but the concurrent use of dextroamphetamine and alcohol is not necessarily contraindicated.
Question 13
1 out of 1 points
A patient asks the nurse practitioner about food sources such as soybeans and soy products. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The nurse practitioner understands that these foods are considered
Question 14
1 out of 1 points
A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should
Response Feedback:
In second- and third-degree burns, the skin is often broken, and the nurse needs to use sterile technique when applying a topical drug to prevent introducing bacteria and other organisms into the body. Do not cool medications unless instructed to do so. Children should not be instructed to apply medications to burned areas of their body. Using clean technique will not be as effective as sterile technique in decreasing the risk of infection when applying the medication.
Question 15
1 out of 1 points
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should
Response Feedback:
Preschoolers are often uncooperative during drug administration. Strategies for enlisting cooperation include offering choices (e.g., between liquid medicines or chewable tablets) when feasible. This is preferable to forcibly administering a medication. Teaching is unlikely to influence a 3-year-old child’s reluctance. A central IV line would not be a preferred strategy if oral medications are available. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Question 16
1 out of 1 points
A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?
Response Feedback:
In school-aged children and adolescents, assess for the use and abuse of substances such as caffeine, alcohol, tobacco, and street drugs. During drug therapy, these substances cause the same complications in children as in adults. Adolescence is a time of experimentation, which may include experimentation with legal and illegal substances. The boy’s subjective report of his weight, his response to over-the-counter drugs, and acceptable pain level do not directly address the potential for adverse drug reactions.
Question 17
1 out of 1 points
A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to
Response Feedback:
Both children and their parents need to be provided with an honest and detailed explanation and rationales regarding any medications that the child takes. Children should be given information regarding their drug therapy, especially before an invasive procedure; otherwise, their fears and anxiety will escalate. Answers and explanations should be provided in terms that both the child and the parents can understand. Never assume that children do not want to know about their medications or brush them off by telling them not to worry. A mother should never force a child to take medication but should encourage the child to do so.
Question 18
1 out of 1 points
A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. The breast tenderness occurs primarily during her menstrual cycle. The nurse practitioner probably suspects
Question 19
1 out of 1 points
A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication
Question 20
1 out of 1 points
The recommended treatment for trichomoniasis is
Question 21
1 out of 1 points
A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the
Response Feedback:
The ventrogluteal site is the best choice because it is free of major nerves and blood vessels and is characterized by deep muscle mass. The drug is injected into the gluteus medius muscle, which is in the ventrogluteal site. Injection in the gluteus medius is less painful than injection in the vastus lateralis. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The dorsogluteal site should be used only as a last resort because of potential damage to the sciatic nerve if the site is not chosen with precision. The scalp veins are never used for injections; they are used only as intravenous sites in infants.
Question 22
1 out of 1 points
A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)
Response Feedback:
Age, disease process, dosage form, route of administration, and foods and drugs present in the child’s body have an effect on drug absorption. Weight is used to calculate the correct dosage to administer and does not affect absorption.
Question 23
1 out of 1 points
An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
An inability to safely and effectively manage the child’s drug regimen is evident by the mother’s actions that likely introduced microorganisms into the child’s vasculature. A knowledge deficit likely contributed to this problem, but the essence of the situation is the parent’s mismanagement of the IV line.
Question 24
1 out of 1 points
A preterm neonate received caffeine for the treatment of apnea. The nurse should monitor the neonate for which of the following?
Response Feedback:
In neonates, there is a possible association between the use of caffeine and the development of necrotizing enterocolitis. All preterm neonates treated with caffeine should be monitored for the development of gastric related adverse effects such as abdominal distension, vomiting, and bloody stools. Sinus tachycardia and diarrhea are adverse effects of caffeine, and hyperglycemia can indicate intolerance or overdose of caffeine.
Question 25
1 out of 1 points
A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should
Response Feedback:
Children can be offered a flavored ice pop or ice chips prior to administering the drug to help numb the taste buds and promote cooperation to take a foul-tasting drug. Most 5-year-old children cannot swallow pills, and only certain pills can be crushed and dissolved in small amounts of liquid or soft food, such as applesauce, gelatin, or ice cream, to mask the flavor of the drug. Medication should never be forced on a child; it increases the risk of aspiration. Play therapy reduces the anxiety related to drug therapy, but you should never tell the children that the medicine is candy.
Question 26
1 out of 1 points
A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
An important question that should be asked during the assessment is whether there is a safe place to keep drugs out of the reach of the patient and the other children. Many drugs have serious adverse and toxic effects in children if taken without adult supervision. Although factors like health status of other family members, the cleanliness of the house, and the parent’s understanding about the medications are important considerations, the most important consideration is the safety of the child who is taking the medication and the other children.
Question 27
1 out of 1 points
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
Response Feedback:
Tetracycline is an example of a drug that can adversely affect a body system during a phase of child development. If administered to a child between the ages of 4 months and 8 years, it can stain the child’s permanent teeth. Discolored urine, deep muscle pain, and sleep deprivation are not associated with tetracycline.
Question 28
1 out of 1 points
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
Response Feedback:
Although smoking marijuana is often thought to be relatively safe compared with smoking tobacco, the smoke is virtually identical in both cases. Smoking marijuana involves inhaling larger volumes of smoke and holding the breath as much as four times longer than with tobacco, which ultimately makes smoking three to four marijuana joints a day equivalent to smoking one pack of tobacco cigarettes a day. Marijuana is not considered to highly addictive and it is not normally associated with a potential for overdose or potentially fatal drug interactions.
Question 29
1 out of 1 points
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?
Response Feedback:
Cocaine use during pregnancy has disastrous effects on the fetus; it causes potent vasoconstriction that reduces placental blood flow by about 50%. This reduction results in fetal hypoxia and alters the maternal–fetal nutrient exchange. The deleterious effects on the infant are not primarily a result of toxins, impaired maternal nutrition, or changes in the process of labor. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Question 30
1 out of 1 points
A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis. The nurse practitioner is aware that
Question 31
1 out of 1 points
A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to
Response Feedback:
Children are more at risk of the deleterious effects of drug errors because they have not physiologically matured. Immature liver or renal function, for example, can increase the circulating level of a drug beyond what would be expected in adults. This characteristic supersedes differences in body surface area, cardiac function, and ability to verbalize complaints.
Question 32
1 out of 1 points
A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops
Response Feedback:
By placing the medication in the buccal pouch, the child is less likely to spit the medicine out than when placing it under or on top of the tongue and at the back of the mouth. Also, placing the medication in an area other than the buccal pouch could cause aspiration.
Question 33
1 out of 1 points
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
Response Feedback:
An allergic response is an immune system response. If the body interprets the drug as a foreign substance (antigen) and forms antibodies against the drug, the antigen–antibody response of the immune system is initiated when the drug is taken again. This response involves the release of histamine, which is responsible for many symptoms of allergy—redness, itching, swelling, rash, and hives. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. Idiosyncratic responses are related to an individual’s unique response to a drug, rather than to the dose of a drug. Idiosyncratic responses are unusual and in fact may be the opposite of what is anticipated, which is sometimes called a paradoxical response.
Question 34
1 out of 1 points
A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Question 35
1 out of 1 points
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?
Response Feedback:
To maximize the therapeutic effects of the drug, the patient should take cromolyn sodium for one full week before coming in contact with allergens. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. Taking the drug on a full stomach is inappropriate, since the drug is in the form of a nasal spray. Neither avoiding high noise levels nor drinking plenty of fluids would help maximize the therapeutic effects of the drug.
Question 36
1 out of 1 points
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
Response Feedback:
In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.
Question 37
1 out of 1 points
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary?
Response Feedback:
Because the patient is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age patient, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.
Question 38
1 out of 1 points
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
The nurse should evaluate the patient’s hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lungs with acetaminophen.
Question 39
1 out of 1 points
To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?
Response Feedback:
The nurse would most likely administer the caffeine to the preterm neonate with apnea. Caffeine stimulates gastric secretions and would aggravate gastric ulcerations. Caffeine is not used to treat ADHD or narcolepsy. Dextroamphetamine is the drug of choice for these conditions.
Question 40
1 out of 1 points
A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
Dextroamphetamine is contraindicated in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and glaucoma. Use of this drug could place the patients at risk for hypertension and increased intraocular pressure. The only patient that the nurse could administer this drug to would be the 48-year-old Caucasian man who has adult-onset diabetes. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs.
A.
Triphasic OC
B.
Ortho Tri-Cyclen
C.
Biphasic OC
D.
Monophasic
1 points
QUESTION 2
A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the
A.
rectus femoris muscle.
B.
ventrogluteal muscle.
C.
dorsogluteal muscle.
D.
deltoid muscle.
1 points
QUESTION 3
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
A.
electrocardiogram (ECG).
B.
electrophysiologic study (EPS).
C.
electromyelogram (EMG).
D.
electroencephalogram (EEG).
1 points
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QUESTION 4
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
A.
“Every year, thousands of Americans end up in emergency departments with marijuana overdoses.”
B.
“Most people don’t know that marijuana can be just as addictive as heroin or cocaine over time.”
C.
“Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes.” NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
D.
“Marijuana can easily interact with other drugs and cause potentially fatal reactions.”
1 points
QUESTION 5
A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient?
A.
“Take this drug once each day on an empty stomach.”
B.
“It’s best to take a dose of sibutramine after each meal.”
C.
“This drug will help you to lose weight without having to exercise or change your normal diet.”
D.
“Take a dose when you feel like you are tempted to binge on food.” NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
1 points
QUESTION 6
A preterm neonate received caffeine for the treatment of apnea. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. The nurse should monitor the neonate for which of the following?
A.
Constipation
B.
Hypoglycemia
C.
Bloody stools
D.
Bradycardia
1 points
QUESTION 7
A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to
A.
increased heart rate and subsequently rapid drug distribution among infants and children.
B.
the inability of infants and children and describe symptoms of adverse drug reactions.
C.
increased body surface area relative to body volume in infants and children.
D.
immature liver and kidney function in infants and children.
1 points
QUESTION 8
A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?
A.
That there is less body surface area to be concerned about
B.
That there is a lower concentration of water in an infant’s body compared with an adult
C.
That the infant’s skin has greater permeability than that of an adult
D.
That there is decreased absorption rates of topical drugs in infants
1 points
QUESTION 9
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
A.
deep muscle pain.
B.
sleep deprivation.
C.
orange-tinged urine.
D.
staining of permanent teeth.
1 points
QUESTION 10
A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
A.
The health status of the other children
B.
Where the medications will be stored
C.
How clean the house is
D.
The mother and grandmother’s understanding about the drugs
1 points
QUESTION 11
A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals
trichomonas vaginalis
. The nurse practitioner is aware that
A.
asymptomatic women are diagnosed with trichomoniasis by a routine pap smear.
B.
trichomoniasis is an incurable disease.
C.
trichomoniasis discharge is typically thin and clear.
D.
it is unusual to have an odor with trichomoniasis.
1 points
QUESTION 12
A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
A.
“How much do you weigh?”
B.
“Do you ever use alcohol or drugs?”
C.
“Did Tylenol or other over-the-counter pain remedies ever relieve your pain?”
D.
“On a scale of zero to ten, what level of pain is acceptable to you?”
1 points
QUESTION 13
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be
A.
height and weight.
B.
Vision.
C.
body temperature.
D.
blood pressure.
1 points
QUESTION 14
A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of
A.
grapefruit juice.
B.
trans fat.
C.
alcohol.
D.
caffeine.
1 points
QUESTION 15
A patient asks the nurse practitioner about food sources such as soybeans and soy products. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. The nurse practitioner understands that these foods are considered
A.
taboo.
B.
phytoestrogens.
C.
monotherapy.
D.
inappropriate.
1 points
QUESTION 16
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?
A.
Drink plenty of fluids.
B.
Take the drug for one full week before coming in contact with allergens
C.
Avoid high noise levels
D.
Take the drug on a full stomach
1 points
QUESTION 17
A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should
A.
use sterile technique when applying the medication.
B.
allow the child to apply the medication if possible.
C.
use clean technique only when applying the medication.
D.
cool the medication prior to administration.
1 points
QUESTION 18
A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. The breast tenderness occurs primarily during her menstrual cycle. The nurse practitioner probably suspects
A.
breast cancer.
B.
PMS.
C.
pain in the heart.
D.
cancerous breast tenderness.
1 points
QUESTION 19
A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)
A.
Disease process
B.
Age
C.
Weight
D.
Route of administration
E.
Diet
1 points
QUESTION 20
To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?
A.
A 34-year-old woman with a diagnosis of gastric ulcerations
B.
A school-age child with severe ADHD
C.
A preterm neonate who has apnea
D.
A 52-year-old man with narcolepsy
1 points
QUESTION 21
The recommended treatment for trichomoniasis is
A.
Amoxicillan.
B.
Flagyl.
C.
Meclizine.
D.
Diflucan.
1 points
QUESTION 22
A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should
A.
involve the child in a play therapy session, and then tell the child that the medicine is candy.
B.
offer the child a flavored ice chip or ice pop prior to administering the drug.
C.
have the parent gently force the child’s mouth open.
D.
give the drug in a pill form.
1 points
QUESTION 23
A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem?
A.
Obesity
B.
ADHD
C.
Respiratory depression
D.
Anxiety
1 points
QUESTION 24
A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication
A.
every day until the infection is gone.
B.
once a day.
C.
for 20 days.
D.
for 30 days.
1 points
QUESTION 25
The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?
A.
Having nurses check their math calculations with a colleague before administering a drug.
B.
Avoiding intravenous administration of drugs whenever possible.
C.
Ensuring that a full assessment takes place no more than 30 minutes before giving a drug.
D.
Recording drug administration in both the nurse’s notes and the medication administration record (MAR)
1 points
QUESTION 26
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
A.
Nephrotoxicity
B.
Hypertensive crisis
C.
Hypokalemia
D.
Cardiac dysrhythmia
1 points
QUESTION 27
A 12-year-old boy is being discharged from the hospital after major surgery. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to
A.
the mother regarding why the boy needs to take the medications.
B.
the mother and be sure to reinforce the need to force the medications, if her son does not want to take them.
C.
the boy by telling him not to worry about the medications and to take them as directed.
D.
both the boy and his mother regarding all medication issued.
1 points
QUESTION 28
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?
A.
Decreased myocardial contraction
B.
Increased cardiac conduction
C.
Decreased heart rate
D.
Increased intranodal conduction time
1 points
QUESTION 29
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should
A.
offer a choice between liquid and chewable medications, if possible.
B.
have the mother hold the child firmly and sooth him while the drugs are administered.
C.
teach the boy about the fact that he will feel much better after he takes his medications.
D.
insert a central intravenous line.
1 points
QUESTION 30
A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose?
A.
2000 mg
B.
4000 mg
C.
3000 mg
D.
1000 mg
1 points
QUESTION 31
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary?
A.
“We live in a two-story house.”
B.
“My mother is going to give me my insulin.”
C.
“I am on the middle school track team.”
D.
“I walk two blocks to school every day.”
1 points
QUESTION 32
A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?
A.
A 60-year-old African-American man who experiences angina
B.
A 28-year-old African-American woman with hyperthyroidism
A 48-year-old Caucasian man who has adult-onset diabetes
1 points
QUESTION 33
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using
A.
body surface area.
B.
age in years.
C.
weight.
D.
age in months.
1 points
QUESTION 34
A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops
A.
under the tongue.
B.
on top of the tongue.
C.
in the buccal pouch.
D.
at the back of the mouth.
1 points
QUESTION 35
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?
A.
Vasoconstriction leading to reduced placental blood flow
B.
Hypoxia as a result of a prolonged second stage of labor
C.
Impaired maternal nutrition as a result of drug use
D.
Changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity
1 points
QUESTION 36
An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation?
A.
Knowledge Deficit
B.
Delayed Growth and Development
C.
Ineffective Family Therapeutic Regimen Management
D.
Caregiver Role Strain
1 points
QUESTION 37
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
A.
A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects.
B.
A child’s gastric pH is decreased, causing less of the drug to be absorbed from the subcutaneous skin, therefore producing more adverse effects.
C.
A child has an erratic blood flow from an immature peripheral circulation, which increases drug absorption, causing an increase in adverse effects.
D.
A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects.
1 points
QUESTION 38
A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. The nurse will inform the patient that during sibutramine therapy she should
A.
use adequate contraception.
B.
take a pregnancy test every month.
C.
abstain from sex.
D.
obtain a pap smear .
1 points
QUESTION 39
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate?
A.
Hepatic function
B.
Renal function
C.
Respiratory function
D.
Cardiac function
1 points
QUESTION 40
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
A.
a paradoxical response.
B.
an allergic response.
C.
a hepatotoxic response.
D.
an idiosyncratic response.
Question 1
1 out of 1 points
A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs.
Question 2
1 out of 1 points
A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the
Response Feedback:
The ventrogluteal site is the best choice because it is free of major nerves and blood vessels and is characterized by deep muscle mass. The drug is injected into the gluteus medius muscle, which is in the ventrogluteal site. Injection in the gluteus medius is less painful than injection in the vastus lateralis. The dorsogluteal site should be used only as a last resort because of potential damage to the sciatic nerve if the site is not chosen with precision. The scalp veins are never used for injections; they are used only as intravenous sites in infants.
Question 3
1 out of 1 points
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
Response Feedback:
In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.
Question 4
1 out of 1 points
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
Response Feedback:
Although smoking marijuana is often thought to be relatively safe compared with smoking tobacco, the smoke is virtually identical in both cases. Smoking marijuana involves inhaling larger volumes of smoke and holding the breath as much as four times longer than with tobacco, which ultimately makes smoking three to four marijuana joints a day equivalent to smoking one pack of tobacco cigarettes a day. Marijuana is not considered to highly addictive and it is not normally associated with a potential for overdose or potentially fatal drug interactions.
Question 5
1 out of 1 points
A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient?
Response Feedback:
Patients should take sibutramine on an empty stomach to maximize peak concentration levels. They should take it only once a day. It is important to remember that sibutramine should be used in conjunction with a low-calorie diet and daily exercise routine for maximum results. It is not taken on an “ass-needed” basis to control food cravings.
Question 6
1 out of 1 points
A preterm neonate received caffeine for the treatment of apnea. The nurse should monitor the neonate for which of the following?
Response Feedback:
In neonates, there is a possible association between the use of caffeine and the development of necrotizing enterocolitis. All preterm neonates treated with caffeine should be monitored for the development of gastric related adverse effects such as abdominal distension, vomiting, and bloody stools. Sinus tachycardia and diarrhea are adverse effects of caffeine, and hyperglycemia can indicate intolerance or overdose of caffeine. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Question 7
1 out of 1 points
A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to
Response Feedback:
Children are more at risk of the deleterious effects of drug errors because they have not physiologically matured. Immature liver or renal function, for example, can increase the circulating level of a drug beyond what would be expected in adults. This characteristic supersedes differences in body surface area, cardiac function, and ability to verbalize complaints.
Question 8
1 out of 1 points
A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?
Response Feedback:
Compared to adult skin, infants’ skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult patient. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Question 9
1 out of 1 points
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
Response Feedback:
Tetracycline is an example of a drug that can adversely affect a body system during a phase of child development. If administered to a child between the ages of 4 months and 8 years, it can stain the child’s permanent teeth. Discolored urine, deep muscle pain, and sleep deprivation are not associated with tetracycline.
Question 10
1 out of 1 points NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment?
Response Feedback:
An important question that should be asked during the assessment is whether there is a safe place to keep drugs out of the reach of the patient and the other children. Many drugs have serious adverse and toxic effects in children if taken without adult supervision. Although factors like health status of other family members, the cleanliness of the house, and the parent’s understanding about the medications are important considerations, the most important consideration is the safety of the child who is taking the medication and the other children.
Question 11
1 out of 1 points NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals
trichomonas vaginalis
. The nurse practitioner is aware that
Question 12
1 out of 1 points
A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?
Response Feedback:
In school-aged children and adolescents, assess for the use and abuse of substances such as caffeine, alcohol, tobacco, and street drugs. During drug therapy, these substances cause the same complications in children as in adults. Adolescence is a time of experimentation, which may include experimentation with legal and illegal substances. The boy’s subjective report of his weight, his response to over-the-counter drugs, and acceptable pain level do not directly address the potential for adverse drug reactions.
Question 13
1 out of 1 points
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be
Response Feedback:
The nurse should assess blood pressure, body temperature, and vision at each clinic visit as routine nursing measures in caring for a pediatric patient. However, the priority assessment would be of height and weight. Monitoring the growth and development of children taking amphetamines is extremely important because these drugs have been associated with growth suppression.
Question 14
1 out of 1 points
A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of
Response Feedback:
Caffeine-containing drinks such as tea, coffee, and cola may increase the adverse effects associated with dextroamphetamine. Intake of trans fat and grapefruit does not impact the use of dextroamphetamine. A history of drug and alcohol abuse may contribute a risk of dextroamphetamine abuse, but the concurrent use of dextroamphetamine and alcohol is not necessarily contraindicated.
Question 15
1 out of 1 points
A patient asks the nurse practitioner about food sources such as soybeans and soy products. The nurse practitioner understands that these foods are considered
Question 16
1 out of 1 points
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
Response Feedback:
To maximize the therapeutic effects of the drug, the patient should take cromolyn sodium for one full week before coming in contact with allergens. Taking the drug on a full stomach is inappropriate, since the drug is in the form of a nasal spray. Neither avoiding high noise levels nor drinking plenty of fluids would help maximize the therapeutic effects of the drug.
Question 17
0 out of 1 points
A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should
Response Feedback:
In second- and third-degree burns, the skin is often broken, and the nurse needs to use sterile technique when applying a topical drug to prevent introducing bacteria and other organisms into the body. Do not cool medications unless instructed to do so. Children should not be instructed to apply medications to burned areas of their body. Using clean technique will not be as effective as sterile technique in decreasing the risk of infection when applying the medication.
Question 18
1 out of 1 points
A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. The breast tenderness occurs primarily during her menstrual cycle. The nurse practitioner probably suspects
Question 19
1 out of 1 points
A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)
Response Feedback:
Age, disease process, dosage form, route of administration, and foods and drugs present in the child’s body have an effect on drug absorption. Weight is used to calculate the correct dosage to administer and does not affect absorption.
Question 20
1 out of 1 points
To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?
Response Feedback:
The nurse would most likely administer the caffeine to the preterm neonate with apnea. Caffeine stimulates gastric secretions and would aggravate gastric ulcerations. Caffeine is not used to treat ADHD or narcolepsy. Dextroamphetamine is the drug of choice for these conditions.
Question 21
1 out of 1 points
The recommended treatment for trichomoniasis is
Question 22
1 out of 1 points
A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should
Response Feedback:
Children can be offered a flavored ice pop or ice chips prior to administering the drug to help numb the taste buds and promote cooperation to take a foul-tasting drug. Most 5-year-old children cannot swallow pills, and only certain pills can be crushed and dissolved in small amounts of liquid or soft food, such as applesauce, gelatin, or ice cream, to mask the flavor of the drug. Medication should never be forced on a child; it increases the risk of aspiration. Play therapy reduces the anxiety related to drug therapy, but you should never tell the children that the medicine is candy. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Question 23
1 out of 1 points
A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem?
Response Feedback:
Methylphenidate is clinically used to treat ADHD and narcolepsy. The drug is not indicated in the treatment of obesity, respiratory depression, or anxiety.
Question 24
1 out of 1 points
A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication
Question 25
1 out of 1 points
The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?
Response Feedback:
Of all the problems that may contribute to an incorrect dose, the most common involve errors in math during dosage calculation. Dosage calculation can involve several steps, and a mathematical error can occur at each step. Documentation in multiple locations, rigorous assessment, and avoidance of IV administration are not practices that appreciably reduce the potential for incorrect doses.
Question 26
1 out of 1 points
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Response Feedback:
Because of its pressor effects, dextroamphetamine is contraindicated during the first 14 days after discontinuing monoamine oxidase inhibitor (MAOI) therapy, because MAOI therapy itself may predispose the patient toward elevated blood pressure. Therefore, this 14-day washout period for MAOIs must be observed to prevent hypertensive crisis. This particular combination of drugs does not constitute a risk for a dysrhythmias, kidney damage, or electrolyte imbalances.
Question 27
1 out of 1 points
A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to
Response Feedback:
Both children and their parents need to be provided with an honest and detailed explanation and rationales regarding any medications that the child takes. Children should be given information regarding their drug therapy, especially before an invasive procedure; otherwise, their fears and anxiety will escalate. Answers and explanations should be provided in terms that both the child and the parents can understand. Never assume that children do not want to know about their medications or brush them off by telling them not to worry. A mother should never force a child to take medication but should encourage the child to do so. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Question 28
1 out of 1 points
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?
Question 29
1 out of 1 points
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should
Response Feedback:
Preschoolers are often uncooperative during drug administration. Strategies for enlisting cooperation include offering choices (e.g., between liquid medicines or chewable tablets) when feasible. This is preferable to forcibly administering a medication. Teaching is unlikely to influence a 3-year-old child’s reluctance. A central IV line would not be a preferred strategy if oral medications are available.
Question 30
1 out of 1 points
A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose?
Question 31
1 out of 1 points
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary?
Response Feedback:
Because the patient is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age patient, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.
Question 32
1 out of 1 points
A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?
Response Feedback:
Dextroamphetamine is contraindicated in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and glaucoma. Use of this drug could place the patients at risk for hypertension and increased intraocular pressure. The only patient that the nurse could administer this drug to would be the 48-year-old Caucasian man who has adult-onset diabetes.
Question 33
1 out of 1 points
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using
Response Feedback:
Body surface area is the external surface of the body expressed in square meters. The ratio of body surface area to weight is inversely proportional to length. Drug calculation using body surface area is more accurate than using the weight of the child alone. The methods of using the child’s age in months and years are no longer recommended to calculate drug dosages for pediatric patients.
Question 34
1 out of 1 points
A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops
Response Feedback:
By placing the medication in the buccal pouch, the child is less likely to spit the medicine out than when placing it under or on top of the tongue and at the back of the mouth. Also, placing the medication in an area other than the buccal pouch could cause aspiration.
Question 35
1 out of 1 points
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?
Response Feedback:
Cocaine use during pregnancy has disastrous effects on the fetus; it causes potent vasoconstriction that reduces placental blood flow by about 50%. This reduction results in fetal hypoxia and alters the maternal–fetal nutrient exchange. The deleterious effects on the infant are not primarily a result of toxins, impaired maternal nutrition, or changes in the process of labor.
Question 36
1 out of 1 points
An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Response Feedback:
An inability to safely and effectively manage the child’s drug regimen is evident by the mother’s actions that likely introduced microorganisms into the child’s vasculature. A knowledge deficit likely contributed to this problem, but the essence of the situation is the parent’s mismanagement of the IV line.
Question 37
1 out of 1 points
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
Response Feedback:
Increased absorption of topical drugs is common in pediatric patients because children have a greater body surface area and a child’s skin exhibits greater permeability. Increased absorption of topical drugs can result in adverse effects that do not occur in adult patients. Erratic blood flow would affect an intramuscular or subcutaneous route of drug administration. Gastric pH would not affect topical absorption.
Question 38
0 out of 1 points
A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. The nurse will inform the patient that during sibutramine therapy she should
Response Feedback:
Before sibutramine therapy is started, the nurse should assess the female patient for pregnancy or the intention to become pregnant. This drug is classified as pregnancy category C. Patients should be told to use adequate contraception and to advise their physician if they become or intend to become pregnant during sibutramine therapy. It would not be appropriate to tell the patient to abstain from sex, and a pregnancy test would not be necessary once a month. However, it would be advisable to have a pregnancy test before therapy begins if the patient is unsure if she is pregnant or if the patient has irregular menstrual periods. A pap smear is not necessarily related to the use of sibutramine but should be done on a regular basis as a normal disease-prevention measure for women.
Question 39
1 out of 1 points
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Response Feedback:
The nurse should evaluate the patient’s hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lungs with acetaminophen.
Question 40
1 out of 1 points
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
An allergic response is an immune system response. If the body interprets the drug as a foreign substance (antigen) and forms antibodies against the drug, the antigen–antibody response of the immune system is initiated when the drug is taken again. This response involves the release of histamine, which is responsible for many symptoms of allergy—redness, itching, swelling, rash, and hives. Idiosyncratic responses are related to an individual’s unique response to a drug, rather than to the dose of a drug. Idiosyncratic responses are unusual and in fact may be the opposite of what is anticipated, which is sometimes called a paradoxical response.
– Types of histories: Complete, inventory (touches up on major points), Problem (focused, acute life-threatening problem), Interim (designed to chronicle events that have occurred since last meeting)
• Recording and documenting patient information Chapter 26
– Write out abbreviations Copy and paste or carry forward (CPCF)
– International Classification of Disease (ICD): diagnostic coding system that classifies diseases and injuries and u used to track mortality and morbidity NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
– Geriatric screening tool: Katz Index consists of six items (bathing, dressing, toileting, transferring, continence and feeding
– Geriatric screening tool: Lawton Instrumental ADL-scale consists of eight items in women (ability to use the telephone, shopping, cooking, housekeeping, doing laundry, taking own medication, making transports, and ability to handle finances)
§ Functional impairment was defined as dependency on at least one domain of ADL (score <6) or IADL (a score <8 from women or <5 for men). Functional decline was defined as deterioration on at least one domain of ADL or IADL compared to baseline (decline ≥1 point). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
– Sullivan Book:
§ CPTP is a listening of descriptive terms and identifying code for reporting medical services and procedures
SOAP note documentation
– S: subjective (what patient tells you)
– O: objective (observations)
– A: assessment (interpretation and conclusions)
– P: plan (diagnostic testing, rationale for decisions)
• Subjective vs objective information when documenting
– S: pain (use pain score)
– O: relate findings to the process of inspection, palpation, auscultation, percussion. “no masses on palpation” “tympanic membranes are pearly gray”
– O: Use anatomic landmarks to add precision
– O: Findings that vary by degrees are customarily graded or recorded in an incremental scale format (pulse amplitude, heart murmur intensity, muscle strength, DTR NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
– Illustrations useful in describing the origin of pain and where it radiates and the size, shape and location of a lesion
– HX of present illness: OLDCARTS: onset, location, duration, character, aggravating factors, relieving factors, temporal factors, severity of symptoms
Ethical decision making and beneficence
– Beneficence: doing good
Diversity and Health Assessment – Bullets 6, 7, 8
Cultural Awareness and Diversity
Achieving cultural competence is a learning process that requires self-awareness, reflective practice, and knowledge of core cultural issues
A culturally competent health care provider adapts to the unique needs of patients of backgrounds and cultures that differ from his or her own
Culture
, in its broadest sense, reflects the whole of human behavior, including ideas and attitudes; ways of relating to one another; manners of speaking; and the material products of physical effort, ingenuity, and imagination. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
The
stereotype,
a fixed image of any group that denies the potential of originality or individuality within the group
Multiple studies have shown that health care providers activate these implicit stereotypes, or non-conscious bias, when communicating with and providing care to minority patients
Members of racial and ethnic groups are not uniform. Each group is highly heterogeneous and includes a diverse mix of immigrants, refugees, and multigenerational Americans who have vastly different histories, languages, spiritual practices, demographic patterns, and cultures
Culturally competent care requires that health care providers be sensitive to patients’ heritage, sexual orientation, socioeconomic situation, ethnicity, and cultural background
When cultural differences exist, be certain that you grasp exactly what the patient means and know exactly what the patient thinks you mean in words and actions
The definition of “ill” or “sick” is based on the individual’s belief system and is determined in large part by his or her enculturation.
Socioeconomic, spiritual, and lifestyle factors affecting diverse populations
Age, gender, race, ethnic group and, with these variables, cultural attitudes, regional differences, and socioeconomic status influence the way patients seek medical care and the way clinicians provide care
A patient who knows the English language, however well, cannot be assumed to know the culture.
Poverty and inadequate education disproportionately affect various cultural groups (e.g., ethnic minorities and women); socioeconomic disparities negatively affect the health and medical care of individuals belonging to these groups
Age, gender, race, ethnic group and, with these variables, cultural attitudes, regional differences, and socioeconomic status influence the way patients seek medical care and the way clinicians provide care.
Black and Latino children in the United States also experience health disparities, including lower overall health status and lower receipt of routine medical care and dental care compared to white children NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
Functional Assessments
Functional Assessment for All Patients
Quite simply, functional assessment is an attempt to understand a patient’s ability to achieve the basic activities of daily living. This assessment should be made for all older adults and for any person limited by disease or disability, acute or chronic. A well-taken history and a meticulous physical examination can bring out subtle influences, such as tobacco and alcohol use, sedentary habits, poor food selection, overuse of medications (prescribed and nonprescribed), and less than obvious emotional distress. Even some physical limitations may not be readily apparent (e.g., limitations of cognitive ability or of the senses). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide. Keep in mind that patients tend to overstate their abilities and, quite often, to obscure reality.
When performing a functional assessment consider a variety of disabilities: physical, cognitive, psychologic, social, and sexual. An individual’s social and spiritual support system must be as clearly understood as the physical disabilities. There are a variety of physical disabilities, including:
Mobility
Difficulty walking standard distances: ½ mile, 2 to 3 blocks, 1/3 block, across a room
Difficulty climbing stairs, up and down
Problems with balance
Upper extremity function
Difficulty grasping small objects, opening jars
Difficulty reaching out or up overhead, such as taking something off a shelf
Housework
Heavy (vacuuming, scrubbing floors)
Light (dusting)
Meal preparation
Shopping
Medication use
Money management
Instrumental activities of daily living
Bathing
Dressing
Toileting
Moving from bed to chair, chair to standing
Eating
Walking in home
Any limitations, even mild, in any of these areas will affect a patient’s independence and autonomy and, to the extent of the limitation, increase reliance on other people and on assistive devices. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide. These limitations indicate the loss of physical reserve and the potential loss of physical function and independence that indicate the onset of frailty. The patient’s social support system and material resources are then integral to the development of reasonable management plans.
#9 Growth and Development Ch 6 of text book
Growth Hormone-Releasing Hormone stimulates the pituitary to release the growth hormone.
70% of secretion of the growth hormone occurs during sleep
Critical brain growth between conception and 3 yrs old.
P
uberty- Dependent on the GH and androgens (Sex Steroids). They stimulate and increase in the growth Hormone.
Lymphatic tissues reach adult size by 6 yrs old and double by 10-12 yrs old.
Pregnancy Weight
Child- 6-8lbs of wt blood-3-4lbs Maternal Fat/protein 4-6lbs
Uterus 2lbs breast 1-2 lbs
Fluid 2-3lb Amniotic fluid 2lbs
Older Adults
Physical Stature decrease at 50 yrs
60 yrs – decrease HT, WT, BMI
Increase Body Fat
Children and Adolescence
Sexual Maturation Girls
Early < 7 yrs Delayed > 13 yrs
• *Macronutrient is required in significant amounts of the diet. Macronutrient includes proteins, carbohydrates, and lipids.
*Macronutrients are so named because they are required in LARGE AMOUNTS.
Micronutrients
The nutrient which is required in smaller amounts in the body is called micronutrients. Two categories of micronutrients are vitamins and minerals.
• Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency?
Ans. Rickets, a disease manifested by spinal curvature and bowed legs NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Nutrition
• *The nutrients that are deficient in vegetarian diet are protein, Calcium, Iron, Vitamin B12, and vitamin D.
*Carbohydrates and proteins supply 4 calories per gram while fats supply 9 calories. Alcohol provides 7 calories per gram.
Carbohydrate
The body handles excess carbohydrate by storing as fat.
Protein
*Mrs. Webb is a 38-year-old patient who has been changing her lifestyle to eat in a healthy way and lose weight. During your health promotion education regarding her nutritional status, you explain the function of dietary protein as:
a. providing an energy source for the brain.
b. building and maintaining tissues.
c. participating in specific detoxifying metabolic pathways.
d. synthesizing and regulating hormones.
The correct Ans is b
*Which of the following are major functions of dietary protein?
Building and maintain tissues;
Regulating water and acid-base balance;
Working as a precursor for enzymes, antibodies, and several hormones
*The recommended minimum daily protein requirement for the normal adult is? Ans. 14%-20% of total calorie or 45 grams for adults.
Fat
*The recommended dietary fat intake for the normal adult is? About 20 to 35 grams per day.
*Advising a person to reduce which macronutrient will produce the greatest caloric reduction per gram of reduction?
o Ans. Fat
Which age group requires the highest percentage of dietary fat intake?
Ans. Before 2 years of age, fat intake may reach 35% 40% of calories.
Water
*Which one of the following would be assessed first in the patient with sustained respiration?
Ans. Hydration/ water
Rationale: A person can exist without food or vitamins for several weeks but without water for only a few days.
2-2.5 L water loss occurs daily by the body in a healthy person under normal circumstances.
Food Diary
• *The food diary is recorded as it happens, making this method the most accurate reflection of an individual’s food intake NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
#13 BMI
BMI is calculated by the weight in pounds multiplied by 703 divided by the height in inches squared.
*Monitoring a patient’s waist to hip ratio provides data concerning patient’s disease risk in cardiovascular term.
*When obesity occurs mostly in lifetime?
Obesity occurs during adolescents 70% of the time. Obesity occurs before skeletal growth or sexual maturation is complete.
*A scale is used to assess patient’s weight need to be calibrated every time before using.
*When monitoring serial measures, such as head circumference or abdominal girth, which procedure is best to ensure that the tape measure is placed in the same position each time?
Ans. Mark the borders of the tape at several intervals on the skin with a pen.
*You are using rule of thumb for advising a 150-pound person decrease calorie intake for weight loss. How many calorie intakes is appropriate per day?
ANS. 150 pounds/2.2 = 68 kg
68×25= 1700 calories.
Rule of thumb for weight loss equals 25 multiply each kg body weight.
*What medication may cause weight gain?
Steroids, oral contraceptives, antidepressants, and insulin
In a pregnant woman, 5-10 pounds of the total gained weight is considered fetus weight in a normal pregnancy. The remainder results from placenta, blood and fluid volume, amniotic fluid, uterus, breasts, and fat. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that contains mostly:
a.fruit and vegetables.
b.lean meat and fish.
c.sandwiches and diet drinks.
d.pasta and chicken.
Correct ANS: B
Carbohydrates are the only source of fuel for the brain and central nervous system. A diet low in carbohydrates, such as a diet mostly of meat and fish, could affect brain function. Fruits and vegetables, sandwiches and diet drinks, and pasta and chicken have moderate levels of needed carbohydrates.
When using “rule of thumb” estimates of energy needs of healthy adults, how many kcal/kg are required to maintain the individual’s current weight?
30 kcal/kg is required for weight maintenance. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
#14 Pernicious anemia:
-B12 deficiency is usually the result of impaired B12 uptake caused by a lack of intrinsic factor that is caused by a loss of parietal cells in the stomach lining. The loss of these cells can be caused by partial or full gastrectomy, Crohn’s disease, autoimmune disorders such as DM1 and immunocompromised diseases such as HIV
-A smooth red tongue with a slick appearance may indicate NIACIN or Vit. B12 deficiency.
Pernicious Anemia can result in Vitamin B12 deficiency!!! (image attached in group)
Examination techniques and equipment #15
Student Laboratory Manual
Seidel’s Guide to physical Examination 8
th
edition Page 10, 11 and 168.
Tape measure
– use to examine multiple raised lesions.
Transilluminate
– An appropriate examination technique to assess vesicle in the skin. It also a source of light with a narrow beam.
Otoscope
– use to visualize the lower and middle turbines of the nose.
Inspection –
is applied throughout the entire examination and interview process.
Auscultation
– is carried out last except when examining kidney or abdomen . it is also used to listen for sounds produced by the body
Fist
– use for indirect finger percussion involves striking the middle finger of the nondominant hand
Deep abdominal palpation of the kidney
is used to assess tenderness over the kidney.
Ulnar surface of the hand
is used to palpate Mass in the skin
Diaphragm
– pressed lightly against skin to detect high frequency.
Scoliometer- measures the degree of rotation of the spine to screen for scoliosis. Pg. 49 8
th
edition.
Pneumatic attachment of an otoscope
– use to evaluate the cone of light reflex in adult and kids.
Red – free light
-seen through the ophthalmoscope to estimate the size and location of lesion. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Dorsal surface of the hand
– sensitive to vibration
Amsler grid
– use to screen patient at risk for macular degeration
Pederson speculum
– use for women with small vaginal opening
Near-vision (Rosenbaum
) or
Jaeger chart
– Use for screening near vision
Dermatoscope
– is a skin surface microscope used to inspect the surface of pigmented skin lesions
Bell of stethoscope
– detects low frequency sound.
Wood lamp-
black light used to detect fungal infection.
Pan-optic ophthalmoscope
– larger field of view in eye examination.
Palpation-
gathering information through touch.
Monofilament
– help identify a patient with decreased sensation and increased risk for injury
Percussion Tone Expected
Stomach-
Tympanic
Sternum
-flat
Liver
-Dull
Lung with patient with Pneumonia
-Dull
Abdomen with lung tumor
-Dull
Diagnostic Assessment tools and tests to include tuning forks, BP monitoring, use of stethoscope, otoscope, ophthalmoscope
Tuning Fork
i. Weber Testà Place base of tuning fork on top of the head and see if the patient hears it equally in both ears. If not, this is considered conductive hearing loss and they will hear the sound in the impaired ear.
ii. Rinne Test à Base of the tuning fork is placed on the mastoid bone, count how long they hear it. Then move it in front of the ear and count how long they hear that. Normally the sound is heard longer through air than through bone. In conductive hearing loss, sound is heard through bone as long as or longer than it is through air (BC>AC). In sensorineural hearing loss, sound is heard longer through air (AC>BC). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
b. Ophthalmoscope
i. Examine patient right eye with your right eye
ii. Visualize the RED reflex (caused by light illuminating the retina, opacities will stand out)
c. Otoscope
i. External auditory canal and tympanic membrane (should be translucent, pearly gray color) (middle ear)
1. Adult: pull ear up and back
2. Child: pull ear down and back
#17
Covers skin, pharmacology,GI, Nervous system, and MUCH MORE
information located in the files of this group. A large table.
Skin lesion characteristics
Maculeà flat discoloration, usual <1 cm in diameter (freckle/ measles)
b. Patchà flat area of skin discoloration, larger than a macule (vitiligo)
c. Papuleà raised lesion, <1 cm same or different color than surrounding skin (raised nevus)
d. Vesicleà fluid filled, <1 cm (varicella/ chicken pox)
e. Plaqueà raised lesion, >1 cm may be same or different color from surrounding skin (Psoriasis)
f. Purpuraà lesions caused by RBCs leaving circulation and becoming trapped in skin (Petechiae, ecchymosis)
g. Pustuleà vesicle like lesion with purulent content (impetigo, acne)
h. Whealàcircumscribed area of skin edema (Hive)
i. Noduleà raised lesion, >1 cm usually mobile (epidermal cyst)
j. Bullaà fluid-filled, >1 cm (blister with 2nd degree burn)
k. Excoriationà marks from scratches (pruritic skin disease)
l. Lichenificationà skin thickening resembling callus formation (chronic dermatitis)
m. Fissureà narrow linear crack into epidermis (split lip, athletes’ foot)
n. Erosionà partial focal loss of epidermis, heals without scarring (areas exposed after bullous lesion opens)
o. Ulcerà loss of epidermis and dermis, heals with scarring (pressure sore)
p. Scaleà raised, flaking lesion (dandruff, psoriasis)
q. Atrophyà loss of skin markings and full skin thickness (area tx excessively with higher potency corticosteroids) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
#18- ABCD assessment of skin lesions:
A -asymmetry of lesion.
B- border (regular or irregular)
C- Color (is it uniform or varying colors)
D- Diameter (anything larger than 6mm)
Images posted in group
#19 Anatomy and physiology of skin layers
Epidermis
i. Outermost portion (stratum corneum & cellular stratum)
ii. Avascular
iii. Stratum Corneum: packed dead squamous cells, contain keratin, keratin cells formed in stratum germinativum (where melanocytes synthesize melanin)
iv. Cellular stratum: in thicker layers of palms and soles
b. Dermis
i. Very vascular connective tissue layer (supports and separates epidermis from adipose)
ii. Elastin, collagen and reticulum fibers, sensory nerve fibers NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
c. Hypodermis
i. Loose connective tissue filled with fatty cells (generates heat/insulation/ shock absorption)
ii. Connected to underlying organs
d. Appendages
i. Eccrine sweat glandsà regulate body temp through water secretion
ii. Apocrine sweat glandsà found in axilla, nipple, areolae, genital, eyes and external ears
iii. Sebaceous glandsà lipid rich substance, stimulated by sex hormones (testosterone)
The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold.
Skin has three layers:
Epidermis
Your skin’s top layer, the epidermis, is super thin on some parts of your body (your eyelids) and thicker on others (the bottoms of your feet). The epidermis is the layer of skin in charge of:
• Making new skin cells: This happens at the bottom of the epidermis. The skin cells travel up to the top layer and flake off, about a month after they form.
• Giving skin its color: The epidermis makes melanin, which is what gives your skin its color (find out more about this in What gives skin its color?).
• Protecting your body: The epidermis has special cells that are part of your immune system and help you stay healthy.
Dermis
A lot happens in the next layer, the dermis. The jobs of the dermis include:
• Making sweat: There are little pockets called sweat glands in the dermis. They make sweat, which goes through little tubes and comes out of holes called pores. Sweating keeps you cool and helps you get rid of bad stuff your body doesn’t need.
• Helping you feel things: Nerve endings in the dermis help you feel things. They send signals to your brain, so you know how something feels if it hurts (meaning you should stop touching it), is itchy or feels nice when you touch it.
• Growing hair: The dermis is where you’ll find the root of each tiny little hair on your skin. Each root attaches to a tiny little muscle that tightens and gives you goose bumps when you are cold or are scared.
• Making oil: Another type of little pocket, or gland, in your skin makes oil. The oil keeps your skin soft, smooth and waterproof. Sometimes the glands make too much oil and give you pimples. (See Acne: Pimples and Zits.
• Bringing blood to your skin: Blood feeds your skin and takes away bad stuff through little tubes called blood vessels.
Subcutaneous fat
The bottom layer of skin is the subcutaneous fat layer. This layer plays an important role in your body by:
• Attaching the dermis to your muscles and bones: This layer has a special connecting tissue that attaches the dermis to your muscles and bones.
• Helping the blood vessels and nerve cells: Blood vessels and nerve cells that start in the dermis get bigger and go to the rest of your body from here.
• Controlling your body temperature: The subcutaneous fat is the layer that helps keep your body from getting too warm or too cold.
• Storing your fat: This fat pads your muscles and bones and protects them from bumps and falls.
#20 Abnormal nail findings in older adults
Nail changes associated with aging are common in the elderly and include characteristic modifications of color, contour, growth, surface, thickness, and histology. The calcium content of the aging nail increases and iron decreases.
keratinocytes of the nail plate are increased in size with an increased number of ‘pertinax bodies’ (remnants of keratinocyte nuclei)
• nail bed dermis also shows thickening of the blood vessels and elastic tissue, especially beneath the pink part of the nail.
• Nail growth decreases by approximately 0.5% per year between 20 and 100 years of age.
• Prominent longitudinal ridges were the most common change
• Brittleness of the nail is a common condition related to aging.
• Onychauxis which is an age-associated thickening of the nail plate
• changes in nail contour, increased transverse curvature
White banding (Terry Nails) is a nail disorder that is specifically linked to age – p. 158.
Pathophysiology: associated with cirrhosis, CHF, adult-onset diabetes mellitus, and age.
Appearance: transverse white bands cover the nail except for narrow zone at the distal tip
Onychomycosis is a fungal infection that causes the nail plate to crumble – p. 156.
Pathophysiology: this is not specifically related to older adults but is associated with loss of manual dexterity (interfere with exercise or walking).
Appearance: distal nail plate turns yellow or white as hyperkeratotic debris accumulates, causing the nail to separate from the nail bed
#21 PSORIATIC SKIN LESIONS
Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.
Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.
There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help
here are several types of psoriasis. These include:
• Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques might be itchy or painful and there may be few or many. They can occur anywhere on your body, including your genitals and the soft tissue inside your mouth.
• Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
• Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.
The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.
• Inverse psoriasis. This mainly affects the skin in the armpits, in the groin, under the breasts and around the genitals. Inverse psoriasis causes smooth patches of red, inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
• Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.
It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.
• Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.
• Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes swollen, painful joints that are typical of arthritis. Sometimes the joint symptoms are the first or only manifestation of psoriasis or at times only nail changes are seen. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease usually isn’t as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.
Causes
The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.
T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.
But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.
Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.
The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.
Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.
Psoriasis triggers
Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:
• Infections, such as strep throat or skin infections
• Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
• Stress
• Smoking
• Heavy alcohol consumption
• Vitamin D deficiency
• Certain medications — including lithium, which is prescribed for bipolar disorder, high blood pressure medications such as beta blockers, antimalarial drugs, and iodides
Risk factors
Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:
• Family history. This is one of the most significant risk factors. Having one parent with psoriasis increases your risk of getting the disease, and having two parents with psoriasis increases your risk even more.
• Viral and bacterial infections. People with HIV are more likely to develop psoriasis than people with healthy immune systems are. Children and young adults with recurring infections, particularly strep throat, also may be at increased risk.
• Stress. Because stress can impact your immune system, high stress levels may increase your risk of psoriasis.
• Obesity. Excess weight increases the risk of psoriasis. Lesions (plaques) associated with all types of psoriasis often develop in skin creases and folds.
• Smoking. Smoking tobacco not only increases your risk of psoriasis but also may increase the severity of the disease. Smoking may also play a role in the initial development of the disease.
Complications
If you have psoriasis, you’re at greater risk of developing certain diseases. These include:
• Psoriatic arthritis. This complication of psoriasis can cause joint damage and a loss of function in some joints, which can be debilitating.
• Eye conditions. Certain eye disorders — such as conjunctivitis, blepharitis and uveitis — are more common in people with psoriasis.
• Obesity. People with psoriasis, especially those with more severe disease, are more likely to be obese. It’s not clear how these diseases are linked, however. The inflammation linked to obesity may play a role in the development of psoriasis. Or it may be that people with psoriasis are more likely to gain weight, possibly because they’re less active because of their psoriasis.
• Type 2 diabetes. The risk of type 2 diabetes rises in people with psoriasis. The more severe the psoriasis, the greater the likelihood of type 2 diabetes.
• High blood pressure. The odds of having high blood pressure are higher for people with psoriasis.
• Cardiovascular disease. For people with psoriasis, the risk of cardiovascular disease is twice as high as it is for those without the disease. Psoriasis and some treatments also increase the risk of irregular heartbeat, stroke, high cholesterol and atherosclerosis.
• Metabolic syndrome. This cluster of conditions — including high blood pressure, elevated insulin levels and abnormal cholesterol levels — increases your risk of heart disease.
• Other autoimmune diseases. Celiac disease, sclerosis and the inflammatory bowel disease called Crohn’s disease are more likely to strike people with psoriasis.
• Parkinson’s disease. This chronic neurological condition is more likely to occur in people with psoriasis.
• Kidney disease. Moderate to severe psoriasis has been linked to a higher risk of kidney disease.
• Emotional problems. Psoriasis can also affect your quality of life. Psoriasis is associated with low self-esteem and depression. You may also withdraw socially.
#22 Vesicular Skin Characteristics
o Vesicles are small, clear, fluid-filled blisters. (page 127)
o A vesicle is elevated, superficial and less than 1cm. The vesicle does not go into the dermis. (page 127)
o Examples of a vesicle are varicella (chickenpox) and herpes zoster (shingles) viruses. (page 127)
o A bulla is a vesicle (blister) that is greater than 1cm. (page 128).
23 hair loss
youtube video
#24 Characteristics of Hair Distribution
Quantity and distribution of hair vary according to individual genetic makeup
Hair is commonly on the scalp, lower face, neck, nares, ears, chest, axillae, back and shoulders, arms, legs, toes, pubic area, and around the nipples
Hair loss is generalized or localized
Hair loss on toes may indicate poor circulation or nutritional deficit
Diffuse hair loss usually occurs without inflammation and scarring
Note if the hair shafts are broken off or completely absent
Scarring is helpful in diagnosis
During adulthood men who are genetically predisposed often display gradual symmetric hair loss on the scalp as a response to androgens
Asymmetric hair loss may indicate pathologic condition
Women in their 20s and 30s can also develop adrenal androgenic female pattern alopecia (hair loss), gradual hair loss from the central scalp
Fine vellus hair covers the body
Coarse terminal hair occurs on the scalp, pubic, axillary area, arms, legs (to some extent), and a man’s beard
Male pubic hair configuration is upright triangle with the hair extending midline to umbilicus
Female pubic hair configuration is an inverted triangle; hair may extend midline to the umbilicus
Assess for hirsutism in women- the growth of terminal hair in a male distribution pattern on the face, body, and pubic area. Hirsutism, alone or with other signs of virilization, may indicate an endocrine disorder
Ball et al., 2015, p. 133-134
Hair loss on lateral eyebrows and scalp may indicate a thyroid dysfunction
Dains et al., 2016, p. 251
Evaluate hair loss that is diffuse or localized and compare areas such as temporal and crown region to the occiput
Hair pull test will reveal any increased hairs shed with a gentle pull
Dains et al., 2016, p. 335
Hair disorders
Alopecia Areata
o Sudden, rapid, patchy loss of hair, usually from face or scalp
o Unknown cause may be triggered by genetic-environmental interactions
o Any hair may be affected
o Regrowth begins in 1-3 months
o Subjective data: sudden, rapid, patchy hair loss, may report nail pitting, may have family history
o Objective data: hair loss sharply defined round areas, hair shaft is poorly formed and break off at skin surface
Ball et al., 2015, p. 154
Scarring Alopecia
o Replacement of hair follicles with scar tissue
o Skin disorders of the scalp or follicles resulting in scarring and destruction of hair follicles and permanent hair loss
o Subjective data: may have other concurrent skin or systemic disorders
o Objective data: patchy hair loss, scalp may be inflamed, hair follicles may be pustular or plugged
Ball et al., 2015, p. 155
Traction Alopecia
o Hair loss that is the result of prolonged tightly pulled hairstyles
o Prolonged tension of the hair from traction breaks the hair shaft
o Follicle is not damaged, loss is reversible
o Subjective data: history of wearing certain hairstyles: braids, hair rollers, or hot combs
o Objective data: patchy hair loss that corresponds directly to the area of stress
o Scalp may or may not be inflamed
Ball et al., 2015, p. 155
Hirsutism
o Caused by high androgen levels (from ovaries or adrenal glands) or by hair follicles that are more sensitive to normal androgen levels, free testosterone causes hair growth
o Causes: genetic, physiologic, endocrine, drug-related, and systemic disorders
o Subjective data: excessive hair growth on face or body; onset, severity, and rate depend on underlying cause
o Objective data: thick dark terminal hairs in androgen-sensitive sites: face, chest, areola, external genitalia, upper and lower back, buttocks, inner thigh, and linea able; may or may not be accompanied by other signs of virilization
Ball et al., 2015, p.155
Hair-Pulling (Trichotillomania)
o Loss of scalp hair caused by physical manipulation
o Hair is twisted around the finger and pulled or rubbed until it breaks off; the act of manipulation is usually an unconscious habit
o Subjective data: may report tension, anxiety, emotional stressors
o Objective data: affected area has an irregular border, and hair density is greatly reduced, but the site is not bald
Ball et al., 2015, p. 163
Tinea capitits- the triad of hair loss, scaling, and lymphadenopathy in children
Dains et al., 2016, p. 334
#25 Cranial Nerves associated with HEENT exam
CN1: Olfactoryà sniff testà Sensory* O
• CN2: Opticà Vision (Snellen eye chart)àSensory* O
• CN3: Oculomotorà 6 cardinal gazes, pupils constrict, opening/closing of eyesà Motor O
• CN4: Trochlearà 6 cardinal gazes, downward/lateral of eye movementà Motor To
• CN5: Trigeminalà facial sensation- temp, pain, tactile (Tri/3), taste, mastication, corneal reflex à Both Touch
• CN6: Abducensà 6 cardinal gazes, lateral movement of eyesà Motor And
• CN7: Facial à dysfunction (Bell’s palsy) puffing out cheeks, smile/frown, facial symmetry* Both Feel
• CN9: Glossopharyngeal à tongue (glosso) throat (pharynx) gag reflex, swallowàBoth Good
• CN10: Vagus à aortic pressure, regulating BP, slowing HR, taste and digestionà Both Vagina
• CN11: Accessory/Spinalà shoulder shrug/ lateral neck movementà Motor* A
• CN12: Hypoglossal à tongue movement/strengthà Motor*
God gave you 1 nose (Olfactory) and 2 eyes (Optic). Nerves 3,4, and 6 make your eyes do tricks (3 Occularmotar, 4 Trochlear, and 6 Abducens). FIVE rhymes with TRI (5 Trigeminal). 7 is like an “F” backwards (F for Facial). 8 looks like earrings (8 Vestibulocochlear (Auditory)). “9 and10, under my chin” (IX Glossopharyngeal (Swallowing, saliva, taste), X Vagus (Control of PNS e.g. smooth muscles of GI tract) (just check gag reflex), 12 for swallowing (XII Hypoglossal (Tongue muscles – speech & swallowing)), and the number 11 looks like the neck (XI Accessory (Moving head & shoulders).
In the pic of the face attached, each part of the number 5 the crosses the face (3 lines) corresponds with the first, second, and third segments of the Trigeminal nerve (Forhead, maxila and mandible).
Here is a quick, meat and potatoes crainial nerve assessment video that is to point:
As the video suggests, the 1st crainial nerve is not tested during routine exam, but you could blindfold the patient and hold coffee, alchohol, etc under the nose and test like you would a taste for sugar and salt.
Now, to remember the order, a “clean” acronym for remembering the crainial nerve order would be,
“Oh Oh Oh To Touch And Feel Very Good Velvet, Such Heaven.” Take the first letter of this acronym for the order of the nerves. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
There is another acronym that helps you determine whether the nerve is sensory, motor, or both. This acronym is, “Some Say Marry Money But My Brother Says Big Brains Matter Most.”
sutures palpable with small separation between each.
Common variations: Caput succedaneum: swelling of the soft tissue in the scalp caused by pressure of the fetal head on a cervix that is not fully dilated. Swelling crosses suture line and decreases rapidly in a few days.
Examination findings of a patient with hypothyroid and hyperthyroid
Palpate lower trachea w thumbs at each side to eval space between trachea and sternocleidomastoid muscles on each side (uneven indicates displacement) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Palpate movement with swallowing (smooth and nontender) movement of cartilages should be felt under finger
ROM 193/516/578: Flex, extend, rotation without pain, resistance or dizziness
Palpation for tenderness in the paravertebral musculature and spinous processes (upper/lower back) coupled with ROM of neck for eval of stiff neck
Take note of any mass, webbing, skin folds (excessive posterior cervical skin)
Thyroid 194:
inspection, palpation, and auscultation for bruit if enlarged
Gently extend neck, use water for swallowing, gentle touch
Can be done from front or behind (learn and be consistent with your method)
Palpation for size, shape, configuration, pain, nodules
Lymph nodes 174-175:
Palpation (so much info pictures, I wasn’t sure how to break it down)
Eyes 208-209:
Near vision- Rosenbaum pocket vision screen (14 inch from face)
Distant Vision- Snellen eye chart/Pin hole (no glasses first) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Peripheral Vision- Confrontation test (bringing fingers in from the side)
Eyebrows 210:
Inspect texture, size, extension to temporal canthus
Eyelids 210-211:
Open and closes completely?
Eyelash position (should curve away)
Ptosis (drooping eyelid)
Fasciculation (twitching/tremor)
Flakey, redness, swelling?
Palpate for nodules -closed lids w gentle push into orbit (should be no discomfort)
Pull lower lid down to assess for color, discharge, lacrimal gland punctum, pterygium
Orbits 210:
Inspect for edema, puffiness, excess tissue
External Eye 212-214:
Corneal clarity using a pen light
Corneal sensitivity using a cotton wisp (slight touch across the cornea)
Corneal arcus: circle around the cornea
Color of irises should be the same
Pupils should be round, regular, equal size, and reactive to light
Pupillary defect with swing flashlight test (checks optic nerve)
Nystagmus- have patient follow your finger to check for involuntary movement
Muscle balance & movement 214-216:
Corneal light reflex 215: light source (used to check strabismus) Cover-uncover test 215, Six cardinal fields of gaze: assess extraocular muscles and cranial nerves, Nasal- straight, up, and down, Temporal- straight, up, and down
Opthalmic examination 216-218:
Give rest periods between tests using bright light, Dim the lights, Ophthalmoscope in the hand with corresponding eye (right hand-right eye), Instill dilating medications as necessary
Ears 239:
Inspect for size, shape, symmetry, landmarks, color, abnormalities.
Position- pull ear up and back
Palpate auricles and mastoid area for pain, swelling or nodules
Auditory canal 240: otoscope 1-1.5 cm depth- color, cerumen, abnormalities
Tympanic membrane 240-241: otoscope- movement (w positive pressure), color, landmarks, abnormalities
Hearing 240-242:
Response to questions during history, whispered voice, and tuning forks (top of head and mastoid area) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Nose and Sinuses 242-244:
Inspect external nose
Palpate bridge and soft tissues of nose
Nares -nasal speculum and light source
Palpate maxillary and frontal sinuses for swelling or pain
Transillumination 244: of sinuses if tender or infection is present
Mouth 245-249:
Inspect lips, teeth, and oral cavity for abnormalities
Palpate and inspect gingivae and buccal mucosa for color, lesions, and pain
Inspect and palpate the tongue
Elicit a gag reflex
Inspect tonsils and pharynx
#30 Examination findings for a patient with sinus symptoms
Seidel page 231, 243-244
Inspect the external nose, noting the shape, size, color, and nares.
Palpate the bridge and soft tissues of the nose, noting tenderness, displacement, and masses.
Evaluate the patency of the nares
Inspect the nasal mucosa and nasal septum for the following: color, alignment, discharge, selling of turbinates, or perforation.
Inspect the frontal and maxillary sinus area for swelling
Palpate the frontal and maxillary sinuses for any tenderness, pain, or swelling
Signs and Symptoms
Sinus infections often follow a cold and cause pain and pressure in your head and face. Palpating over the infected sinus will cause tenderness.
Sinusitis can be either acute or chronic. With chronic sinusitis, the infection or inflammation does not completely go away for 12 weeks or more.
Sinusitis can be caused by three things: viruses, bacteria, fungi. The same viruses that cause the common cold cause most cases of sinusitis. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
-Viral Sinusitis: When the lining of the sinus cavities gets inflamed from a viral infection like a cold, it swells. The swelling can block the normal drainage of fluid from the sinuses into the nose and throat.
-If the fluid cannot drain and builds up over time, bacteria or fungi (plural of fungus) may start to grow in it. These bacterial or fungal infections can cause more swelling and pain.
-Nasal allergies or other problems that block the nasal passages and allow fluid to build up in the sinuses can also lead to sinusitis.
Other common symptoms of sinusitis may include: headache, bad breath, cough that produces mucus, fever, pain in your teeth and a reduced sense of taste or smell.
Viral infections normally resolve without antibiotics within 14 days. Bacterial infections may require antibiotics. OTC medications can be obtained to relieve discomforts and sinus symptoms. Fungal infections (less common) require anti-fungals, these infections can require additional interventions (surigal).
Transillumination of the sinuses:
A transilluminator or small, bright light can be used.
Darken the room.
Maxillary sinuses: place the light source lateral to the nose, just beneath the medial aspect of the eye. Look through the patients open mouth for immunination of the hard palate.
Frontal sinuses: place the light source against the medial aspect of each supraorbital rim. Look for a dim red glow just above the eyebrow. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
The sinuses may differ in degree of illumination
-Opaque: no transillumination
-Dull: reduced transillumination
-Glow (expected): transillumination.
-An opaque response may indicate the sinus is filled with secretions or never developed.
-Asymmetry of transillumination is a significant finding.
#31 appropriate tuning fork frequencies to approximate vocal frequencies
Seidel page 241-242
Weber test: helps assess unilateral hearing loss. Place the base of the vibrating tuning fork on the midline of the patients head. Ask the patient if the sound is heard equally in both ears or is better in one ear. If the sounds is heard better in one ear, have the patient identify which ear.
-To test reliability have the patient occlude one ear. Repeat the test, the sound should be heard better in the occluded ear.
Rinne test: helps to distinguish if the patient hears better by air or bone conduction. Place the base of the vibrating tuning fork against the patients mastoid bone and ask the patient to tell you when the sound is no longer heard. Time this interval of bone conduction, noting the number of seconds. Quickly position the still vibrating tines 1-2 cm from the ear, and again ask the patient to tell you when the sound in no longer heard. Time the interval of sound conduction as well. Compare the seconds recorded for both bone and air conduction.
-Air conduction should be heard twice as long as bone conduction. (see figure 12-16 on page 242 in Seidel)
*Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for? Lateralization of sound
*To approximate vocal frequencies, which tuning fork should be used to assess hearing?
The oral cavity is the first component of the digestive tract, which is delimited by the lips anteriorly and the oropharynx posteriorly. The oral cavity functions as a protective barrier and is an essential component for speech and swallowing, mastication, digestion, and taste sensation. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
To exam of the oral cavity:
Inspect the dorsum of the tongue: Note any swelling or variation in size or color
Ask the patient to extend the tongue while you inspect for limited movement: test CN XII
Tongue should maintain at midline
Normal tongue: dull red, moist, and glistening; smooth surface with papillae with small fissures is visualized on the anterior surface; Posterior tongue: should have rugae
ABNORMAL: smooth red tongue with slick appearance may indicate B12 deficiency; hairy tongue with yellow-brown or black elongated papillae may follow ABT therapy NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Ask the patient to touch the tip of the tongue to the palate area behind the upper incisor
Inspect the roof of the mouth
Inspect the ventral surface of the tongue
A ranula (mucocele) may be seen on the floor of the mouth when an obstruction of the sublingual salivary gland duct
Wrap the tongue in a piece of gauze and gently pull it to each side while inspecting the lateral border
Scrape and white or red margins to distinguish between food particles and leukoplakia
Palpate the tongue and the floor of the mouth for lumps, nodules or ulcerations
Ask the patient to tilt the head back for inspection of the palate and uvula NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Normal: The whitish hard palate should be domed shaped with transverse rugae
Assess the movement of the soft palate by asking the patient to say “ahh” – as the patient vocalizes, observe the soft palate rise symmetrically with the uvula remaining midline – this test CN IX and X
ABNORMAL: A bifid uvula can be associated with Loey-Dietz syndrome
Oral Manifestations with HIV:
Oral hairy leukoplakia: white irregular lesion on lateral side of tongue or buccal
Angular cheilitis: red, unilateral, or bilateral fissures at the corner of the mouth
Candidiasis: creamy white plaque on oral mucosa that bleed when scraped
Herpes Simplex: recurrent vesicular crusting lesions on the lips
Herpes Zoster: Vesicular lesions distributed on the trigeminal nerve
Human papillomavirus: sessile or pedunculated nodules in the oral cavity
Aphthous ulcer: recurrent circumscribed ulcers with erythematous margins
Periodontal disease: gingivitis with bone and soft tissue degeneration with pain
Kaposi sarcoma: incomplete formed blood vessels proliferate, forming lesions
#33 hearing loss findings when examining the elderly patient
Textbook chapter 12 pg. 236
Findings include:
~Conductive hearing loss in older adults may result from an excess deposition(amount) of bone cells along the ossicle (bone in the middle ear)
~ a fixation of the stapes in the oval window(stapes are bones in the middle ear that focuses on conduction of sound vibrations in the inner ear) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Elaborating on what I read on the fixation of stables…. when doing the test with the tuning fork these patients may have abnormal results bc the vibrations are diminished
~cerumen (earwax) impaction
~sclerotic tympanic membrane (sclerotic= becoming rigid, unresponsive, or losing the ability to adapt)
#34 Thyroid Exam
Physical exam:
-inspection of neck
-palpation of paratracheal area
-palpation of lateral neck
-pulse rate
Looking for: exophthalmos, hoarseness of voice, distant mass
Examination techniques used to examine the trachea and thyroid
b. Inspect then Palpate trachea with thumb along each side (sternocleidomastoid muscle on each side)
i. A tugging sensation, synchronous with the pulse is evidence of tracheal tug sign (Cardarelli sign or Oliver sign) suggesting an aortic aneurysm
c. Thyroid: extend neck, have the patient take a sip of water
i. *The estimation of thyroid size by lateral inspection is the most sensitive test for determining the presence of a goiter
ii. FRONT: place thumb over trachea 3 cm beneath thyroid cartilage, to examine RIGTH lobe use left thumb and press trachea towards patients left with your left thumb. Place first 3 fingers of your right hand in the right thyroid bed- leave fingers still while the patient swallows. To examine LEFT lobe, move your fingers o the reverse positions NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
iii. BEHIND: 2 fingers on each sides of the trachea- swallow (feeling for movement of the isthmus) displace trachea to left (with fingers from right hand) with fingers from left hand palpate left lobe as patient swallows.
#35 Organs involved in the alimentary tract
The alimentary tract is 27 feet long and runs from the mouth to the anus including:
Esophagus
• collapsible 10 inches’ longs connecting the pharynx to the stomach
Stomach
• three sections fundus, body, and pylorus
• secretes hydrochloric acid and digestive enzymes that break down fats and proteins
• Pepsin digests proteins
• Gastric lipase emulsifies fat
• Little absorption takes place here
Small intestines
• 21 feet long
• coiled in the abdominal cavity
• first 12 inches’ duodenum forms a C shaped curve around the head of the pancreas
• Next 8 feet is the jejunum that gradually becomes larger and thicker
• Last 12 feet are the ileum
• Ileocecal valve lies between the ileum and the large intestines to prevent backflow
• Nutrients are absorbed through the mucosa of the small intestines
Large intestines
• Begins with the cecum, a blind pouch about 2-3 inches long that hold ileal contents
• vermiform appendix extends from the cecum
• Ascending colon extends from the cecum along the right posterior abdominal wall- under surface of the liver
• Transverse colon crosses the abdominal cavity toward the spleen and down toward the splenic flexure
• Descending colon runs along the left abdominal wall to the rim of the pelvis turning medially and inferiorly
• Sigmoid colon is the S shaped that connects to the rectum extending from the sigmoid to the pelvic floor through the anal canal and terminates at the anus NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
The alimentary tract functions to digest food; absorb nutrients, electrolytes, and water; and excrete waste products
# 36
Correct assessment order for the abdomen
Patient remains supine. Cover chest with the patients gown. Arrange draping to expose the abdomen from the pubis to the epigastrium.
• Inspect skin characteristics, contour, pulsations, and movement
• Auscultate all quadrants for bowel sounds
• Auscultate the aorta and renal, iliac, and femoral arteries for bruits or venous hums
• Percuss all quadrants for tones
• Percuss liver borders and estimate span
• Percuss left midaxillary line for splenic dullness
• Lightly palpate all quadrants
• Deeply palpate all quadrants
• Palpate right costal margin for liver borders
• Palpate left costal margin for spleen
• Palpate laterally at the flanks or right and left kidneys
• Palpate midline for aortic pulsation
• Test abdominal reflexes
• Have your patient raise their head as you inspect the abdominal muscles
#37 Examination of the Liver pg. 385-386
Assessment YouTube Video:
Liver palpation
The lower edge of the liver can be palpable on inspiration about 3 cm below the right rib cage. The liver palpation can be performed with one hand or bimanually, and in the case of obese patients, the so-called “hooking” technique might be helpful as well.
One-hand liver palpation
Place your right hand on patient’s abdomen, lateral to the rectus muscle, well below the level of percussed border of liver dullness.
Orient your fingers towards the patient’s head or slightly diagonally towards the midline. Press your fingers firmly in and up (towards the patient’s head).
Ask the patient to take a deep breath. On inspiration, the liver descends, and its edge meets the fingertips of the palpating hand.
Continue palpating, moving your hand toward the coastal margin until you feel the liver edge (usually a few cm below right costal margin). Note liver edge texture and regularity. Slight tenderness on palpation is normal. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
When your fingers meet the liver edge, slightly reduce the pressure on the abdominal wall while the patient is still taking a deep breath in. This maneuver allows the examiner to feel the anterior liver surface as it slips under the finger pads. Make a note of the consistency of the liver surface-nodes, granularity, etc. (Figure 2)
Bimanual liver palpation
Place your left hand posteriorly at the level of the patient’s two lower ribs, and gently press upward to elevate the liver into a more accessible position.
Ask the patient to take a deep breath and perform palpation with your right hand as described above.
The “hooking” technique
This can be helpful when the liver is not palpable by the standard techniques.
Stand on the right of the patient, facing the patient’s feet.
Place your flexed fingers over the edge of costal margin.
Ask the patient to take a deep breath and try to feel the liver edge as you press downward and upward (towards the patient’s head).
Signs and symptoms of liver disease include:
Skin and eyes that appear yellowish (jaundice)
Abdominal pain and swelling
Swelling in the legs and ankles
Itchy skin
Dark urine color
Pale stool color, or bloody or tar-colored stool
Chronic fatigue
Nausea or vomiting
Loss of appetite
Tendency to bruise easy
Question # 38 – Examination findings associated with appendicitis
Appendicitis
The incidence of appendicitis peaks at age 10 to 20 years, although it can occur at any age.
The patient reports sudden onset of colicky pain that progresses to a constant pain.
The pain can begin in the epigastrium or periumbilicus and later localize to the RLQ.
The pain worsens with movement or coughing.
Vomiting after the onset of pain sometimes occurs.
On physical examination, the patient will be lying still and demonstrate involuntary guarding.
Classically, tenderness occurs in the RLQ.
The other tests for peritoneal irritation will be positive.
Rebound tenderness may be present. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
Variation in presentation is common, particularly with infants, children, and the elderly.
Diagnostic testing includes complete blood count (CBC) with differential to confirm or rule out infection and the use of either ultrasonography, CT scan, or laparoscopy.
Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis.
Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess.
An accurate diagnosis based on history and physical examination can facilitate immediate surgical evaluation and definitive treatment and prevent unnecessary use of radiologic imaging.
In adults, historical symptoms that increase the likelihood of appendicitis are right lower quadrant (RLQ) pain, initial periumbilical pain with migration to the RLQ, and the presence of pain before vomiting.
The presence of rigidity, a positive psoas sign, fever, and/or rebound tenderness are physical examination findings that increase the likelihood of appendicitis.
EVIDENCE-BASED PRACTICE
Clinical Diagnosis of Appendicitis
In a review of clinical decision rules to assist in diagnosing appendicitis, the authors concluded that decision models that score combinations of findings from the history and clinical examination are more powerful than any single finding.
They point to the Alvarado model as one that balances accuracy with ease of use and familiarity to clinicians.
It combines the results for eight findings; a score of 7 or more out of a potential 10 indicates the need for surgical intervention. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
The Alvarado model has a sensitivity of 81% and a specificity of 74%.
ALVARADO SCORE FOR EARLY DIAGNOSIS OF ACUTE APPENDICITIS
VARIABLE
SCORE
Migration of pain
1
Anorexia-acetone
1
Nausea/vomiting
1
Tenderness in RLQ
2
Rebound pain
1
Elevation of temperature
1
Leukocytosis
2
Shift to the left on differential (neutrophils >75%)
1
Maximum total score
10
Positive score
≥7
*
*A score of 7 or more indicates the need for surgical intervention
#39
Examining Mc Burney’s sign:
McBurney’s Point:
– Lies 2 inches from anterior superior point of ileum along a line drawn to the umbilicus.
– Localized tenderness at/around area is indicative of appendicitis. (youtube video attached in group)
a. Find umbilicus, find ASIS (Anterior superior iliac spine/hip bone)
b. Draw imaginary line from umbilicus to ASIS- go 2/3 up line from ASIS!
a. Localized tenderness at/around area is indicative of appendicitis.
#40 Assessment of abdominal pain in women
*Key Points
Auscultation should be done last when examining the abdomen
Example question found through Elsevier online: Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to: inspect for ecchymosis of the flank.
When assessing abdominal pain in college-aged women always ask when the first day of their last menstrual period was!!! NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
Before performing an abdominal exam have the patient empty their bladder!
After abdominal inspection then AUSCULTATE
Inspection of the abdomen should begin with the patient SUPINE
Advanced Health Assessment and Clinical Diagnosis in Primary Care (Dains, Baumann, & Scheibel: Chapter 3 pg. 11
Pg. 20: Perform a pelvic exam in women to rule out STI, PID, ovarian pain, ectopic pregnancy, and uterine fibroids. Cervical motion tenderness (CMT) is the hallmark of PID.
Pg. 28-32 table with common causes of acute abdominal pain
Examples for women:
Ectopic Pregnancy:
women of childbearing age, sudden onset of spotting and persistent cramping in lower quadrant that begins shortly after missed period.
Dysmenorrhea:
typical premenstrual pain onset soon after menarche, gradually diminishes with age. Gynecology consult is needed with pelvic ultrasound. (pg. 30)
Uterine Fibroids:
pain related to menses or intercourse. (
Physical Findings:
Palpable myomas. Pelvic ultrasound is needed with gynecology consult (pg. 27, 31)
Ovarian Cyst:
common with younger women. (pg. 27, 31)
Physical Findings:
adnexal pain and palpable ovarian cysts especially later in cycle
Cholecystitis:
more common in women. Pain located in RUQ and radiates to right scapular area, dark urine, N/V, light stools, and may be aggravated by certain foods. (pg. 29)
Pelvic Inflammatory Disease (PID):
common in women younger than 35 who are sexually active usually with more than one partner. Often caused by chlamydia trachomatis and Neisseria gonorrhoeae with onset occurring after menses. Patients present with lower abdominal pain that progressively becomes severe. Upon examination: tender abdomen, CMT, and adnexal tenderness. Patients may guard and have rebound tenderness, fever, irregular bleeding, vaginal discharge, and vomiting, WBC and ESR are usually elevated. (pg. 25) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
Causes of lower abdominal or pelvic pain
Lower abdominal or pelvic pain, refers to discomfort that occurs at or below your belly button. Most women will experience pain in the
lower abdomen
from time to time. More often than not this is due to menstruation.
The bladder and reproductive organs are often where pelvic pain occurs. In many cases it is difficult to diagnose the exact cause of the pain, but noting certain symptoms will help come to a diagnosis.
The most common lower abdominal pain causes are:
A urinary disorder, such as bladder or kidney problems.
A bowel problem.
A problem with the reproductive system – the uterus, fallopian tubes and ovaries.
Abdominal pain arising from the urinary system
Urine infections
are common and present symptoms, such as burning when you pass urine and going to the toilet more often.
Infection can spread to the kidneys (pyelonephritis) and can make you feel unwell with a high temperature and back pain.
If you have pain that spreads from your back down to your groin and is severe – your doctor may be more concerned that you have
kidney stones
. The doctor will test your urine if you have any of the above symptoms.
Abdominal pain arising from the digestive system
Pain arising from the large intestine is a particularly common cause of lower abdominal pain in both men and women. Features suggesting your pain may be to do with the bowel are:
Pain associated with bowel movement
A change in bowel habit
Blood with bowel movement
Bloating
Both
constipation
and
diarrhea
can give you pain. The pain they are often associated with is described as crampy or ‘colicky.’ This means that it comes and goes in waves. Large bowel pain is characteristically relieved on opening the bowels.
Potential causes of pain arising from the bowel include
irritable bowel syndrome
(IBS), which can give you alternating diarrhea, constipation and bloating.
Other conditions include diverticular disease and its complications which are more frequent in older patients. Inflammatory bowel disease (ulcerative colitis or Crohn’s). A rare but important diagnosis is colorectal cancer.
Bloating and swelling is also a common symptom that people report and can be due to a problem affecting the bowels. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Abdominal pain arising from the reproductive organs
Pain can originate from your uterus (womb), fallopian tubes or ovaries. It’s usually felt in the middle of the lower abdomen.
Pain that is felt more to the side can be more typical of a pain coming from the ovary.
Pain coming from the uterus is often worse during your period and is called dysmenorrhea.
Some conditions affecting the reproductive system can also cause pain during intercourse. This is called
dyspareunia
and it is important to let your doctor know if you are concerned.
Examples of conditions of the reproductive organs include:
Endometriosis
Fibroids
Pelvic inflammatory disease
Ovarian cysts
Problems related to the early stage of pregnancy, such as a miscarriage or ectopic pregnancy.
*Seek immediate medical assistance if your symptoms include a fever, vomiting blood, passing dark or bloody stools or acute and worsening pain.
Questions about a person’s emotional life-family, home, work and sex life are appropriate.
Further abdominal pain investigations
Depending on the exact symptoms and duration, referral to the appropriate specialist is often required. These may include:
Gynecological causes may require vaginal swabs, cervical smears or pelvic ultrasound examination. Ultrasound may also be performed from within the vagina. Specialized blood test for ovarian cancer, CA-125, are usually performed. More invasive tests will depend upon the doctor’s suspicion of the cause of the pain.
Urinary causes can be investigated by urine culture, ultrasound or CT scan.
Colonic causes may require internal endoscopic examination of the bowel by Flexible Sigmoidoscopy or Colonoscopy. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
A CT (Computerized Tomography Scan) may be appropriate for all three major sites of pain.
#41
Landmarks for Abdominal Examination
Have the patient void before performing abdominal examination because a full bladder may interfere with an accurate examination of organs and makes the exam uncomfortable. Approach patient from the right side.
• Four Quadrants of the abdomen: RUQ, LUQ, RLQ, LLQ
• Refer to the nine regions of the abdomen. Figure 17-4 in Ball et al., 2015 p. 378. 1: Epigastric; 2: Umbilical; 3: Hypogastric; 4 & 5: right and left hypochondriac;6 & 7: right and left lumbar; 8 & 9: right and left inguinal.
• Refer to Box 17-1 in Ball et al., p. 379 for landmarks of abdominal exam
o Right Upper Quadrant (RUQ)
• Liver & Gallbladder NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
• Pylorus
• Duodenum
• Head of Pancreas
• Right Adrenal Gland
• Portion of the Right Kidney
• Hepatic Flexure of Colon
• Portions of ascending and transverse colon
o Left Upper Quadrant (LUQ)
• Left lobe of liver
• Spleen
• Stomach
• Body of Pancreas
• Left Adrenal Gland
• Portion of the Left Kidney
• Splenic flexure of colon
• Portions of transverse and descending colon
o Right Lower Quadrant (RLQ)
• Lower pole of right kidney
• Cecum and appendix
• Portion of ascending colon
• Bladder (if distended)
• Ovary and Salpinx
• Uterus (if enlarged)
• Right Spermatic cord
• Right ureter
o Left Lower Quadrant (LLQ)
• Lower pole of left kidney
• Sigmoid Colon
• Portion of descending colon
• Bladder (if distended)
• Ovary and Salpinx
• Uterus (if enlarged)
• Left Spermatic Cord
• Left Ureter
• Refer to Box 17-1 on page 379 of Ball et al., 2015 to refer to the anatomic correlates of the nine regions of the abdomen.
#42 Characteristics of bowel sounds heard on auscultation
Always perform auscultation of the abdomen prior to percussion and palpitation as these maneuvers can change the frequency and intensity of the bowel sounds NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
• Listen for bowel sounds and note frequency and character
• Usually heard as clicks and gurgle that occur irregularly and range from 5-35 sounds per minute.
• They are generalized so often can just be assessed by listening in one area.
• Increased bowel sounds can happen with gastroenteritis, early obstruction, or hunger
• High-pitched tinkling sounds can be indicative intestinal fluid and air under pressure, ie early obstruction.
• Decreased bowel sounds occur with peritonitis and paralytic ileus (auscultate in all 4 quads, if there is a concern) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
• Absent bowel sounds- inability to hear bowel sounds after 5 minutes of continuous listening-associated with abdominal pain/rigidity and is considered a surgical emergency. (Seidle’s Guide to Physical Examination, pg 381)
• You should listen over all 4 quadrants and be able to recognize what is in what quad. (RUQ-lower margin of the liver, gallbladder, part of the large intestine, few loops of the small intestine), (RLQ- appendix, connection between the large and small intestine and loops of bowel), (LUQ- lower margin of the spleen, part of the pancreas and some of the stomach and duodenum), (LLQ- bowel loops and descending colon)
• Important to chart location, quality, intensity, and frequency of bowel sounds. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions
Question 1
1 out of 1 points
Underestimation of blood pressure will occur if the blood pressure cuff’s width covers:
Question 2
1 out of 1 points
Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions
Question 3
1 out of 1 points
The most superior part of the stomach is the:
Question 4
ORDER A PLAGIARISM-FREE PAPER HERE
1 out of 1 points
When recording physical findings, which data are recorded first for all systems?
Question 5
1 out of 1 points
Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence?
Question 6
1 out of 1 points
To perform the Rinne test, place the tuning fork on the:
Question 7
1 out of 1 points
When are open-ended questions generally most useful?
Question 8
0 out of 1 points
The review of systems is a component of the:
Question 9
1 out of 1 points
Fluorescing lesions are best distinguished using a(n):
Question 10
1 out of 1 points
Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 11
1 out of 1 points
Mr. Franklin is speaking with you, the health care provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate for enhancing communication? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 12
1 out of 1 points
The term denoting the caregiver’s need to do no harm to the patient is:
Question 13
0 out of 1 points
Recommended carbohydrate content of total dietary intake (% total calories) is ____%.
Question 14
1 out of 1 points
Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:
Question 15
1 out of 1 points
Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 16
1 out of 1 points
When examining the skull of a 4-month-old baby, you should normally find:
Question 17
1 out of 1 points
Ms. G. is being seen for her routine physical examination. She is a college graduate and president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G.’s _____ history.
Question 18
1 out of 1 points
During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially, you should:
Question 19
1 out of 1 points
Before performing an abdominal examination, the examiner should:
Question 20
1 out of 1 points
The adult recommended dietary fat intake should be _____ g/day.
Question 21
1 out of 1 points
Nuchal rigidity is most commonly associated with:
Question 22
1 out of 1 points
A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:
Question 23
1 out of 1 points
A flat, nonpalpable lesion is described as a macule if the diameter is:
Question 24
1 out of 1 points
Bulging of an amber tympanic membrane without mobility is most often associated with:
Question 25
1 out of 1 points
The position on a clock, topographic notations, and anatomic landmarks:
Question 26
1 out of 1 points
When assessing abdominal pain in a college-age woman, one must include:
Question 27
1 out of 1 points
The infant should be placed in which position to have his or her height or length measured? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 28
1 out of 1 points
A fixed image of any group that rejects its potential for originality or individuality is known as a(n):
Question 29
1 out of 1 points
Sweat glands, hair, and nails are all formed from:
Question 30
1 out of 1 points
Mr. Walters, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the:
Question 31
1 out of 1 points
Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would be:
Question 32
1 out of 1 points
Tracheal tug suggests the presence of a(n):
Question 33
1 out of 1 points
Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 34
1 out of 1 points
The most common form of birth trauma of the scalp is:
Question 35
1 out of 1 points
Which question would be considered a leading question?
Question 36
1 out of 1 points
A brief statement of the reason the patient is seeking health care is called the:
Question 37
1 out of 1 points
Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to:
Question 38
1 out of 1 points
A tool used to screen adolescents for alcoholism is the:
Question 39
1 out of 1 points
Expected hair distribution changes in older adults include:
Question 40
1 out of 1 points
Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 41
1 out of 1 points
When hearing is evaluated, which cranial nerve is being tested?
Question 42
1 out of 1 points
Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia?
Question 43
1 out of 1 points
Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?
Question 44
1 out of 1 points
You are examining a pregnant patient and have noted a vascular lesion. When you blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a:
Question 45
1 out of 1 points
A blood pressure cuff bladder should be long enough to:
Question 46
1 out of 1 points
A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that consumes mostly:
Question 47
1 out of 1 points
After thorough inspection of the abdomen, the next assessment step is:
Question 48
1 out of 1 points
Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On examination, you have noted a bruit heard over the thyroid. This is suggestive of:
Question 49
1 out of 1 points
During percussion, a dull tone is expected to be heard over:
Question 50
1 out of 1 points
Which of the following occurs when firm pressure is used to apply the stethoscope’s bell end-piece to the skin?
Question 51
1 out of 1 points
When communicating with older children and teenagers, you should be sensitive to their:
Question 52
1 out of 1 points
To approximate vocal frequencies, which tuning fork should be used to assess hearing?
Question 53
1 out of 1 points
You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data would indicate:
Question 54
1 out of 1 points
When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate?
Question 55
1 out of 1 points
Expected normal percussion tones include:
Question 56
1 out of 1 points
Subjective and symptomatic data are:
Question 57
1 out of 1 points
You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 58
1 out of 1 points
Which technique is most likely to result in the patient’s understanding of questions?
Question 59
1 out of 1 points
Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:
Question 60
1 out of 1 points
Unusual white areas on the skin may be due to:
Question 61
1 out of 1 points
George Michaels, a 22-year-old patient, tells the nurse that he is here today to “check his allergies.” He has been having “green nasal discharge” for the last 72 hours. How would the nurse document his reason for seeking care? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 62
0 out of 1 points
To correctly document absent bowel sounds, one must listen continuously for:
Question 63
1 out of 1 points
Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?
Question 64
1 out of 1 points
Which type of speculum should be used to examine a patient’s tympanic membrane?
Question 65
1 out of 1 points
Ms. Jones is a 31-year-old female patient who presents for a routine physical examination. Which examination technique will be used first?
Question 66
1 out of 1 points
In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for:
Question 67
1 out of 1 points
Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the:
Question 68
0 out of 1 points
Peritonitis produces bowel sounds that are:
Question 69
1 out of 1 points
The recommended minimum daily protein requirement for the normal adult is ______.
Question 70
1 out of 1 points
As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include:
Question 71
1 out of 1 points
Which is the best way to position a patient’s neck for palpation of the thyroid? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 72
1 out of 1 points
When taking a history, you should:
Question 73
1 out of 1 points
Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which medication is frequently associated with weight gain?
Question 74
1 out of 1 points
Which of the following is an expected change in the assessment of the thyroid during pregnancy?
Question 75
1 out of 1 points
Brittle nails are typical findings in:
Question 76
1 out of 1 points
Regardless of the origin, discharge is described by noting:
Question 77
1 out of 1 points
Nasal symptoms that imply an allergic response include:
Question 78
1 out of 1 points
Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence?
Question 79
1 out of 1 points
Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADLs) is part of a(an):
Question 80
1 out of 1 points
Tangential lighting is best used for inspecting skin:
Question 81
1 out of 1 points
A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness you should palpate over the:
Question 82
1 out of 1 points
Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure:
Question 83
1 out of 1 points
Which statement is true regarding the relationship of physical characteristics and culture?
Question 84
1 out of 1 points
A guideline for history taking is for caregivers to:
Question 85
1 out of 1 points
A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 86
1 out of 1 points
During an interview, you have the impression that a patient may be considering suicide. Which action is essential?
Question 87
1 out of 1 points
Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia due to:
Question 88
1 out of 1 points
Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical. This visit would be documented by creating a(n):
Question 89
1 out of 1 points
You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration?
Question 90
1 out of 1 points
In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of the tracheal cartilage is at the: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 91
1 out of 1 points
You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for:
Question 92
1 out of 1 points
Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?
Question 93
1 out of 1 points
Under normal circumstances, how much water is lost daily by the body?
Question 94
0 out of 1 points
Tympanic thermometers measure body temperature when a probe is placed:
Question 95
1 out of 1 points
Which cranial nerves innervate the face?
Question 96
1 out of 1 points
Which of the following is an “ABCD” characteristic of malignant melanoma?
Question 97
1 out of 1 points
Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her fingernails are not growing. Which structure is the site of new nail growth?
Question 98
1 out of 1 points
Which of the following is the most accurate reflection of an individual’s food intake?
Question 99
1 out of 1 points
A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:
Question 100
1 out of 1 points
White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are:
Question 101
0 out of 0 points
When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology
Disorders of the Veins and Arteries
Part of the roles of a nurse practitioner is to diagnose and treat illnesses that creates imbalances in the body. Blood clots and altered circulation are factors that can affect the venous system. The biological and physical manifestation of the arteries and veins will be expounded. will be expounded. Arterial thrombosis and venous thrombosis will be discussed at length and their dissimilarities will be outlined. Two mind maps will be attached to this assignment at the end of this paper per the instructor on CVI and DVT.
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Deep Venous Thrombosis (DVT)
According to Douketis (2017), DVT occurs when there is a formation of clot in the deep vein of the body’s extremity and it is dislodges from the wall of the blood vessel. The triad of Virchow is made up of factors that are responsible for DVT. These three factors are responsible or advances DVT and they are hypercoagulability, endothelial injury and abnormal blood flow (Laureate Education, 2012). According to Heuther and McCance (2017), DVT can develop from trauma, pregnancy or spinal injury. Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology. DVTs are known to develop near the venous valve and also from the buildup of clotting materials in the blood such as thrombin, fibrin and platelets (Douketis, 2017). Homan’s sign can be a sign of DVT and this is when there is pain behind the knee when there is a forced dorsiflexion. To prevent DVT after surgery ambulation (early) is encouraged; anticoagulants are used and compression devices are applied on patients legs to keep blood flowing (Heuther & McCance, 2017). According to Heuther and McCance (2017), diagnostic instrument like Doppler ultrasonography and lab test such as d-Dimer are used to detect and confirm DVTs after the clinician suspects one.
Chronic Venous Insufficiency (CVT)
The main cause of CVT is the disruption in the competence of superficial venous system but can also develop due to the incompetence of the valves, and sometimes both case can lead to CVI (Weiss, & Izaguirre-Anaribe, 2017). The absence of valves (Congenital) could lead to CVI. The risk for developing CVI is high for an individual who regularly stands for long period of time, wears tight clotting or crosses their legs constantly (Heuther & McCance, 2017). An individual with CVI will present symptoms such as swelling of leg, pain that worsens with standing and improves when leg is raised, varicose veins and restless legs (Weiss, & Izaguirre-Anaribe, 2017). Duplex sonography and d-dimer are used to diagnose and confirm CVI after physical examination.
Dissimilarities between Arterial Thrombosis and Venous Thrombosis
In the case of arterial thrombosis the obstruction of blood flow leads to the side effects and arterial thrombosis can affect various areas of the body while venous thrombosis occurs in the lower extremity. When there is restriction in the flow of blood from the coronary artery to the muscles of the heart it will result to a heart attack and this is linked to arterial thrombosis (NHS Choices, 2017). According to Weinberg (2017) crossed embolism which is known as paradoxical embolism occurs when a clot carried by the venous circulation crosses over or travels to the arterial side and vice-versa. Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology.
The Role of Gender in DVT and CVI
Research has not proven any direct link to DVT and gender but the use of oral contraceptives and hormone replacement therapy in women is known to cause hypercoagulability which is part of the triad (Huether & McCance, 2017). CVI occurs in women more than men and varicose is the main culprit of CVI in women and women tend to put on tight clothings also (Huether & McCance, 2017).
Summary
The pathophysiology of DVT and CVI has been discussed in the paper and the characteristics of venous and arterial thrombosis. The role of gender in CVI and DVT with regards to females being more susceptible to CVI than males was explained. Diagnosis and treatment of DVT and CVI were also presented in this paper. The next step will be to attach the mind maps of both DVT and CVI.
DVT and CVI Mind Maps
References
Arterial thrombosis – NHS Choices
. (2017). Retrieved 26 March 2017, from
Huether, S. E., & McCance, K. L. (2017).
Understanding Pathophysiology, 6e (Huether,
understanding Pathophysiology)
(6th ed.). Philadelphia, PA, United States: Elsevier Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology
Health Sciences.
Laureate Education, Inc. (Executive Producer). (2012a).
Alterations of cardiovascular functions
PPT lecture
. Baltimore, MD: Author.
Weinberg, I. (2017).
Arterial and Venous Thrombosis | Angiologist
.
Angiologist.com
. Retrieved
25 March 2017, from
http://www.angiologist.com/thrombosis-section/arterial-and-
venous-thrombosis/ Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology
Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System
Assessing the Heart, Lungs, and Peripheral Vascular System
Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?
In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.
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In this Discussion, you will consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.
Note:
By
Day 1
of this week, your Instructor will have assigned you to one of the video case studies in this week’s Learning Resources titled
Advanced health assessment and diagnostic reasoning
. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.
To prepare:
With regard to the case study you were assigned:
· Review this week’s Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
· Identify
at least five
possible conditions that may be considered in a differential diagnosis for the patient.
Note:
Before you submit your initial post, replace the subject line (“Discussion – Week 6”) with “Review of Case Study” identifying the number of the case study you were assigned. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.
Post a 1 page APA
SOAP Note format
1. a description of the health history you would need to collect from the patient in the case study you were assigned (
See attached case study below
)
2. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis.
3. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
Readings
· Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).
Seidel’s guide to physical examination
(8th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 13, “Chest and Lungs” (pp. 260-293)
This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs.
o Chapter 14, “Heart” (pp. 294-331)
The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.
o Chapter 15, “Blood Vessels” (pp. 332-349)
This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.
· Dains, J. E., Baumann, L. C., & Scheibel, P. (2016).
Advanced health assessment and clinical diagnosis in primary care
(5th ed.). St. Louis, MO: Elsevier Mosby.
o Chapter 8, “Chest Pain” (pp. 81–96)
This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first determining whether the patient is in a life-threatening condition. It includes questions that can help pinpoint the type and severity of pain and then describes how to perform a physical examination. Finally, the authors outline potential laboratory and diagnostic studies.
o Chapter 11, “Cough” (pp. 118-147)
A cough is a very common symptom in patients and usually indicates a minor health problem. This chapter focuses on how to determine the cause of the cough through asking questions and performing a physical exam.
o Chapter 14, “Dyspnea” (pp. 159–173)
The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for determining the cause of the problem through evaluation of the patient’s history, through physical examination, and through additional laboratory and diagnostic tests.
o Chapter 26, “Palpitations” (pp. 310-317)
This chapter describes the different causes of heart palpitations and details how the specific cause in a patient can be determined.
o Chapter 33, “Syncope” (pp. 390-397)
This chapter focuses on syncope, or loss of consciousness. The authors describe the difficulty of ascertaining the cause, because the patient is usually seen after the loss of consciousness has happened. The chapter includes information on potential causes and the symptoms of each. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.
· Sullivan , D. D. (2012).
Guide to clinical documentation
(2nd ed.). Philadelphia, PA: F. A. Davis.
o Chapter 6, “Outpatient Charting and Communications” (pp. 119–141)
Note:
Download these Adult Examination Checklists and Physical Exam Summaries to use during your practice cardiac and respiratory examination.
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).
Physical exam summary: Blood vessels
. In
Mosby’s guide to physical examination
(7th ed.). St. Louis, MO: Elsevier Mosby.
This Blood Vessels Physical Exam Summary was published as a companion to
Seidel’s guide to physical examination
(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).
Adult examination checklist: Guide for cardiovascular assessment
. In
Mosby’s guide to physical examination
(7th ed.). St. Louis, MO: Elsevier Mosby.
This Adult Examination Checklist: Guide for Cardiovascular Assessment was published as a companion to
Seidel’s guide to physical examination
(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).
Adult examination checklist: Guide for chest and lung assessment
. In
Mosby’s guide to physical examination
(7th ed.). St. Louis, MO: Elsevier Mosby.
This Adult Examination Checklist: Guide for Chest and Lung Assessment was published as a companion to
Seidel’s guide to physical examination
(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/ Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).
Physical exam summary: Chest and lungs
. In
Mosby’s guide to physical examination
(7th ed.). St. Louis, MO: Elsevier Mosby.
This Chest and Lungs Physical Exam Summary was published as a companion to
Seidel’s guide to physical examination
(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
· Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).
Physical exam summary: Heart.
In
Mosby’s guide to physical examination
(7th ed.). St. Louis, MO: Elsevier Mosby.
This Heart Physical Exam Summary was published as a companion to
Seidel’s guide to physical examination
(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
· McCabe, C., & Wiggins, J. (2010a). Differential diagnosis of respiratory disease part 1.
Practice Nurse
,
40
(1), 35–41.
Retrieved from the Walden Library databases.
This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions.
· McCabe, C., & Wiggins, J. (2010b). Differential diagnosis of respiratory diseases part 2.
Practice Nurse
,
40
(2), 33–41.
Retrieved from the Walden Library databases. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.
The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations.
· SkillStat Learning, Inc. (2014).
The 6 second ECG
. Retrieved from
http://www.skillstat.com/tools/ecg-simulator#/-home
This interactive website allows you to explore common cardiac rhythms. It also offers the Six Second ECG game so you can practice identifying rhythms.
· University of Virginia. (n.d.).
Introduction to radiology: An online interactive tutorial
. Retrieved from
http://www.med-ed.virginia.edu/courses/rad/index.html
This website provides an introduction to radiology and imaging. For this week, focus on cardiac radiography and chest radiology.
Media
· Laureate Education. (Producer). (2012).
Advanced health assessment and diagnostic reasoning
. Baltimore, MD: Author. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.
Exam Results
Exam Results: Scenario 2
Vital signs:
Temperature: 97.9 oral
Respiratory rate: 32, labored
Heart rate: 112, tachycardic
BP right arm: 148/88
Oxygen saturation: 90% on room air
Weight: 210 lbs, stable
Skin: Cool, diaphoretic
Thorax and lungs: Thorax symmetrical; diminished breath sounds right middle and lower lobes; no rales, rhonchi, or wheezes; breath sounds vesicular with no adventitious sounds left lung
Cardiovascular: Heart rate is irregular with good S1, S2; no S3 or S4; no murmur
Abdomen: Protuberant with normoactive bowel sounds auscultated x4 quadrants Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System
Peripheral vascular: Right calf with 2+ edema, erythema; warmth and tenderness on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally
Neurologic: Anxious; awake, alert, and oriented to person, place, and time Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.
Urinary tract infections (UTIs) are caused by bacteria—most often
Escherichia coli
. However, certain viruses, fungi, and parasites can also lead to infection. The infection can affect the lower and upper urinary tract, including the urethra, prostate (in males), bladder, ureter, and kidney. Due to the progression of the disease and human anatomy, symptoms present differently among the sexes as well as among age groups. It is important to understand how these factors, as well as others, impact the pathophysiology of UTIs. Advanced practice nurses must have this foundation in order to properly diagnose patients.
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To Prepare
· Review Chapter 30 in the Huether and McCance text. Identify the pathophysiology of lower and upper urinary tract infections. Consider the similarities and differences between the two types of infections.
· Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior Urinary Tract Infections Essay Example. Reflect on how the factors you selected might impact the pathophysiology of the infections, as well as the diagnosis of and treatment for the infections.
Write
· a description of the pathophysiology of lower and upper urinary tract infections, including their similarities and differences. (
I am looking for an explanation at the cellular or molecular level (whenever possible).
· Then explain how the factors you selected might impact the pathophysiology of the infections, as well as the diagnosis of and treatment for the infections.
Points to follow when writing a paper:
·
Please all bullets points, bold, red and highlighted area must be attended to.
· A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings.
· Please review all rubrics.
· Check APA format/setting.
· Your final paragraph should be a summary of the key points of your Urinary Tract Infections Essay Example paper.
· Please personalized where necessary.
Refrain from direct quote
you are required to cite scholarly resources including peer-review journals and current practice guidelines
.
May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html
Rules for writing (FYI)
Whether writing a discussion posting or a paper, keep a few things in mind—
1) I am looking for an explanation at the cellular or molecular level (whenever possible).
2) I am not looking for pathophysiological explanations that we would give to patients (e.g. “your heart just isn’t pumping the right way). While this explanation is acceptable for patient teaching, it will not cut it in a course titled “advanced pathophysiology.” To be very specific- I am looking for you to tell me the precise aberrancies (or theorized aberrancies) which inexorably lead to disease states Urinary Tract Infections Essay Example. Thanks.
Many patient symptoms can be tied to multiple disorders, which may lead to misdiagnoses. For instance, consider two digestive disorders of the gastrointestinal tract—inflammatory bowel disease and irritable bowel syndrome. These two disorders are commonly confused because they present similar symptoms. As an advanced practice nurse, you must know the differences to properly diagnose and treat the disorders. Discussion: Digestive Disorders. How does the pathophysiology of inflammatory bowel disease compare to the pathophysiology of irritable bowel syndrome? How do treatments for the two disorders compare?
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To Prepare
· Review Chapter 36 in the Huether and McCance text and Chapter 13 in the McPhee and Hammer text.
· Identify the pathophysiological mechanisms of inflammatory bowel disease and irritable bowel syndrome. Think about similarities and differences between the disorders.
· Consider common treatments for inflammatory bowel disease and irritable bowel syndrome. Reflect on whether treatments for one disorder would work for the other disorder.
· Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factor you selected might impact the pathophysiology of and treatments for each disorder.
write
· An explanation of the pathophysiological mechanisms of inflammatory bowel disorder and irritable bowel syndrome, including similarities and differences. (
I am looking for an explanation at the cellular or molecular level (whenever possible) Discussion: Digestive Disorders.
· Then describe common treatments, addressing whether treatments for one disorder would work for the other disorder.
· Finally, explain how the patient factor you selected might impact the pathophysiology of and treatments for each disorder.
Points to follow when writing a paper Discussion: Digestive Disorders:
· Please all bullets points, bold, red and highlighted area must be attended to.
· A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings.
· Please review all rubrics.
· Check APA format/setting.
· Your final paragraph should be a summary of the key points of your paper.
· Please personalized where necessary.
Refrain from direct quote
Class Rules
Avoid public facing sites like university web pages or foundation pages (such as the American Cancer Society or the Alzheimer’s Association) and medical sites designed for consumption by the general public (such as Mayo Clinic or WebMD).
you are required to cite scholarly resources including peer-review journals and current practice guidelines
.
May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html
Writer must be familiar with nursing pharmacology Discussion: Digestive Disorders.
Rules for writing (FYI)
Whether writing a discussion posting or a paper, keep a few things in mind—
1) I am looking for an explanation at the cellular or molecular level (whenever possible).
2) I am not looking for pathophysiological explanations that we would give to patients (e.g. “your heart just isn’t pumping the right way). While this explanation is acceptable for patient teaching, it will not cut it in a course titled “advanced pathophysiology.” To be very specific- I am looking for you to tell me the precise aberrancies (or theorized aberrancies) which inexorably lead to disease states Discussion: Digestive Disorders. Thanks.
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper
Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.
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Consider the following case study:
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:
Synthroid 100 mcg daily
Nifedipine 30 mg daily
Prednisone 10 mg daily
To prepare:
· Review this week’s media presentation on pharmacology for the gastrointestinal system.
· Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
· Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder.
· Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Post 1 page page APA format
an explanation of your diagnosis for the patient including your rationale for the diagnosis.
Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
(Note this is a pharmacology class make sure medicine is appropriate and will work with pt’s current med list)
Readings
· Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013).
Pharmacotherapeutics for advanced practice: A practical approach
(3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
o Chapter 28, “Nausea and Vomiting” (pp. 392–409)
This chapter focuses on the etiology of nausea and vomiting, as well as body systems that impact or trigger nausea and vomiting. It also covers various drugs used to treat nausea and vomiting including the process of selecting, administering, and managing drug therapy for patients.
o Chapter 29, “Gastroesophageal Reflux Disease and Peptic Ulcer Disease” (pp. 410–423)
This chapter begins with an overview of risk factors, symptoms, and clinical stages of gastroesophageal reflux disease (GERD). It then examines drugs used to treat GERD and peptic ulcer disease (PUD), including proper dosages, possible adverse reactions, contraindications, and special considerations. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
o Chapter 30, “Constipation, Diarrhea, and Irritable Bowel Syndrome” (pp. 424–453)
This chapter begins by exploring disorders associated with constipation and diarrhea, as well as drugs used in treatment. It also covers the pathophysiology of irritable bowel syndrome and related drug therapies.
o Chapter 31, “Inflammatory Bowel Disease” (pp. 454–471)
This chapter examines the causes, pathophysiology, and diagnostic criteria of inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis. It also identifies drugs used to treat IBD, including proper dosage, adverse reactions, and special considerations.
· Starr, S., & Raines, D. (2011). Cirrhosis: Diagnosis, management, and prevention.
American Family Physician
,
84
(12), 1353–1359.
Retrieved from the Walden Library databases.
This article examines the clinical presentation, pathophysiology, diagnosis, management, and prevention of cirrhosis. It also provides methods for managing complications of cirrhosis.
· Drugs.com. (2012). Retrieved from
http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.
Consider the following case study:
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:
Synthroid 100 mcg daily
Nifedipine 30 mg daily
Prednisone 10 mg daily
To prepare:
•Review this week’s media presentation on pharmacology for the gastrointestinal system.
•Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
•Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
•Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Post on or before Day 3 an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
RESOURCES:
Required Resources
To access required library resources, click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Readings
•Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
?Chapter 28, “Nausea and Vomiting” (pp. 392–409)
This chapter focuses on the etiology of nausea and vomiting, as well as body systems that impact or trigger nausea and vomiting. It also covers various drugs used to treat nausea and vomiting including the process of selecting, administering, and managing drug therapy for patients.
This chapter begins with an overview of risk factors, symptoms, and clinical stages of gastroesophageal reflux disease (GERD). It then examines drugs used to treat GERD and peptic ulcer disease (PUD), including proper dosages, possible adverse reactions, contraindications, and special considerations Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
?Chapter 30, “Constipation, Diarrhea, and Irritable Bowel Syndrome” (pp. 424–453)
This chapter begins by exploring disorders associated with constipation and diarrhea, as well as drugs used in treatment. It also covers the pathophysiology of irritable bowel syndrome and related drug therapies.
This chapter examines the causes, pathophysiology, and diagnostic criteria of inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis. It also identifies drugs used to treat IBD, including proper dosage, adverse reactions, and special considerations.
•Starr, S., & Raines, D. (2011). Cirrhosis: Diagnosis, management, and prevention. American Family Physician, 84(12), 1353–1359.
Retrieved from the Walden Library databases Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
This article examines the clinical presentation, pathophysiology, diagnosis, management, and prevention of cirrhosis. It also provides methods for managing complications of cirrhosis.
•Drugs.com. (2012). Retrieved from https://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Media
•Laureate Education, Inc. (Executive Producer). (2012). Pharmacology for the gastrointestinal system. Baltimore, MD: Author. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
This media presentation outlines drug treatment options for disorders of the gastrointestinal system.
Note: The approximate length of this media piece is 2 minutes.
Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
Consider the following case study:
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:
· Synthroid 100 mcg daily
· Nifedipine 30 mg daily
· Prednisone 10 mg daily
To prepare:
· Review this week’s media presentation on pharmacology for the gastrointestinal system.
· Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
· Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder.
· Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
With these thoughts in mind:
Post
an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed
Discussion:
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
Consider the following case study:
Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:
Synthroid 100 mcg daily
Nifedipine 30 mg daily
Prednisone 10 mg daily
To prepare:
Review this week’s media presentation on pharmacology for the gastrointestinal system.
Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
With these thoughts in mind:
By Day 3
Post
an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Points to follow when writing a paper:
Please all bullets points, bold, red and highlighted area must be attended to.
A clear purpose statement (The purposeof this paper is to…) is required in the introduction of all writings.
Please review all rubrics.
Check APA format/setting.
Please personalized where necessary.
Refrain from direct quote
Class Rules
Avoid public facing sites like university web pages or foundation pages (such as the American Cancer Society or the Alzheimer’s Association) and medical sites designed for consumption by the general public (such as Mayo Clinic or WebMD).
you are required to cite scholarly resources including peer-review journals and current practice guidelines
.
May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html
Writer must be familiar with nursing pharmacology. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.
Rules for writing (FYI)
Whether writing a discussion posting or a paper, keep a few things in mind—
1) I am looking for an explanation at the cellular or molecular level (whenever possible).
2) I am not looking for pathophysiological explanations that we would give to patients (e.g. “your heart just isn’t pumping the right way). While this explanation is acceptable for patient teaching, it will not cut it in a course titled “advanced pathophysiology.” To be very specific- I am looking for you to tell me the precise aberrancies (or theorized aberrancies) which inexorably lead to disease states. Thanks. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.