Category: Nursing

NSG 6001 Week 5 Final Exam 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

Question 3.

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

ETT

Coronary bypass surgery

Coronary catheterization

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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? NSG 6001 Week 5 Final Exam.

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

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

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? NSG 6001 Week 5 Final Exam.

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

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. NSG 6001 Week 5 Final Exam 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

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. NSG 6001 Week 5 Final Exam 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? NSG 6001 Week 5 Final Exam

Bloated stomach

Kidney failure

Bleeding ulcers

Abdominal aortic aneurysm

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 NSG 6001 Week 5 Final Exam. 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

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 NSG 6001 Week 5 Final Exam

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?NSG 6001 Week 5 Final Exam

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

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? NSG 6001 Week 5 Final Exam.

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 NSG 6001 Week 5 Final Exam. 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

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? NSG 6001 Week 5 Final Exam

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 NSG 6001 Week 5 Final Exam. 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? NSG 6001 Week 5 Final Exam.

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

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 NSG 6001 Week 5 Final Exam.

Alterations of Cardiovascular Function Essay

What is the initiating event that leads to the development of atherosclerosis?

What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis?

Which inflammatory cytokines are released when endothelial cells are injured?

When endothelia cells are injured, what alteration contributes to atherosclerosis?

Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?

What pathologic change occurs to the kidney’s glomeruli as a result of hypertension?

What effect does atherosclerosis have on the development of an aneurysm? Alterations of Cardiovascular Function Essay.

Regarding the endothelium, what is the difference between healthy vessel walls and those that promote clot  formation?

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What is the usual source of pulmonary  emboli?

Which factor can trigger an immune response in the bloodstream that may result in an embolus?

Which statement best describes thromboangiitis obliterans (Buerger disease)?

Which statement best describes Raynaud  disease?

What change in a vein supports the development of varicose   veins?

Superior vena cava syndrome is a result of a progressive increase of which process?

What term is used to identify when a cell is temporarily deprived of blood supply Alterations of Cardiovascular Function Essay?

The risk of developing coronary artery disease is increased up to threefold by which factor?

Which risk factor is associated with coronary artery disease (CAD) because of its relationship with the alteration of hepatic   lipoprotein?

Nicotine increases atherosclerosis by the release of which neurotransmitter?

Which substance is manufactured by the liver and primarily contains cholesterol and protein?

Which elevated value may be protective of the development of atherosclerosis?

Which laboratory test is an indirect measure of atherosclerotic   plaque?

Cardiac cells can withstand ischemic conditions and still return to a viable state for how many minutes? Alterations of Cardiovascular Function Essay

Which form of angina occurs most often during sleep as a result of vasospasms of one or more coronary  arteries?

When is the scar tissue that is formed after a myocardial infarction (MI) most vulnerable to injury?

An individual who is demonstrating elevated levels of troponin, creatine kinase–isoenzyme MB (CK-MB), and lactic dehydrogenase (LDH) is exhibiting indicators associated with which  condition?

What is the expected electrocardiogram (ECG) pattern when a thrombus in  a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the  epicardium?

How does angiotensin II increase the workload of the heart after a myocardial infarction (MI)?

A patient reports sudden onset of severe chest pain that radiates to the back and worsens with respiratory movement and when lying down. These clinical manifestations describe:

Ventricular dilation and grossly impaired systolic function, leading to dilated heart failure, characterize which form of   cardiomyopathy? Alterations of Cardiovascular Function Essay.

A disproportionate thickening of the interventricular septum is the hallmark of which form of  cardiomyopathy?

Amyloidosis, hemochromatosis, or glycogen storage disease usually causes which form of  cardiomyopathy?

 

Which condition is a cause of acquired aortic  regurgitation?

Which predominantly female valvular disorder is thought to have an autosomal dominant inheritance pattern, as well as being associated with connective tissue disease?

Which disorder causes a transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center, making them appear as a ringworm?

What is the most common cause of infective  endocarditis?

What is the most common cardiac disorder associated with acquired immunodeficiency  syndrome (AIDS)

A patient is diagnosed with pulmonary disease and elevated pulmonary vascular resistance. Which form of heart failure may result from pulmonary disease and elevated pulmonary vascular  resistance? Alterations of Cardiovascular Function Essay

What cardiac pathologic condition contributes to ventricular   remodeling?

In systolic heart failure, what effect does the renin-angiotensin-aldosterone system (RAAS) have on stroke  volume?

What is the cause of the dyspnea resulting from a thoracic   aneurysm?

Which statement is true concerning the cells’ ability to synthesize cholesterol?

What is the trigger for angina  pectoris?

Individuals being effectively managed for type 2 diabetes mellitus often experience a healthydecline in blood pressure as a result of what   intervention?

Which statements are true regarding fatty streaks? (Select all that   apply.) Fatty streaksprogressively damage vessel walls.

Fatty streaks are capable of producing toxic oxygen radials.

When present, inflammatory changes occur to the vessel walls. Alterations of Cardiovascular Function Essay

Oxidized low-density lipoproteins (LDLs) are involved in their formation.

What factors contribute to the development of orthostatic   hypotension? (Select all that apply.)

Altered body chemistry

Drug action of certain antihypertensive agents

Prolonged immobility

Effects of aging on postural  reflexes

Which assessment findings are clinical manifestations of aortic   stenosis? 
(Select all that apply.)

Which risk factors are associated with infective endocarditis? (Select all that apply.)

Match the descriptions with the corresponding  terms.

A. Impairs flow from left atrium to left  ventricle

B. Impairs flow from the left  ventricle Alterations of Cardiovascular Function Essay

C. Backflow into left atrium

D. Backflow into right atrium

E. Backflow into left ventricle

Aortic stenosis

Aortic regurgitation

 

Mitral stenosis

Tricuspid regurgitation

Mitral regurgitation

NURS 6512 FINAL EXAM: WALDEN UNIVERSITY

1. Costovertebral angle tenderness should be assessed whenever you suspect the patient may have: –

2. In older adults, overflow fecal incontinence is commonly due to:

3. A 1 month old boy has been vomiting for 2 weeks. How is this symptom of GERD and pyloric stenosis further differentiated in this child’s assessment?

4. Auscultation of borborygmi is associated with:

5. When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? –

6. Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the:

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7. The major function of the large intestine is: –

8. Which structure is located in the hypogastric region of the abdomen? –

9. A 45 year old man relates a several week history of severe intermittent abdominal burning sensations. He relates that the pain is relieved with small amounts of food. Before starting the physical examination, you review his laboratory work, anticipating a (n): –

10. You are caring for a patient with trigeminal neuralgia. During the assessment, the patient would describe the pain as: – NURS 6512 FINAL EXAM

11. Your 85 year old patient is complaining of right knee pain. She has a history of osteoarthritis for which she is given anti-inflammatory medication. To assess her right knee pain, you should ask her if: – 12. A 5 year old is complaining of nondescriptive “belly pain.” Your next action should be to ask him to: – 13. The perception of pain: –

14. Patients presenting with ascites, jaundice, cutaneous spider veins, and nonpalpable liver exhibit signs of: –

15. A patient presents to the emergency department after a motor vehicle accident. The patient sustained blunt trauma to the abdomen and complains of pain in the upper left quadrant that radiates to the left shoulder. What organ is most likely injured?

16. Imaging studies reveal that a patient has dilation of the renal pelvis from an obstruction in the ureter, what condition will be documented in this patient’s health record? –

17. Visible intestinal peristalsis may indicate: –

18. Infants born weighing less than 1500g are at higher risk for:

19. Which of the following factors is not known to affect patient compliance with his or her treatment regimen? –

20. One of the most important aspects to consider in the orthopedic screening examination is: –

21. The sequence of the physical examination should be individualized to:

22. As you greet the patient, which examination technique is first implemented? –

23. Which of the following is most likely to enhance examiner reliability?

24. A 7 year old boy is brought to your office with a chief complaint of possible fracture to his left third finger. He jammed it while playing basketball 2 days ago. The mother states that she really does not think it is broken because he can move it. What is your best response? –

25. A patient presenting for the first time with typical low back pain should receive which of the following diagnostic tests?

26. Skeletal changes in older adults are the result of: –

27. A positive straight leg raise test usually indicates: – NURS 6512 FINAL EXAM

28. What technique is performed at every infant examination during the first year of life to detect hipdislocation? –

29. Expected normal findings during inspection of spinal alignment include-

30. Temporalis and masseter muscles are evaluated by:-

31. When palpating joints, crepitus may be caused when: –

32. A 3 year old is brought to the clinic complaining of a painful right elbow. He is holding the right arm slightly flexed and pronated and refuses to move it. the mother states that symptoms started right after his older brother had been swinging him around by his arms. This presentation supports a diagnosis of: –

33. Light skin and thin body habitus are risk factors for: –

34. Risk factors for sports-related injuries include: –

35. Injuries to long bones and joints are more likely to result in fractures than in sprains until: –

36. Ligaments are stronger than bone until: –

37. The family history for a patient with joint pain should include information about siblings with: –

38. The Thomas test is used to detect: –

39. A goniometer is used to assess: –

40. During a football game, a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee you should initially perform the ­­­­­­­­­­­­­­­­________ test. – NURS 6512 FINAL EXAM

41. You note that a child has a positive Gower Sign. You know that this indicates generalized:  –

42. The dowager hump is: –

43. What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention?–

44. A common finding in markedly obese and pregnant women is: –

45. A 45-year-old laborer presents with low back pain, stating that the pain comes from the right buttock and shoots down and across the right anterior thigh, down the shin to the ankle. Which examination finding is considered more indicative of nerve root compression?A 45 year old laborer presents with low back pain, stating that the pain comes from the right buttock and shoots down and across the right anterior thigh, down the shin to the ankle. Which examination finding is considered more indicative of nerve root compression? –

46. Mrs. Bower is a 57 year old patient who comes in for an office visit. Which of the following disorders is known to be hereditary? –

47. Testing of cranial nerve ­­­­________ is not routinely performed unless a problem is suspected. – I

48. The patient is able to rapidly touch each finger to his thumb in rapid sequence. What does this finding mean? –

49. Which question asked by the examiner may hellp to determine prevention strategies for seizures that a patient is experiencing? –

50. A patient has a complaint of dizziness. The patient makes the following statement: “I sometimes feel as if the whole room is spinning.” What type of neurologic dysfunction should the examiner suspect? –

51. The examiner asks the patient to close her eyes, then places a vibrating tuning fork on the patient’s ankle and asks her to indicate what is felt. What is being assessed? –

52. Which of the following findings should an examiner consider a normal finding if associated with pregnancy? – –

52. Jack is a 52 year old obese man with a history of poorly controlled diabetes. He also smokes. Based on the above data, the examiner should recognize that Jack has several risk factors for: – –

53. Mrs. Jones is a 24 year old patient who presents to your office 2 days postpartum. She complains that she is experiencing foot drop. Which of the following problems should the examiner consider? –

54. The examiner is assessing deep tendon reflex response in a 12 year old boy. The response is an expected reflex response. Which of the following scores should be documented? –

55. A 68 year old patient presents to your office for follow-up. He tells you, “I have a hard time finding the right words when I am talking;” he also is experiencing numbness. On examination, you note postural instability. This symptom may be: –

56. Motor maturation proceeds in an orderly progression from: –

57. The thalamus is the major integration center for perception of: –

58. The examiner should be concerned about neurologic competence if a social smile cannot be elicited by the time a child is ________old. –

59. Normal changes of the aging brain include: – –

60. When interviewing a 70 year old female clinic patient, she tells you that she takes ginkgo biloba and St. John’s Wort. You make a short note to check for results of the: —

61. The area of body surface innervated by a particular spinal nerve is called a: – –

62. If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation? – –

63. The finger-to-nose test allows assessment of: – –

64. You ask the patient to follow a series of short commands to assess: – –

65. As Mr. B. enters the room, you observe that his gait is wide based and he staggers from side to side while swaying his trunk. You would document Mr. B.’s pattern as: –

66. When is the mental status portion of the neurologic system examination performed? –

67. An aversion to touch or being held, along with delayed or absent language development, is a characteristic of: —

68. The autonomic nervous system coordinates which of the following? –

69. The major function of the sympathetic nervous system is to: – –

70. The parasympathetic nervous system maintains the day-to-day function of: –

71. Cerebrospinal fluid serves as a: – –

72. You are performing a two-point discrimination test as part of a well physical examination. The area with the ability to discern two points in the shortest distance is the: —

73. Which type of hallucination is most commonly associated with alcohol withdrawal? – –

74. On a scale of 0 to 4+, which deep tendon reflex score is appropriate for a finding of clonus in a patient? –

75. Which statement is true regarding mental status changes in older adults? – –

76. A characteristic related to syphilis or diabetic neuropathy is testicular: —

77. When collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding: – –

78. What risk factor is associated with cervical cancer? – –

79. A 23 year old female presents with severe right lower quadrant tenderness. All of the following should be considered in the differential except: – –

80. What is the initial diagnostic radiology test that should be ordered if you suspect a ruptured ovarian cyst? – –

81. A 17 year old male was brought into the emergency room with testicular/scrotal pain. The differential diagnosis should include all except: –

82. The nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremicbreasts bilaterally. NURS 6512 FINAL EXAM You should advise the patient to: – –

83. A normal vas deferens should feel: – –

84. In a woman complaining of a breast lump, it is most important to ask about: – –

85. The finding of a painless indurated lesion on the glans penis is most consistent with: – –

86. Thrombosed hemorrhoids are: – –

87. Pregnancy-related cervical changes include: –

88. You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should: – –

89. An adolescent male is being seen for acute onset of left testicular pain. The pain started 3 hours ago. He complains of nausea and denies dysuria or fever. Your prioritized assessment should be to: –

90. A 23 year old white woman has come to the clinic because she has missed two menstrual periods. She states that her breasts have enlarged and that her nipples have turned a darker color. Your further response to this finding is: – –

91. What accommodations should be used in the position of a hearing-impaired woman for a pelvic examination? – –

92. Sexual differentiation in the fetus has occurred by ­­­_______weeks gestation. – –

93. You are performing a clinical breast examination for a 55 year old woman. While palpating the supraclavicular area, you suspect that you felt a node. In order to improve your hooked technique, you should: —

94. If a firm, transverse ridge of compressed tissue is felt bilaterally along the lower edge of a 40 year old patient’s breast, you should: —

95. A therapeutic technique for dealing with grieving individuals is to: –

96. The examination of the newborn should begin with: – –

97. Which one of the following patient characteristics is most likely to limit patient reliability during history taking? – –

98. In crying infants, it is often difficult to: – –

99. Which of the following statements accurately reflects the sensitivity and specificity of laboratory tests? –-

100. Which medical condition would exclude one from sports participation? – –

101. Your 15 year old patient is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You question this patient about her: – –

102. Which of the following are examined with the patient in a reclining 45 degree position? –-

103. Functional assessment is most important during the examination of a(n): —

104. The best way to ease the apprehension of a 3 year old child before a physical examination is to: – –

105. An ophthalmoscopic eye examination involves: – –

106. When conducting a geriatric assessment, basic activities of daily living (ADLs) include: –

107. The checkout station for preparticipation physical evaluation (PPE) is critical because at this point: –

108. Which of the following is true regarding the relationship between the examiner and the patient? –

109. Which of the following factors is not known to affect patient compliance with his or her treatment regimen? –

110. One of the most important aspects to consider in the orthopedic screening examination is: –

111. As you greet the patient, which examination technique is first implemented? –

112. Which portion of the physical examination is best done with the patient standing? –

113. Which patient position facilitates inspection of the chest and shoulders? –

114. The NURS 6512 FINAL EXAM least reliable indicator of newborn distress is: –

115. Proprioception should be assessed while the patient is: –

116. Part of the screening orthopedic component of the examination includes evaluating the person while: –

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: NURS 6512 FINAL EXAM

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:

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? NURS 6512 FINAL EXAM

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:

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? NURS 6512 FINAL EXAM

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?

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?

56. Penicillin is considered a? NURS 6512 FINAL EXAM

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:

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: NURS 6512 FINAL EXAM

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: Walden University

 

Which of the following is an expected change in the assessment

of the thyroid during pregnancy?

 

When recording physical finding, which data are recorded first for all systems?

 

In counseling a Client regarding education .,you explain that Linoleic acid, a major fatty acid, is thought to be essential for:

Peritonitis produces bowel sounds that are:

 

Sweat glands, hair, and nails are all formed:

 

The adult recommended dietary fat intake

 

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

____ %.

 

Which of the formats would be used for a  (POMR)

 

Question 141 out of 1 pointsMr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:

 

Question 151 out of 1 pointsYour patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to:

 

Question 161 out of 1 pointsWhen examining the skull of a 4-month-old baby, you should normally find:

 

Question 171 out of 1 pointsMs. G. is being seen for her routine physical examination. She is a college graduate and president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G.’s _____ history.

 

To perform the Rinne test, place the tuning fork on the:

 

Question 71 out of 1 pointsWhen are open-ended questions generally most useful?

Question 80 out of 1 pointsThe review of systems is a component of the:

 

Fluorescing lesions are best distinguished using a(n):

 

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

 

Mr. Franklin is speaking with you, the health care provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate for enhancing communication?

 

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

 

Underestimation of blood pressure will occur if the blood pressure cuff’s width covers:

 

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?

 

The most superior part of the stomach is the:

 

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

 

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

 

Which cranial nerves innervate the face? NURS 6512 FINAL EXAM

Focused Exam: Abdominal Pain – Esther Park shadow health assignment

Esther Park is a 78-year-old Korean woman presenting with abdominal pain in the ED. the abdominal pain is a 6 and described as a constant dull, crampy feeling low low in her abdomen that began as a general discomfort about 5 days ago when the patient states she began having difficulties going to the bathroom and has not had a bowel movement for several days. The pain worsens when she moves around a lot or eats something. The only surgeries she has had is gallbladder removal and C-section, both in her 40s. She takes 10mg of Accupril daily. She has pain in her LLQ of her abdomen when percusses. Upon palpation of

the LLQ a firm, oblong mass approximately 2X4cm was noted. Focused Exam: Abdominal Pain – Esther Park shadow health assignment

NAPSRx Final Exam Question and 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

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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.

 

3. What does AMA stand for?

A. American Medical Academy

B. American Medical Accreditation

C. American Medical Association

D. Association of Medical Assistants

 

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 NAPSRx Final Exam Question and Answers

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? NAPSRx Final Exam Question and Answers

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

 

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%

 

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.

 

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

 

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

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? NAPSRx Final Exam Question and Answers

A. preclinical

B. Phase I

C. Phase II

D. Phase III

 

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. NAPSRx Final Exam Question and Answers

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

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. NAPSRx Final Exam Question and Answers

 

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

 

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. NAPSRx Final Exam Question and Answers.

 

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.

 

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 Question and Answers

 

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. NAPSRx Final Exam Question and Answers.

C.Sustained release

D.Titration

 

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.

NAPSRx Final Exam Question and Answers

NURS 6560 Final Exam Question 1

 
A patient with suspected Cushing’s syndrome is being evaluated to establish the diagnosis and cause. Patients with an adrenal tumor typically will demonstrate:

 

A.

Low ACTH and low cortisol

B.

Low ACTH and high cortisol

C.

High ACTH and low cortisol

D.

High ACTH and high cortisol

 

ORDER A PLAGIARISM-FREE PAPER HERE

Question 2

 

Pneumatosis, or gas cysts, may form in the wall anywhere along the gastrointestinal tract; in some cases, they will produce symptoms such as abdominal discomfort, diarrhea with mucus, and excess flatulence. Treatment of pneumatosis most often involves:

 

A.

Several days of oxygen by face mask

B.

Hyperbaric oxygen

C.

Surgical resection

D.

Treatment of underlying disease

 

Question 3

 

Jennifer is an RN applicant for a staff nurse position in the surgical ICU. She has had a screening PPD and comes back in 48 hours to have it read. There is a 12-mm induration at the site of

injection. A chest radiograph is negative. The AGACNP knows that the next step in Jennifer’s evaluation and management should include:

 

A.

No further care, because the chest radiograph is negative

B.

Quantiferon serum assay for exposure

C.

Consideration of prophylactic therapy

D.

Beginning therapy for pulmonary TB pending sputum cultures

 

Question 4

 

P. E. is a 61-year-old female who presents for a postoperative visit following a gastric resection after a perforation of peptic ulcer. She reports feeling better, although it is taking longer than she expected. However, she says she is feeling better each day, her appetite is returning, and her incision is healing well NURS 6560 Final Exam. She is being discharged from surgical care and advised to continue her routine health promotion follow-up with her primary care provider. As part of her surgical discharge teaching, the AGACNP counsels P. E. that as a result of her gastric resection she will need lifelong follow-up of:

 

A.

Blood group substances

B.

Electrolytes

C.

Vitamin B12

D.

Gastric pH

 

 

Question 5

 

M. T. is a 71-year-old female who presents for evaluation of a ―lump on her chest.‖ She denies any symptoms—there is no pain, erythema, edema, ecchymosis, or open areas—it is just a lump. She has no idea how long it has been there and just noticed it a few weeks ago. Physical examination reveals a round, smooth, flesh-colored tumor. It is firm but not hard; it has smooth borders. It measures 6 cm in diameter and is non-tender to palpation. The AGACNP suspects that this is a classic presentation of the most common chest wall tumor known as a:

 

A.

Neurolemma

B.

Lipoma

C.

Hemangioma

D.

Lymphangioma

 

Question 6

 

The AGACNP is receiving report from the recovery room on a patient who just had surgical resection for pheochromocytoma. He knows that which class of drugs should be available immediately to manage hypertensive crisis, a possible consequence of physical manipulation of the adrenal medulla?

 

A.

 

Alpha-adrenergic antagonists

B.

Beta-adrenergic antagonists

C.

Intravenous vasodilators

D.

Arteriolar dilators

 

Question 7

 

In myelodysplastic syndromes, the primary indications for splenectomy include:

 

A.

Major hemolysis unresponsive to medical management

B.

Severe symptoms of massive splenomegaly

C.

Sustained leukocyte elevation above 30,000 cells/µL

D.

Portal hypertension

 

 

Question 8

 

The AGACNP is evaluating a patient who reportedly fell down a flight of steps. Her history is significant for several emergency room visits, but she denies any significant medical conditions. Some documentation in her chart indicates that she may have been subjected to physical abuse. Today she presents with a periorbital ecchymosis of the left eye and swelling in the left side of the face. Her neurologic examination is within normal limits. Which head imaging study would be most useful in assessing for findings consistent with a history of abuse?

 

A.

Radiographs

B.

CT scan without contrast

C.

MRI

D.

PET scan

 

Question 9

 

The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kg/day. The best approach to this patient’s management is to:

 

A.

Continue the current regimen

B.

D/C the spironolactone and begin a loop diuretic

C.

Add a loop diuretic to the spironolactone

D.

Proceed to large-volume paracentesis

 

Question 10

 

 

Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?

 

A.

High-dose initial steroids are tapered to off over a period of 4 to 6 weeks posttransplant

B.

There is a strong interest in developing corticosteroid-free posttransplant protocols

C.

Better results are demonstrated in corticosteroid-free protocols for second-transplant recipients

D.

Evidence supports corticosteroid-free rejection protocols

 

 

Question 11

 

K. T. presents for a routine wellness examination, and the review of systems is significant only for a markedly decreased capacity for intake and a vague sense of nausea after eating. K. T. denies any other symptoms; the remainder of the GI review of systems is negative. His medical history is significant for complicated peptic ulcer disease that finally required resection for a perforated ulcer. The AGACNP advises the patient that:

 

A.

He will need endoscopy to evaluate the problem

B.

Chronic gastroparesis is a known complication of ulcer surgery

C.

Medication is unlikely to help, and he may need another surgery

D.

His symptoms occur in 5 to 10% of people after ulcer surgery

 

 

Question 12

 

The AGACNP is rounding on a patient following splenectomy for idiopathic thrombocytopenia purpura. On postoperative day 2, a review of the laboratory studies is expected to reveal:

 

A.

Increased MCV

B.

Increased Hgb

C.

Increased platelets

D.

Increased albumin

 

Question 13

 

A patient being monitored post-heart transplant suffers a bradyarrhythmia. The AGACNP knows that which of the following medications is not indicated as part of emergency intervention for bradycardic abnormalities in a posttransplant patient?

 

A.

Isoproterenol 0.2 to 0.6 mg IV bolus

B.

External pacemaking

C.

Atropine 0.5 mg IV

D.

Epinephrine 1 mg IV

 

Question 14

 

Ms. Carpenter is a 28-year-old female who presents in significant pain; she indicates that the discomfort is in the right lower quadrant. The discomfort is colicky in nature and has the patient in tears. Which of the following associated findings increases the index of suspicion for ureteral colic?

 

A.

Temperature > 102°F

B.

White blood cell count > 14,000 cells/µL

C.

Vomiting

D.

Hematuria

Question 15

 

Which of the following is not a true statement with respect to decision making for a cognitively impaired patient?

 

A.

Only a court can declare a patient incompetent

B.

Impaired cognition does not make a person incompetent

C.

Living wills typically are honored if a person is terminally ill

D.

A patient can give informed consent if not declared incompetent

 

 

Question 16

 

Hepatic encephalopathy is a clinical syndrome seen in patients with chronic liver disease; its presentation may range from mild personality changes, to psychosis, to coma. The primary chemical mediators of hepatic encephalopathy include all of the following except:

 

A.

Gamma-aminobutyric acid (GABA)

B.

Ammonia

C.

False neurotransmitters

D.

Serotonin

Question 17

 

Ross A. is a 38-year-old who has just had a kidney transplant. The AGACNP knows that, due to the characteristic and anticipated response of transplanted kidneys, the patient requires:

 

A.

Aggressive rehydration

B.

Controlled hydration

C.

Hypertonic rehydration

D.

Isotonic rehydration

 

Question 18

 

Janice is a 32-year-old female who presents for evaluation of abdominal pain. She has no significant medical or surgical history and denies any history of ulcers, reflux, or gastritis. However, she is now in significant pain and is afraid something is ―really wrong.‖ She describes what started out as a dull discomfort in the upper part of her stomach a few hours ago but has now become more profound and centered on the right side just under her ribcage. She has not vomited but says she feels nauseous. Physical exam reveals normal vital signs except for a pulse of 117 bpm. She is clearly uncomfortable, and palpation of the abdomen reveals tenderness with deep palpation of the right upper quadrant. The AGACNP orders which imaging study to investigate the likely cause?

 

A.

Abdominal radiographs

B.

CT scan of the abdomen with contrast

C.

Right upper quadrant ultrasound

D.

A HIDA scan

 

 

Question 19

 

Justin F. is seen in the emergency department with an 8-cm jagged laceration on the dorsal surface of his right forearm. He says he was working with his brother-in-law yesterday morning building a deck on the back of his home. A pile of wooden planks fell on top of him, and he sustained a variety of cuts and superficial injuries. He cleaned the wound with soap and water but didn’t want to go to the emergency room because he didn’t want to risk being in the waiting room for hours. He wrapped up his arm and went back to work, and then took a normal shower and went to bed last night. This morning the cut on his arm was still flapping open, and he realized he needed sutures. The appropriate management of this patient includes:

 

A.

Proper cleansing and covering of the laceration, along with antibiotic therapy

B.

Local anesthesia, cleansing, and wound exploration for foreign bodies

C.

Local anesthesia, cleansing, and suture repair

D.

Cleansing, covering, antibiotic therapy, and tetanus prophylaxis

 

Question 20

 

T. O. is a 44-year-old female patient who presents for evaluation of sudden, severe upper abdominal pain. She is clear about the onset, which was profound and occurred approximately one hour ago. She denies that the onset had any relationship to food or eating, and she denies nausea or vomiting. On examination, she is lying on her right side with her hips and knees flexed to draw her knees to her chest. Vital signs are stable, but examination reveals involuntary guarding. The abdomen is painful and tympanic to percussion in all quadrants. CBC reveals a white blood cell count of 15,600/µL. The AGACNP suspects:

 

A.

Dissecting aortic aneurysm

B.

Acute pancreatitis

C.

Perforated peptic ulcer

D.

Mallory-Weiss tear

 

 

Question 21

 

A 42-year-old woman presents to the emergency department after being raped. The AGACNP examines her and realizes that the patient’s husband is the rapist. The patient does not want to press charges and wants to return home with her husband. The AGACNP’s initial action should be to:

 

A.

Report the physical assault to law enforcement

B.

Have the patient sign a release to go home with her husband

C.

Consult psychiatry for a psych hold

D.

Provide counseling to the patient regarding her options

 

 

Question 22

 

M. R. is a 52-year-old female who presents complaining of significant abdominal pain, which she rates as 8 to 9 on a 1 to 10 scale. The pain has been going on for a matter of hours, and she is afraid it won’t go away on its own. She denies any nausea or vomiting, and she cannot remember precisely when her last bowel movement occurred; probably it was a few days ago. She reports

that she is ―always‖ constipated. On physical examination, she is tachycardic but otherwise has normal vital signs; her abdomen is tensely rigid, but no point tenderness to palpation is appreciated. The entire abdomen percusses as tympanic—there is no distinct dullness over the upper quadrants. Bowel sounds are present but hypoactive and intermittent. There is rebound tenderness to palpation. The AGACNP suspects:

 

A.

Perforated bowel

B.

Peritonitis

C.

Ischemic bowel

D.

Intestinal abscess

 

 

Question 23

 

C. V. is a 70-year-old African American male patient who presents for surgical consultation. His history includes 4 months of severe hypertension that has been poorly responsive to medication. He also complains of intermittent pounding headaches, palpitations, and a vague sense of anxiety with tremors. A 24-hour urine demonstrated elevated metanephrines. The AGACNP recognizes that this patient has a:

 

A.

 

Malignant hyperthyroidism

B.

Catecholamine-secreting tumor

C.

Pituitary adenoma

D.

Hyperaldosteronism

 

Question 24

 

The AGACNP knows that when evaluating a patient with suspected acute pyelonephritis, which of the following is not a common feature?

 

A.

Pyuria

B.

Fever

C.

CVA tenderness

D.

Gross hematuria

 

Question 25

 

B. T. is a 49-year-old male who has been admitted for the management of an episode of diverticulitis. This is his fifth hospitalization this year, and in previous hospitalizations he has had both abscess and stricture as a consequence of his disease. His treatment this hospitalization should include:

 

A.

Extended-spectrum antibiotics

B.

Surgical consultation for colectomy

C.

Expectant treatment with nonabsorbable antibiotics

D.

Colonoscopy

 

 

Question 26

 

Based upon an understanding of the normal relationship between gastrin levels and acid secretion, the AGACNP recognizes that which of the following combinations is almost diagnostic of gastrinoma?

 

A.

 

Hypogastrinemia and acid hyposecretion

B.

Hypergastrinemia and acid hyposecretion

C.

Hypogastrinemia and acid hypersecretion

D.

Hypergastrinemia and acid hypersecretion

 

Question 27

 

The AGACNP is covering an internal medicine service and is paged by staff to see a patient who has just pulled out his ET tube. After the situation has been assessed, it is clear that the patient will go into respiratory failure and likely die if he is not reintubated. The patient is awake and alert and is adamant that he does not want to be reintubated. The AGACNP is concerned that there is not enough time to establish a DNR—the patient needs to be reintubated immediately and already is becoming obtunded. Which ethical principles are in conflict here?

 

A.

Veracity and beneficence

B.

Beneficence and nonmalfeasance

C.

Autonomy and beneficence

D.

Justice and autonomy

 

Question 28

 

R. S. is a 66-year-old female with Cushing’s syndrome due to an ACTH-producing pituitary tumor. The tumor is readily isolated by imaging, and the patient had an uneventful surgery. When seeing her in follow-up, the AGACNP anticipates:

 

A.

Rapid reversal of symptoms, with good pituitary function

B.

Transient rebound release of remaining pituitary hormones

C.

Markedly improved dexamethasone suppression test

D.

Hyponatremia and compensatory SIADH

Question 29

 

A 16-year-old male presents with fever and right lower quadrant discomfort. He complains of nausea and has had one episode of vomiting, but he denies any diarrhea. His vital signs are as follows: temperature 101.9°F, pulse 100 bpm, respirations 16 breaths per minute, and blood pressure 110/70 mm Hg. A complete blood count reveals a WBC count of 19,100 cells/µL. The AGACNP expects that physical examination will reveal:

 

A.

+ Murphy’s sign

B.

+ Chvostek’s sign

C.

+ McBurney’s sign

D.

+ Kernig’s sign

 

Question 30

 

N. C. is a 60-year-old female with primary hyperaldosteronism. She has been referred to your service for surgical management. Anticipated findings on clinical history would include:

 

A.

Palpitations, headaches, and sweating

B.

Polyuria, weakness, and paresthesias

C.

Dry skin, straie, and unplanned weight loss

D.

Early satiety, tremors, and fatigue

 

 

Question 31

 

Mrs. Maroldo is an 81-year-old female who presents for evaluation of pain in her left lower quadrant. She has had this pain before and says she usually takes antibiotics and it goes away. However, this time it seems worse, and she has had it for 4 days even though she says she started taking her leftover antibiotics from the last episode. She denies any nausea or vomiting but says she simply isn’t hungry. She had a little diarrhea yesterday but no bowel movements today. She has a temperature of 100.9°F and a pulse of 104 bpm, respirations of 20 breaths per minute, and a blood pressure of 94/60 mm Hg. She has some discomfort to deep palpation in the left lower quadrant. The AGACNP suspects:

 

A.

Irritable bowel syndrome

 

 

 

B.

 

Inflammatory bowel disease

 

C.

Diverticulitis

 

D.

Appendicitis

 

 

Question 32

 

In the majority of cases, the first clinical manifestation of physiologic stress ulcer is:

 

A.

Epigastric pain

B.

Change in mental status

C.

Fever

D.

Hemorrhage

 

Question 33

 

A patient with chronic hepatic encephalopathy is being discharged home. Discharge teaching centers upon long-term management strategies to prevent ammonia accumulation. Teaching for this patient includes instruction about:

 

A.

Lactulose taken 20 g PO daily

B.

Spironolactone taken 100 mg PO daily

C.

Protein intake of 50 g daily

D.

Zolpidem taken 10 mg PO qhs.

 

Question 34

 

R. R. is a 61-year-old male patient who presents with a chief complaint of fever and urinary symptoms. He was in his usual state of good health when for no apparent reason he developed pain in his back and perineal region, as well as fever and chills. He presents as septic. He had urinary hesitancy and decreased stream but now reports that he has not passed urine in more than 12 hours. Palpation of the lower abdomen is consistent with bladder distention NURS 6560 Final Exam. The AGACNP knows that which of the following is contraindicated in this circumstance?

 

A.

Digital prostate examination

B.

Urinary catheterization

C.

Fluoroquinolone antibiotics

D.

Drainage of prostate abscess

 

Question 35

 

On postoperative day 7 following hepatic transplant, the patient evidences signs and symptoms of acute rejection, confirmed by histologic examination. The AGACNP knows that first-line treatment of acute rejection consists of:

 

A.

Cyclosporine

B.

Azathioprine

C.

Methylprednisolone

D.

Sirolimus

 

Question 36

 

R. R. is a 71-year-old female who presents with left lower quadrant pain that started out as cramping but has become more constant over the last day. She reports constipation over the last few days but admits that for as long as she can remember she has had variable bowel habits. Her vital signs are normal, but physical examination reveals some tenderness in the left lower quadrant. Which diagnostic test is most likely to support the leading differential diagnosis?

 

A.

CT scan with IV, oral, and rectal contrast

 

 

B.

 

CBC with WBC differential

 

 

C.

Colonoscopy

 

 

D.

Barium enema

 

 

Question 37

 

Ms. O’Reilly is a 69-year-old patient who is having a bowel resection for a malignant tumor of the right colon. She has several chronic medical conditions and takes numerous daily medications, including metoprolol 100 mg daily, warfarin 5 mg daily, vitamin E 200 units daily, and metformin 1000 mg bid. Which of the following regimens is the most appropriate approach to managing her medications preoperatively? NURS 6560 Final Exam.

 

A.

All medications should be taken up to and including the morning of surgery

B.

The beta blocker may be taken up until the day of surgery, metformin should be held the day of surgery, and the remaining medications should be d/c’d 5–7 days before surgery

C.

Warfarin should be held 5 days before surgery; all other medications may be taken through the morning of surgery

D.

Metformin should be held if the morning blood sugar is < 200 mg/dL; all other medications except warfarin may be given the day of surgery   Question 38   Mr. Novello is an 81-year old male patient who presents with crampy abdominal pain in the hypogastrum and a vague history as to his last normal bowel movement. Physical examination reveals distention and high-pitched bowel sounds. The patient says he has never has this kind of problem before and denies any history of abdominal surgery. Abdominal radiographs reveal a frame pattern of colonic distention. The AGACNP considers:   A. A stimulant laxative to relieve bowel contents B. Carcinoma of the bowel as a leading diagnosis C. Decompression of the colon with rectal tube D. Angiography to rule out mesenteric ischemia Question 39   Jane S. is a 35-year-old female patient who is at 30 weeks gestation. She is being followed regularly for prenatal care and has always been healthy; she just had an office visit and was told everything was fine. Tonight she presents to the emergency room complaining of significant pain in the upper abdomen. NURS 6560 Final Exam. Her vital signs reveal a temperature of 98.4°F, pulse of 110 bpm, respirations of 20 breaths per minute, and blood pressure of 144/90 mm Hg. A urinalysis reveals proteinuria, and a metabolic panel is significant for increased transaminases. Her hemogram is normal, but the CVC reveals platelets of 85,000. The AGACNP knows that which of the following must be evaluated as a cause of her abdominal pain?   A. HELLP syndrome B. Placental abruption C. Spontaneous hepatic rupture D. Preterm labor     Question 40   Which of the following statements is true with respect to adrenal tumors that produce gender symptoms?   A. Feminizing adrenal tumors are almost always carcinomas B. Feminizing adrenal tumors are the most common type of adrenal tumor C. Virilizing tumors in women are most often localized to the adrenal cortex D. Virilizing adrenal tumors are more likely to be malignant in children   Question 41   G. D. is a 13-year-old male patient who has a history of recurrent fever and flank pain. His parents traditionally are not believers in the health care system, and he has not been seen by a health care provider for many years. Today he has fever, chills, and costovertebral angle tenderness. Urinalysis reveals findings consistent with acute urinary infection. The AGACNP treats the patient for pyelonephritis and considers which study to evaluate for vesicoureteral reflux?   A. Bilateral renal ultrasound B. CT scan of the abdomen and pelvis C. Voiding cystourethrograpy D. Radioisotope scanning   Question 42   In which form of hypospadias should circumcision be deferred in order to preserve the prepuce for later surgical repair?   A. Ventral displacement B. Proximal displacement C. Midscrotal hypospadias D. Meatus proximal to the corona     Question 43   T. G. is a 48-year-old female who presents with biliary colic. She has had previous episodes but has resisted operation because she is afraid of anesthesia. Today her physical exam reveals a clearly distressed middle-aged female with right upper quadrant pain, nausea, and vomiting. Which of the following findings suggests a complication that requires a surgical evaluation? NURS 6560 Final Exam   A. A temperature of 101.5°F B. A leukocyte count of 18,000/µL C. A palpable gallbladder D. A positive Murphy’s sign Question 44   Achalasia is a risk factor for:   A. Squamous cell carcinoma B. Gastroesophageal reflux disease C. Esophageal atrophy D. Malabsorption syndromes   Question 45   Carolyn C. has a history of Crohn’s disease and has been managed with immunologic agents, with moderate success. Today she presents with severe abdominal pain that comes and goes in waves; it started shortly after she ate a little bit of cottage cheese and crackers. This has never happened before with her Crohn’s disease. She has difficulty localizing the pain but seems to indicate the general area of the umbilicus. She had one episode of diarrhea this morning. Abdominal examination is nonspecific, producing mild tenderness on palpation. Plain abdominal films reveal a dilated small bowel with air fluid levels. The AGACNP suspects:   A. Perforated small bowel B. Ulceration through the thickness of small bowel C. Small bowel obstruction D. Gastroenteritis   NURS 6560 Midterm Exam (2018): Advanced Practice Care of Adults in Acute Care Settings: Walden University (100 Questions) Question 1 S. is a 59-year-old female who has been followed for several years for aortic regurgitation. Serial echocardiography has demonstrated normal ventricular function, but the patient was lost to follow-up for the last 16 months and now presents complaining of activity intolerance and weight gain. Physical examination reveals a grade IV/VI diastolic aortic murmur and 2+ lower extremity edema to the midcalf. The AGACNP considers which of the following as the most appropriate management strategy? A. Serial echocardiography every 6 months B. Begin a calcium channel antagonist C. Begin an angiotensin converting enzyme (ACE) inhibitor D. Surgical consultation and intervention Question 2 An ascending thoracic aneurysm of > 5.5 cm is universally considered an indication for surgical repair, given the poor outcomes with sudden rupture. Regardless of the aneurysm’s size, all of the following are additional indications for immediate operation except:

A. Comorbid Marfan’s syndrome

B. Enlargement of > 1 cm since diagnosis

C. Crushing chest pain

D. History of giant cell arteritis

Question 3

Jasmine is a 31-year-old female who presents with neck pain. She has a long history of injection drug use and admits to injecting opiates into her neck. Physical examination reveals diffuse tracking and scarring. NURS 6560 Final Exam. Today Jasmine has a distinct inability to turn her neck without pain, throat pain, and a temperature of 102.1°F. She appears ill and has foul breath. In order to evaluate for a deep neck space infection, the AGACNP orders:

A. Anteroposterior neck radiography

B. CT scan of the neck

C. White blood cell (WBC) differential

D. Aspiration and culture of fluid

Question 4

Mr. Draper is a 39-year-old male recovering from an extended abdominal procedure. As a result of a serious motor vehicle accident, he has had repair of a small bowel perforation, splenectomy, and repair of a hepatic laceration. He will be on total parenteral nutrition postoperatively. The AGACNP recognizes that the most common complications of parenteral nutrition are a consequence of:

A. Poorly calculated solution

B. Resultant diarrhea and volume contraction

C. The central venous line used for infusion

D. Bowel disuse and hypomotility

Question 5

Mr. Mettenberger is being discharged following his hospitalization for reexpansion of his second spontaneous pneumothorax this year. He has stopped smoking and does not appear to have any overt risk factors. While doing his discharge teaching, the AGACNP advises Mr. Mettenberger that his current risk for another pneumothorax is:

A. < 10% B. 25-50% C. 50-75% D. > 90

Question 6

One of the earliest findings for a patient in hypovolemic shock is:

A. A drop in systolic blood pressure (SBP) < 10 mm Hg for > 1 minute when sitting up

B. A change in mental status

C. SaO2 of < 88% D. Hemoglobin and hematocrit (H&H) < 9 g/dL and 27% Question 7 Traumatic diaphragmatic hernias present in both acute and chronic forms. Patients with a more chronic form are most likely to be present with: A. Respiratory insufficiency B. Sepsis C. Bowel obstruction D. Anemia Question 8 The AGACNP is managing a patient in the ICU who is being treated for a pulmonary embolus. Initially the patient was stable, awake, alert, and oriented, but during the last several hours the patient has become increasingly lethargic. At change of shift, the oncoming staff nurse appreciates a profound change in the patient’s mental status from the day before. Vital signs and hemodynamic parameters are as follows: BP 88/54 mm Hg Pulse 110 bpm Respiratory rate 22 breaths per minute SaO2 93% on a 50% mask Systemic vascular resistance (SVR) 1600 dynes ∙ sec/cm5 Cardiac index 1.3 L/min Pulmonary capillary wedge pressure (PCWP) 8 mm Hg This clinical picture is most consistent with which shock state? NURS 6560 Final Exam. A. Hypovolemic B. Cardiogenic C. Distributive D. Obstructive   Question 9 When counseling patients to prevent postoperative pulmonary complications, the AGACNP knows that with respect to smoking cessation, the American College of Surgeons and National Surgical Quality Improvement Program guidelines are clear that patients who stop smoking _____ weeks before surgery have no increased risk of smokingrelated pulmonary complications. A. 2 B. 4 C. 6 D. 8 Question 10 Mitch C. is a 39-year-old male who is brought to the ED by paramedics. According to the report of a neighbor, Mitch was distraught over a breakup with his fiancée and attempted to commit suicide by mixing some chemicals from under his kitchen sink and drinking them; afterward he changed his mind and knocked on his neighbor’s door asking for help. Mitch is awake but stuporous, and the neighbor has no idea what he drank. Visual inspection of his mouth and oropharynx reveals some edema and erythema. He is coughing and has large amounts of pooling saliva. Mitch is not capable of answering questions but he appears in pain. Endoscopy reveals full thickness mucosal injury with mucosal sloughing, ulceration, and exudate. The AGACNP knows that the appropriate course of treatment must include: A.At least 6 hours of observation in the emergency department B. Periodic esophagram C. Aggressive fluid resuscitation D.Esophagogastrectomy Question 11 Jared V. is a 35-year-old male who presents for evaluation of a dry cough. He reports feeling well overall but notices that he gets out of breath more easily than he used to when playing soccer. A review of systems yields results that are essentially benign, although the patient does admit to an unusual rash on his legs. Physical examination reveals scattered erythematous nodules on both shins. There is no drainage, discomfort, or itch. Additionally, diffuse, mildly enlarged lymph nodes are appreciated bilaterally. Results of a comprehensive metabolic panel and complete blood count are within normal limits. Twelve-lead ECG reveals sinus bradycardia at 58 bpm. Chest radiography reveals bilateral hilar and mediastinal lymphadenopathy. The AGACNP suspects: A.Bronchiectasis B. Pulmonary fibrosis C. Sarcoidosis D.Lung carcinoma Question 12 Mrs. Miller is a 44-year-old female who is on postoperative day 1 following a total abdominal hysterectomy. Her urine output overnight was approximately 200 mL. The appropriate response for the AGACNP would be to order: A.A urinalysis and culture B. 1 liter of NSS over 8 hours C. Encourage increased mobility D.Liberalize salt in the diet Question 13 All of the following are risk factors for spontaneous pneumothorax except: NURS 6560 Final Exam A.Connective tissue disease B. Scuba diving C. Chronic obstructive pulmonary disease (COPD) D.Central line insertion Question 14 The AGACNP is going over preoperative information and instructions with a patient who is having a major transverse abdominal procedure tomorrow morning. The patient is very nervous and is asking a lot of questions. The AGACNP prescribes a sleeping agent because he knows that anxiety and sleeplessness may: A.Lead to hypoxia due to hyperventilation B. Increase the physiologic stress response postoperatively C. Contribute to risk of delirium and prolonged length of stay D.Decreasep.o. intake and produce nutritional risk Question 15 In a patient with thyroid nodules, which of the following is the diagnostic study of choice to rule out thyroid cancer? A.Radioiodine scanning B. Percutaneous needle biopsy C. CT scan D.Ultrasound Question 16 When counseling a patient about treatment modalities for achalasia, the AGACNP advised that which of the following is the treatment of choice? A.Calcium channel antagonists B. Intrasphincter botulinum injection C. Pneumatic dilation D.Myotomy and partial fundoplication     Question 17 Mr. Liu is a 52-year-old male who has a history of thyroidectomy. He presents complaining of numbness and tingling in his legs and feet and generalized fatigue. Physical examination reveals a positive Chvostek’s sign. Which of the following laboratory studies should be ordered first? A.Renal function tests B. Parathyroid hormone C. Calcium D.Magnesium Question 18 V. is a 75-year-old male patient who, during a recent wellness evaluation, was found to have a new onset grade II/VI crescendo-decrescendo cardiac murmur at the 2nd intercostal space, right sternal border. He is symptom free and reports no limitations to his usual daily activity. He specifically denies activity intolerance or near syncope, and he is very active physically. Echocardiography reveals a mild aortic calcification. NURS 6560 Final Exam. The AGACNP knows that ongoing management for R. V. must include: A.Annual or biannual serial echocardiography B. Modification of activity level C. Baseline cardiac catheterization D. Statin therapy Question 19 The lower esophageal sphincter is characterized by periods of intermittent relaxation called transient lower esophageal sphincter relaxations. These relaxations are independent of the relaxation triggered by swallowing and are the most common cause of: A. Physiologic reflux B. Symptomatic esophagitis C. Barrett’s metaplasia D.Esophageal carcinoma Question 20 While reviewing morning labs on a postoperative patient, the AGACNP notes that the patient’s basic metabolic panel is as follows: Na+ 132 mEq/L K+ 4.6 mEq/L Cl- 87 mEq/L CO2 25 mEq/L A normal saline infusion is ordered in an attempt to avoid: A.Hyperkalemia B. Hypernatremia C. Metabolic alkalosis D.Metabolic acidosis Question 21 W. is a 49-year-old man who presents for evaluation. He has a long history of alcohol and tobacco use, with a 65-year pack history and an admitted 14-drink-per-week alcohol habit. He is getting worried because he can no longer swallow his bourbon. He is not a good historian but he does admit to a 1+ year history of bloating, heartburn, and progressive difficulty swallowing food. He didn’t worry too much about his symptoms until he stopped being able to swallow bourbon. He thinks he has lost approximately 15 lbs in the last year. He denies any blood in his stool and has not had any vomiting. The AGACNP knows that the most likely diagnosis is: A.Zenker’s diverticulum B. Achalasia C. Esophageal carcinoma D.Hiatal hernia Question 22 Which of the following treatment modalities has no role in the treatment of shock? A.Lactated Ringer’s B. Fresh frozen plasma (FFP) C. Vasopressors D.Colloid solutions Question 23 The development of coronary artery disease (CAD) and, ultimately, plaque formation is a multifactorial process that includes endothelial injury from hypertension, cigarette smoking, and dyslipidemia. These events lead to endothelial cell dysfunction, which is theorized to result in: A.Decreased nitric oxide production B. Smooth muscle cell atrophy C. Collagen degradation D.Enlarged arterial lumen Question 24 Mr. Comstock is a 71-year-old male who presents with a general sense of feeling weak and unwell; he thinks he has the flu even though he received a flu vaccination this year. He describes a vague collection of symptoms, including weakness, nausea, dizziness, and “getting out of breath” very easily. He says he can barely climb the steps anymore without stopping to rest. Of the possible differential diagnoses, coronary artery disease (CAD) is high among the probabilities because of his age and gender. His physical examination is unremarkable except that he appears weak. His vital signs are as follows: temperature 98.0°F, pulse 100 bpm, respiratory rate 16 b.p.m., and BP 178/100 mm Hg. A chest radiograph is within normal limits with no acute pulmonary infection. A 12-lead ECG reveals inverted T waves in leads V1 to V5. The AGACNP is suspicious that most of his symptoms are: NURS 6560 Final Exam A. Psychosomatic B. Early congestive heart failure (CHF) C. Anginal equivalents D.Normal age-related changes Question 25 Mrs. Carpenter is a 59-year-old female who presents with an acute myocardial infarction. She is acutely short of breath and has coarse rales on auscultation. Physical examination reveals a grade V/VI systolic murmur, loudest at the point of maximal impulse with radiation to the midaxillary line. The AGACP recognizes: A. Acute mitral valve regurgitation B. Acute aortic valve regurgitation C. Acute cardiac tamponade D. Acute pulmonary embolus Question 26 Mr. Nelson is a 65-year-old male who has been advised that he is a candidate for coronary artery bypass grafting. He has been doing some internet research and is asking about whether or not he should have a “beating heart” bypass. Regarding off-pump coronary bypass grafting, the AGACNP advises Mr. Nelson that: A.There is a slightly higher risk of neurologic complications B. Long-term results suggest that the grafts do not stay open as long as those in traditional bypass grafting C. The incidence of off-pump bypass grafting has increased significantly in the last 10 years D.The off-pump procedure is considerably more expensive but is correlated with better long-term outcomes Question 27 Mrs. McCallum is a 48-year-old female who presents for evaluation of a vague set of gastrointestinal symptoms. She feels generally well and has always been healthy, but lately she has had a lot of heartburn and a sense of reflux in her throat. Most recently she has had a recurring sense of food getting stuck in her throat. The AGACNP knows that which diagnostic study should be performed first? A.Barium swallow B. Upper endoscopy C. Esophageal manometry D.Ambulatory pH monitoring Question 28 Mr. Key is a 53-year-old male patient who developed empyema following a serious bout of bacterial pneumonia. He presented as septic and was started immediately on intravenous antibiotics and drainage of the sinus cavity. Forty-eight hours later, he is much improved clinically and drainage has receded. The next step in his care would be: A.A CT scan B. Eloesser’s procedure C. Decortication D.Reexpansion Question 29 Mrs. Bowers is a 41-year-old patient who requires surgical management of osteomyelitis. She has a long history of methamphetamine use and has a BMI of 17.9 kg/m2 . She clearly is nutritionally depleted and volume contracted, but she has no clear chronic medical history except for unmedicated hypertension, which may be due to her chronic stimulant use. She denies alcohol use but admits to a 1½ pack a day cigarette habit. A primary postoperative concern for Mrs. Bowers is: A.Excess bleeding B. Thromboemboli development C. Poor wound healing D.Renal failure Question 30 The congenital diaphragmatic hernia that occurs more often in women and does not usually produce symptoms until midlife is known as: A.Zenker’s hernia B. Bochdalek’s hernia C. Morgagni’s hernia D.Atraumatic hernia Question 31 B. is a 67-year-old male who is being discharged following inpatient management for unstable angina. S. B. did not know that he had coronary artery disease (CAD) and in fact had not seen a health care provider for many years. While reviewing his lifestyle habits, he admits that he is obese, has poor eating habits, does not engage in any purposeful physical activity, and smokes two packs of cigarettes daily NURS 6560 Final Exam. He verbalizes that he is grateful that this was not a “real” heart attack and does not seem receptive to lifestyle management strategies. The AGACNP advises him that it is important to take this “warning” attack seriously because: A. 10% of patients with unstable angina will die of cardiovascular disease within 6 months B. 25% of patients with unstable angina will develop congestive heart failure within 6 months C. 65% of patients with unstable angina will have an ST elevation MI within 1 year D. 90% of patients with unstable angina will have cerebrovascular symptoms within 1 year Question 32 According to the American College of Surgeons (ACS), who among the following patients should have a chest radiograph as part of preoperative assessment? A.All patients > 40 years of age

B. All patients who smoke cigarettes

C. All patients having thoracic procedures

D.All patients with cardiac disease

Question 33

According to the Carpentier classification scheme of mitral valve regurgitation, a type I regurgitation is most likely due to:

A.Cardiomyopathy

B. Excessive leaflet motion

C. Ruptured papillary muscles

D.Rheumatic heart disease

Question 34

V. is a 37-year-old female who is admitted via the emergency room after her roommate called emergency medical services (EMS). She has no significant medical history and does not know what is wrong with her. She has been feeling generally unwell for the last few days, and today she had an episode of confusion that scared her roommate to the extent that the roommate called EMS. Her physical examination reveals a temperature of 101.9°F, pulse of 110 bpm, respiratory rate of 20 breaths per minute, and blood pressure of 92/58 mm Hg. A comprehensive metabolic panel reveals a slightly elevated blood urea nitrogen (BUN)/creatinine but otherwise is normal. A white blood cell differential reveals a leukocyte count of 14,000 cells/µL with neutrophils of 83%. The AGACNP knows that these values are consistent with:

A. Systemic inflammatory response syndrome (SIRS)

B. High-output septic shock

C. Neurogenic shock

D.Multiple organ dysfunction syndrome (MODS)

Question 35

Which shock state is worsened in the setting of mechanical ventilation?

A. Septic

B. Cardiac compressive

C. Neurogenic

D.Cardiogenic

Question 36

B. is a 41-year-old male being admitted for surgical reduction of an open femur fracture sustained in a multiple vehicle collision. Preoperative assessment reveals that he is on beta-adrenergic antagonists after having been diagnosed with coronary artery disease approximately 1 month ago. He admits that he feels a little better but says he still gets pain in his chest when he exerts himself. He is pain free now. Vital signs are as follows: temperature 98.1°F, pulse 88 bpm, respiratory rate 18 breaths per minute, and blood pressure 142/86 mm Hg. The AGACNP knows that which of the following is the most important action before R. B. goes to the operating room?

A.A cardiology consultation

B. Blood pressure control

C. Resuming beta-adrenergic antagonists

D. Pain control

Question 37

Cholesteatoma is a condition characterized by a collection of desquamated keratin leading to bony erosion in the ossicular chain and inner ear. The goal of surgery in cholesteatoma is:

A. Production of a dry ear

B. Preservation of sensorineural hearing

C. Debridement of infection

D.Restoration of the tympanic membrane

Question 38

The AGACNP k

NURS 6560 Final Exam

NURS 6550 FINAL EXAM QUESTION 1

Mr. Jeffers was admitted 2 days ago for a carotid endarterectomy. A Foley catheter was inserted intraoperatively and remains in place. His urine output has declined markedly despite continued IV fluid infusion. Today his morning labs reveal a BUN of 19 mg/dL and a creatinine of 2 mg/dL. A leading differential includes:

 

A.

Foley lodged in the urethra causing post-renal failure

 

B.

Decreased renal perfusion causing prerenal failure

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C.

Age-related decreased eGFR causing prerenal failure

 

D.

Post-surgical rhabdomyolysis causing intrarenal failure

 

NURS 6550 FINAL EXAM QUESTION 2

Janet is admitted with symptomatic tachycardia. Her pulse is 160 b.p.m. and she is weak, diaphoretic, and anxious. Physical examination reveals a 5’4” 107 lb black female who is awake, alert, and oriented, anxious, with moist skin and racing pulse. Her blood pressure is 140/100 mm Hg. Temperature and respiratory rate are within normal limits. The patient admits to having a “thyroid condition” but she never followed up on it when she was advised to see an endocrinologist. The AGACNP anticipates a diagnosis of:

 

A.

Hashimoto’s thyroiditis

 

B.

Cushing’s syndrome

 

C.

Grave’s disease

 

D.

Addison’s disease

 

QUESTION 3

Systemic lupus erythematosis (SLE) is a multiorgansystem autoimmune disorder that can prevent with a wide variety of manifestations. Which clinical triad should prompt an evaluation for SLE?

 

A.

Fever, normal white count, elevated sedimentation rate

 

B.

Hyperkalemia, hyponatremia, low blood pressure

 

C.

Leukocytosis, hyperglycemia, hypokalemia

 

D.

Joint pain, rash, fever

 

QUESTION 4

A patient presents with profound vertigo of acute onset yesterday. She can barely turn her head without becoming very vertiginous; she is nauseous and just doesn’t want to move. This morning when she tried to get out of bed she felt like she was pushed back down. The vertigo is reproducible with cervical rotation. The patient denies any hearing loss or tinnitus, she has no fever or other symptoms. The AGACNP knows that the most helpful intervention will probably be:

 

A.

Meclizine

 

B.

Diazepam

 

C.

Bed rest

 

D.

Epley’s maneuvers

 

QUESTION 5

Mrs. Mireya is an 85-year-old female who is admitted for evaluation of acute mental status change from the long term care facility. She is normally ambulatory and participates in lots of facility activities. Today a nursing assistant found her in her room, appearing confused and disconnected from her environment. When she tried to get up she fell down. Her vital signs are stable excepting a blood pressure of 90/60 mm Hg. The AGACNP knows that the most likely cause of her symptoms is:

 

A.

Osteoarthritis

 

B.

Drug or alcohol toxicity

 

C.

Hypotension

 

D.

Urosepsis

 

NURS 6550 FINAL EXAM QUESTION 6

A patient with SIADH would be expected to demonstrate which pattern of laboratory abnormalities?

 

A.

Serum Na+ 119 mEq/L, serum osmolality 240 mEq/L, urine Na+ of 28 mEq/L, urine osmolality of 900 mOsm/kg

 

B.

Serum Na+ 152 mEq/L, serum osmolality 315 mEq/L, urine Na+ of 5 mEq/L, urine osmolality of 300 mOsm/kg

 

C.

Serum Na+ 121 mEq/L, serum osmolality 290 mEq/L, urine Na+ of 7 mEq/L, urine osmolality of 850 mOsm/kg

 

D.

Serum Na+ 158 mEq/L, serum osmolality 251 mEq/L, urine Na+ of 20 mEq/L, urine osmolality of 420 mOsm/kg

 

QUESTION 7

Sean is a 29-year-old male who presents to the emergency department for evaluation and treatment of foreign body in the eye. Ophthalmic anesthesia is achieved and removal is attempted unsuccessfully with a moist cotton tipped swab. A wet fluorescein stain is applied to the lower eyelid, and a corneal abrasion ruled out but the AGACNP notes a positive Seidel sign. This indicates:

 

A.

Penetration of the cornea with resultant aqueous leak

 

B.

A rust ring remnant due to metal foreign body

 

C.

An elevated intraocular pressure

 

D.

Paradoxical pupil dilation in response to light

 

QUESTION 8

Mrs. Lowen is an 82-year-old female who comes to the emergency department for evaluation of a fever of 102.9° F. She complains of a headache in the right side of her temple and some right-sided jaw pain. A urinalysis, chest radiograph, complete blood count (CBC) and 12-lead ECG are all non-contributory. A comprehensive metabolic panel is significant only for a slightly elevated BUN and creatinine. The AGACNP appreciates distinct right temple tenderness to percussion. Which laboratory test is necessary to support the suspected diagnosis?

 

A.

An erythrocyte sedimentation rate

 

B.

A white blood cell differential

 

C.

Two sets of blood cultures

 

D.

Echocardiography

 

NURS 6550 FINAL EXAM QUESTION 9

Ms. Schiebel, a 31-year-old female who is brought to the emergency department by police after being arrested for disruptive behavior in a public establishment. The differential diagnosis includes drug and alcohol ingestion/toxicity, central nervous system disease, severe trauma, and psychotic illness; ultimately the alcohol and toxicology screen as well as head imaging are negative. When considering psychotic illness, the AGACP knows that this is a physiologic imbalance that typically involves an excess of:

 

A.

Serotonin

 

B.

Norepinephrine

 

C.

Acetylcholine

 

D.

Dopamine

 

QUESTION 10

Mr. Lincoln is a 55-year-old male who was admitted for management of sepsis secondary to pneumonia. He has declined rapidly, and today chest radiography demonstrates a diffuse, bilateral “white-out” appearance. His paO2 is 55 mm Hg. In order to increase his oxygenation the AGACNP knows that which of the following interventions is indicated?

 

A.

Increased FiO2

 

B.

Increased respiratory rate

 

C.

Increased tidal volume

 

D.

Increased PEEP

 

QUESTION 11

A 29-year-old female patient presents with a complaint of palpitations. Physical examination reveals an essentially healthy female with no significant medical history and no maintenance medications; the only thing she can report is that she had a head cold a week or so ago. The vital signs include a blood pressure of 139/90 mm Hg, pulse of 105 b.p.m, respiratory rate of 16 b.p.m. and a temperature of 98.6° F. The only abnormal finding on physical examination is diffuse anterior neck tenderness with thyroid palpation. The AGACNP considers which medication for symptom control?

 

A.

Ibuprofen

 

B.

Pseudoephedrine

 

C.

Propranolol

 

D.

Methimazole

 

QUESTION 12

Jennifer is an 18-year-old homeless female who was found unresponsive. She was admitted to the hospital for management of severe bleeding after a spontaneous abortion escalated to a uterine hemorrhage. An underlying infection and dehydration were corrected and nutritional supplements were started. Her volume status is stable, morning labs were all within normal limits and she is to be discharged today. When the AGACNP enters the room to prepare the patient for discharge, she finds her agitated, pale, and diaphoretic with vital signs to include a pulse of 105 bpm, respirations of 24 bpm, blood pressure of 110/76 mm Hg and a temperature is 97.9° F. The most appropriate action would be to:

 

A.

Order a CBC to assess for recurrent bleeding

 

B.

Request and abdominal CT to assess for bleeding

 

C.

Evaluate the patient for anxiety/panic attack

 

D.

Prescribe alprazolam 1 mg now

 

QUESTION 13

Physical examination findings in a patient with pneumothorax is likely to reveal:

 

A.

Increased tactile fremitus

 

B.

Low grade temperature

 

C.

Hyperresonance to percussion

 

D.

Egophany

 

NURS 6550 FINAL EXAM QUESTION 14

Mr. Parker brings his 73-year-old wife to a clinic appointment because he is worried about her. She has a long history of hypertension and dyslipidemia, but he says she has taken medication for years and everything has been OK. His concern today is that for a long time she has been very forgetful, and he has tried to help her by keeping a strict routine around the house. Over the past few months, she just seems more and more forgetful, does not seem interested in doing anything, and now seems to be forgetting how to do simple everyday tasks. Yesterday she could not figure out which dollar bills to use at the store to pay the cashier. The AGACNP knows Mrs. Parker should first be screened for:

 

A.

Depression

 

B.

A brain tumor

 

C.

Hypothyroidism

 

D.

Adrenal dysfunction

 

QUESTION 15

M.R. is a 40-year-old female who has a known history of peptic ulcer disease. She has been admitted through the emergency room with a diagnosis of GI bleeding—she is vomiting dark blood and had a nasogastric tube placed. When attached to low intermittent suction it initially drained 400 cc of dark brown/black drainage, but now it is starting to drain lighter red colored blood. The AGACNP knows that immediate priorities of care include:

 

A.

Ensuring hemodynamic stability

 

B.

Beginning a parenteral proton pump inhibitor

 

C.

Beginning gastric lavage

 

D.

Ordering a gastrointestinal consult

 

QUESTION 16

A patient with sharp, stabbing chest pain directly over the precordium has a 12-lead ECG that demonstrates concave ST-T wave elevations in leads II, III, avR, avL, avF, and all six precordial leads. The AGACNP expects which physical finding?

 

A.

A grade IV/VI systolic murmur with radiation to the axilla

 

B.

A split S2 that increases with inspiration

 

C.

A pericardial friction rub

 

D.

An S4 heart sound

 

QUESTION 17

J.Q. is a 45-year-old male who had gastric bypass surgery 18 months ago. A CBC reveals a macrocytic anemia with aHgb of 9.8 g/dL, HCT of 30%, MCV of 115 and RDW of 19%. The AGACNP suspects which type of anemia?

 

A.

Iron deficiency

 

B.

Sickle cell anemia

 

C.

Pernicious anemia

 

D.

Anemia of chronic disease

 

QUESTION 18

Megan K. is a 21-year-old female who presents complaining of irritated eyes. She says this happens a couple of times a year and this time it is really a problem. Both eyes are itchy and red and she has a lot of stringy discharge, especially at the end of the day. Her visual acuity is 20/25 OS, OD, and OU with her glasses on. Physical exam reveals injected conjunctiva bilaterally but there is no photophobia. Pupils are equal, round, briskly reactive, and accommodate. The AGACNP knows that immediate treatment should include ophthalmic application of:

 

A.

Steroids

 

B.

Antihistamine

 

C.

Antibiotic

 

D.

Cycloplegic

 

NURS 6550 FINAL EXAM QUESTION 19

Ellen is a 61-year-old female who presents with a chief complaint of neck pain. The history of present illness reveals that Ellen felt as though a bug bit her behind the neck a few days ago. A day or two later it started to hurt, and when she began to pick at it she felt drainage come out. She is here now for evaluation. Physical exam reveals an 8 cm x 8 cm draining abscess in the right post auricular region with posterior cervical lymphadenopathy. Ellen has a temperature today of 101.9° F. The AGACNP knows that in addition to incision and drainage of the abscess, effective management must include:

 

A.

Systemic antibiotics

 

B.

Tetanus immune globulin

 

C.

Tetanus toxoid

 

D.

Antipyretics

 

QUESTION 20

A 13-year-old male presents with a chief complaint of ear drainage. The patient and his mother both indicate that the patient has not had any pain or any systemic complaints, but the pus-like discharge from the ear is very persistent. According to Mom they went to a retail clinic two weeks ago and the patient was prescribed both oral antibiotics and ear drops, but it didn’t help. Physical exam of the ear reveals a painless pinna; otoscope exam reveals only a large amount of mucopurulent drainage—the tympanic membrane could not be visualized. The AGACNP knows the diagnosis is most likely:

 

A.

Acute otitis media

 

B.

Acute otitis externa

 

C.

Cholesteatoma

 

D.

Otitis media with effusion

 

QUESTION 21

A 71-year-old male patient with lung cancer is admitted for treatment of sepsis related to his chemotherapy-induced immunosuppression. He seems to be improving from an infectious perspective, but during today’s assessment the AGACNP appreciates coarse rales in the lung fields, a blood pressure of 140-100 mm Hg, a bounding pulse, and trace pretibial edema. The urine output via Foley catheter has only been 100 mL in the last 8 hours. Suspicious for syndrome of inappropriate antidiuretic hormone (SIADH), the AGACNP orders a basic metabolic panel anticipating which of the following abnormalities? NURS 6550 FINAL EXAM.

levine’s conservation model in nursing practice powerpoint presentation

žConservation Model

Myra estrin Levine

 

žMyra E. Levine

žWhy nurses use theory to guide their practice:

oA nursing theory provides the theoretical foundation of the profession.

oTheory defines what nursing is, what it does, and the goals or outcomes of nursing care.

oNursing is the synthesis of many theories.

oOur group identified with Levine’s Conservation Model because it focuses on conserving an individual’s wholeness. It addresses an individual from birth to death and aims to maintain an equilibrium conducive to health.

o

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žPurpose:

The purpose of this project is to describe the use of a conceptual nursing model, Levine’s Conservation Model.

žTheory Overview

Myra Estrin Levine proposed four principles of conservation. The process by which conservation is achieved is adaptation and the desired outcome is integrity or wholeness. Adaptation includes responses based on past experiences (historicity), specific to the need (specificity), and with a variety of levels of possible response (redundancy). The principles of conservation relate to the conservation of energy, structural integrity, personal integrity, and social integrity of the individual.

žLevine’s Nursing model:

Objectives

oDescribe the historical background of the development of Levine’s model for health

oDefine Levine’s three major concepts and four principles of conservation

oPresent the relationship between Levine’s model and concepts in nursing’s metaparadigm

oProvide an example of Levine’s model in a clinical practice

oEvaluation of the Conservation Model

o

o

o

žHistorical background and motivation for development of conservation model

žEducational Background

and accomplishments

žPhilosophic Values and knowledge development levine’s conservation model in nursing practice powerpoint presentation

ž

žMany Teachers influenced the conservation model

ž

ž

žThe Three Major Concepts of the Conservation Model

Wholeness (Holism)

ž

Adaptation

Conservation

žWholeness

oTo understand the whole person, one must first understand the parts of the whole.

o

oLevine used Erickson’s description of wholeness as an open system (Levine, 1969).

o

oLevine believed that humans respond in “ an integrated, singular fashion to environmental changes” (Levine 1966).

žAdaptation

“Adaptation is the process of change whereby the individual retains his integrity within the realities of his internal and external environment” (Levine, 1973).

oAll adaptations vary in degree, and not all are successful.

oConservation is the outcome.

oAdaptation has three characteristics

oHistoricity

oSpecificity

oRedundancy

žConservation

“Conservation describes the way complex systems are able to continue to function even when severely challenged (Levine, 1973).

oThe primary goal of conservation is maintaining wholeness and uniqueness.

oNursing actions reflecting this model are directed at helping the client conserve:

o* Energy  * Personal Integrity

o* Structural Integrity  * Social Integrity

žGlobal Concepts in the Nursing Profession

oHuman Being: Each person has freedom of choice, identity, and self-worth.  Each person expresses themselves as a summary of all contributing parts.

oHealth: Defined in social contexts; the ability to function within reasonable limits.  Health is more than the absence of disease, and changes with time. levine’s conservation model in nursing practice powerpoint presentation

oEnvironment:  Not just the place a person lives, but also the situation.  There is an internal and an external environment, and both contribute to accommodation.

žGlobal Concepts in the Nursing Profession

“The goal of nursing is to promote adaptation and maintain wholeness” (Levine 1971). 

oNursing is not a series of specific tasks but is a human interaction.

oIt is based on knowledge and scientific reasoning, but is an art that each person practices in a unique manner based on each client’s needs.

ž

Each one of the global concepts of nursing has the ability to add to wholeness or to detract from it.

žInterpretation & Inference

Implications & Consequences

žEvaluation of nursing model

oMyra Levine’s conservation model focuses on promoting adaptation and maintaining wholeness using the principles of conservation.

oAccording to Levine (1973) “human beings conserve their bodies’ incredible ability to adapt to environmental stimuli” (Schaefer & Pond, 1994, p.53). levine’s conservation model in nursing practice powerpoint presentation

žOrigins

Levine’s Conservation Model is clearly influenced by other disciplines.  It is not unique to nursing.  It has elements of the physical sciences as evidenced by the principle of energy conservation.  The social sciences are represented in the concept of the perseveration of personal integrity.  The influence of humanities is reflected by the concept of how a person’s social system is part of their environment and all forms of environment have an influence on the person.

žorigins

Levine’s Conservation model was developed as an organizational framework for teaching medical surgical nursing.  It was not intended to be a nursing theory (Schaefer, 2006, p.228).

žLevine’s theory and its uniqueness to nursing

oThe conservation principles are used by the nurse to identify interventions and to maintain wholeness for the patient (Schaefer & Pond, 1994, p.53).

oThis theory is influenced by a person’s wholeness and their ability to adapt and respond to different environmental challenges.

o

žFour Global concepts

This model adequately describes the four global concepts:

o     Human being

o     Environment

o     Health

o     Nursing

All of these concepts represent the factors that influence individuals and their ideas about their own health and how they view healthcare in general which can influence the individual’s treatment goals and outcome.

žapplications

oA theory deals with one or more specific concepts and is usually derived from a conceptual model (Kearney-Nunnery, 2005).

oLevine’s Conservation model is a general guide of systems and statements and uses broad concepts in a logical, organized form that can be used in different settings.  “Conservation principles as a framework are not limited to nursing care in the hospital but can be generalized and used in every environment, hospital, or community (Levine, 1990, 1991)” (Schaefer, 2006, p.233).

žApplications levine’s conservation model in nursing practice powerpoint presentation

This model has been used in varied areas of nursing.  “Conservation principles have been used as frameworks for numerous practice settings in cardiology, obstetrics, gerontology, acute care (neurology), pediatrics, long-term care, emergency care, primary care, neonatology, critical care areas, and in the homeless community” (Savage & Culbert, 1989; Schaefer & Pond, 1991).

žapplications

“Use of an appropriate conceptual model facilitates the design and testing of theory-based interventions and the development of science to support nursing practice”(Mock et al, 2007, p. 512).

žPutting the Conservation Model to Work

ž

You are a labor and delivery nurse working for a local hospital.  You are caring for a teenager who is about to deliver her first child.  In the room are her boyfriend, her mother, and her best friend.  She is quiet and is not making eye contact with care staff, and her family members are watching television.  You sit down next to the bed and ask the patient if there is anything she needs and she replies “no” but your gut instinct tells you there’s more to the picture.  Your assessment skills tell you there is a great potential here for problems.

ž

You ask the patient how she feels about becoming a mother.  She tells you she is scared.  In further conversation, she tells you she is not planning to go back to school because she is embarrassed and afraid of social rejection.  She did not take any birthing classes or childcare education.  She is afraid of pain during active labor, and has questions about pain control options.  She says her mother and her boyfriend have been supportive, but also voices concern about taking care of her mother, who has a physical disability.

žAssessing the situation

oIs this patient demonstrating wholeness?

o

oIs this patient demonstrating adaptation?

o

oIs this patient demonstrating conservation?

žWholeness

Wow.  This patient has issues, right?  Let’s look at the pieces here.  Levine states we have to look at all of the little pieces to see the whole person.  In order to understand our patient, we have to assess her lifestyle, social integration, spirituality, self-image, family dynamic, environment, cultural identity, and anything else she feels may contribute to her identity.  We get a few hints of that in our initial conversation. levine’s conservation model in nursing practice powerpoint presentation

žAdaptation

How well is your patient adapting?  Before you say “poorly” look at what you can build on.  Adaptation is not a “pass or fail” but can vary in degree.  Consider environment, organismic response, and trophicognosis in your response.  This is a new situation for your patient. How is she relating this to past experiences?  What does she perceive as a challenge?  What does she not perceive as a challenge or a goal?

žConservation

Levine describes conservation as “… the way complex systems are able to continue to function even when severely challenged” (1990).  Is your patient conserving energy? Is she conserving structural (physical) integrity?  Is she conserving her personal integrity?  Is she preserving social integrity?  How could you, as a nurse, promote these principles?

žPutting the model to work

žPromoting
wholeness
:  Talk with your patient about what roles for her are important, discuss what parts of her identity have been fragmented.  What is she proud of?  What is she missing?  What are her goals?

žPromoting
adaptation
:  Although your patient has not been to prenatal education and has dropped out of school, she has spent time gathering baby supplies and has stopped hanging out with unsupportive friends.  Build on this.  Encourage her and tell her about other community resources available to her.  Help her explore all of her options and consider her preferences.

ž

žPromoting
conservation
:  Provide her with pain control options, encourage physical rest.  Encourage her to advocate for her needs and allow her to carry out her social roles during her hospital stay by involving friends and family there to support her, if that is what she desires.

ž

Using Levine’s Conservation Model to guide our nursing practice takes conscious effort, but has   the potential to help our patients reach a higher state of health, which is the ultimate goal of nursing practice.

Conservation Model

žReferences

Alligood, M.R.,& Tomey, A.M.(2006). Myra Estrin

Levine :The conservation model. Y. Alexopoulos, & K. Hebberd (Eds.),
Nursing theorists
(pp. 726 – 742).St. Louis, MO: Mosby

Chitty, K. (2007).
Professional Nursing Concepts &Challenges
. St. Louis, Missouri: Saunders. George, J.

Current Nursing. (n.d.). Nursing theories: Levine’s four conservation      principles. Retrieved from http://currentnursing.com on July 2009.

Dalida D. N207 Blogger (2009). Myra Levine’s Conservation Theory.
University of the Philippines Open University

Retrieved from
http://nursingtheories.blogspot.com

George, J. B. (2001). Nursing theories: Base for professional nursing. (5th ed). Pearson Education.

Levine, M. E. (1992). Nightingale redux. In B.S. Barnum (Ed.),
Nightingale’s notes on nursing
(pp. 39-43). Philadelphia: J.B. Lippincott.

Schaefer, K.M. (2006). Nursing Theorists and Their Work. In Y.Alexopaoulos (Ed. “Et al”), Myra Estrin Levine: The Conservation Model (pp. 227-243). St. Louis, Missouri: Mosby Elsevier.

Schaefer, K.M. & Pond, J.B. (1994). Levine’s Conservation Model as a Guide to Nursing Practice.
Nursing Science Quarterly,
7, 53-54. doi: 10.1177/089431849400700204 levine’s conservation model in nursing practice powerpoint presentation

ž

Aquifer High Value Care 04: 80-year-old woman – Medications and value

High Value Care 04: 80-year-old woman – Medications and value

Author(s):
 Susan Merel, MD University of Washington Medicine; Anne Eacker, MD University of Washington Medicine

REASON FOR ADMISSION

HISTORY

You are rounding on Mrs. Miller, a newly admitted 80-year-old patient with a heart failure (HF) exacerbation. She had been discharged from the hospital just 10 days ago after presenting with the same problem after a 5 day hospitalization. Aquifer High Value Care 04: 80-year-old woman – Medications and value.

You review her list of chronic problems:

Problem list

Systolic heart failure due to ischemic cardiomyopathy with EF of 35% on last echocardiogram

Well-controlled diabetes: A1c of 6.5

Chronic kidney disease Stage 3

Recurrent urinary tract infections

Mild cognitive impairment

Osteoarthritis

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You have found no evidence of infection, Mrs. Miller has not changed her diet, and her EKG is unchanged from previous. On rounds today your attending asks you why you think this patient had a second HF exacerbation so soon after discharge. Aquifer High Value Care 04: 80-year-old woman – Medications and value.

Question

Which of the following are likely to contribute to a HF exacerbation requiring readmission? Select all that apply.

Medication nonadherence

Residence in a skilled nursing facility

Chronic kidney disease

Diabetes

Hyponatremia

Medication side effects

References

Flacker J, Park W, Sims A. Hospital discharge information and older patients: do they get what they need? 
J Hosp Med.
 2007;2(5):291-296
.

Amabile CM SA. Keeping your patient with heart failure safe: a review of potentially dangerous medications. 
Arch Intern Med.
 2004;164(7):709-720
.

Krumholz HM, Chen YT, Wang Y, Vaccarino V, Radford MJ, Horwitz RI. Predictors of readmission among elderly survivors of admission with heart failure. 
Am Heart J.
 2000;139(1 Pt 1):72-7
.

DEEP DIVE Aquifer High Value Care 04: 80-year-old woman – Medications and value

References

Journal of Managed Care & Specialty Pharmacy, Volume 22 Issue (5) 2016 May 22 (5): 516-523
.

 

Answer Comment

The correct answers are A, C, D, F.

Medication nonadherence (A)
 and 
medication side effects (F)
 are important risk factors for readmission in patients discharged after a hospitalization for HF.

Medication nonadherence is a pervasive problem; up to 25% of prescriptions ordered are never filled. In one study of elderly patients discharged from a county hospital with medication changes, only about 50% reported getting their prescriptions filled. (See the Expert to learn about the types and prevalence of medication nonadherence.)

Older patients are likely to take multiple medications and are more susceptible to side effects and adverse drug events than younger patients because of comorbidities, frailty, and age-related physiologic changes in drug metabolism and excretion. Drug-induced HF exacerbations are also common. Medications to consider include non-steroidal anti-inflammatories (NSAIDS), corticosteroids, alpha-blockers, calcium-channel blockers, and tricyclic antidepressants.

Elderly patients with 
renal failure (C)
 and 
diabetes (D)
 are at increased risk for readmission after an exacerbation of HF. Both conditions make it more difficult to control heart failure.

Hyponatremia (E) is a common condition in the elderly and may make it more difficult to 
treat
 heart failure, but has not been shown to be associated with HF readmission.

Advanced age and residence in a skilled nursing facility (B) have not been shown to be risk factors for HF readmission.

 

 

REASON FOR ADMISSION

HISTORY

READMISSION QUESTION

HISTORY

Question

Why is readmission to the hospital within 30 days of discharge a concern? Select all that apply.

Association with increased mortality

Increased occurrence in patients with depression

Cost to health care facility

Cost to the patient

SUBMIT

TEACHING POINT

Early readmission, within 30 days of discharge, is associated with an increased rate of all-cause mortality for community-dwelling elderly patients. Patients over age 80, with five or more comorbidities, or depression are at greater risk of early readmission

References

Lum HD, Studenski SA, Degenholtz HB, Hardy SE. Early hospital readmission is a predictor of one-year mortality in community-dwelling older Medicare beneficiaries. 
J Gen Intern Med.
2012;27(11):1467-74
.

Marcantonio ER, McKean S, Goldfinger M, Kleefield S, Yurkofsky M, Brennan TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. 
Am J Med.
 1999;107(1):13-17
.

Centers for Medicare and Medicaid Services. Readmissions Reduction Program
.

 

 

Question

Why is readmission to the hospital within 30 days of discharge a concern? Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

Association with increased mortality

Increased occurrence in patients with depression

Cost to health care facility

Cost to the patient

SUBMIT

Answer Comment

The correct answers are A, B, C, D.

All of the above are correct.

Early readmission, within 30 days of discharge, is associated with an 
increased rate of all-cause mortality (A)
 for community-dwelling elderly patients initially admitted for any diagnosis. It is more common in patients who:

Are over age 80

Have five or more comorbidities

Have 
depression (B)
.

The Affordable Care Act currently requires the Center for Medicare and Medicaid Services (CMS) to reduce payments to hospitals in the setting of “excess readmissions” of patients hospitalized for acute myocardial infarction, heart failure, and pneumonia within 30 days of the first hospitalization. If readmission rates exceed the expected rate, a 
penalty is charged to the hospital (C).
 The amount of these penalties will increase in the future, and additional medical conditions will be added.

Even with insurance, Medicare or otherwise, 
most patients still have to pay (D)
 some portion of their health care costs. For example, Medicare Part A covers 80% of inpatient costs. The average cost of inpatient care per day in the U.S. is about $2270. 
Hospital Adjusted Expenses per Inpatient Day 2015
.

 

 

 

MEDICATION REVIEW

HISTORY

While you are rounding, Mrs. Miller’s daughter arrives with her mother’s home medications in a grocery bag. You express your appreciation that she was able to bring these in for review. They are as follows:

Scheduled medications

Aspirin 81 mg po daily

Calcium carbonate 500 mg po bid

Furosemide 20 mg po daily

Glipizide 5 mg po daily

Lisinopril 10 mg po daily

Metformin 500 mg po bid

Metoprolol XL 50 mg po daily

Multivitamin one tab po daily

Nitrofurantoin 50 mg po daily

Pravastatin 40 mg po daily

Cholecalciferol 800 IU po daily

Naproxen over-the-counter, patient has been taking 500 mg twice a day for a week.

As needed medications

Diphenhydramine 25 mg po q 6 hours prn pruritus

Zolpidem 5 mg po qhs prn insomnia

Hydrocodone/acetaminophen 5/500 mg po q 6 hours prn pain

Question

After a discussion with the patient and her primary care doctor, which of the following medications would be appropriate to consider discontinuing during this hospitalization? Select all that apply.

Aspirin

Nitrofurantoin

Metoprolol

Diphenhydramine

Naproxen

Vicodin

Zolpidem

SUBMIT

TEACHING POINT

Older patients are at increased risk of adverse drug events.

The Beers Criteria is an evidence-based list developed by experts documenting medications which are potentially inappropriate in the elderly and should be referenced when caring for older patients.

References

Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. 
N Engl J Med.
 2011;365(21):2002-12
.

Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. 
J Am Geriatr Soc.
 2006;54(10):1516-23
.

Steinman MA, Story PS. Managing medications in clinically complex elders: “There’s got to be a happy medium.” 
JAMA.
 2010;304(14):1592-1601
.

Kolla BP, Lovely JK, Mansukhani MP, Morgenthaler TI. Zolpidem is independently associated with increased risk of inpatient falls. 
J Hosp Med.
 2013;8(1):1-6
.

DEEP DIVE

References

Brater DC. Effects of nonsteroidal anti-inflammatory drugs on renal function: Focus on cyclooxygenase-2-selective inhibition. 
Am J Med.
 1999;107(6A):65S-71S
.

 

 

Question

After a discussion with the patient and her primary care doctor, which of the following medications would be appropriate to consider discontinuing during this hospitalization? Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

Aspirin

Nitrofurantoin

Metoprolol

Diphenhydramine

Naproxen

Vicodin

Zolpidem

SUBMIT

Answer Comment

The correct answers are B, D, E, F, G.

Adverse Drug Events in the Elderly

Older patients are at high risk for adverse drug events due to age-related changes in physiology, including changes in drug metabolism.

Older patients generally have more comorbid conditions and are prescribed more medications: 40% of adults over age 65 take 5 to 9 medications and 18% take 10 or more.

Frail elderly patients who take multiple medications are at increased risk for falls, fractures and delirium; these conditions can have serious consequences for an elderly patient’s health and independence.

As many as 10% of hospital admissions in older adults may be related to adverse drug events.

The 
Beers Criteria
 is an evidence-based list developed by experts documenting medications which are potentially inappropriate in the elderly.

Medication

Category

Risks

Nitrofurantoin

Antibiotic

Pulmonary toxicity

Diphenhydramine

Anticholinergic

Side effects include somnolence, confusion, constipation and dry mouth

Naproxen

NSAID

Increased risk of gastrointestinal bleeding, acute kidney injury

Hydrocodone/acetaminophen (Vicodin)

Opioid

Associated with delirium and falls in the elderly

Zolpidem

Sedative-hypnotic (nonbenzodiazepine)

Associated with increased risk of falls, fractures, and delirium in older adults

Nitrofurantoin (B), diphenhydramine (D), naproxen (E), Vicodin (F), and zolpidem (G)
 are all medications which may be appropriate to discontinue:

Nitrofurantoin
is generally an inappropriate medication in the elderly because of its pulmonary toxicity; it is also less effective in patients with a creatinine clearance less than 60 ml/min due to inadequate concentration in the urine. It should not be used for long-term suppression of urinary tract infections in elderly patients. The reason for the nitrofurantoin should be determined and this medication should be stopped or replaced with a safer appropriate antibiotic. If she is taking nitrofurantoin as suppressive therapy to reduce the risk of recurrent UTI’s, the role of suppressive therapy should be reconsidered as the evidence supporting this is not strong.

Diphenhydramine
(Benadryl) should be avoided in all elderly patients because of its strong anticholinergic properties, unless it is necessary for acute treatment of a severe allergic reaction. Side effects include somnolence, constipation, and dry mouth. Anticholinergic drugs (
view list
) increase the risk of both delirium and falls in elderly patients.

Naproxen
is an NSAID. The American Society of Nephrology recommends that patients of all ages with hypertension, heart failure or chronic kidney disease avoid NSAIDs when possible (read the 
ASN’s recommendation
). NSAIDs should also be avoided in many elderly patients, especially those over age 75 or those taking antiplatelet agents, anticoagulants, or corticosteroids because of the increased risk of gastrointestinal bleeding. See the Deep Dive to learn about the physiologic effects of NSAIDs on the kidney. NSAIDs can also contribute to both hypertension and congestive heart failure exacerbations, and should be avoided in patients with these conditions.

Diphenhydramine and NSAIDs are both examples of over-the-counter medications that are inexpensive, but of low value in many patients because of their associated toxicities. It is important to ask about over-the-counter and herbal medications when taking a medication history.

Zolpidem
, which binds the benzodiazepine receptor subunit of the GABA-A receptor complex, is associated with an increased risk of falls, fractures, and delirium in older adults, and is not proven to be very effective in the elderly. Always teach patients about sleep hygiene before considering a sedative-hypnotic.

Vicodin
is an opioid combined with acetaminophen. Opioids can be associated with delirium and falls in the elderly population and should be used with caution. They also carry the risk of addiction.

If the patient has osteoarthritis pain that is refractory to conservative measures, such as exercise, acetaminophen, and physical therapy, judicious use of hydrocodone/acetaminophen is reasonable if it improves her function. Although opioids can be associated with delirium and falls in the elderly population, untreated pain can also contribute to delirium, decreased mobility and decreased quality of life. Opioids should be used with caution in the elderly patient for pain that has been refractory to acetaminophen and non-pharmacologic measures at the lowest effective dose with the goal of improved function. While opioids should be used with caution, they are often appropriate in older adults with refractory pain and would not need to be stopped in this patient if they are used sparingly and improve her function.

Aspirin (A), metoprolol,(C)
 and lisinopril are indicated in this patient because of her systolic heart failure and ischemic cardiomyopathy.

 

 

 

Question

Which of the following contribute to increased drug costs, particularly for elderly patients? Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

Medication price inflation has far exceeded general inflation.

The number of medications prescribed to patients is rising over time.

The elderly pay a larger percentage of their prescription medication costs out of pocket.

Medicare Part D pays 80% of the cost of each prescription medication for those over 65.

SUBMIT

Answer Comment

The correct answers are A, B, C.

Nonadherence with medications can increase the use of medical resources. Always ask your patients if they are able to afford their prescriptions. Patients on minimal fixed incomes (most elderly patients) may be unable to afford necessary medications. Aquifer High Value Care 04: 80-year-old woman – Medications and value

Since 1980, prescription 
medication prices have increased (A)
 two to three times faster than all consumer prices.

Prescription drug use in the U.S. has been steadily increasing over time. Between 1999 and 2008, the 
percentage of Americans taking at least one prescription drug increased (B)
 by 10% and use of five or more drugs increased by 70%; spending for prescription drugs doubled during that time period.

Medicare Part D subsidizes the cost of prescription medications; 
however, there is a monthly premium, a yearly deductible, and a per prescription co-pay (C)
, which varies by plan. In addition there is a coverage gap for patients who have more than about $3000 in annual drug costs in 2013. While a patient is in the coverage gap (a.k.a. “donut hole”), he or she pays 79% of the costs of all generic medications and 47.5% of the costs of all brand-name medications. This coverage gap ends at $4750 of drug coverage annually. Because of these costs, not all patients sign up for Medicare Part D.

Medicare Part D does not provide 80% coverage of each prescription (D).

References

Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007-2008. Centers for Disease Control. 
NCHS Data Brief.
 No. 42, September 2010:1-8
.

 

 

REASON FOR ADMISSION

HISTORY

READMISSION QUESTION

HISTORY

MEDICATION REVIEW

HISTORY

MEDICATION NON-ADHERENCE

MANAGEMENT

MEDICATION COST

THERAPEUTICS

During her hospitalization, some of Mrs. Miller’s medications have been stopped or changed, and some have been added. Her current medication list in the hospital is as follows:

Hospital Medications

Medications at Home

Scheduled Aquifer High Value Care 04: 80-year-old woman – Medications and value

Aspirin
 81 mg po daily

Aspirin
 81 mg po daily

Calcium carbonate
 500 mg po bid

Calcium carbonate
 500 mg po bid

Cholecalciferol
 800 IU po daily

Cholecalciferol
 800 IU po daily

Furosemide (Lasix)
 40 mg po daily

Furosemide
 20 mg po daily

Glipizide
 5 mg po daily

Glipizide
 5 mg po daily

Lisinopril (Prinivil)
 10 mg po daily

Lisinopril
 10 mg po daily

Metformin
 500 mg po bid

Metformin
 500 mg po bid

Multivitamin
 1 tab po daily

Multivitamin 
1 tab po daily

Carvedilol (Coreg)
 25 mg po bid

Metoprolol XL
 50 mg po daily

Rosuvastatin (Crestor)
 10 mg po daily

Pravastatin
 40 mg po daily

Omeprazole
 20 mg po daily

Nitrofurantoin
 50 mg po daily

Naproxen
 (over-the-counter) patient has been taking 500 mg twice a day for a week

As Needed

Hydrocodone/acetaminophen
 5/500 mg po q 6 hours prn pain

Hydrocodone/acetaminophen
 5/500 mg po q 6 hours prn pain

Benadryl
 25 mg po q 6 hours prn pruritus

Zolpidem
 5 mg po qhs prn insomnia

Question

How could you make this medication list more cost-effective? Document an appropriate discharge medication list here. Aquifer High Value Care 04: 80-year-old woman – Medications and value

Letter Count: 805/1000

SUBMIT

TEACHING POINT

Six Simple Rules for High-Value Medication Prescribing

Have a compelling reason for every medication you prescribe. Consider non-pharmacologic alternatives when appropriate.

Keep your patient’s medication list as short as possible. Discontinue all non-essential medications and review the list for duplicates.

Evaluate affordability before prescribing new medications to patients. This may mean reviewing the patient’s actual copay, generic versus brand name, and the medication tier in their insurance plan. (See High Value Care 06: 65-year-old man – Paying for value: Insurance Part 1.)

Make every effort to prescribe generic equivalent medications. Also be aware of lists of less expensive generic prescriptions available at large chain pharmacies, often for as little as $4 per month.

Collaborate with pharmacists to avoid drug-drug interactions and help provide lower-cost alternatives.

Ask the patient to “teach-back” to show they understand the reason for each medication on the list and how/when to take it.

References

Bulger J, Nickel W, Messler J, et al. Choosing wisely in adult hospital medicine: five opportunities for improved healthcare value. 
J Hosp Med.
 2013;8(9):486-92
.

 

 

The medication list can be made more cost effective by ensuring the list is as short as possible and ensuring that there is a compelling reason for each prescribed medication. When appropriate, non-pharmacologic alternatives and generic equivalent medications should be considered. It will also be important to find out if there are other lower-cost alternative medications used to treat same health condition and have them replace the medications on the list. Lastly, I will collaborate with pharmacists to help suggest lower-cost alternatives.

 

Furosemide (Lasix) 40 mg po daily

Multivitamin 1-tab po daily

Aspirin 81 mg po daily

Lisinopril 10 mg po daily

Pravastatin 40 mg po daily

Metformin 500 mg po bid

Rosuvastatin (Crestor) 10 mg po daily

Hydrocodone/acetaminophen 5/500 mg po q 6 hours prn pain

 

Answer Comment

The table below outlines a suggested higher-value medication list for this patient, with a comparison of actual monthly costs of the 
initial
 and the 
higher-value
 medication list, without consideration of her prescription drug plan coverage:

Initial hospital medication list

Cost for 30-day

supply ($)

Higher-value medication list

Cost* for 30-day

supply ($)

Aspirin
 81 mg po daily

0.30

Aspirin
 81 mg po daily

0.30

Calcium supplement with Vitamin D

1.20

Calcium supplement with Vitamin D

1.20

Coreg (carvedilol)
 25 mg po bid

164.24

Metoprolol XL
 50 mg po daily

17.65

Crestor (rosuvastatin)
 10 mg po daily

188.29

Atorvastatin
 40 mg po daily

17.00

Furosemide
 40 mg po daily

3.37

Furosemide
 40 mg po daily

3.37

Glipizide
 5 mg po daily

4.00

Glipizide
 5 mg po daily

4.00

Metformin
 500 mg po bid

4.00

Metformin
 500 mg po bid

4.00

Multivitamin

0.90

(discontinued)

–

Prinivil (lisinopril)
 10 mg po daily

44.44

Lisinopril
 10 mg po daily

4.00

Omeprazole
 20 mg po daily

10.25

(discontinued)

–

Hydrocodone/acetaminophen
 5/500 mg po q 6 hours prn severe pain, thirty tabs

17.00

Hydrocodone/acetaminophen
 5/500 mg po q 6 hours prn severe pain

17.00

Total cost for a one-month supply

$437.99

Total cost for a one-month supply

$68.52

*Costs are based on GoodRx.com using the zip code 98115 and cheapest Costco prices for over-the-counter medications.

Using a 
Medicare Part D plan,
 the per-month cost for these medications using the higher value medication list could be reduced to about $20/month out of pocket, including the monthly premium, copay, and annual deductible. However, many patients do not sign up for Medicare Part D due to the cost.

Discontinue nonessential medications started during a hospital stay.

In the hospital, this patient was started on a proton pump inhibitor, omeprazole. Proton pump inhibitors are sometimes started as prophylaxis against stress ulcers, but there is 
no evidence to support this
outside of the intensive care unit, and proton-pump inhibitors are associated with an increased risk of pneumonia and 
difficile
 colitis.

Always switch back to generics from brand-name hospital formulary medications.

Hospital formularies often contain expensive brand-name medications obtained through special pricing arrangements between the hospital and pharmaceutical companies.

In this case, generic lisinopril was substituted for the brand name Prinivil and carvedilol was substituted for brand name Coreg. Although brand name Crestor is available as generic rosuvastatin, another high intensity statin, atorvastatin, was less expensive in Mrs. Miller’s town. Aquifer High Value Care 04: 80-year-old woman – Medications and value

If there is no generic for the brand-name drug chosen, consider whether it is appropriate to switch to a drug in the same class that does have a generic option available.

 

 

 

CARE DISCUSSION

CARE DISCUSSION

It is hospital day four. Mrs. Miller’s dyspnea has resolved, and she is near her goal weight. You plan to discharge her later this morning.

Question

What is the 
best
 way to educate your patient about her medications before discharge? Choose the single best answer.

Use the teach-back method to review the medication list with the patient and her daughter.

Have the nurse review the medication list with the patient and her daughter.

Ask the clinical pharmacist to do discharge medication education.

Order home health nursing and have the nurse check to make sure she is taking her medications correctly.

SUBMIT

TEACHING POINT

The teach-back method assesses the patient’s recall and comprehension of any new concept. It is an effective method for both assessing a patient’s understanding of a situation and providing education. It should be used to educate patients about their medications before hospital discharge.

References

Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. 
Arch Intern Med.
 2005;165(16):1842-1847
.

Wong JD, Bajcar JM, Wong GG, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. 
Ann Pharmacother.
 2008;42(10):1373-1379
.

White M, Garbez R, Carroll M, Brinker E, Howie-Esquivel J. Is “teach-back” associated with knowledge retention and hospital readmission in hospitalized heart failure patients? 
J Cardiovasc Nurs.
2013;28(2):137-46
.

Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication wtih diabetic patients who have low health literacy. 
Arch Intern Med.
 2003;163(1):83-90
.

 

Question

What is the 
best
 way to educate your patient about her medications before discharge? Choose the single best answer.

The best option is indicated below. Your selections are indicated by the shaded boxes.

Use the teach-back method to review the medication list with the patient and her daughter.

Have the nurse review the medication list with the patient and her daughter.

Ask the clinical pharmacist to do discharge medication education.

Order home health nursing and have the nurse check to make sure she is taking her medications correctly.

SUBMIT

Answer Comment

The correct answer is A.

Discrepancies between what a patient is prescribed upon discharge from the hospital and what they actually take at home are common and are associated with a higher rate of hospital readmission, as happened in this case. Thoughtful patient education may improve adherence and reduce the chance of readmission. The 
teach-back method (A)
, in which a clinician assesses the patient’s recall and comprehension of any new concept, is an effective method for both assessing a patient’s understanding of a situation and providing education if the patient cannot demonstrate understanding. Using teach-back simply involves asking patients to restate information that has been presented to them. It allows the provider to check the patient’s understanding, reinforce important concepts, and engage in open dialogue.

Answers B and C are not the best answers as it is not clear that the nurse and pharmacist will use the teach back method. Ordering home health nursing and having the nurse check to make sure she is taking her medications correctly (D) is a strategy to identify medication nonadherence after it occurs. The best strategy should prevent nonadherence.

View guidelines for using teach-back in patient education.

Mrs. Miller receives her discharge instructions:

Mrs. Miller discharge instructions

Click here for a transcript of the video above.

 

DISCHARGE FOLLOW-UP

CARE DISCUSSION

You see Mrs. Miller in clinic with your preceptor three months later. Mrs. Miller has not been rehospitalized, and her heart failure has been stable. She has had one fall without serious injuries and continues to have trouble with her memory.

Your preceptor asks you to review the patient’s diabetes control during this visit. She has been on metformin and glipizide, and a recent HbA1C was 6.5%. She has stage II chronic kidney disease with a recent creatinine of 1.2 mg/dL and eGFR of 45. She watches her diet carefully, and in fact has lost ten pounds in the past year. Her BMI is 25. Aquifer High Value Care 04: 80-year-old woman – Medications and value

Question

What should you do today regarding Mrs. Miller’s diabetes management? Choose the single best answer.

The best option is indicated below. Your selections are indicated by the shaded boxes.

Continue her metformin and glipizide; recheck a HbA1C in three months

Continue her metformin but stop the glipizide

Reduce the metformin to 500 mg po daily and stop the glipizide

Stop her metformin but continue the glipizide

Stop both her metformin and her glipizide

SUBMIT

Answer Comment

The correct answer is B.

Reducing medications in the elderly reduces harm. Elderly patients on more than 4 medications are at higher risk of adverse events such as falls.

Mrs. Miller is a frail, community-dwelling elderly person, with a life expectancy that is likely less than 10 years. See the Expert for more information regarding prognosis in the elderly. Her goal HbA1C should be about 8% based on 
current guidelines
 (see guideline #3).

Comorbidities

Goal HbA1C

Healthy older adults with long life expectancy

7-7.5%

Older adults with comorbidities and life expectancy <10 years 7.5-8% Multiple comorbidities and shorter life expectancy, including most patients in long-term care facilities 8-9% Because Mrs. Miller’s HbA1C was 6.5%, and because she had fallen and is at increased risk of falling with hypoglycemia, her glipizide should be stopped, thus answers (A) and (D) are incorrect. In the future, the metformin could be decreased (C) or stopped (E) depending on her A1c and renal function. Her weight should be monitored closely because weight loss in the elderly is a marker of frailty and may reflect difficulties with self-care in a patient with cognitive impairment. Glipizide should be stopped before metformin because of the risk of hypoglycemia with sulfonylureas and better evidence for efficacy and safety in the older population with metformin. TEACHING POINT Reducing medications in the elderly reduces harm. Considering an elderly patient’s life expectancy before offering interventions is an important part of high-value care in this population. References Sue Kirkman M, Briscoe VJ, Clark N, et al. Diabetes in older adults: a consensus report.  J Am Geriatr Soc.  2012;60(12):2342-56 . DEEP DIVE References Yourman L, Lee S. Prognostic Indices for Older Adults: A Systematic Review.  JAMA.  2012;307(2);182-192 . This is the final page of the case. We value your perspective on the learning experience. After completing three required feedback ratings you can finish the case and access the case summary. Aquifer High Value Care 04: 80-year-old woman – Medications and value

Organizational Structures and Leadership sample essay

In most health care settings, it is unlikely that you would hear the terms “ad hoc” or “matrix” as you walk down the hallway. Although it is helpful for any organization to delineate pathways of responsibility and authority in an organizational chart, the lived experience of these structures is most apparent through the inquiries and behaviors people share everyday.

BUY A PLAGIARISM-FREE PAPER HERE

In your own workplace, you may find yourself wondering, who should I turn to when I have a practice dilemma? or Where can I go to learn more about this issue? Organizational Structures and Leadership sample essay. These questions speak to the intricacies of formal and informal organizational structure and leadership.

To prepare:

· Review the information presented in Chapter 12 of the course text. Focus on the information about formal versus informal structure as well as the types of organizational structures. Organizational Structures and Leadership sample essay.

· Consider the overall structure or hierarchy of your organization or one with which you are familiar. Which organizational structure best describes your organization—line (or bureaucratic), ad hoc, matrix, service line, or flat? 
Note:
 It is possible to have a combination of structures in one organization. Is decision making centralized or decentralized in this organization?

· What is the role of committees, task forces, and councils in the organization, and who is invited to join? Consider how this relates to formal and informal leadership.

· Reflect on how decisions are made within a specific department or unit. Which stakeholders provide input or influence the decision-making process? Assess this in terms of formal and informal leadership.

· To support your analysis, consider your own experiences and investigate these matters by speaking with others at the organization and reviewing available documents. Be sure to consider how the concepts of formal and informal structure and leadership relate to one another and are demonstrated in the organization and in the particular department or unit. Organizational Structures and Leadership sample essay.

Post 
a depiction of your organization’s formal structure, indicating whether it is best described as line, ad hoc, matrix, service line, flat, or a combination. Describe how decisions are made within the organization and within one department or unit in particular, noting relevant attributes of centralized/decentralized decision making. Explain the influence of formal and informal leadership on decision making within this department or unit. Organizational Structures and Leadership sample essay.

Learning Resources

Required Readings

Marquis, B. L., & Huston, C. J. (2017). 
Leadership roles and management functions in nursing: Theory and application 
(9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

· Chapter 2, “Classical Views of Leadership and Management” Organizational Structures and Leadership sample essay.

 

The information introduced through this chapter relates to this week’s Discussion, and will also be referred to in future weeks of the course.

 

· Chapter 3, “Twenty-First Century Thinking About Leadership and Management”

 

This chapter examines new thinking about leadership and management and how this may influence the future of nursing.

 

· Review Chapter 12, “Organizational Structure”

Allmark, P., Baxter, S., Goyder, E., Guillaume, L. & Crofton-Martin, G. (2013), Assessing the health benefits of advice services: Using research evidence and logic model methods to explore complex pathways. 
Health & Social Care in the Community, 21
, 59–68. doi:10.1111/j.1365-2524.2012.01087.x Organizational Structures and Leadership sample essay

 

This manuscript examines causal pathways between the provision of advice services and improvements in health. It may also be useful to commissioners and practitioners in making decisions regarding development and commissioning of advice services.

Downey, M., Parslow, S., & Smart, M. (2011). The hidden treasure in nursing leadership: Informal leaders. 
Journal of Nursing Management, 19
(4), 517–521.

Retrieved from the Walden Library databases. Organizational Structures and Leadership sample essay.

 

Informal leaders can have a strong impact in the workplace. This article explores the value informal leaders can provide.

Stetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for evidence-based practice: strategic and functional behaviors for institutionalizing EBP. 
Worldviews on Evidence-Based Nursing
, 
11
(4), 219–226. doi:10.1111/wvn.12044

Retrieved from the Walden Library databases.

Required Media

Laureate Education (Producer). (2012a). 
Diverse organizational structures.
Baltimore, MD: Author. Organizational Structures and Leadership sample essay.