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NR 602 Midterm Study Guide

Week 1: Early child development notes (chapter 6):

Toddler: 12-24 months

Preschoolers: 2-5 years old

WHO growth charts should be used to measure weight and length for children less than 24 months

CDC weight and length charts used for children older than 24 months

Average 24 month weighs 26 lbs, length 33.5 in and HC 18.5 in

Most have no palpable fontanelle by 12 months NR 602 Midterm Study Guide

Ant fontanelle closes by 18-19 months

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3-6 yrs weight gain expectation is 4.5-6.5 lbs/year

3-6 yrs height gain expectation is 2.5-3.5 inches/yr

4 yrs length at birth has doubled

4-5 years old legs grow faster than rest of the body

Use of dominant hand may appear as early as 8-12 months generally emerges 2-4 years old; handedness established at 5yrs

May develop bowel and bladder control by age 3, but many will not. Boys usually take longer than girls to maintain bedtime bladder control.

Articulation:

-24 months- 25% is understood by a stranger

-24m-36m- 66% is understood by a stranger

-3 years old- 90% should be understood by a stranger

3 and 4-year-old have a normal hesitance or show stuttering, considered abnormal if beyond 5 years of age

Speech problems often can be from lack of stimulation, hearing problems, ear infections, developmental delay. Early detection important. NR 602 Midterm Study Guide

Lexicon:

girls typically say their first word between 8-11 months; boys by 14 months

2 year olds: have more than 200 words in their vocabulary

3 years old: 900 words in vocabulary

3-4 yrs old: able to follow simple commands, talks incessantly

4-5 year olds: add at least 50 new words a month; 1500-2100 words in vocabulary (including names, coins, colors, knows days of the week) NR 602 Midterm Study Guide

5 year olds: should be able to define certain words with other words (cup: something you drink with)

Syntax:

8 months: develop receptive language- they understand what a word means before they are able to use it themselves

12-28 months: use holophrases (single words) to express whole ideas

18 months: use telegraphic speech (get milk, go bye-bye)

2 years old: short sentences

3 years old: add plurals, 3-4 word sentences

4 years old: past tense

5 years old: syntax is close to adult style, 5-6 word sentences NR 602 Midterm Study Guide

NURS 6512 
Week 6 Midterm Exam: Advanced Health Assessment: Walden University

 

1. Before performing an abdominal examination, the examiner should:

2. During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially, you should:

3. Which of the following is the most accurate reflection of an individual’s food intake?

4. Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the:

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5. A fixed image of any group that rejects its potential for originality or individuality is known as a:

6. Peritonitis produces bowel sounds that are

7. Brittle nails are typical findings in:

8. Which of the following is an expected change in the assessment of the thyroid during pregnancy?

9. You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration?

10. A 5-year-old child presents with nasal congestion and a headache to assess for sinus tenderness you should palpate over the: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

11. During physical examination of a 30-year-old Chinese man you notice a slight asymmetry of his face. the cranial nerve examination is normal. Your best action is to

12. Unusual white areas on the skin may be due to

13. You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for:

14. 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:

15. Mr. Akins is a 78-y/o patient who presents to the clinic with complaints of hearing loss. Which of the following are changes in hearing that occur in the elderly? Select all that apply.

16. The most superior part of the stomach is the

17. 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?

18. A 51-y/o woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

19. Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for:

20. Which technique is most likely to result in the patients understanding of questions?

21. Mr. Williams, age 25, has recovered recently from an upper and lower respiratory infection. He describes a long-standing nasal dripping. He is seeking treatment for a mild hearing loss that has not gone away. Information concerning his chronic postnasal drip should be documented within which section of the history?

22. Nasal symptoms that imply an allergic response include:

23. 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 am here! You tell me what’s wrong.” Which caregiver response would be the most appropriate for enhancing communication?

24. When taking a history, you should:

25. Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?

26. 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:

27. Which question would be considered a leading question?

28. Mr. Black is a 44y/o 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?

29. The term denoting the caregiver’s need to do no harm to the patient is:

30. A tool used to screen adolescents for alcoholism is the:

31. Under normal circumstances, how much water is lost daily by the body?

32. You have just completed a skin assessment on Mr. Baker. During your assessment, you have transilluminated a skin lesion. During the physical examination, you know that skin lesions are transilluminated to distinguish:

33. Mr. Mills is a 55/y/o patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of activities of daily living is part of a(n):

34. Sweat glands, hair, and nails are all formed from?

35. A brief statement of the reason the patient is seeking health care is called the?

36. Which part of the information contained in the patient’s record may be used in court?

37. Which cranial nerves innervate the face? NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

38. In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for?

39. When are open-ended questions generally most useful?

40. Knowledge of the culture or cultures represented by the patient should be used to?

41. Mrs. Berger is a 39-year-old woman who presents with a complaint of epigastric abdominal pain. You have completed the inspection of the abdomen. What is your next step in the assessment process?

42. A guideline for history taking is for caregivers to?

43. Which type of speculum should be used to examine a patient’s tympanic membrane?

44. You are palpating a patient’s thyroid and find that its broadest dimension measures 4cm. the right lobe is 25% larger than the left. These data would indicate?

45. Mr. L. presents to the clinic with severe groin pain and a history of kidney stones. Mr. L.’s son tells you that, for religious reasons, his father wishes to keep any stone that is passed into the urine filter that he has been using. What is your most appropriate response?

46. Before performing an abdominal examination, the examiner should?

47. 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?

48. As you explain your patient’s condition to her husband, you notice that he is leaning toward you and pointedly blinking his eyes. Knowing that he is from England, your most appropriate response to this behavior is to?

49. When palpating the abdomen, you should note whether the liver is enlarged in the?

50. Expected normal percussion tones include?

51. 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 ate concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to?

52. Fluorescing lesions are best distinguished using a(n)?

53. 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?

54. Underestimation of blood pressure will occur if the blood pressure cuff’s width covers?

55. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4’3cm, rough, elevated area of psoriasis. This is an example of a? NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

56. Penicillin is considered a?

57. Small, minute bruises are called?

58. After thorough inspection of the abdomen, the next assessment step is?

59. When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate?

60. Regardless of the origin, discharge is described by noting?

61. Recommended carbohydrate content of total dietary intake (% total calories) is?

62. Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure?

63. Auscultation should be carried out last, except when examining the?

64. Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence?

65. Which of the following is an “ABCD” characteristic of malignant melanoma?

66. Tracheal tug suggests the presence of a(n)?

67. 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?

68. The review of systems is a component of the:

69. Cherry angiomas are a common finding in:

70. Mr. Donalds is a 45-year-old roofer. Your inspection to determine color variations of the skin is best conducted:

71. To correctly document absent bowel sounds, one must listen continuously for:

72. The adult recommended dietary fat intake should be ____g/day.

73. Mr. Jones is a 45-year-old patient who presents for a physical examination. On examination, you note costochondral beading, enlarged skull, and bowed legs and diagnose him with rickets. A deficiency of which fat-soluble micronutrient can result in rickets?

74. A flat, nonplapable lesion is described as a macule if the diameter is:

75. Mrs. Raymonds is a 24-year-old patient who has presented for a routine concern over her current weight.  In your patient teaching with her, you explain the importance of macronutrients. Which of the following is a macronutrient?

76. Which of the following organs is part of the alimentary tract?

77. Mr. Sanchez is a 45-year-old gentleman who has presented to the office for a physical examination to establish a new primary care health care provider. Which of the following describes a physical, not a cultural, differentiator?

78. To approximate vocal frequencies, which tuning fork should be used to assess hearing?

79. During percussion, a dull tone is expected to be heard over:

80. The attitudes of the health care professional:

81. When recording physical findings, which data are recorded first for all systems?

82. Spasmodic muscular contractions of the head, face, or neck are called:

83. Which of the following occurs when firm pressure is used to apply the stethoscope’s bell end-piece to the skin?

84. Differential diagnoses belong in the: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

85. Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish:

86. Mr. Walter’s, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the:

87. 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:

88. Tympanic thermometers measure body temperature when a probe is placed:

89. A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:

90. White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are:

91. When assessing abdominal pain in a college-age woman, one must include:

92. 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:

93. The infant should be placed in which position to have his or her height or length measured?

94. 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?

95. Which of the following is the most vital nutrient?

96. What finding is unique to the documentation of a physical examination of an infant?

97. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the:

98. 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:

99. You are completing a general physical examination on Mr. Rock, a 39-year-old man with complaints of constipation. When examining a patient with tense abdominal musculature, a helpful technique is to have the patient:

100. When communicating with older children and teenagers, you should be sensitive to their:

101
. 
Periods of silence during the interview can serve important purposes, such as: NURS 6512 Week 6 Midterm Exam: Advanced Health Assessment

NURS 6541 Week 7 Quiz : Advance Practice Care of Children and Adolescents

Question 1

In children who have not received antibiotics in the past month, which antibiotic is recommended by the Centers for Disease Control and Prevention for the management of acute bacterial respiratory infection?

a.

Azithromycin (Zithromax)

b.

Amoxicillin (Amoxil)

c.

Amoxicillin plus clavulanic acid (Augmentin)

d.

Sulfamethoxasole (Bactrim)

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Question 2

A 3-year-old presents to your office with a history of wheezing over the last 3 months and has only been moderately responsive to therapy. Which of the following diagnostic tests would be appropriate?

a.

Sweat chloride testing

b.

Pulmonary function testing

c.

Bronchoscopy

d.

All of the above

 

Question 3

A 7-year-old presents with abrupt fever, stridor, drooling, and hyperextension of the neck. You examine the nose and throat and notice one tonsil is enlarged and there is marked erythema of the pharynx with uvular deviation. Which is most appropriate? NURS 6541 Week 7 Quiz : Advance Practice Care of Children and Adolescents

a.

Start amoxicillin at the appropriate dose for weight after obtaining a throat culture.

b.

Place on a 5-day course of oral steroids after obtaining a monospot, EBV titers, and a CBC.

c.

Refer to otolaryngology for management of a peritonsillar abscess and possible hospital admission.

d.

Start cephalexin (Keflex) at the appropriate dose for weight after obtaining a throat culture.

 

Question 4

Hope is a 7-month-old who presents in January with a 1-day history of cough, yellow nasal discharge, and low-grade temp (T max 100°F). She was previously healthy. She does have 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office. Her chest, mouth, and ears are clear. You prescribe:

a.

Guaifenesin liquid suspension

b.

Amoxicillin 80 mg/kg/day in two divided doses for 10 day

c.

Neo-Synephrine half-strength drops three times a day for 5 to 6 days

d.

Saline drops, bulb suction, humidified air, and increased PO fluids

 

Question 5

You are on call and receive a phone call from the parents of a 13-year-old known asthmatic. She has been having chest tightness and a worsening cough for 48 hours. She has significant nasal discharge that began 14 days ago and intermittent complaint of headache. She is now running a low-grade fever. Her peak flow the last 48 hours is 70–80% of personal best. Her temperature right now is 101.7°F. She is on salmeterol with corticosteroid (Advair) and PRN albuterol. Which of the following is most appropriate? NURS 6541 Week 7 Quiz : Advance Practice Care of Children and Adolescents

a.

Continue home management with the use of inhaled beta agonists and inhaled corticosteroids, and add the use of oral antihistamine/decongestant combinations.

b.

See her in the office in the morning and prescribe a 14-day course of amoxicillin plus the addition of a short course of oral steroids.

c.

See her in the office in the morning and prescribe a short course of oral steroids.

d.

Continue home management and add inhaled cromolyn sulfate.

 

Question 6

Anthony is a known asthmatic. He has symptoms three times a week but never more than once a day. Exacerbations affect his normal activities occasionally. He awakens with cough three to four times a month. You classify his asthma as: NURS 6541 Week 7 Quiz : Advance Practice Care of Children and Adolescents

a.

Mild intermittent

b.

Mild persistent

c.

Moderate persistent

d.

Severe persistent

 

Question 7

Which of the following symptoms are most suggestive of pneumonia in a young child?

a.

Headache, fever, malaise, congestion, scattered rhonchi

b.

Fever, tachypnea, coryza, cough, scattered rales

c.

Fever, vomiting, coryza, cough, scattered rales

d.

Irritability, fever, decreased appetite, scattered rhonchi

 

Question 8

A 16-year-old presents with pharyngitis, cough, and high fever. Her chest X-ray reveals bilateral pulmonary infiltrates. Her white blood cell count is normal and the neutrophil count is normal. The most likely etiology is:

a.

Chlamydia pneumonia

b.

Streptococcus pneumonia

c.

Legionella

d.

Staphylococcus aureus

 

Question 9

A 2-year-old presents to your office with the following symptoms: nasal congestion and rhinorrhea for 48 hours, low-grade fever, and a harsh/barky cough that is significantly worse at night. Inspiratory stridor is present and she has clear but slightly decreased breath sounds. Which of the following treatments is best? NURS 6541 Week 7 Quiz : Advance Practice Care of Children and Adolescents

a.

Albuterol sulfate solution via nebulizer every 4 to 6 hours

b.

Azithromycin (Zithromax) treatment for 5 days

c.

One dose of oral dexamethasone

d.

Oral dextromethorphan extended release at night only

 

Question 10

A 2-year-old presents with a history of wheezing and persistent cough. The father reports the child had a coughing/choking episode about a week ago that was spontaneously resolved. A few days later she began to cough and wheeze. This scenario is most consistent with:

a.

Restrictive airway disease

b.

Sinusitis

c.

Bronchiolitis

d.

Foreign body aspiration NURS 6541 Week 7 Quiz : Advance Practice Care of Children and Adolescents

PHIL 347N Final Exam | Complete Solution

(TCOs 1, 2) Determine whether the following passage is an argument.

Mark is the newest member of the requisitions department. The requisitions department oversees the purchasing of all goods, services, and capital equipment for the entire company. (Points : 5)

Argument

Not an argument because there are no claims or only one claim

Not an argument because none of the claims offers a reason for the other PHIL 347N Final Exam

Not an argument because the reasons explain rather than prove the other claims

Question 2.

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2. (TCOs 1, 2) Determine whether the following passage is an argument.

Either you are planning to vote in the fall election or you donât really want to improve the politics of the local community. (Points : 5)

Argument

Not an argument because there are no claims or only one claim

Not an argument because none of the claims offers a reason for the other

Not an argument because the reasons explain rather than prove the other claims

Question 3.

3. (TCOs 2, 3) Choose the best answer.

Donât drive over the speed limit. Itâs against the law. You donât want a speeding ticket.

Which of the following claims represents the conclusion of this argument? (Points : 5)

Driving over the speed limit is against the law.

You donât want a speeding ticket.

You should not drive over the speed limit.

Question 4.

4. (TCOs 2, 3) Choose the best answer.

Healthy. Delicious. Drink Ovaltine!

Which of the following claims represents the implied conclusion of this argument? (Points : 5)

Ovaltine is healthy.

Ovaltine is delicious

You should drink Ovaltine.

None; this is not an argument.

Question 5.

5. (TCOs 3, 4) Identify the kind of argument.

Since all Ford Mustangs are automobiles, and not all Ford Mustangs are red, some automobiles are not red. (Points : 5)

Causal argument

Categorical argument

Inductive generalization

Analogical argument

Question 6.

6. (TCOs 3, 4) Identify the kind of argument.

Using a lemon when cooking is like using a lime. Given that limes can be added to bland foods to give them some zest, lemons, too, will give zest to bland foods. (Points : 5)

Analogical argument

Categorical argument

Truth-functional argument

Causal argument

Question 7.

7. (TCO 3, 4) Identify the kind of argument.

Learning to think critically is like learning to play the piano. Given that you have to practice a lot to be good at playing the piano, you must practice a lot to be a critical thinker. (Points : 5)

Causal argument

Truth-functional argument

Inductive generalization

Analogical argument

Question 8.

8. (TCOs 2, 3, 5) Relate to the proper terminology.

What evaluative language should you use for analogical arguments? (Points : 5)

Valid/invalid; cogent/uncogent

Valid/invalid; sound/unsound

Strong/weak; cogent/uncogent

Strong/weak; sound/unsound

Question 9.

9. (TCOs 2, 3, 5) Relate to the proper terminology.

What evaluative language should you use for truth-functional arguments? (Points : 5)

Valid/invalid; cogent/uncogent

Valid/invalid; sound/unsound

Strong/weak; cogent/uncogent

Strong/weak; sound/unsound

Question 10.

10. (TCO 4) Select the answer that represents the proper standard form for the following statement.

The bill should be paid by whoever bought the item. (Points : 5)

All people who bought the items are not people who should pay the bill.

All people who pay the bill are people who bought the item.

All people who bought the item are people who should pay the bill. PHIL 347N Final Exam

Question 11.

11. (TCO 4) Select the answer that represents the proper standard form for the following statement.

Some sports cars are red. (Points : 5)

No red things are sports cars.

Some sports cars are red things.

All sports cars are red things.

Question 12.

12. (21. (TCO 4) Select the answer that represents the proper standard form for the following statement.

If you want to be a nursing major, then you must take an anatomy class. (Points : 5)

Valid/invalid; cogent/uncogent PHIL 347N Final Exam

Valid/invalid; sound/unsound

All people who want to be nursing majors are people who must take an anatomy class.

Strong/weak; sound/unsound

Question 13.

13. (TCO 4) Choose the correct translation for each of the following compound claims.

You cannot enter the chess tournament (C) unless you are ranked (R). (Points : 5)

R ⢠~ C

C > R

~ C > R

~ R > ~ C

Question 14.

14. (TCO 4) Choose the correct translation for each of the following compound claims.

Small-scale agriculture will be profitable (P) and growers will get subsidies (S) only if demand (D) for local food does not decrease. (Points : 5)

~ [D > (P ⢠S)]

(P ⢠S) > ~ D

~ D > (P ⢠S)

P ⢠(S > ~ D)

Question 15.

15. (TCOs 3, 5) Which inductive generalization is stronger? (Points : 5)

Our universityâs womenâs basketball team has won its last three games. Thus, it seems obvious that the team will repeat as champions this year. PHIL 347N Final Exam

Our universityâs womenâs basketball team has won its last six games. Thus, it seems obvious that the team will repeat as champions this year.

Question 16.

16. (TCOs 3, 5) Which analogical argument is stronger? (Points : 5)

Grease, oil, road tar, and paint thinner are all flammable. Thus, paint thinner is a refined product because grease, oil, and road tar are refined products.

Grease, oil, and paint thinner are all flammable. Thus, paint thinner is a refined product since grease and oil are refined products.

Question 17.

17. (TCOs 3, 5) Which causal argument is stronger? (Points : 5)

The population of frogs in three California counties has declined dramatically in the last decade. Loss of habitat must be the cause because increased demand for housing has eliminated more than half of the available wetlands in all three counties, and this appears to be the only factor all three have in common.

The population of frogs in three California counties has declined dramatically in the last decade. Loss of habitat must be the cause because increased demand for housing has eliminated more than half of the available wetlands in all three counties, and this appears to be the only factor all three have in common. Only one county is rural, and only two counties have experienced an increase in frog predators.

Question 18.

18. (TCO 6) Identify the fallacy.

The Chinese government should encourage freedom of speech because doing so would be a good idea. (Points : 5)

Begging the question

Appeal to ignorance

Strawman

No fallacy committed

Question 19.

19. (TCO 6) Identify the fallacy.

Has anyone ever proven that soccer players would be protected from head injuries if they wore some kind of helmet? Then it must be true that helmets are unnecessary in soccer. (Points : 5)

Ad hominem

Appeal to ignorance

Strawman

Begging the question

Question 20.

20. (TCO 6) Identify the fallacy.

Mr. Banks cancels meetings at the last minute for no reason at all. At the meetings he does not cancel, he has lately been showing up smelling of alcohol. Now he cannot account for the disappearance of over 700 dollars raised last year. Clearly, it is inappropriate to keep him on as scout leader. (Points : 5)

Appeal to ignorance

Red herring

No fallacy committed

Ad hominem PHIL 347N Final Exam

NSG 6001 Week 5 Final Exam Questions

Question 1

More than half of all cardiac arrhythmias involve the atria.

True

False

Question 2.

What are the most common symptoms caused by tachyarrhythmias?

Sweating

Thirst

Palpitations

Headaches

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Question 3.

For women with known CAD and diabetes, which is most appropriate to assess CAD risk?

ETT

Coronary bypass surgery

Coronary catheterization

ETT with imaging

Question 4.

Of the following, which is the best answer when asked for an advantage of echocardiogram exercise testing over thallium stress testing?

Does not depend on operator experience

Costs are the same

Results are available more quickly

Doesn’t matter because there are no advantages

Question 5.

Your patient has uncomplicated pyelonephritis. In deciding your recommended treatment, you consider the most common pathogenic reason for this diagnosis. What pathogen accounts for the majority of pyelonephritis?

E. Coli

Gardnerella Vaginalis

Mycoplasma Hominis

Chlamydia

Question 6.

What purpose does the principle of fidelity serve in the provider/patient relationship?

Ensures that providers honor their commitments to the patient

Obligates the provider to a one-on-one relationship with the individual

Ensures that patients receive whatever they want

Maintains costs in the healthcare arena NSG 6001 Week 5 Final Exam

Question 7.

In CAD, after both systolic and diastolic dysfunction have occurred, the typical pattern of chest pain and related EKG changes occur. During an EKG, you should expect to see ST-segment and T-wave changes that are central to demonstration of ischemia occurring relatively late in the ischemic cascade. Is this true or false?

True

False

Question 8.

The leads on the ECG showing ischemic changes during or immediately after an ETT can correlate roughly to the culprit artery or arteries with significant CAD. Is this true or false?

True

False

Question 9.

Skin cancer is the most common malignant neoplasm in males in the US. What is the second leading cause of cancer deaths in men greater than 50 years of age?

Prostate cancer

Lung cancer

Lymphoma

Lupus

Question 10.

What ECG changes can reduce the specificity of the ETT?

Exercise induced bundle branch blocks

Paced rhythm and resting bundle branch block

Paced rhythm and exercise induced bundle branch blocks

Low voltage up sloping of the ST-segment

NSG 6001 Week 5 Final Exam

Question 11.

You have confirmed that your patient does indeed have an abdominal aortic aneurysm. In teaching your patient about symptoms to report immediately to the vascular surgeon, you instruct the patient to report which of the following?

Newly diagnosed diabetes

Back pain or flank pain

Visual disturbances

Headaches

Question 12.

What is one of the common causes of a Saccular Abdominal Aneurysm?

Poor kidney functioning

Age

Drugs: illicit and prescribed

Trauma

Question 13.

The diagnostic accuracy of stress testing is decreased among women compared to men for what reasons?

Women having thinner ventricular and septal muscles

Women usually have single vessel or non-obstructive disease

Women cannot exercise as vigorously as men

Women typically have multiple vessel disease

NSG 6001 Week 5 Final Exam Question 14.

Population disease management is a term used to describe:

High specificity disease states

Low specificity diseases states

Low prevalence specific diseases

High prevalence specific diseases

Question 15.

You receive a report back on the suspected abdominal aortic aneurysm for your patient. It confirms your suspicion of AAA. The report describes the aneurysm as a symmetric weakness of the entire circumference of the aorta. You know that this form of aneurysm is referred to as what kind of aneurysm?

Thoracic aneurysm

Budging sac aneurysm

Saccular aneurysm

Fusiform aneurysm

Question 16.

Your practice partner just ordered an exercise echocardiography 2DE for a patient with suspected cardiovascular risk. This patient has known resting wall motion abnormalities.Why would this not be the best test to assess this patient’s cardiac risk?

Sensitivity is increased

Sensitivity is decreased

Specificity is increased

Specificity is decreased

Question 17.

Your 60-year old male patient arrives for his appointment. He complains of general malaise and fever over the past several days with low back pain. He also states that he is getting up at night more often to urinate and never feels his bladder is completely empty.What differential diagnosis should you consider in this patient?

Acute viral prostatitis

Stomach virus

Acute bacterial prostatitis

BPH only

NSG 6001 Week 5 Final Exam Question 18.

We all know that collaboration is integral to becoming a successful nurse practitioner. Among collaborations, however, only one can be considered as the most important. While each example below is important, which is the most important collaboration? The one that occurs:

Between the nurse practitioner and their physician mentor

Between two healthcare providers about a single patient

Between the patient and their family

Between the patient and the nurse practitioner

Question 19.

The sensitivity of a routine ETT is effort dependent. What physiological changes occur during effort in the routine ETT?

Rapid heart rates and coronary artery narrowing

Decrease in coronary blood flow

Decreased heart rate and increased systolic blood pressure

Increased coronary flow and increased systolic blood pressure

Question 20.

A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic as a referral from another nurse practitioner. Several blood tests and chest x-rays have been completed without any diagnosis or outstanding abnormalities.You decide to order an ETT despite the fact that the recent ECG does not show any abnormalities. From the answers below, which would be the best answer to support your decision?

You are out of other options

CAD in women is under diagnosed

To please the patient

Women present with the same pattern of CAD as do males

Question 21.

Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST-segment.What do you need to know about these changes to manage your patient’s care?

: This patient needs to see someone more experienced in treatment of CAD

These changes are predictive of myocardial infarction

These changes have minimal predictive value for CAD

These changes predict dire outcomes

Question 22.

When there is a consequential loss of structural integrity of the abdominal aorta, the resulting issue is what condition?

Bloated stomach

Kidney failure

Bleeding ulcers

Abdominal aortic aneurysm

NSG 6001 Week 5 Final Exam Question 23.

You see a 60-year old African American male in your clinic with a recent diagnosis of hypertension. He asks you what he should restrict in his diet, and is particularly interested in limiting his sodium intake. What amount of sodium intake would you recommend on a daily basis for this patient?

1.5 g/day

No added table salt

3.0 g/day

2.3 g/day

Question 24.

Why would inability to exercise reduce the specificity of the routine ETT?

Produces QRS changes that cannot be interpreted

Produces persistent ST-segmental changes and T-wave abnormalities

Causes ST-segment changes and P-wave abnormalities

Will not produce any changes in ECG

Question 25.

By standard criteria, how is a positive stress test defined?

Development of a horizontal or down sloping ST-segment depression of 1mm

Down sloping of the ST-segment at the J point of the QRS

Development of a horizontal or down sloping ST-segment depression of 10mm

Upward sloping ST-segment measured at the J point of the QRS

Question 26.

What are the two types of bradycardia recognized by the American Heart Association?

Relative and absolute

Absolute and pending

Refractory and non-refractory

Relative and dynamic

Question 27.

You see a 75-year old female in your clinic today complaining of urinary incontinence. She is otherwise healthy based upon her last visit. She states that her mother told her this would happen someday because it happens to every woman at some age. What would you tell this patient?

This happens to all women as they age

No need to worry. This is normal. Your mother was correct.

This is not an expected condition related to aging.

This happens to men as well and most women before your age.

Question 28.

What do you know regarding ischemia that is confined to only the posterior and or lateral segments of the left ventricle?

ETT cannot be used for detection

Difficult to detect by ETT

Requires both for detection of changes by ETT

Easier to detect by ETT

NSG 6001 Week 5 Final Exam Question 29.

What three conditions definitely alter the results of echocardiography in determining CAD?

Obesity, rapid heart rate and lung disease

Diabetes, kidney disease and tooth decay

Obesity, slow heart rates and hypertension

Previous MI, hypotension and diabetes

Question 30.

Specifically, when is an ETT considered to be negative?

Patient has ST-segmental changes with down sloping of greater than 1 mm at 50% of age-predicted maximum heart rate

Patient exercises to 85% of age predicted maximum heart rate without evidence of induced ischemia

Patient exercises to 20% maximum age-predicted heart rate without induced ischemia

Patient exercises until tired without evidence of induced ischemia

Question 31.

All patients, even is asymptomatic, require risk stratification according to the Farmingham risk score. At present, ACC/AHA guidelines, however, do not normally support stress tests for asymptomatic patients without addiitonal justification. From the list below, what could be used to justify a ETT in an asymptomatic patient?

A smoker of 3 weeks

A member of congress

Sedentary and wishes to begin aggressive exercise

Developmentally challenged

Question 32.

BPH is not a risk factor for Prostate cancer. Is this statement true or false?

True

Question 33.

Spread of genital herpes only occurs during the time period with active lesions. Is this statement true or false?

True

False(not confirm)

Question 34.

Abdominal aortic aneurysms are often asymptomatic. What percent of AAA’s are discovered in asymptomatic patients?

40%

20%

10%

75%

Question 35.

Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?

President and Congress

Population management and healthcare practice

Socialized medicine and governmental controls

Monetary savings and limited disruption in healthcare delivery

Question 36.

What are the two main types of heart failure?

Systolic and diastolic

Hopeless and severe

Left sided and main

End diastolic and pressure related

NSG 6001 Week 5 Final Exam Question 37.

The majority of all strokes are non-ischemic. Is this statement true or false?

True

False

Question 38.

When a murmur is first heard, it is important to determine if it is due to a pathological condition or benign. For an experienced practitioner, it is always easy to determine the cause of a murmur merely by listening to the sound. Is this statement true or false?

True

False

Question 39.

Maintenance of an Isometric ST-segment during exercise is the response of?

A normal heart

Hypo profusion

An abnormal heart

CAD

Question 40.

The goal of self-management is to specifically do what?

Engage patients in their own care

Engage insurance providers in patient care

Engage providers in patient care

Engage government in greater involvement in patient care

Question 41.

Your 56-year old patient presents with bradycardia with a rate of 55 and first degree AV block. The patient is hemodynamically stable and is not experiencing any syncope or chest pain. History includes previous myocardial infarction. Home medications include beta blockers, daily aspirin. Lab work is non-significant for electrolyte imbalance. You decided to treat this patient for the arrhythmia to prevent future destabilization. From the choices below, which might be the appropriate first measure to consider?

Add digitalis to control the heart rate

Consult cardiologist immediately for guidance

Discontinue Beta Blocker and replace with another therapy if necessary

Atropine injections

Question 42.

Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysema. You need to make an assessment of the risk of significant CAD and your patient’s family says that their relative had their diagnosis based on an ultrasound echocardiography. What facts would influence your decision regarding the family request for echo assessment?

Sensitivity would be increased because of lung disease

Specificity would be increased because of obesity

Sensitivity would be reduced because of obesity and lung disease

Specificity would be reduced because of obesity and lung disease

Question 43.

You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male that has been experiencing slight chest pressure almost daily during exercise.While observing your patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall. From your time in the clinic, you know that this test will be considered to be what type of result?

Negative

Impossible

Positive

Non-readable

NSG 6001 Week 5 Final Exam Question 44.

Your patient is newly diagnosed with persistent Atria Fibrillation. You consider electrocardioversion. Before undergoing this procedure you should order the following examination to assess thrombus risk.

X-Ray of chest

Tranesophageal echocardiography

Ultrasound of chest

CT Scan

Question 45.

Tachyarrhythmias cause a drop in commonly blood pressure, cardiac output, syncope, shortness of breath, and chest pain. What phenomenon most often occurs during these arrhythmias to cause these symptoms?

Shortened diastole

Lengthened diastole

Lengthened systole

Shortened systole

Question 46.

At what age is atria fibrillation most common?

In childhood

60 years or older

30 years

45 years

Question 47.

Automaticity is a property common to all cardiac cells. Is this statement true or false?

True

False

Question 48.

Your patient has a maximum age-predicted heart rate of 180. During the exercise he reaches a heart rate of 140 and then states he can no longer exercise. You see evidence of ischemic changes on the ECG. This would be predictive of what condition?

Stroke

Significant CAD

Impending death

Low risk of CAD

Question 49.

You tell a patient that he has a murmur. He says he has been told this before, but wonders what causes the unique sounds of a murmur. Which of the following would be your best option?

Turbulent flow of blood

High pressures caused from HTN

There is no reason, it just happens

Almost always from a sclerotic valve

Question 50.

What is the treatment of choice for uncomplicated community-acquired cystitis?

TMP-SMZ

Any antibiotic will treat this diagnosis

Amoxicillin

Penicillin

Question 51.

Any patient presenting with symptomatic bradycardia should be referred

to a cardiologist for management. Is this statement true or false?

True

False

Question 52.

Encouragement of patients to take effective actions in their own healthcare refers to the concept of:

Self-management support

Interprofessional support

Physician or provider-driven care

Family care givers

Question 53.

You are considering adding an adjunctive form of testing to detect wall motion abnormalities during the ETT.You select Echocardiography as the added testing. You choose this test because you know that echocardiography does what when added to a standard ETT?

Enhances sensitivity and specificity of CAD detection

Enhances sensitivity while reducing specificity of CAD detection

Enhances specificity while not changing sensitivity of detection for CAD

You like pretty pictures of wall motion

Question 54.

Medicaid is mandated to be provided by each state through federal codes. Each state must offer Medicaid exactly as the federal government prescribes. True or false?

True

False

Question 55.

What sexually transmitted disease is most widespread in the USA today?

Chlamydia

Gonorrhea

Syphilis

HIV/AIDS

Question 56.

Your preceptor decides to add Doppler Flow studies to the echocardiogram exercise test for a patient with a recent history of a holistic murmur best auscultated at the left steral boarder. The patient has no history of cardiac surgeries. He asks you what might be the main advantages of adding Doppler Flow for this particular patient. You know from your readings that there are several reasons to add Doppler Flow and below are listed more than one correct reason. Your best response for this specific case, however, would be that Doppler Flow studies would be of what additive value during the echocardiogram study?

Detect and evaluate blood shunting from a septal defect

No advantage is seen for this patient

Gives better screen shots of wall abnormalities

Provides assessment of prosthetic valve function

Question 57.

Sexual partners of a patient with a diagnosed STI should always be examined and treated. Is this statement true or false?

True

False

Question 58.

Your patient presents with tachycardia. The QRS is measured at 0.10 seconds. Which of the following tachycardias would be an appropriate conclusion based on this information alone?

Ventricular tachycardias

Premature junctional contractions

Atria fibrillation

Ventricular fibrillation

NSG 6001 Week 5 Final Exam Question 59.

A 65-year old white male arrives in your clinic with general complaints of slight abdominal discomfort. He has a known history of smoking two packs per day for 40 years and hypertension. He also has COPD and has been treated numerous times with oral steroids. You consider several optional diagnoses. Of the ones listed below, which should be included as a potential top suspect in your choice of diagnosis?

Chronic bowel obstruction

Meglacolon

Appendicitis

Abdominal aortic aneurysm

Question 60.

What are the most common mechanisms to produce cardiac arrhythmias?

Decreased automaticity, triggered activity or reentry

Reentry, electrical dysfunction or activity

Stress, hard work or swimming

Enhanced automaticity, triggered activity or reentry

 

 

 

1.      
Patient urinates then has incontinence right after what type of incontinence is this

2.      
 How long should you take TMP-SMZ for uncomplicated UTI

3.      
If someone presents with atrial arrythmia and is stable hemodynamically what intervention will you plan

4.      
What signifies impending AAA rupture

5.      
Who is at the highest risk with AAA

6.      
Most common cause of AAA rupture

7.      
The two types of AAA are fusiform and saccular.. if you have a bleb on one side what type is this

8.      
Gives definition and says what does this represent think the answer is veracity, the other didn’t make sense.  

9.      
UTI in 35 year old denies homosexual activities what else will you ask .. you know this is uncommon is adults younger than 35.

10.  
Why is there more prevalence of chlamydia

11.  
Who is eligible under Medicaid?

12.  
 There is abnormal left ventricle EF without ischemia what does this mean?

13.  
The next questions asks the same questions but says theres evidence of ischemia so I put

14.  
Women and CT imaging is limited because of

15.  
15.   #1 leading cause of death in women

16.  
If AAA is 4cm in healthy adult what intervention would you do

17.  
What is relative bradycardi

18.  
 
What is the definition of CHF

19.  
Question about pt wanting to start exercise and is obese what test will the provider order

20.  
 Drug for ETT

21.  
2 common types of ETT

22.  
Most common cause of systolic HF

23.  
 What indicates a positive Stress test

24.  
You are in the clinic with your mentor observing the echo exercise test of a 45 year old who has been experiencing slight chest pressure almost daily during exercise. While observing your patient your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall. From your time in the clinic you know that this test will be what type of result

25.  
 Medicare covers inpatient hospital services under which part of the medicare insurance

26.  
 
Of the answers below which would be included in defining a positive Exercise echocardiogram

27.   
A 35 year old female arrives at your clinic, she has had diabetes and peripheral artery disease for the past 5 years. You decide to obtain an ETT. The insurance company argues that this is appropriate. You justify the ETT because you are planning secondary strategies to prevent future heart disease. Where could one find the supporting data for these guidelines NSG 6001 Week 5 Final Exam

28.  
Medicare hospital insurance is funded through what system

29.  
Your patient underwent an exercise stress test for CAD. There is significant elevation of the ST segment. What do you need to know about these changes to manage your patients care

30.  
Population disease management is a term used to describe

31.  
You are counseling a patient diagnosed with stress induced ischemia. You base your discussion on your knowledge that stress induced ischemia is caused by

32.  
AAA are often asymptomatic, what percent of AAA are discovered in asymptomatic patient

33.  
Improvement in the delivery and management of the healthcare are necessary if we are to improve the overall health of this nations population. Which of the following are identified in your readings as strategic in the movement to improve healthcare system

34.  
Your patient is morbidly obese and cannot sit on a bicycle or walk a treadmill. She also has marked and severe emphysems. You need to make an assessment of the risk of significant CAD and your patients family says that their relative had their diagnosis base don an ultrasound echo. What facts would influence your decisions regarding the family request for echo assmnt

35.  
Question about where the J point?  NSG 6001 Week 5 Final Exam

NAPSRx Final Exam Answers 

 

1. How are drugs sorted into therapeutic groups and classes?

A. first by the conditions that they are used to treat. and then by their mechanisms of action

B. first by their mechanisms of action. and then by their therapeutic effects

C. first by their side effects. and then by their therapeutic effects

D. first by their toxicity. and then by their effectiveness

 

2. Bone marrow transplants…

A. require that the patient first undergo chemotherapy or radiation to kill the diseased stem cells and promote white blood cell production.

B. are a type of stem cell therapy. unless patient’s own cells are reinjected.

C. are always a type of stem cell therapy.

D. can help people with leukemia. a condition in which the body does not produce enough white blood cells.

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3. What does AMA stand for?

A. American Medical Academy

B. American Medical Accreditation

C. American Medical Association

D. Association of Medical Assistants

 

NAPSRx Final Exam 4. What section of a drug’s package insert describes situations in which the drug should not be used because the risks outweigh the therapeutic benefits?

A. adverse reactions

B. contraindications

C. overdosage

D. warning/precautions

 

5 What is tertiary care?

A. adding medications together to achieve a better clinical effect

B. highly specialized medical and surgical care provided by a large medical center for unusual or complex medical problems

C. receiving medical or surgical care that does not require an overnight stay in the treatment facility

D. seeing a physician for routine checkups and general healthcare

 

6. Which of the following is NOT one of the stages in the classic approach to brand development strategy covered in your manual?

A. brand personality

B. brand positoning

C. brand quality

D. brand values

 

7 What are vasodilators used to do?

A. decrease vascular resistance and increase blood flow

B. mimic pathogens to stimulate the immune system

C. narrow the blood vessels

D.stimulate the CNS to make the heart beat faster

 

8. What is the name of the condition that occurs after a specific dose of a drug is given at such regular intervals that absorption and elimination (and therefore drug plasma concentration) have become fairly constant?

A. homeostasis

B. steady state

C. titration

D. tolerance

 

9. Which statement is TRUE about ocular administration?

A. Ocular administration is primarily for drugs that must cross the blood-brain barrier.

B. Ocular administration is used primarily to treat the eye.

C. Ocular administration is used when a drug must enter the bloodstream immediately.

D. Ocular administration is used when a drug must produce immediate effects on the brain or spinal cord.

10. Which entities invest’s the most money in pharmaceutical R&D?

A. Canadian pharmaceutical companies

B. the NIH

C. the U.S. Government

D. U.S. pharmaceutical companies

 

NAPSRx Final Exam 11. How are most drugs excreted?

A. via the bloodstream

B. via the heart

C. via the kidneys

D. via the skin

 

12. Over the last few decades, what has happened to legal limitations on sales’ reps discussions about off label uses?

A. Limitations have decreased.

B. Limitations have increased significantly.

C. Limitations have increased slightly.

D. Limitations have remained about the same.

 

13. Answer: Branding name

 

14. What does it mean if two drugs are at parity?

A. Both drugs are essentially in a neutral position.

B. Both drugs are generics.

C. Both drugs have exclusive preferred status.

D. The two drugs are bioequivalent.

 

15 Who is most likely to benefit from electronic sampling programs?

A. Everyone would benefit equally from electronic sampling programs

B. physicians in hospitals who are too busy to see representatives

C. physicians in rural areas who are not as frequently visited by representatives

D. physicians in urban areas who are too busy to see representatives

 

16. When referring to medication dosage, which abbreviation means “one-half’:

A. MS

B. OH

C. SM

D. SS

 

17 What is an internist?

A. a physician who practices internal medicine

B. a physician’s intern

C. a type of oncologist who specializes in chemotherapy

D. an internal sales representative

 

18. Which of the following is a type of white blood cell?

A. erythrocytes

B. insulin

C. Lymphocytes

D.HCs

 

19. Why are novice sales representatives often placed in charge of negotiating MCO formularies?

A. to become more familiar with the healthcare industry

B. to become more familiar with their territories

C. P&T committees are more receptive to new faces.

D. They are not. This job is usually reserved for more experienced reps.

 

20. What distinguishes pharmacodynamics from pharmacokinetics?

A. Pharmacodynamics studies a drug’s ex vivo effects.

B. Pharmacodynamics studies how drugs affect the body.

C. Pharmacodynamics studies the how the body affects drugs.

D. Pharmacodynamics studies the time required for a drug’s absorption.

21 What proportion of the drugs tested on human subjects are eventually approved by the FDA?

A. about 20%

B. about 60%

C. about 70%

D. about 95%

 

NAPSRx Final Exam 22. According to a study discussed in your manual, how do most physicians prefer to receive their drug samples?

A. by borrowing them from hospitals

B. by ordering them over the Internet

C. by trading them for services

D. directly from sales representatives

 

23. Which of the following is an example of a central value?

A. I buy Advil to show that I’m a modern consumer.

B. I like Advil because we were both born in the 80s.

C. I prefer Advil because I like the flavor.

D. I prefer Advil because it’s easier to swallow.

 

24. Which of the following specialties likely has the MOST emergency calls?

A. cardiology

B. psychiatry

C. urology

D. All specialists have the same number of emergency calls.

 

25. What affects the rate of active transport?

A. the availability of carriers. but not energy

B. the availability of energy. but not carriers

C. the availability of carriers and energy

D. neither the availability of carriers nor the availability of energy

 

26. Over the last few decades, what has happened to the FDA approval time for new drugs?

A. It has been lengthened to ensure safer drug products.

B. It has been lengthened to limit DTC marketing

C. It has been shortened to improve drug quality

D. It has been shortened to reduce the cost of new drug development.

 

27. Which of the following would NOT help improve compliance?

A. patients liking their providers

B. patients using only one pharmacist

C. pharmacists understanding how generics differ from brand name drugs

D.  support groups

 

28. Which entity chooses a drug’s trade name?

A. the drug’s inventor

B. the drug’s manufacturer

C. the FDA

D. the United States Pharmaceutical Council

 

29. What type of stem cells are obtained from embryos and can develop into any cell type?

A. multipotent

B.  pluripotent

C. totipotent

D. All stem cells can develop into any cell type.

 

NAPSRx Final Exam 30. As the price a patient pays for a prescription increases, what happens to the likelihood that the patient will fill it?

A. It decreases.

B. It increases.

C. It remains unaffected because the prescription is needed.

D. It remains unaffected because the prescription’s increased cost is offset by its perceived value.

 

31. Most involuntary movements come from which type of muscle tissue?

A. cardiac and smooth

B. only skeletal

C. skeletal and cardiac

D. skeletal and smooth

 

32. Which of the following is NOT one of the body’s major organ systems?

A. the cardiovascular system

B. the cellular system

C. the gastrointestinal system

D.  the musculoskeletal system

 

33. How do most drugs exert their primary physiological effects?

A.  by activating synapses between different types of tissues

B. by binding to cell receptors that are sensitive to their presence

C. by inhibiting synapses between different types of tissues

D.  through genetic mutation

 

34. What is the most reliable source of information for determining therapeutically equivalent drug products?

A. AMA guide

B. Blue Book

C. FDA drug list

D.  Orange Book

 

35. What does subcutaneous mean?

A. beneath the intervention

B. beneath the muscle tissue

C. beneath the outer skin

D. beneath the suture

 

36. What should a sales representative do if all of the prime spaces in a drug cabinet are coccupied?

A. ask staff for permission to move some of the other products in the cabinet

B. ask staff for permission to throw away expired products in the cabinet

C. ask the doctor if he still needs some of the other products in the cabinet

D. surreptitiously move your largest competitors’ products out of the way

 

37. It is inappropriate for physicians’ prescribing behaviors to be educated by their personal tastes and idiosyncrasies

A. TRUE

B. FALSE

 

38.The FDA defines API as the active__ ingredient in a drug, which produces the desired change in the body.

A. pharmaceutical

B. positive

C. potent

D.  primary

 

39. What are the 2 legal classifications of wholesalers?

A. distributors and supply chains

B. pharmacists and NAMs

C. primary and secondary wholesale distributors

D. retailers and institutions

 

40.What term describes the usage of a medication for purposes other than the FDA-approved indications on the labeling?

A. contraindicative indication

B. off-indication usage

C or D. off-label

 

41. What is the acronym for pharmacokinetics?

A. KN

B. PC

C. PK

D. pT

 

42. The dosage range of a drug that is both safe and beneficial is known as the therapeutic window.

A. TRUE

B. FALSE

 

43. What is typically NOT a characteristic of a pharmaceutical sales rep?

A. Pharmaceutical sales reps are authentic and real.

B. Pharmaceutical sales reps are creative.

C. Pharmaceutical sales reps are focused.

D. Pharmaceutical sales reps are not concerned about competitors.

 

44. What entity grants drug patents?

A. the FDA

B. the FDA if the drug is over-the-counter and the U.S. Patent and Trademark Office if the drug is prescription

C. the FDA if the drug is prescription and the U.S. Patent and Trademark Office if the drug is over-the-counter

D. the U.S. Patent and Trademark Office

 

45. Which of the following refers to all active and inert pharmaceutical ingredients in a drug, including fillers and colors?

A. formulation

B. mycoplasma

C. peptide

D. saccharide

 

NAPSRx Final Exam 46. What is the difference between potency and efficacy?

A. Doctors prefer more potent drugs.

B. Drug manufacturers prefer more potent drugs.

C. Potency refers to the drug’s effectiveness. while efficacy refers to its strength.

D. Potency refers to the drug’s strength, while efficacy refers to its effectiveness.

 

47. What is the minimum level of education required for a nurse practitioner?

A. a certification program

B. an associate’s degree

C. a bachelor’s degree

D. a graduate degree

 

48. How many names must a drug have?

A. at most three

B. at least three

C. at most five

D. at least five

 

49. How has a longer development time increased the cost of bringing a new drug to market?

Answer: Increasing the cost of capital

 

50. Senior citizens consume over times as many pharmaceuticals as people under 65.

A. three

B. five

C. ten

D. fifteen

 

51. What agency regulates the distribution and use of narcotics?

A. DEA

B. FTC

C. OIG

D.TSA

 

52. What is passive diffusion?

A. a type of pinocytosis

B. membrane transport via vesicles

C. the use of energy to help a substance pass from a low concentration gradient to a high one

D. when a substance freely moves through a membrane from a high concentration gradient to a low one

 

53. What are the MAIN categories of drugs under FDA jurisdiction?

A. active drugs and active placebos

B. biopharmaceuticals and nutraceuticals

C. non-prescription and nutraceuticals

D. prescription and non prescription

 

54. Answer: Oxytocin

 

55. What are all metabolites?

A. active substances

B. inactive substances

C. injections

D. products of metabolism

56. When a drug is administered orally, where does first-pass metabolism occur?

A. intestine

B. liver

C. pancreas

D. stomach

 

57. What is the medical term for swelling?

A. assay

B. edema

C. instillation

D. protease

 

58. Which of the following is NOT part of the Seven Step Cascade of Emotion?

A. be a consultant. not a rep

B. identify what your product does

C. reflect

D. visualize the power of 10

 

59. Which part of a clinical research paper is frequently referred to as the road map?

A. abstract

B. findings

C. letter to the editor

D . methods

 

60. Which of the following is a main active ingredient in lung surfactants?

A. animal lung extract

B.  germicides

C.  sympathomimetic drugs

D.  theophylline

 

61. What does parenteral mean?

A. child prescriptions

B. injection

C. oral

D. tablet

 

62. Which term denotes a type of substance that enhances the action of a drug or antigen?

A. adjuvant

B. indicated

C. ligase

D peptide

 

63. If a sales representative’s product is placed on the second tier of a standard three-tier formulary, which of the following is most likely true?

A. It has not been reviewed by the P&T committee.

B. It is in a neutral position unless it is at parity with other drugs.

C. It probably has exclusive preferred status if it is not at parity with any other drugs.

D. It will essentially sell itself if it is granted exclusive preferred status.

64. Which of the following is NOT one of the four basic transport mechanisms?

A. active transport

B. homeostasis

C. passive diffusion

D. pinocytosis

 

65. Which statement accurately describes a relationship between drug agonists and antagonists?

A. Agonists and antagonists can be used together.

B. Agonists and antagonists should not be used together.

C. Antagonist drugs activate receptors. while agonists block access to receptors.

D. Antagonists are endogenous whereas agonists are man-made.

66. What is the study of the effects and movement of drugs in the human body?

A. anatomy

B. antology

C. clinical pharmacology

D. pathology

 

67. According to your manual, what is a common complaint that physicians have about traditional sampling methods?

A. that drug sample supply is too unpredictable

B. that patients are less likely to take free samples because they think they are lower quality

C. that patients do not like seeing drug representatives in their offices

D. that they receive too many drug samples

 

68. Which of these entities is formed by two or more hospitals or other healthcare entities to negotiate reduced rates with its aggregated purchasing power?

A. GPO

B. In-state wholesaler

C. PPO

D. RPO

 

69. What is another name for a drug derived from a biologic compound?

A. large molecule

B. oligonucleotide

C. orgaanism

D. small molecule

 

70. What is the most common policy regarding pharmaceutical reps dispensing drug samples in hospitals?

A. By federal law. drug sampling is permitted in all hospitals.

B. By federal law. it is up to individual physicians. not the hospital.

C. Drug sampling is encouraged. but not required.

D. Drug sampling is often forbidden.

 

71 Which of the following would help you build trust with a physician?

A. asking if he or she is having any problems with the managed care coverage of your products

B. repeating a question you already asked

C. surprising the office staff with a new poster in the break room

D. None of these would help you build trust with a physician.

 

72. What term denotes the difference between the usual effective dose and the dose that induces severe or life-threatening side effects?

A. dose-response relationship

B. margin of safety

C. the placebo effect

D. therapeutic window

 

73. What are excipients?

A. a type of cell receptor to which antagonists bind to decrease the effects of the body’s natural agonists

B. another term for generic equivalents

C. sites of action besides the target sites of action

D. the inert ingredients in a drug formulation

 

74. What is another term for the AWP?

A. dock-to-dock price

B. float price

C. list price

D. non-stock price

75. Which of these is the most likely use for a uterotonic agent?

A. to induce labor

B. to make the urine more alkaline

C. to supplement oral food intake

D. to treat hyperthyroidism

 

76. As of November 2013, which of these countries has legalized DTC advertising of prescription drugs?

A. Canada

B. Japan

C. Spain

D. none of these

 

77. Why are oral drugs often taken on an empty stomach?

A.  to be more wholly absorbed by the stomach

B. to minimize absorption by the intestine

C.  to minimize nausea

D. to pass through the stomach more quickly

NAPSRx Final Exam 78. What is one factor that differentiates community health centers from hospitals?

A.  Community health center formularies are more restrictive.

B. Community health centers have higher reimbursement rates.

C. Newer brand name drugs are easier to access at community health centers.

D. None of these

 

79. How does drug sampling provide a social benefit?

A. Doctors donate their unused drug samples to charities.

B. Doctors often use drug samples to treat patients who otherwise could not afford it.

C. It allows patients to try out different prescription medications before consulting with physicians.

D.  Drug sampling provides a social benefit in all of these ways.

 

80. Which medical term denotes the use of a stethoscope to listen to the heart?

A. auscultation

B. cardioversion

C. catheterization

D. echocardiography

 

81. What do enteric coatings do?

A. facilitate vomiting

B. help drugs dissolve in the stomach

C. help drugs enter the bloodstream more quickly

D. prevent dissolution in the stomach

 

82. What is the duration of exclusivity for orphan drugs?

A.  6 months

B. 1 year

C.  7 years

D.  15 years

 

83. What do National Account Managers do?

A. act as the sales reps’ primary point of contact with the rest of the corporation

B. manage the FDA approval process

C. negotiate contracts with MCOs and PBMs

D.  sell only to pharmacies

84. What does it usually mean if a drug recall is voluntary?

A. Pharmacies may choose whether to return the drug or dispense it.

B. The FDA has determined that the drug is perfectly safe. but ineffective.

C. The manufacturer has recalled the product on its own. but negotiated with the FDA beforehand.

D. The manufacturer has recalled the product without negotiating with the FDA.

85. Which phase of clinical trials is also known as the pivotal phase?

A. Phase I

B. Phase III

C Phase IV

D. Phase IX

 

86. During which phase of clinical trials is the new drug’s safety and effectiveness first tested in the target group?

A. preclinical

B. Phase I

C. Phase II

D. Phase III

 

NAPSRx Final Exam 87. How do antacids work?

A. by increasing blood flow to the stomach

B. by lowering gastric pH

C. by raising gastric pH

D. by suppressing cholesterol formation by the liver

 

88. What is one of the biggest time wasters for a pharmaceutical sales rep?

A. Caterers

B. Pharcists

C. receptionists

D. travel time

 

89. What happens when equilibrium is reached?

A.  equal numbers of molecules cross the membrane in both directions

B.  molecules stop moving

C. the concentration gradient decreases indefinitely

D. the concentration gradient increases indefinitely

 

90. What are the most common vectors used in gene therapy?

A.  autologous antigens

B. liposomes

C. naked DNA

D. viruses

 

91. What is the percentage fee that the dispenser pays the wholesaler for distribution?

A. margin fee

B. recharge

C. standard fee

D. upcharge

 

92. What is the difference between a chronic (or continuing) reaction, and a delayed reaction?

A. Chronic reactions are exaggerated. whereas delayed reactions are idiosyncratic.

B. Chronic reactions occur only during treatment. whereas delayed reactions only occur during withdrawal.

C. Chronic reactions persist for a long time. whereas delayed reactions take some time to develop.

D. Delayed reactions are always idiosyncratic. but chronic reactions are not.

 

93 What is clinical effect?

A. federally funded research condition

B. the effect of maximum dosage

C. the response produced by a medication

D. the use of treatment drugs in chemotherapy

 

94. Which of the following is an example of noncompliance?

A. a patient forgetting to take a drug at a specified time of day

B. a patient taking a drug. but only because it has been court-mandated

C. a pharmacist dispensing a generic equivalent of a drug instead of the brand name

D. a physician refusing to prescribe a drug because he or she does not trust the clinical studies on it

 

95. What is the average circulation time of blood?

A. about a minute

B. about 5 minutes

C. about 5 to 10 minutes depending on the patient’s age and health conditions

D. about 10 minutes

 

96. What is one way in which pharmaceutical selling is different from selling in most other industries?

A. In pharmaceutical sales. the decisions-makers. consumers. and payers are usually the same entity.

B. Pharmaceutical selling takes less time because doctors are so busy.

C. Representatives do NOT sell to the end user of the product.

D. Representatives DO sell to the end user of the product.

 

97. From what types of entities do primary wholesale distributors buy most of their drugs?

A. brokerages

B. buying clubs

C. manufacturers

D. physicians

98.What is the Office of the Inspector General (01G)?

A. a department in pharmaceutical companies

B. an arm of the Department of Health and Human Services

C. an arm of the European Medicines Agency D an arm of the FDA

 

99. What are doctors required to consider when deciding whether or not to prescribe a particular drug?

A. quantity of life over quality of life

B. that no drugs with adverse effects should ever be used

C. the inferiority of OTC drugs

D. the severity of the disorder being treated and the effect it has on the patient’s quality of life

NAPSRx Final Exam 100. Which entity assigns a new drug its generic names?

A. the drug’s inventor

B. the Food and Drug Administration

C. the United States Adopted Name Council

D. the United States Pharmaceutical Council

 

101. Drugs can be used days beyond their expiration date.

A.  2-7 days. depending on the most current monograph.

B.  2-90 days. depending on state laws

C. 7-90 days. depending on the type of drug and its therapeutic class.

D. none of these

 

102. What is necessary for a drug to be excreted extensively via the kidneys?

A. The drug must be water-soluble. and not bind too tightly to proteins in the bloodstream.

B. The drug must have a phospholipid bilayer and be non-water-soluble.

C. The drug must have a phospholipid bilayer and bind well to proteins in the bloodstream.

D. The drug must not be water-soluble.

 

103. Which organization or individual initiates the clinical trial and finances the study?

A. clinical research organization

B. investigator

C. researcher

D. sponsor

 

104. The name describes the atomic or molecular structure of a drug.

A. chemical

B.  generic

C. pharmaceutical

D. proprietary

 

105. Under PhRMA Code, is it acceptable or unacceptable for a pharmaceutical sales rep to take a physician and the physician’s spouse to a fundraising dinner?

A. acceptable if only the physician attends

B. acceptable if only the physician attends. and the total is under $100

C. acceptable if the total is under $100

D. unacceptable

 

106. The Hatch-Waxman Act is considered the most significant drug-related affecting the pharmaceutical industry since 1962.

A. experiment

B. legislation

C. process

D. research

 

107. What term denotes the the extent, quality, or degree to which a substance is poisonous or harmful to the body?

A. caliber

B. chronicity

C. indication

D. toxicity

 

108. What issue has MOST encouraged consumers’ desire to see more OTC medications?

A. a weaker patients’ rights movement

B. lack of insurance coverage

C. less reliance on the Internet

D. proliferation of herbal remedies

 

109. What is the degree to which a medication produces a therapeutic effect?

A. diffusion

B. efficacy

C. protease

D. vector

 

110. What is the most important benefit of electronic prescribing?

A. Choice

B. cost

C. inquiries

D.  safety

 

111. When does the FDA regulate generic drugs?

A. only if they are branded generics

B. only if they have been contested

C.  always

D never

 

NAPSRx Final Exam 112. Which phase of trials largely determines the clinical dose?

A. preclinical trials

B. Phase II trials

C. Phase III trials

D. Phase IV trials

 

113. What is an advantage of inactivated vaccines over attenuated vaccines?

A.  Inactivated vaccines are less expensive to prepare.

B. Inactivated vaccines have a higher probability of eliciting the desired immunological response.

C. Inactivated vaccines have a more stable shelf life.

D.  Inactivated vaccines only require a single dose.

114. Which medical term denotes a low supply of oxygen due to low blood flow?

A. potentiation

B. ischemia

C. TID

D. titration

 

115. What are the two main types of prescription drug marketing?

A. (1) marketing to insurance companies. and (2) marketing to pharmacies

B. (1) PBM marketing. and (2) marketing to governments

C. (1) professional physician promotions. and (2) direct-to-consumer advertising

D. (1) publicly-funded marketing. and (2) physician-funded marketing

 

116. What is the site of delivery for subcutaneous injections?

A. fatty tissue beneath the surface of the skin

B.  lymphatic tissue

C. muscle tissue

D. the stomach, via a special type of needle

 

117. What must be contained in the Description section of a pharmaceutical package insert?

A. adverse effects

B. mechanism of action

C. pharmacokinetics

D. the proprietary name and the established name

 

118. What is the study of a medication’s effects as it travels through the body?

A. pharmacodynamics

B. pharmacogenetics

C. pharmacogenomics

D. pharmacokinetics

 

119. Customers purchase products from people they like, trust, and respect. This is called the  

A. closing of the sale

B. first time advantage

C. likeability factor

D. power of knowledge

 

120. What is penicillin’s primary mechanism of action?

A. It disturbs bacterial cell wall synthesis.

B It inhibits the production of viruses.

C. It prevents proper DNA replication.

D. It sends a messenger to the bone marrow to produce extra white blood cells

 

121. According to your manual, how has the U.S. healthcare marketplace changed in the last few decades?

A. Fewer and fewer prescription drugs have been made available as OTCs.

B. Managed care has been increasingly replaced by more patient-centered approaches.

C. The aging Baby Boomer generation has begun demanding more personalized attention.

D. There has been decreased emphasis on preventive health.

 

122. How does pharmaceutical marketing help narrow the treatment gap?

A. It encourages patients to take more active roles in their healthcare.

B. It makes doctors more skeptical of the pharmaceutical industry.

C. It makes patients more skeptical of their doctors’ opinions.

D. all of these

 

123. What do immunosuppressive agents do?

A. decrease risk of infection

B. increase risk of infection

C. reduce the risk of rejection of foreign bodies

D. treat psoriasis

 

124. What types of drugs are EGFR inhibitors?

A. antineoplastics

B. cardiovascular agents

C. CNS agents

D. mitotic inhibitors

 

125. Which of the following means outside of the living body?

A. en vivo

B. ex vitro

C. ex vivo

D. intra vivo

 

126. The FDA requirements for nutraceuticals and medicinal herbs are just as stringent as for pharmaceuticals.

A. TRUE

B. FALSE

 

127. What is the estimated net gain of private-sector healthcare’s contributions to increased U.S. life expectancy?

A. $5-10 billion

B. $40-50 billion

C. $800-900 billion

D.$ 2-5 trillion

 

128. Which statement is TRUE regarding post-approval drug monitoring?

A. All side effects are determined during clinical trials.

B. Drug manufacturers are only required to report adverse effects if they are severe or life-threatening.

C. Drug manufacturers are only required to report adverse effects if they have been proven in clinical studies.

D. The FDA can choose to withdraw their approval if new evidence arises.

 

NAPSRx Final Exam 129. Which term denotes when tolerance to one medication causes increased tolerance to another medication?

A. cell tolerance

B. cross-tolerance

C. indicated tolerance

D. minimized tolerance

 

130. Patents expire __ years from the date of filing.

A. ten

B. fifteen

C. twenty

D. thirty

 

131. After a trade-name drug’s patent expires, how may generic versions of it be sold?

A. only under the branded generic name

B. only under the generic name

C. only under the original trade name

D. under the original trade name or a generic name

 

132. What is required for a new pharmaceutical to be considered a viable therapy?

A. It causes no serious adverse effects.

B. It causes no side effects.

C. It has an active placebo.

D. It is more effective and/or causes fewer serious adverse effects than other drugs on the market.

 

133. Under the AMA guidelines, who is ultimately responsible for minimizing conflicts of interest?

A.  doctors

B. lawyers and office managers

C. pharmaceutical companies

D. sales representatives

 

134. The act of dispensing a pharmaceutical alternative for the product prescribed is

A. alternative licensure

B. equivalence practice

C.  necessitated substitution

D. pharmaceutical substitution

 

135. What does it mean if a drug is said to have a wide margin of safety?

A. Its safety levels have yet to be adequately verified.

B. Its safety varies widely among different types of patients.

C. There is a greater chance of severe or life-threatening side effects.

D. There is a lower chance of severe or life-threatening side effects.

136. Which of the following is the correct medical acronym for effective dose?

A. DE

B. ED

C. EFD

D. eff D

 

137. Why is one group of subjects given an active drug, while another group only receives a placebo?

A. to assess patients’ expectations

B. to assess the drug’s effectiveness

C. to assess the professionalism of the study staff

D. to assess the subjects’ demographics

 

138. A generic version is likely to have some inactive ingredients that are different from those of the original drug.

A. TRUE

B. FALSE

 

139. Which of the following is an example of a functional value?

A.  I drink Coca-Cola because I am a citizen of the world.

B.  I drink Coca-Cola because I like looking like a traditionalist.

C.  I drink Coca-Cola because I like the taste.

D.  I drink Coca-Cola because it is an international brand.

 

140. Where are most drugs metabolized?

A.  interstitial spaces

B.  liver

C. stomach

D . the bloodstream

 

141. What is essential to the ethical requirement that subjects be selected fairly?

A. Selection criteria should be well-supported by documented evidence.

B. Studies should make every attempt to conduct research on subjects who are underprivileged and in need of medical attention.

C. Subjects should be selected based on scientific objectives.

D. all of these

 

NAPSRx Final Exam 142. Which of the following is the most appropriate salutation for a cover letter if you cannot find a contact name?

A. Dear Personnel Department.

B. Dear Sir or Madam,

C. Dear Sir

D.To Whom It May Concern.

 

143. What is part of becoming an indispensable pharmaceutical sales rep?

A. asking for feedback

B. giving the doctors anything they ask for to prescribe your products

C. keeping your market share goals the same each term

D. not bothering busy doctors in hospitals

 

144. Which of the following is NOT typically included in the indications and usage section of the package insert information?

A. diseases or conditions that the drug is approved to treat

B. the drug’s active metabolites

C. the drug’s recommended usual dosage

D. the drug’s usual dosage range

 

145. Which term denotes the practice of classifying physicians and other potential prescribers by anticipated prescription volume?

A. conditioning

B. deciling

C. detailing

D. private labeling

 

146. What makes a drug eligible for fast track approval from the FDA?

A. It is a generic that has already been approved as a branded drug.

B. It is a new drug.

C. It is less expensive than what is currently on the market.

D. It treats patients with a serious. life-threatening condition.

 

147. In the gastrointestinal tract, help break up tablets to ensure full release of the active pharmaceutical ingredient.

A. binders

B. disintegrants

C. dispersing agents

D. lubricants

 

148. According to your manual, what does the PDRP do?

A. It educates patients on their treatment options.

B. It expands sales representatives’ access to patient information.

C. It improves communication between sales representatives and patients in doctors’ offices.

D. It limits sales representatives’ abilities to see individual physicians’ prescribing data.

 

149. What are the components of the central nervous system?

A. the brain and sense organs

B. the brain and spinal cord

C. the brain. spinal cord. and peripheral nervous system

D. the spinal cord and sense organs

150. Which term denotes the origin or cause of a medical condition?

A. cytology

B. discovery

C. etiology

D. pathology

 

151. Patients diagnosed with Type 1 diabetes…

A.  …do not produce enough insulin because they do not have enough B cells.

B.  …have an autoimmune disease.

C.  …produce enough insulin. but it is not as effective.

D.  …rely on insulin from porcine sources.

 

152. Which DTC pharmaceutical marketing tactic is permitted in European countries?

A. disease state ads

B. branded billboards and disease state ads

C. branded highway billboards

D. branded radio ads

 

153. What is one way in which psychologists DIFFER from psychiatrists?

A. Psychologists are more concerned with subconscious memories than conscious ones.

B. Psychologists deal more with emotional than physical issues.

C. Psychologists deal more with physical issues than emotional ones.

D. Psychologists do not have graduate degrees.

 

154. What are PBMs?

A. governmental organizations that provide healthcare

B. organizations that design marketing campaigns

C. organizations that negotiate between pharmaceutical companies and large drug purchasers

D. organizations that write FDA new drug applications

 

155. How does the Hatch-Waxman Act protect research-based drug manufacturers?

A. by limiting the competition

B. by making it easier to bring generic drugs to market

C. by providing a 30-month cooling off period

D. by requiring the FDA to only look at bioavailability studies when approving an ANDA

 

156. What is the process of adjusting drug doses to achieve the maximum positive therapeutic effects while minimizing adverse or side effects?

A.homeostatic maximization

B.steady state administration

C.Sustained release

D.Titration

 

NAPSRx Final Exam 157. Which of the following is studied more in pharmacodynamics than in pharmacokinetics?

A. absorption. Distribution metabolism and excretion

B. dose-response effects

C. the transportation of the drug to the specific site for drug-receptor interaction

D. the way the human body deals with a drug after it has been administered

 

158. How does the healthy human immune system use MHC markers?

A. Substances with MHC markers are discerned as foreign and targeted for destruction.

B. Substances with MHC markers as discerned as foreign and quarantined in the liver.

C. Substances with MHC markers as discerned as foreign and quarantined in the pancreas.

D. Substances without MHC markers are discerned as foreign and targeted for destruction.

 

159. What is a behind-the-counter drug?

A. an OTC drug that must be closely monitored by the pharmacist

B. another term for a generic prescription drug

C. another term for a prescription drug

D. another term for an OTC drug

 

160. When do MSLs meet with clinicians?

A. at nearly any stage of the product’s life cycle

B. only after the district’s sales representatives

C. only prior to launch

D. MSLs do not meet with physicians.

Reflection on Cardiovascular Shadow Health

I learned that a thorough cardiovascular assessment will help to identify significant factors that can influence cardiovascular health such as high blood cholesterol, cigarette use, diabetes, or hypertension. Therefore, a cardiovascular exam should be a part of every abbreviated and complete assessment.    A focused cardiovascular assessment is usually indicated after a comprehensive assessment indicates a potential cardiovascular problem. The focused cardiovascular assessment is also indicated when an interval or abbreviated assessment shows a change in status from your previous assessment or the report you received, when a new symptom emerges, or the patient develops any distress.

I feel there is always room for growth, and I would say growth in documentation and placements regarding murmurs was very much discussed in the Shadow Health module.   I think an advantage of a focused assessment, like when we are doing the module, it helps us understand each body system.  The fact the modules looks at so many ways to assess, subjective, objective, and even empathy, can only improve our charting and communication.

I plan on improving by integrating the cardiovascular health history and physical exam.  It takes a lot of objective and subjective information, and knowing how assess, in order to make the correct diagnosis.  Shadow Health, makes us better NP’s by working with the patient and talking into the computer.  It is very important that as I grow into a NP role, the correct questions are asked and for me to be able to analyze all the health information for a diagnosis.

 

Reflection on Cardiovascular Shadow Health

I learned that a thorough cardiovascular assessment will help to identify significant factors that can influence cardiovascular health such as high blood cholesterol, cigarette use, diabetes, or hypertension. Therefore, a cardiovascular exam should be a part of every abbreviated and complete assessment.    A focused cardiovascular assessment is usually indicated after a comprehensive assessment indicates a potential cardiovascular problem. The focused cardiovascular assessment is also indicated when an interval or abbreviated assessment shows a change in status from your previous assessment or the report you received, when a new symptom emerges, or the patient develops any distress.

I feel there is always room for growth, and I would say growth in documentation and placements regarding murmurs was very much discussed in the Shadow Health module.   I think an advantage of a focused assessment, like when we are doing the module, it helps us understand each body system.  The fact the modules looks at so many ways to assess, subjective, objective, and even empathy, can only improve our charting and communication.

I plan on improving by integrating the cardiovascular health history and physical exam.  It takes a lot of objective and subjective information, and knowing how assess, in order to make the correct diagnosis.  Shadow Health, makes us better NP’s by working with the patient and talking into the computer.  It is very important that as I grow into a NP role, the correct questions are asked and for me to be able to analyze all the health information for a diagnosis.

Self-Reflection

Explicitly describe the tasks you undertook to complete this exam.

Student Response:
I performed a comprehensive assessment. It is a complete, in-depth assessment that includes a complete health history and physical assessment. I have followed the comprehensive assessment following our school immersion examination steps for gathering an objective physical examination. I feel much more comfortable doing the head-to-toe examination somehow. In addition, the interview I performed to obtain were the personal history of illness, family medical history, current and past treatment, medications, risk factors, surgeries, and lastly interview for mental status.

Explain the clinical reasoning behind your decisions and tasks.

Student Response:
Through a comprehensive assessment, the interview started with finding the reason for the clinic visitation, with any health concerns Tina may have. While interviewing Tina, I obtained the subjective data and an education on the current medical problem or preventive medical issues.

Identify how your performance could be improved and how you can apply “lessons learned” within the assignment to your professional practice.

Student Response:
Overall, I have improved my assessment techniques by not only interviewing but also through a physical examination throughout the last 7 weeks. I’m glad that I have the opportunity to use this simulation before an encounter with my first real patient for clinical practice, and know what I am looking for assessment. Honestly, I have never comfortable to ask personal questions such as a sexual relationship, use of illicit drugs, etc. which I thought of privacy which I have never touched before in my nursing career. I realized these questions are part of the necessary data for assessing and diagnosis patients and I feel much comfortable and thankful for this opportunity.

 

Explicitly describe the tasks you undertook to complete this exam.

Student Response:
I performed a comprehensive assessment. It is a complete, in-depth assessment that includes a complete health history and physical assessment. I have followed the comprehensive assessment following our school immersion examination steps for gathering an objective physical examination. I feel much more comfortable doing the head-to-toe examination somehow. In addition, the interview I performed to obtain were the personal history of illness, family medical history, current and past treatment, medications, risk factors, surgeries, and lastly interview for mental status.

Explain the clinical reasoning behind your decisions and tasks.

Student Response:
Through a comprehensive assessment, the interview started with finding the reason for the clinic visitation, with any health concerns Tina may have. While interviewing Tina, I obtained the subjective data and an education on the current medical problem or preventive medical issues.

Identify how your performance could be improved and how you can apply “lessons learned” within the assignment to your professional practice.

Student Response:
Overall, I have improved my assessment techniques by not only interviewing but also through a physical examination throughout the last 7 weeks. I’m glad that I have the opportunity to use this simulation before an encounter with my first real patient for clinical practice, and know what I am looking for assessment. Honestly, I have never comfortable to ask personal questions such as a sexual relationship, use of illicit drugs, etc. which I thought of privacy which I have never touched before in my nursing career. I realized these questions are part of the necessary data for assessing and diagnosis patients and I feel much comfortable and thankful for this opportunity.

SOAP Note Format

Patient Information:

Tina Jones is an obese 28-year-old African American female, who comes in today for evaluation and treatment of asthma exacerbation.

S.

CC
(chief complaint)

“I came in because I’ve been having breathing problems, and my inhaler just isn’t working the way it normally does.”

HPI
:
include all the information regarding the CC using the OLDCART format.

Onset: 2 days ago

Location: Nose and lungs

Duration: 2 days

Characteristics: Chest feels tight and she has noticed some wheezing, with non-productive, dry cough

Aggravating Factors: Worse at night when she is lying down on her back.

Relieving Factors: Albuterol inhaler 3 puffs every four hours (however, does not feel like it is completely under control). Drinking water helps with the cough.

Treatment: Albuterol inhaler 3 puffs every four hours

Current Medications
:

Albuterol 90 mcg/spray 3 puffs every four hours as needed for wheezing when around cats

Allergies:

Penicillin= rash

Cats and dust= runny nose, itchy and swollen eyes and increased asthma symptoms

Ms. Jones denies any food or latex allergies

PMHx
:

Asthma diagnosed at age 2 ½

Last time hospitalized for asthma was when she was a little girl, has never been intubated

Type 2 Diabetes Mellitus diagnosed at age 24

Menarche at age 11

Sexually active with men only, last tested for STIs four years ago, never tested for HIV

Soc Hx
:

Tine is a supervisor at Mid American Copy and Ship she has been working there since she was in high school. She is single and never been pregnant. Tine is a non-smoker and reports drinking alcohol socially with friends once a month. Reports the use of Marijuana from age 18 to 20. Tina is part of a book club and enjoys going to church talks. She currently lives with her mother and sister.

Fam Hx
:

Tina reports her sister also has asthma. Denies any family history of COPD, or any throat or neck surgeries. Her mother is living and has high cholesterol and hypertension. Her father passed away in a car accident a year ago. Father had high cholesterol, hypertension and type 2 diabetes. Her bother is obese and her sister has asthma. Tina denies any family history of eczema or COPD.

ROS
:
cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows:
Constitutional:

Head
:
EENT
: etc. You may list these in paragraph format or bullet format.
Always document the systems in order from head to toe.
You may focus the ROS to match the chief complaint unless you are doing a complete health history.

CONSTITUTIONAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Reports shortness of breath, chest tightening, wheezing and non-productive dry cough

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain.

GENITOURINARY:  No burning on urination, never been pregnant. Last menstrual period started yesterday.

NEUROLOGICAL:  No headache, No change in bowel or bladder control.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES: History of asthma, with allergy to cats, dust and penicillin.

O.

Physical exam
: See above ROS.

Diagnostic results
: None

A
.

Differential Diagnoses

Asthma exacerbation

No intervention is self-evident. Provide a rationale and evidence based in-text citation for each intervention

Diagnostics:
 

Order PFTs to be completed after exacerbation to have a baseline

Obtain oxygen saturation

 

 

Rx:

list treatments and medications you will order and “continue previous meds” if pertinent. State dosages, length of treatment and reason for choosing a specific treatment or drug.

Tina would be started on corticosteroids such as Flovent (44mcg per actuation) 2-4 puffs inhaled bid

Continue with Albuterol inhaler as well.

Education:
think about covering yourself legally; also indicate when written instructions are given.

 

Tine would be educated on the importance of seeing her asthma doctor regularly to manage and treat asthma symptoms.

 

Encourage her to keep a log of her asthma symptoms and triggers, and bring to her next visit for review.

Referral/Consults
:

 

Ms. Jones would be referred to an Allergist for evaluation and treatment.

 

Follow up:

indicate when patient should return to clinic and provide detailed instructions indicating if the patient should return sooner than scheduled or seek attention elsewhere.

 

Follow up appointment would be in 2-4 weeks to review asthma log and make sure medications are helping.

 

Reference

Prieto Centurion, V., Huang, F., Naureckas, E. T., Camargo, C. J., Charbeneau, J., Joo, M. J., & … Krishnan, J. A. (2012). Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation.
BMC Pulmonary Medicine
,
12
73. doi:10.1186/1471-2466-12-73. Retrieved from:
http://web.a.ebscohost.com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=4&sid=285efade-b569-4623-8faf-d8f0d3ad546f%40sessionmgr4007

APN Capstone Portfolio Part 2

 

Table of Contents

APN Capstone Portfolio Part 2. 1

Background
. 4

Exemplar #1: NR503 Population Health, Epidemiology & Statistical Principles
. 5

Chamberlain Program Outcomes
. 7

AACN MSN Essentials
. 7

NONPF Core Competencies
. 7

Connect
. 8

Reflection
. 8

References
. 8

Exemplar #2: NR505 Advance Research Methods: Evidence-Based Practice)
. 9

(Week 4; Research Literature, Design Approach and Sampling Guidelines)
. 9

Chamberlain Program Outcomes
. 10

MSN Essentials
. 10

NONPF Competencies
. 11

Connection
. 11

Reflection
. 11

References
. 12

Exemplar #3: NR507 Advanced Pathophysiology
. 12

Chamberlain Program Outcomes
. 14

AACN MSN Essentials
. 14

NONPF Core Competencies
. 14

Connect
. 15

Reflection
. 15

References
. 16

Exemplar #4: NR508 Advanced Pharmacology
. 16

Chamberlain Program Outcomes
. 17

AACN MSN Essentials
. 18

NONPF Core Competencies
. 18

Connect
. 18

Reflection
. 18

References
. 19

Exemplar #5: NR509 Advanced Physical Assessments
. 20

Chamberlain Program Outcomes
. 21

AACN MSN Essentials
. 21

NONPF Core Competencies
. 21

Connect
. 22

Reflection
. 22

References
. 22

Exemplar #6: NR510: Leadership and Role of the Advanced Practice Nurse
. 23

Chamberlain Program Outcomes
. 24

AACN MSN Essentials
. 24

NONPF Core Competencies
. 25

Connect
. 25

Reflection
. 25

Reference
. 26

Exemplar #7: NR 511 Differential Diagnoses and Primary Care
. 27

Chamberlain Program Outcomes
. 28

AACN MSN Essentials
. 28

NONPF Core Competencies
. 28

Connect
. 29

Reflection
. 29

References
. 30

Exemplar #8: NR601 Primary Care of the Maturing and Ageing Family
. 30

Chamberlain Program Outcomes
. 31

AACN MSN Essentials
. 32

NONPF Core Competencies
. 32

Connect
. 32

Reflection
. 33

References
. 33

Exemplar #9: NR 602 Primary Care of the Childbearing and Childbearing Family
. 34

Chamberlain Program Outcomes
. 35

AACN MSN Essentials
. 35

NONPF Core Competencies
. 35

Connect
. 36

Reflection
. 36

References
. 37

Exemplar #10: NR 602 Advanced Clinical Care and Practice Across the Lifespan Practinum
.. 37

Chamberlain Program Outcomes
. 38

AACN MSN Essentials
. 39

NONPF Core Competencies
. 39

Connect
. 40

Reflection
. 40

References
. 41

References
. 42

Appendix 1: Tabulation of achieved program 0utcome, MSN Essentials and NONPF Competencies. 45

 

 

 

 

 

 

 

 

 

 

 

 

Background

On account of the intense and comprehensive nursing education program that I have undergone at Chamberlain College of Nursing, resulting into an award of Masters of Science in Nursing, here is a compilation of a reflection through the journey. The reflection entails the Program Outcomes, Master’s Education Essentials and the Core Competencies of the National Organization of Nurse Practitioners Faculties with the abbreviations as PO, MSN Essentials, and NONPF. Further, this documentation also covers ten exemplars with an assessment on views of the right argument that all of the above requirements have been covered.

Exemplar #1: NR503 Population Health, Epidemiology & Statistical Principles

In #Week 6 of this course we conducted an Evaluation of Epidemiological Problem. This assignment enabled the students to meet different course outcomes. The assignment required defining key terms in community health, epidemiology, and population-based research. We also gained the knowledge and skills to compare study designs used for obtaining population health information from observation, surveillance, community, and control trial-based research. The assignment also enabled us to commonly used measures of health risk and identify appropriate outcome measures and study designs applicable to epidemiological subfields, for instance chronic disease, infectious disease, reproductive health, environmental exposures, and genetics. We were able to identify important sources of epidemiological data and evaluate a public health problem as regards to place, person, magnitude, and person.

The task was to discuss HIV/AIDS and give its background information. The assignment was able to realize that HIV/AIDS is both an infectious disease and an epidemic disease. Learning that, since its onset, HIV/AIDS has claimed over 35 million lives was very scaring. HIV is considered infectious because it causes a severe impairment of the immune system, which then leads to AIDS (Moyer, 2015). With a weak immune system, AIDS patients become susceptible to other cancers, diseases and infections – often called opportunistic infections since their causal organisms only take advantage of the weakened immune system (Maartens, Celum & Lewin, 2014).

I was able to learn about the worrying prevalence statistics of AIDS with 23,304 people estimated to be living with HIV in Houston Texas (Maartens, et al., 2014). I also established the current surveillance techniques and strategies of HIV in the US and a clear descriptive epidemiological analysis. Finally, I was able to understand the screening and diagnosis methods of HIV. I was then able to develop and action plan for dealing with the disease or infection when I finished my MSN.

Chamberlain Program Outcomes

This assignment enabled me to meet course outcome PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care). The course was able to realize Program Outcome #1 by calculating HIV prevalence in Houston Texas and breaking it down to address particular interests of the populations. The assignment discussed the surveillance methods for HIV, which is one of the techniques that support community intervention plan. I was able to successfully suggest an intervention plan of increasing health awareness on HIV to help in its prevention.

AACN MSN Essentials

This assignment met the AACN MSN Essential I: Background for Practice from Sciences and Humanities. This MSN Essential captures the importance of obtaining an understanding of a disease and using an informed background for practice to manage its prevalence. As demonstrated in the assignment, in identifying HIV’s prevalence and designing an intervention for Houston Texas, I relied on nursing scientific findings to advocate for quality and improved health outcomes.

NONPF Core Competencies

The NONPF that I was able to demonstrate with this assignment were Practice Inquiry, Scientific Foundation and Technology and Information Literacy Competencies. I was able to think critically while compiling data on HIV and being able to apply evidence-based practice to design the intervention plan. I also included research outcomes for practice improvement and improving patient outcomes. I also had to include knowledge from other disciplines as a way of practice inquiry. Using spreadsheet application demonstrated technology and information competency.

Connect

The concepts that I can connect with from the exemplar are screening and surveillance. In nursing context, screening is used to refer to a test conducted to determine a health condition prior to manifestation of symptoms. Screening helps to detect diseases and conditions in their early periods to improve treatment outcomes. This makes screening an essential part of preventive care (Moyer, 2015).

On the other hand, disease surveillance refers to information-oriented activity encompassing gathering, analyzing and interpreting relevant health data from varied and different sources (Houston Health Department. 2015). This requires the use of informatics and technology to enhance surveillance and enable real time analysis. Surveillance leads to effective disease management and enhances preventive measures (Moyer, 2015).

Reflection

This course was very insightful. It enables accomplishments of Program Outcome #, which is to promote safe and high-quality patient-driven care anchored in holistic health tenets. To produce the document of HIV program, I had gone through several scientific studies on HIV prevalence in Houston to understand the disease’s status in the target population. I also had to compare different studies to conclude on the prevalence and determine the incident rate. Understanding the epidemiological perspective of the disease enabled proper identification of the intervention plan. I was also able to apply evidence-based practice in the work.

References

Houston Health Department. (2015). HIV Surveillance Program. HIV Infection in Houston: An Epidemiologic Profile 2010-2014. Houston, Texas; 2015.

Maartens, G., Celum, C., & Lewin, S. R. (2014). HIV infection: epidemiology, pathogenesis, treatment, and prevention. The Lancet, 384(9939), 258-271.

Moyer, V. A. (2015). Screening for HIV: US preventive services task force recommendation statement. Annals of internal medicine, 159(1), 51-60.

Exemplar #2: NR505 Advance Research Methods: Evidence-Based Practice)

(Week 4; Research Literature, Design Approach and Sampling Guidelines)

In NR505 the assignment was Research methods and evidence-based practice. In week #4 of about Research Literature, Design Approach and Sampling Guidelines. I chose obesity in children and adolescents as the phenomenon of interest in the evidence-based practice project. The selected nursing issue for the project was prevention of adolescent and childhood obesity, with the overall aim being to prevent obesity’s co-morbidities. Child and teenage obesity has become a key problem in our society today. I was able to discuss the literature support research of the research, as well as identify the appropriate theoretical framework, research design and methodology including sampling method procedure.

Literature support generated three key pieces of information. The reviewed CDC (2017) document recommended the need for multi-disciplinary research to help develop proper behavioral interventions to prevent childhood obesity. The CDC document also gave a conclusive perspective of diet and exercise as the proper initiatives for obesity control. In a longitudinal study, Cunningham, Kramer & Narayan (2014) agreed with the CDC recommendation and suggestions. Kliegman, et al (2016) suggested the Nelson Textbook of Pediatrics as the key resource for approaches that can help pediatric care including obesity. Lobstein, et al (2015) study concluded an improved governance of food markets and food supply can help address the challenge of obesity. However, it would be impractical to govern food markets and supply, thus instead education should be improved.

The theoretical framework suggested for the study was Henderson’s Needs Theory. The argument was that although the theory works well with inpatients, it can support the problem of helping obesity patients (Ahtisham & Jacoline, 2015). The suggested research approach and design of the study would be qualitative study with a non-experimental (descriptive) inquiry-based design based on the Grounded Theory (GT). The research, as suggested, use interviews and existing documents as its primary data collection tools.

Chamberlain Program Outcomes

The assignment enabled realization of program outcome (PO) #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing). This is because, evidence-based practice is one of the ways through which nurses can advocate for desirable health outcomes. The assignment enabled the application of the ability to design an evidence-based research. The process involves selecting an appropriate research article, summarizing and reviewing its relevance and information, research design, methodology, sampling and presentation of research findings.

MSN Essentials

This assignment met MSN Essential VI: Health Policy and Advocacy. I was able to engage in advanced research method, and research critique, to inform health advocacy and policy as to attain MSN Essential VI. It is evident that an MSN prepared nurse can apply research outcomes, become a change agent, resolve a nursing practice issues, and help disseminate research findings. I concluded that being able to translate findings of a nursing research is an important.

NONPF Competencies

To achieve the assignment outcome, I needed such NONPF Competencies as policy, scientific foundation and health delivery systems. Policy and health delivery systems competencies enabled me to use health informatics for determining the best guidelines for managing critical health issues. Through scientific foundation I was able to critique different study findings to generate appropriate information for the research. Through health delivery systems competency I was able to synthesize nursing practice methods that would improve patient outcomes.

Connection

I was able to connect with two concepts from this exemplar – research gap and research limitations. Research gaps are the areas with inadequate information, which constraints the research’s effective conclusion. A research gap often leads to recommendation of a new research to further the information. One can conclude there’s a research gap only after a comprehensive literature review.

Research Limitation are the research aspects that inhibit a researcher from attaining the full potential of the research outcomes. It is assumed that every research has a given limitation level such as resources, scope or knowledge. Limitations are the conditions, which an investigator cannot fully manage and will constraint the research’s conclusions and methodology.

Reflection

I thank this course for giving me insight on conducting scientific research and critique. Through program Outcome #5 I am now able for advocating for the realization of a positive health outcome through engaging evidence-based compassionate and collaborative advanced nursing practices that are evidence-based. Having gone through this course, it is evident that nurses could experience challenges in research critiques and general research conduct. Nurses should therefore exhibit NONPF Core Competencies particularly the scientific foundation competencies.

References

Centers for Disease Control and Prevention. (2017). Childhood Obesity Facts. Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion.

Kliegman, R. M., Schor, N. F., St Geme III, J. M., & Behrman, R. E. (2016). Nelson Textbook of Pediatrics. Philadelphia: Elsevier.

Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., . . . Mc Pherson, K. (2015). Childhood and adolescent obesity: Part of a bigger picture. The Lancet, 2510-2520.

National Collaborative on Childhood Obesity Research. (2012). Childhood Obesity in the United States. NCCOR.

 

 

Exemplar #3: NR507 Advanced Pathophysiology

The NR507 Course of Advance Pathophysiology was key in realizing the Chamberlin trained nurse practitioner’s program outcomes, master’s essentials, and core competencies. Pathophysiology focuses on the symptoms and function of diseased organs, to enable diagnosis and effective patient care. The different between pathophysiology and pathology, is that pathology studies all aspects of a disease, and not just the organic function. The question that NR507 sought to answer is how the study of pathophysiology help nurses in their practice. Nurse practitioners must have the right information coupled with practice knowledge and skills to be able to achieve the best evidence-based, comprehensive quality patient outcomes.

Pathophysiology entails Disease and etiology, signs and symptoms, investigation and diagnosis, treatment and prognosis. Pathophysiology puts together all of these steps. Nurse practitioners are expected to have a clear understanding of the process from the etiology and symptoms, through to medical testing, investigation, diagnosis and finally prognosis. It is clear that pathophysiology works closely with evidence-based practice. Thus, nurse can conduct more effective treatments through pathophysiology especially in such situations where anxious, scared patients don’t really understand their conditions. Nurses can educate the patients and calm them down.

There are cases where, through pathophysiology, nurses can help generate a valuable discovery for a patient’s healthcare team. Acting – in their usual crucial role – as their patients’ advocates, it is possible that nurses could catch some overlooked signs or and make them know to the doctor. The course sheds the light of pathophysiology as a way of facilitating the nurses’ knowledge to enable them to comfortably walk their patients through the process of disease etiology, testing, diagnosing, treating and prognosis. Nurses become effective in their work when they clearly understand the different ways biological processes and human organs behave in the presence of a disease. This experience and practice skills is gained through. effective research.

Chamberlain Program Outcomes

I found this course highly critical since it concerns understanding a disease, correct diagnosis, treatment and its prognosis for effective and quality patient care through proper professional identity. Thus, this course met two program outcomes. It met PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused) and PO #4: Integrate professional values through scholarship and service in health care (Professional identity). Pathophysiology ensures that the patient’s care environment is perfect for achieving quality treatment outcomes.

AACN MSN Essentials

The course managed to achieve MSN Essential IV: Translating and Integrating Scholarship into Practice and MSN Essential VIII: Clinical Prevention and Population Health for Improving Health. These two essentials are connected to PO #4, which this course was also able to meet. An MSN prepared nurse must be able to integrate broad, effective patient-centered, culturally competent and organizational concepts to assess, manage and deliver proper clinical care to the patient. As an MSN prepared nurse, I can use pathophysiology to manage a patient and the disease following through all the necessary steps learned throughout the nursing course with appropriate understanding to achieve quality health outcome for the patient.

NONPF Core Competencies

To effectively achieve this course, it was imperative to have such NONPF competencies as quality, independent practice and health delivery systems Competencies. To be able to apply pathophysiology, an MSN trained nurse must exhibit independent practice competencies. It is only through independent practice that the nurse can bring to the doctor’s attention certain aspects of the disease that were overlooked. This competency is supported by quality-oriented practice and having a clear knowledge of the health delivery systems.

Connect

The Autonomic Nervous System, controls the body’s internal organs functions. It controls body muscles and is also an integral part of the peripheral nervous system (Tappen, 2016). The renal system is comprised of body organs, which filter out excess fluid and other substances from the bloodstream. It is responsible for the production, storage and elimination of urine is done. The kidneys, being key part of the renal system, help to excrete excess fluid waste. Further, the kidney filters waste and extra blood from the blood system (Tappen, 2016).

Reflection

One among the many useful and important courses in MSN, this this NR507 Advanced Pathophysiology course sought to answer the question of how the study of pathophysiology help nurses in their practice. It is now clear to me that through this course the nurse can conduct more effective treatments especially in such situations where anxious, scared patients don’t really understand their conditions. I even learned that there are cases where, through pathophysiology, nurses can help generate a valuable discovery for a patient’s healthcare team. This course was important in realizing two program outcomes: PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused) and PO #4: Integrate professional values through scholarship and service in health care (Professional identity). Understanding pathophysiology is an important aspect of nurse evidence-based treatment.

 

References

American Association of Colleges of Nursing.  The Essentials of Masters Education for Nursing (2011). Retrieved from
http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

Robinson, B. K., & Dearmon, V. (2013). Evidence-based nursing education: Effective use of instructional design and simulated learning environments to enhance knowledge transfer in undergraduate nursing students. Journal of Professional Nursing, 29(4), 203-209.  doi: 10.1016/j.profnurs.2012.04.022

Tappen, R. M. (2016).
Advanced nursing research: From theory to practice
. Jones & Bartlett Publishers.

Exemplar #4: NR508 Advanced Pharmacology

The focus of this course is on advanced knowledge base and practice skills of pharmacology across in different clinical settings. It discusses the principles of clinical pharmacology, pharmacokinetics, therapeutics, and drug metabolism. Being a dynamic science, advanced Pharmacology as explained in NR508, built upon the previous knowledge to augment our understanding of treatment complexities with pharmacological interventions. The whole of this course expands knowledge of the principles of pharmacology specific to the APN’s role. As a student I was able to explore, analyze, evaluate, and apply common drugs used for treatment of chronic diseases and some self-limiting acute conditions and apply evidence-based practice for prescriptive intervention.

In reflection, through this course, and as an MSN trained nurse, I can now compile patients’ information to provide appropriate evidence-based diagnosis and treatment. I can boast of better understanding of the integration and application of appropriate and quality care to patients while also focusing on organizational standards, and considering distinct and dynamic individual and family populations. I have learned this important aspect of treatment through pharmacokinetics and giving patients appropriate drug choices it is possible to achieve quality treatment.

Through completion of NR 508, I can discuss the principles and concepts of pharmacokinetics, pharmacotherapeutics and pharmacodynamics. I can also now demonstrate an understanding of the key drug classifications with regards to rationale, risks, indications, and efficacy for the pharmacotherapeutic agents regularly prescribed in acute and primary care settings. I also gained the knowledge to evaluate relevant and current research findings to come up with prudent and quality pharmacological interventions. This course has also enabled me to be able to design suitable pharmacologic interventions. This class was one of those that are both enlightening and challenging. I gained the knowledge necessary to arrive at definitive patient diagnosis and establish an apt a treatment plan.

Chamberlain Program Outcomes

I believe this course me program outcome (PO) #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing). It is important that nurses communicate effectively to patients on the drugs given and treatment plan offered. It is possible that NR508 MET PO #5 because it is the only outcome that champions for desirable health outcomes through compassionate and evidence-based encompassed with collaboration

AACN MSN Essentials

The course attained AACN MSN Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes. MSN Essential VII addresses interprofessional collaboration that enhances patient outcomes and quality of population health. As an MSN prepared nurse, I now understand that to attain quality care, it is important to collaborate with other healthcare professionals so as manage and coordinate the care.

NONPF Core Competencies

Through this course (NR508) it is evident that one needs to show Health Delivery Systems Competencies and practice competencies. These two competencies impact the operationalization of public health and community programs. Using these competencies, a nurse can engage inquiry to come up with appropriate diagnosis, treatment plan and drug prescription. You also need to eb culturally competent to deliver appropriate healthcare and work with others in the healthcare field for effective patient outcomes.

Connect

Through this course, can connect with two terms – allergy and NSAIDs. In the context of pharmacology an allergy is used to refer to the immune system’s response – unnecessary – to a harmless foreign substance (Lilley, Shelly & Snyder, 2019). NSAIDs, on the other hand are non-steroidal anti-inflammatory drugs, which work by obstructing prostaglandins. prostaglandins are the chemicals that trigger the inflammation and pain signal. NSAIDs then help to relieve the inflammation from pain (Lilley, Shelly & Snyder, 2019).

Reflection

This course has benefitted me a lot. Other than knowing the essentials and specific applications of advanced pharmacology, I managed to attain PO #5, which advocates for desirable health outcomes through compassionate and evidence-based approach to nursing practice while elevating collaboration. It is understandable that you cannot work alone when you are a nurse practitioner and that you have to engage other practitioners in the healthcare field to attain quality healthcare outcomes. The course is also aligned to MSN Essential VII, which addresses interprofessional collaboration for enhanced patient outcomes. Thus, while conducting evidence-based and compassionate care, elevating interprofessional collaboration also leads to enhanced patient outcomes.

References

Chamberlain College of Nursing. (2016). Graduate Program Outcomes. Retrieved from
http://www.chamberlain.edu

Chamberlain College of Nursing. (2017). Pharmacokinetics, Pharmacodynamics, Art of Pharmacotherapeutics, Reproductive System Medications and Drug-OTC-Herbal Interactions. Week 1 lesson. Retrieved from
http://www.chamberlain.edu

Lilley, L. L., Shelly Rainforth Collins, P., & Snyder, J. S. (2019). Pharmacology and the nursing process. Mosby.

 

 

 

 

 

 

Exemplar #5: NR509 Advanced Physical Assessments

The name and expectation of the NR509 course is far much different from time one needs to successfully complete the course. I never expected that this course would involve that much activity and time. There is much study and practical application in this course than any other MSN course. I was even overwhelmed with the amount of documentation and information involved with the patients.

This course is best for those planning to undertaking autonomous practice. An FNP is an example of an autonomous practicing nurse. They have the knowledge for emergency nursing, primary care, night-nurse practitioners, community matrons, critical care, occupational therapists, physiotherapists, and working in different pre-surgical clinics, and day surgery, among other places. The course aims to enable one, as a practitioner, to develop advanced physical assessment skills and apply them in a clinical context, including when working as an autonomous practitioner.

Immersion weekend – the lab component of NR-509: Advanced Physical Assessment – gave me a great experience while also being nerve wracking. Occurring in week 7 of NR-509, the Immersion Weekend offered me an opportunity to demonstrate competence and engage critical thinking in my health assessment skills. The course has designed the Immersion Weekend to teach us appropriate assessment techniques on various general medical complaints, which help prepare us for practicum experiences in NR-511. This means, one has to do well in NR509 so as to understand NR511.

Even after all the preparations, study and documentations, NR509 was still difficult to pass. I still had low scores in the NR509 APEA exams in three areas – Neurology, Gastroenterology, and Respiratory. I had to put a lot of work to ensure that I performed well in these three areas so that I would succeed in NR511. Also, to succeed in NR509, one has to be well versed with the previous MSN courses that come before 509, and take keen consideration of pharmacology and pathophysiology.

Chamberlain Program Outcomes

The content and information of this course meets those of Chamberlain MSN PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care). Through this course I have become keener on screening and diagnostics both of which exemplify Program Outcome #1 for provision of safe, patient-centered and high-quality care. Conducting advanced physical assessments require not only clear and informed background in nursing, but critical thinking and evidence-based practice.

AACN MSN Essentials

The course met the conditions for arriving at Essential IX: Master’s-Level Nursing Practice. Clearly, advanced physical assessments highly impact individuals’ healthcare outcomes. Its achievement requires clear and well-defined background in nursing which provokes the essentials of master’s level nursing practice. It is a clear demonstration of advanced level of understanding and comprehension of advanced nursing and its relevant fields.

NONPF Core Competencies

The course also needs a demonstration of NONPF Independent Practice Core competencies. It gives an opportunity to work autonomously exhibiting independent practice as a competency. It also involved independently analyzing the given case studies with stellar profession and distinguished care to provide accurate diagnosis and establish quality outcome. A competent MSN prepared nurse should distinguish between normal and abnormal health results, which is supported by this course.

Connect

I can connect with two terms in this course – shadow-health and gastroenterology. Gastroenterology, as a field of medicine, is involved with interrogating, diagnosing, and suggesting treatment that also encompasses listing preventive care for gastrointestinal and hepatological tissues and organs (Tappen, 2016). Shadow health, on the other hand, is a software that gives healthcare students a virtual learning opportunity through simulations (Foronda
et al
., 2019). Thus, it enables students to test their nursing knowledge and skills and hence build their confidence.

Reflection

The name and expectation of the NR509 course is far much different from time one needs to successfully complete the course. I never expected that this course would involve that much activity and time. There is much study and practical application in this course than any other MSN course. I was even overwhelmed with the amount of documentation and information involved with the patients. The sensitivity is on its screening and diagnostic processes, which both inform the treatment plan making any mistake – if any – at this stage costly and fatal and costly. I discovered that conducting advanced physical assessments needs stellar background in nursing information and proper develop critical thinking. Students can use Shadow Health and case studies to test their physical assessment’s skills and knowledge.

References

Codina, L. M. T. (2007). Adult nurse practitioner intensive review: Fast facts & practice questions. New York: Springer Pub. Co.

Foronda, C. L., Alfes, C. M., Dev, P., Kleinheksel, A. J., Nelson Jr, D. A., O’donnell, J. M., & Samosky, J. T. (2017). Virtually nursing: Emerging technologies in nursing education.
Nurse educator
,
42
(1), 14-17.

Tappen, R. M. (2016).
Advanced nursing research: From theory to practice
. Jones & Bartlett Publishers.

Exemplar #6: NR510: Leadership and Role of the Advanced Practice Nurse

This course was not only important but also practice assuring. Id defined the leadership and role of an APNs practitioners in a wide range of possible careers and employment opportunities. Holding either MSN or a doctorate in nursing, APNs are considered to be the most highly trained category of all registered nurses. They conduct certain functions previously reserved for medical doctors such as diagnosing condition, requesting and/or interpreting laboratory tests, and prescribing medications among others. They have a wide scope of practice and lots of duties to perform either as practitioners or leaders.

APNs apply technical, cognitive and integrative abilities to carry out their practice in ethical and safe approaches for quality outcome of patients. APN must also have the capability of peer and patient education, research and inquiry, mentorship and accountability in interpreting and utilizing research to advance and improve nursing practice. There are two main themes identified in the role of an ANP – organization and system‐focused leadership and Patient‐focused leadership. These are the main leadership orientations of APNs as they seek to contribute to and improve the clinical care environment for patients and their families, other nurses including other healthcare providers, and the entire healthcare system.

Being an APN requires a one to have an MSN. Other MSN’s proceed to earn a doctoral degree to become Clinical Nurse Specialists. With an MSN one also has to obtain a certification after sitting an exam to become an APN. (“Advanced Practice Nursing Fact Sheet”, 2017). It is also important to consider the federal and state Licensure and Regulatory Requirements to practice as an MSN trained APN. With an additional certification, degree and license, being an MSN prepared APN means having a higher responsibility. Further, a complex job title, higher knowledge, more skills and authority give APN new challenges and equal opportunities. Nevertheless, regardless of having higher roles or authority, an APN must always keep in mind that providing quality and safe healthcare is paramount.

Chamberlain Program Outcomes

This course meets the needs of program outcome (PO) #3: Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity
(Cultural Humility).
Nurses are generally leaders both to patients and to their lower ranking colleagues. By pursuing an APN level nursing career, one is aligning with Program Outcome #3 that urges continuous personal and professional growth through reflective practice and appreciation of cultural diversity.

AACN MSN Essentials

This course realizes AACN MSN Essential II: Organizational and Systems Leadership. APN’s are naturally leaders because of their skill levels and associated responsibility, roles and authority. Thus, they must demonstrate both organizational and systems leadership to promote safe and quality care. They must also engage critical thinking in their decision making and engage systems-wide view.

 

NONPF Core Competencies

The accurate and obvious competency that this course instill is the Leadership Competency. As an MSN APN I have to build on leadership competencies (Hickey & Brosnan, 2012). This is because you will have more responsibilities, key roles and authority, which put you in a leadership position. As a leader you have to act on the best interest of all the stakeholders involved in the care process including patients, junior colleagues and other health sector practitioners. You must also exercise effective communication skills and participate in professional organizations to enhance your leadership competences.

Connect

Systems-wide view: seeks consider the organization’s entire units or departments in a bid to accomplish a practical approach to leadership. The systems-wide concept views an organization from a cause-effect view which supports implementation of corrective measures (Cherry & Jacob, 2016).

Nursing leadership is a dynamic concept of nursing that, simply stated involves mentoring (or coaching) and building of supportive relationships to maximize individual potential and enhance professional growth. Mentorship involves a nurse leader sharing their knowledge, behaviors, skills, and attitudes with other nurses (Cherry & Jacob, 2016).

Reflection

APNs are trained to be leaders and demonstrate leadership competencies. This course not only teaches leadership but also gives leadership opportunities for APNs in care environment. While nursing leaders provide higher level leadership, individual nurses are always engaged in leadership, for instance when assigned students or nursing interns. This course is aligned with Program Outcome #3, which urges nurses and APNs to indulge in continuous personal and professional growth while considering cultural diversity

Reference

Advanced Practice Nursing Fact Sheet | 2017 NurseJournal.org. (2017). Retrieved from http://nursejournal.org/advanced-practice/advanced-practice-nursing-fact-sheet/

About Boards of Nursing | NCSBN. (2017). Retrieved from
https://www.ncsbn.org/about-boards-of-nursing.htm

Cherry, B., & Jacob, S. R. (2016).
Contemporary nursing: Issues, trends, & management
. Elsevier Health Sciences.

Hickey, J. V., & Brosnan, C. A. (2012). Evaluation of health care quality in advanced practice nursing. New York: Springer Pub. Co.

 

 

 

 

 

 

 

 

 

Exemplar #7: NR 511 Differential Diagnoses and Primary Care

Through
Differential Diagnosis and Primary Care
 nurse practitioners systematically approach treatment symptoms and signs with careful approach as they see them practice. NR 511 was the key test of my education and learning as an MSN prepared nurse. Organized into categories different categories such as mass, pain, bloody and non-bloody discharge, abnormal laboratory results, and functional changes, this course offers a clinical reference for diagnosis and taking appropriate steps in ensuring that the patient gets appropriate diagnosis. I had the opportunity to conduct my first FNP program clinical rotation. As an MSN, you are prepared to handle different aspect of care and diagnosis. In rotation, I realized that there is more that I need to learn as far as diagnosis and primary care is concerned. Primary care is intensive unlike ER, with the need for more follow up and abroad treatment for quality outcome. There is even more time needed to obtain lab results, hence diagnosis and treatment plan must be based on advanced physical test and the patient’s history.

There is also a key difference between primary care and ER when it comes to medication and treatments. In primary care, there are many protocols and many treatment options and sometimes patients have numerous comorbidities that that must be considered while choosing a plan of care. This often calls for differential diagnosis to ensure that the treatment plan addresses specific diseases and not comorbidities.

Primary care indulge different areas of clinical health and rotation exposes you to different patients in terms of age, gender, and disease infections. You have to be updated in treatment methods and ensure that you have the correct information going into treatment. As an MSN trained APN, you are a leader and perceived to be more knowledgeable and with more skills. Thus, it is only prudent to ensure that you follow the right procedures and ensure quality outcome.

Chamberlain Program Outcomes

NR 511 met PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles
(Holistic Health & Patient-Centered Care)
. The differential diagnosis and primary course as it helps the MSN APN nurse determine the final diagnosis of the patient and subsequent treatment plan. Thus, it enables the realization of Program Outcome #1, which advocates for safe, high-quality, patient centered healthcare that is premised on holistic health principles. A critical element of the patient’s safety is ensuring that the patient is given correct of a medical condition or illness is a critical element of patient safety and quality attributes of a healthcare system. The treatment plan should be supported with an evidence-based information.

AACN MSN Essentials

The course helped in the realization of two AACN MSN Essentials – Essential V: Informatics and Healthcare Technologies and Essential IX: Master’s-Level Nursing Practice. The realization of these essentials is demonstrated through the achievement of PO #1. Differential diagnosis and Primary care have a direct impact on patient’s healthcare outcomes as addressed by Essential IX addresses. This is because any nursing aspect that directly impacts healthcare outcomes encompass MSN practice due to their requirement of detailed, keener and more informed with high accountability demands.

NONPF Core Competencies

This course managed to demonstrate the need for Quality CompetenciesThrough this course, MSN-APN trained nurses develop NONPF’s quality competencies to enable them operationalize all the other important competencies. One can achieve this trough applying the current and best research study findings and results to clinical practice. Nurse practitioners should also consider the complex relationships between quality, safety, and cost in healthcare delivery. This competency has many other aspects that an MSN-APN nurse must demonstrate.

Connect

Differential Diagnoses – when a patient has a condition that is difficult to understand, clinicians and nurse practitioners use differential diagnosis to distinguish one condition, disorder or disease from others, especially when these conditions present close or similar clinical features (Gorenstein & Comer, 2015). This makes differential diagnosis a systematic diagnostic method that can identify a particular disease where there is a possibility of multiple alternatives.

Test sensitivity – In medical diagnosis, clinicians use test sensitivity to describe a test’s ability “to correctly identify those with the disease (true positive rate)” (Cummings
et al
., 2015). This is the exact opposite of test specificity which describe the test’s ability to correctly identify those without the disease (true negative rate) (Cummings
et al
., 2015).

Reflection

I can categorically say that this course was very critical in MSN because it directly addresses the healthcare’s sensitive stages. It informs the patient’s final diagnosis and all the subsequent treatment plan that the nurse will give. By meeting the requirements of PO #1 this course also directly advocates for f safe, high-quality and patient-centered healthcare that is premised on key holistic health principles. It emphasizes quality outcome and patient safety, which are salient element of healthcare provision. It also encourages evidence-based practice for better outcome.

 

References

Cummings, J., Soomans, D., O’laughlin, J., Snapp, V., Jodoin, A., Proco, H., … & Rood, D. (2015). Sensitivity and specificity of a nurse dysphagia screen in stroke patients.
MedSurg Nursing
,
24
(4), 219-224.

Gorenstein, E. & Comer, R. (2015). Case studies in abnormal psychology. New York, NY: Worth Publishers, a Macmillan Higher Education Company.

National Organization of Nurse Practitioner Facilities. (2013). Nurse practitioner population focused competencies.
http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf

Exemplar #8: NR601 Primary Care of the Maturing and Ageing Family

Part of nursing is being able to provide primary care from pediatrics to the aged population. This course was an opportunity to learn and practice about providing primary care for the maturing and ageing population. This is a very delicate population and one that needs intensive care. Primary care for this category of this population is more intense during prognosis and managing them after treatment (Boeckxstaens & De Graaf, 2011). As an MSN trained APN practitioner, it is important to not only demonstrate leadership but also advocate for the well-being of the patients after treatment.

During this course, I was able to learn that primary care doesn’t mean a fixed organizational structure or style but a blend of functional and variable characteristics to the needs – present and emerging – of the older persons (Boeckxstaens & De Graaf, 2011). Clearly, multimorbidity, disability, dependence and frailty play out often and differently in the aging persons; making a key challenge for primary care to be able to provide an adaptable response to these individuals’ needs. Indeed, caring for the elderly needs involving them in the care decisions since, contrary to what’s believed, the elderly consider their life quality as high (Boeckxstaens & De Graaf, 2011). Furthermore, providing care for the elderly requires coordination and continuity with other specialist care programs.

The central theme of primary care for the old and ageing is delivering seamless integrated care. I learned that instead of disease management, primary care prefers case management approach. This involves proactive geriatric assessment to know the individual’s functional, medical, and social needs, including isolation, and loneliness. We also need clinical or MSN practice guidelines for multimorbidity to avoid costly uncoordinated and multiple prescriptions. Importantly, primary care is a teamwork, and coordinated healthcare provision, and nurses have a significant role in ensuring quality care and alignment with home (family) care and social services

Chamberlain Program Outcomes

This provisions and lessons in this course meet Chamberlain’s PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing). For example, when I helped an elderly patient get a referral by coordination and liaising her service with the relevant office, I operationalized PO #5, which advocates for positive outcomes through collaborative, evidence-based and compassionate practice. The mere fact that coordination and delivering of seamless integrated care in primary care for the ageing is a fulfilment of the PO #5.

AACN MSN Essentials

This course realized the fulfillment of MSN Essential VII, which advocates for Interprofessional Collaboration for Improving Patient and Population Health Outcomes. This essential is in line with PO #5 on the issue of coordinated and integrated care delivery. As an MSN NP you need to be working with different hospital/care departments to support the patient’s and a referral quality result. It is important that a NP consult and coordinate care with other health professionals as provided in essential VII.

NONPF Core Competencies

This course and the achievement of the practical outcomes that I managed to achieve shoed the need for Ethics Competencies as the NONPF core competencies. Dealing with elderly patients needs not only need compassion but also ethics both in their diagnosis and prognosis. I discovered that the elderly person’s families need to be helped to understand the situation including the patient’s prognosis. This is only possible when you infuse ethical principles in decision making.

Connect

        

Geriatrics: refers to the branch of social science or medicine that deals with the health and care of old people (Zaccagnini & White, 2015). This is basically what this course entailed.

Orthopaedic: is a special branch of medicine that deals with the correction of the body’s deformities of bones and muscles. It addresses the diagnosis, corrections, preventing, and treatment of individuals with their skeletal deformities (Zaccagnini & White, 2015). Most old people need to undergo orthopaedic treatment.

Reflection

In summary, I learned that the central theme of primary care for the old and ageing is delivering seamless integrated care. I learned that instead of disease management, primary care prefers case management approach. This involves proactive geriatric assessment to know the individual’s functional, medical, and social needs, including isolation, and loneliness. Nurses also need clinical or MSN practice guidelines for multimorbidity to avoid costly uncoordinated and multiple prescriptions. Importantly, primary care is a teamwork, and coordinated healthcare provision, and nurses have a significant role in ensuring quality care and alignment with home (family) care and social services

Primary care for the old have complex demands. Fortunately, nurses have adequate training to navigate through these complex demands for positive and quality patient outcome. It also needs ethics as a competency to be able to deal with the old and aging population. Further, dealing with this population needs interprofessional collaboration to enhance population and patient health outcomes.

References

Berry, S., Kiel, D. P., Schmader, K. E., & Sullivan, D. J. (2017). Falls: Prevention in nursing care facilities and the hospital setting.
Uptodate. com
.

Boeckxstaens, P., & De Graaf, P. (2011). Primary care and care for older persons: position paper of the European Forum for Primary Care. Quality in primary care, 19(6), 369.

Zaccagnini, M., & White, K. (2015).
The doctor of nursing practice essentials
. Jones & Bartlett Learning

 

Exemplar #9: NR 602 Primary Care of the Childbearing and Childbearing Family

This course course provides an NP student with the essential knowledge, information and experience to be able to diagnose and manage a childbearing/childrearing family and provide them with primary care as well as manage their common health problems. The course placed emphasis on assisting childrearing families to maintain or reach the highest level of functioning and health, focusing on health maintenance, health promotion. I am glad that this course prepared me to meet the MSN PO #1, MSN Essential VII, and the NP Core Competencies #8.

This course is focused on the primary care for low risk of a childbearing woman and her newborn. It is important for an FNP because it applies developmental theoretical perspective, for achieving primary care for during childbearing in a family practice setting. Also, the given clinical component gives the opportunity fo the MSN-FNP’s to integrate the learned theoretical content from their prior courses and use them in clinical gynecologic and obstetrical family practice. It gives the FNP-student nurse practitioner (SNP) skills needed for a quality holistic, primary care of the woman obstetrical client in ambulatory and family practice care.

This course also offers the practice and principles of care for the childbearing woman and family throughout the ante- and post-partum stages. The course explains this process through different ethnicities, ages, and social circumstances and also involves advanced physical assessment (NR509) and management of both normal pregnancy and different pregnancy complications. On top of the different pregnancy’s physiological changes, the course also helps to examine the psychological issues that are commonly encountered during the pregnancy’s prenatal and post-partum care provision.

Furthermore, the builds on human development and growth to focus on support knowledge of assessment and management of chronic and acute health care problems that practitioners encounter in primary care of family, and sometimes pediatric, settings. It analyzes the medical problems and conditions of expectant women, unborn and born infants, as well as children and adolescents within the context of a FNP framework.

Chamberlain Program Outcomes

Program outcome #1 advocates for providing high quality, safe, patient-centered care grounded in holistic health principles (summarized as holistic health & patient-centered care). The significance of holistic care was first emphasized by Florence Nightingale. Holistic care gives a patient satisfaction in the provided healthcare, which is also their right (Andrus, 2014). Through this course, and by meeting MSN PO #1 I am able to address childbearing patients and families’ social, physical, emotional, and spiritual needs, and support them in dealing with their illnesses, to improve their lives.

AACN MSN Essentials

The course achieved MSN Essential VII
:
Interprofessional Collaboration for Improving Patient and Population Health Outcomes. Achievement of this essential recognizes that an APN MSN-prepared nurse, being a leader and member of interprofessional teams, collaborates, consults, and communicates with other professionals in the healthcare field to coordinate and manage care (Andrus, 2014). As an MSN, you coordinate and lead interdisciplinary care teams across different care environment to improve health outcomes. This professional identity is achieved through MSN Essential VII.

NONPF Core Competencies

This course demonstrates the Nurse Practitioner Core Competency # 8: Ethics Competencies. This is because it ensures integration of ethical principles in care decision making, ensures evaluation of the ethical consequences of care decisions. It also applies ethically sound solutions to complex issues related to individuals, populations and systems of care. As an FNP this course has prepared me to promote patient-centered, comprehensive holistic care (Sohi, Champagne & Shidler, 2015). Thus, I know that, ethically it is the patients’ right to choose the type of care they feel comfortable with and can refuse care when they are not comfortable with a given care. This means that the nurse – an MSN-APN prepared FNP – has a responsibility to provide patients with enough information about the treatment and care so that they can make informed decision.

Connect

Postnatal depression: is the form of depression, which a parent can undergo after childbirth. The major victims are mothers but it can also affect fathers. The signs of postnatal depression include difficulty bonding with the new baby, insomnia or intense irritability. If untreated it can go for a long time and can lead to a major depression (Agrawal, 2015).

Postpartum hemorrhage entails excessive bleeding after childbirth. The hemorrhage often takes place after the delivery of the placenta. Its causes include uterine muscles’ loss of tone, or a bleeding disorder or sometimes when the placenta fails to be delivered completely or when it’s tone (Agrawal, 2015).

Reflection

This is one of the courses that is suitable for an FNP because it offers a lot of ways that help the FNP on addressing the social, emotional, spiritual, and physiological needs of parents after childbirth. In essence it helps to the student to operationalize Program Outcome # 1, which urges nurses and care givers to offer safe, high quality and patient-oriented care while considering holistic healthcare tenets. Also, it provides for collaboration and coordination while handling patients enhance desired quality health outcomes. For example, through Essential VII, this course helps you to learn to appreciate other professionals in your team and appreciate the significance of collaboration.

References

Agrawal, P. (2015). Maternal mortality and morbidity in the United States of America.

Andrus, V. L. (2014). Person-Centered Care: Enhancing Patient (Person) Engagement. 
Beginnings
, 
34
(1), 18-21.

Sohi, J., Champagne, M., & Shidler, S. (2015). Improving health care professionals’ collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project. 
Journal of Interprofessional Care
, 
29
(5), 409-414.

Exemplar #10: NR 602 Advanced Clinical Care and Practice Across the Lifespan Practinum

As an MSN-FNP this course is very essential for my practice. This course has helped me achieve MSN-FNP Program Outcome #4: professional identity (Integrate professional values through scholarship and service in health care). This course offered an opportunity for practical experience in nursing scholarship. As described by the American Association of Colleges of Nursing (2011), scholarship includes the activities, which systematically advance the practice, research and teaching of nursing through a rigorous inquiry. The course also supports other MSN qualities such as leadership, advanced practice, coordination, collaboration and authority in advocating and providing quality care.

This enabled attainment of course MSN Essential IV
: 
Translating and Integrating Scholarship into Practice. This essential recognizes that the MSN-prepared nurse must apply research outcomes in the practice to make informed decisions and solve practice problems through evidence-based practice. The MSN-prepared nurse also works as a leader and change agent in healthcare setting. Utilizing the guidelines of clinical practice to recognize, plan, manage and treat diseases satisfies this essential.

This course – being an important APN course – continues to provide expanded the practical and theoretical knowledge of diagnostic and disease management principles specific to the MSN-FNP’s, for healthcare needs of all individuals across all ages. It enables students to further their skills in diagnosis, health promotion, prevention of illness, and general care management of complex chronic and acute conditions, as well as behavioral health. This course leads the student to develop and maintain such care strategies as patient education, follow-up, referral, and protocol development through an experience in clinical practicum in an advanced practice setting.

This course solidifies the FNP’s clinical experience, which involves developing knowledge and skills that supports provision of quality healthcare outcome through best research and evidence-based care. Achievement of the course leads to attainment of numerous Nurse Practitioner Core Competencies, key among them being competency # 7: Health Delivery System Competencies. This cluster of competencies (#7) refer to the design, planning, and implementation of community and public health programs for quality healthcare outcome and encompass such skills as effective communication, leadership, compassion, coordination, research and evidence-based practice in care provision (AACN, 2011).

Chamberlain Program Outcomes

This course has helped me achieve MSN-FNP Program Outcome #4: professional identity (Integrate professional values through scholarship and service in health care). This program outcome is especially important for aspiring FNPs in the clinical practice. For example, I have learned to provide primary care to patients of different ages, class and identities, which is important in FNP practice. As an MSN-FNP prepared nurse you’re expected to become a leader and have more skills in different care settings that will make you stand out among other practitioners. Thus, this course has offered important insights on not only MSN requirements but also cultural diversity and behavioral health concerns.

 
AACN MSN Essentials

The meeting of PO #4 enabled attainment of MSN Essential IV: Translating and Integrating Scholarship into Practice. Also, MSN essential III: quality improvement and safety comes close to this course. Expectedly, conducting advanced primary care to different age groups of patients and conduction differential diagnosis requires reliance on both Essential III and IV. As an FNP, attaining MSN level of practice required covering numerous theories, practical, simulations, laboratory sessions and case studies and being able to apply them in real-world.

 
NONPF Core Competencies

This course solidifies the FNP’s clinical experience, which involves developing knowledge and skills that supports provision of quality healthcare outcome through best research and evidence-based care. Achievement of the course leads to attainment of numerous Nurse Practitioner Core Competencies, key among them being competency # 7: Health Delivery System Competencies. This cluster of competencies (#7) refer to the design, planning, and implementation of community and public health programs for quality healthcare outcome and encompass such skills as effective communication, leadership, compassion, coordination, research and evidence-based practice in care provision (AACN, 2011).

 

Connect

Cryotherapy: is a form of therapy treatment that involves using freezing temperatures. It is also known as cold therapy, and used to cool body temperature and bring it down at the cellular and tissue level for therapeutic benefits (Song
et al
., 2016). It is a relatively new concept.

Immunization: often confused vaccination, and sometimes referred to as inoculation. Vaccination involves administering a vaccine (a mild form an infectious agent) in to your body (usually by injection). Immunization is the result of vaccination. The vaccine helps to stimulate the body’s immune system so that the body can recognize the disease and gradually build defenses against the pathogen to protect the body from future infection (Wilder-Smith
et al
., 2017).

Reflection

This course is an essential course for every MSN-FNP nurse because it forms the core of nursing care. Through this course one gets the opportunity to identify with all MSN Program Outcomes especially PO #4, which requires a nurse practitioner to incorporate scholarship and professional values in healthcare service. This course solidifies the FNP’s clinical experience, which involves developing knowledge and skills that supports provision of quality healthcare outcome through best research and evidence-based care. Achievement of the course leads to attainment of numerous Nurse Practitioner Core Competencies, key among them being competency # 7: Health Delivery System Competencies. This cluster of competencies (#7) refer to the design, planning, and implementation of community and public health programs for quality healthcare outcome and encompass such skills as effective communication, leadership, compassion, coordination, research and evidence-based practice in care provision (AACN, 2011).

 

References

American Association of Colleges of Nursing (AACN). (2011). Defining Scholarship for the Discipline of Nursing. Retrieved from 
http://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Defining-Scholarship.

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2016). Translating research findings to clinical nursing practice. 
Journal of Clinical Nursing
, 
26
(5-6), 862-872.

Goroll, A., & Mulley, A. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). China: Wolters Kluwer Health.

Wilder-Smith, A., Longini, I., Zuber, P. L., Bärnighausen, T., Edmunds, W. J., Dean, N., … & Gessner, B. D. (2017). The public health value of vaccines beyond efficacy: methods, measures and outcomes.
BMC medicine
,
15
(1), 138.

 

 

 

 

 

 

 

 

 

References

American Association of Colleges of Nursing (AACN). (2011). Defining Scholarship for the Discipline of Nursing. Retrieved from
http://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Defining-Scholarship
.

Advanced Practice Nursing Fact Sheet | 2017 NurseJournal.org. (2017). Retrieved from
http://nursejournal.org/advanced-practice/advanced-practice-nursing-fact-sheet/

About Boards of Nursing | NCSBN. (2017). Retrieved from
https://www.ncsbn.org/about-boards-of-nursing.htm

Agrawal, P. (2015). Maternal mortality and morbidity in the United States of America.

Andrus, V. L. (2014). Person-Centered Care: Enhancing Patient (Person) Engagement. Beginnings, 34(1), 18-21.

Berry, S., Kiel, D. P., Schmader, K. E., & Sullivan, D. J. (2017). Falls: Prevention in nursing care facilities and the hospital setting. Uptodate. com.

Boeckxstaens, P., & De Graaf, P. (2011). Primary care and care for older persons: position paper of the European Forum for Primary Care. Quality in primary care, 19(6), 369.

Centers for Disease Control and Prevention. (2017). Childhood Obesity Facts. Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion.

Chamberlain College of Nursing. (2016). Graduate Program Outcomes. Retrieved from
http://www.chamberlain.edu

Chamberlain College of Nursing. (2017). Pharmacokinetics, Pharmacodynamics, Art of Pharmacotherapeutics, Reproductive System Medications and Drug-OTC-Herbal Interactions. Week 1 lesson. Retrieved from
http://www.chamberlain.edu

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Codina, L. M. T. (2007). Adult nurse practitioner intensive review: Fast facts & practice questions. New York: Springer Pub. Co.

Cummings, J., Soomans, D., O’laughlin, J., Snapp, V., Jodoin, A., Proco, H., … & Rood, D. (2015). Sensitivity and specificity of a nurse dysphagia screen in stroke patients. MedSurg Nursing, 24(4), 219-224.

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2016). Translating research findings to clinical nursing practice. Journal of Clinical Nursing, 26(5-6), 862-872.

Gorenstein, E. & Comer, R. (2015). Case studies in abnormal psychology. New York, NY: Worth Publishers, a Macmillan Higher Education Company.

Goroll, A., & Mulley, A. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). China: Wolters Kluwer Health.

Foronda, C. L., Alfes, C. M., Dev, P., Kleinheksel, A. J., Nelson Jr, D. A., O’donnell, J. M., & Samosky, J. T. (2017). Virtually nursing: Emerging technologies in nursing education. Nurse educator, 42(1), 14-17.

Hickey, J. V., & Brosnan, C. A. (2012). Evaluation of health care quality in advanced practice nursing. New York: Springer Pub. Co.American Association of Colleges of Nursing.  The Essentials of Masters Education for Nursing (2011). Retrieved from
http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

Houston Health Department. (2015). HIV Surveillance Program. HIV Infection in Houston: An Epidemiologic Profile 2010-2014. Houston, Texas; 2015.

Kliegman, R. M., Schor, N. F., St Geme III, J. M., & Behrman, R. E. (2016). Nelson Textbook of Pediatrics. Philadelphia: Elsevier.

Lilley, L. L., Shelly Rainforth Collins, P., & Snyder, J. S. (2019). Pharmacology and the nursing process. Mosby.

Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., . . . Mc Pherson, K. (2015). Childhood and adolescent obesity: Part of a bigger picture. The Lancet, 2510-2520.

Maartens, G., Celum, C., & Lewin, S. R. (2014). HIV infection: epidemiology, pathogenesis, treatment, and prevention. The Lancet, 384(9939), 258-271.

Moyer, V. A. (2015). Screening for HIV: US preventive services task force recommendation statement. Annals of internal medicine, 159(1), 51-60.

National Collaborative on Childhood Obesity Research. (2012). Childhood Obesity in the United States. NCCOR.

National Organization of Nurse Practitioner Facilities. (2013). Nurse practitioner population focused competencies.
http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf

Robinson, B. K., & Dearmon, V. (2013). Evidence-based nursing education: Effective use of instructional design and simulated learning environments to enhance knowledge transfer in undergraduate nursing students. Journal of Professional Nursing, 29(4), 203-209.  doi: 10.1016/j.profnurs.2012.04.022

Sohi, J., Champagne, M., & Shidler, S. (2015). Improving health care professionals’ collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project. Journal of Interprofessional Care, 29(5), 409-414.

Tappen, R. M. (2016).
Advanced nursing research: From theory to practice
. Jones & Bartlett Publishers.

Wilder-Smith, A., Longini, I., Zuber, P. L., Bärnighausen, T., Edmunds, W. J., Dean, N., … & Gessner, B. D. (2017). The public health value of vaccines beyond efficacy: methods, measures and outcomes. BMC medicine, 15(1), 138.

Zaccagnini, M., & White, K. (2015). The doctor of nursing practice essentials. Jones & Bartlett Learning

 

 

 

Appendix 1: Tabulation of achieved program 0utcome, MSN Essentials and NONPF Competencies

Exemplar# Title

Program outcome

MSN Essentials Met

NONPF Core Competencies Met

Exemplar I: NR503 Population Health, Epidemiology & Statistical Principles

PO #1: Provide high quality, safe, patient-centred care grounded in holistic health principles (Holistic Health & Patient-Cantered Care)

Essential I: Background for Practice from Sciences and Humanities

Scientific Foundation Competencies.

Technology and Information Literacy Competencies

Exemplar II: NR 505 Advance Research Methods Week 3

PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)

Essential VI: Health Policy and Advocacy

Scientific Foundation Competencies

Policy Competencies

Exemplar III: NR 507 Advanced Pathophysiology

PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused)

PO #4: Integrate professional values through scholarship and service in health care (Professional identity)

Essential VIII: Clinical Prevention and Population Health for Improving Health

Independent Practice Competencies.

Policy Competencies
.

Exemplar IV: NR 508 Advanced Pharmacology

PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)

Essential VII: Interprofessional Collaboration for Improving Patient and

Population Health Outcomes.

Health Delivery Systems Competencies

Exemplar V: NR 509 Advanced Physical Assessments

PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care).

Essential IX: Master’s-Level Nursing Practice

Independent Practice Competencies

Exemplar VI: NR510: Leadership and Role of the Advanced Practice Nurse

PO #3: Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility))

Essential IX: Master’s-Level Nursing Practice

Leadership Competencies

Exemplar VII NR 511 Differential Diagnoses and Primary Care

PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

Essential V: Informatics and Healthcare Technologies

Essential IX: Master’s-Level Nursing Practice

Quality Competencies

Exemplar VIII: NR 601 Primary Care of the Maturing and Ageing Family

PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing))

Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes

Ethics Competencies

Exemplar IX: NR 602 Primary Care of the Childbearing and Childbearing Family

PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)

Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes.

Ethics Competencies

Exemplar X: NR 602 Advanced Clinical Care and Practice Across the Lifespan of Practinum

PO #4: Integrate professional values through scholarship and service in health care (Professional identity)

Essential III: Quality Improvement and Safety

Essential IV: Translating and Integrating Scholarship into Practice

Health Delivery Systems Competencies