Category: Nursing

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

 

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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

Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576

Many elements need to be considered individually by a woman, man, or couple when choosing the most appropriate contraceptive method. Some of these elements include safety, effectiveness, availability (including accessibility and affordability), and acceptability. Although most contraceptive methods are safe for use by most women, U.S. MEC provides recommendations on the safety of specific contraceptive methods for women with certain characteristics and medical conditions. Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576.

Compare and contrast two forms of contraception including indications, contraindications, side effects, US Medical Eligibility Criteria (USMRC), US Selected Practice Recommendations for Contraceptive Use (USSPR), affordability, and mechanisms of action.

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Intra uterine device (Mirena)

Intra uterine devices (IUD) are considered long-acting, reversible contraception (LARC). These types of contraceptives are highly effective since they do not depend on patient’s compliance on a daily basis. Most LARC methods of contraception are appropriate for the majority of women, including adolescents and nulliparous women. Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576.

Mechanisms of action: There are two different type of IUD’s, those with hormones and those without hormones. The Mirena is an IUD that contains synthetic hormones that is 99.9% effective and can stay in for up to 5 years (Mirena, 2018). The ParaGard is also an IUD and is 98% effective with no hormone release and can stay in for up to 10 years. For the sake of this review the author will talk about the Mirena. The Mirena is placed in the uterus by a provider. Mirena has several ways of working, it thickening of the cervical mucus and thins out the lining of the uterus due to the hormone release. The actual device itself sperm movement which reducing sperm survival (Patient Information Mirena, 2017).

Indication: Mirena release hormones that prevents pregnancy for up to 5 years. It is also indicated for treatment of heavy menstrual cycles in women who are also choosing to use a contraceptive (Curtis et al., 2016).

Contraindications: The U.S Medical Eligibility Criteria for Contraception Use advises that an IUD is contraindicated in women with distorted uterine cavity, current breast cancer the LNG- IUD the copper T is safe, endometrial cancer, gestational trophoblastic disease, current pelvic inflammatory disease, immediate post-septic abortion, postpartum sepsis, STD’s, pelvic tuberculosis, and unexplained vaginal bleeding (Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2017).

Side effects: Side effects include but are not limited to bleeding, and pain after insertion. Possible expulsion after insertion. Changes in menstrual cycle that include spotting between cycles especially during the first 3- 6 months and menstruation may be heavier the first 3 months as well. About 12% of women develop ovaria cysts (Curtis et al., 2016).

USSPR: When a woman has not had her cervix dilatate it can become difficult to insert the Mirena, therefore some providers use Misoprostol to dilatate the cervix for insertion. However, this is noS longer the recommended. Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576. It is only indicated who have failed previous insertion (Curtis et al., 2016).

Affordability: The manufacturing company is Liletta’s who has strived to make it affordable or all income levels. Unlike a daily contraception method, the Mirena is a onetime cost that includes the providers services. The price to the patient may range depending on their insurance yet an estimated price is about $1000 (Mirena, 2018).

Depo-Provera

Mechanisms of action: Depo-Provera is an injection that is administered every 3 months. It contains medroxyprogesterone acetate that inhibits the secretion of gonadotropins that prevents follicular maturation and ovulation. It thins the endometrial lining; these are the contraceptive effects. It is 94% effective (Highlights of Prescribing Information, 2018).

Indications: Depo-Provera clinical indication is to prevent pregnancy. However, it is also used for women who suffer from dysmenorrhea. Since Depo-prover thin the lining of the uterus I can eventually result in amenorrhea (Highlights of Prescribing Information, 2018).

Contraindications: The U.S Medical Eligibility Criteria for Contraceptives Use states that contraindications of the use of Depo-Provera is a current diagnosis of breast cancer. Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576. Depo-Provera theoretically or proven risks usually outweigh the advantages in patients who have had past and no evidence of current breast disease for 5 years, severe cirrhosis, nephropathy, retinopathy, neuropathy, other vascular disease or diabetes longer the years, history of stroke, systemic lupus erythematous, unexplained vaginal bleeding (Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use, 2017).

Side effects: More the 5% of women reported having side effects that include headache, abdominal pain, increased weight gain of more than 10 lb. at 24 months, nervousness, dizziness, decreased libido, irregularities with menstruation. About 1-5% of women reported fatigue, backache, dysmenorrhea, hot flashes, nausea, bloating, edema, leg cramps, depression, insomnia, acne, alopecia, rash, leukorrhea, breast pain and vaginitis (Highlights of Prescribing Information, 2018).

USSPR: Depo-Provera can be given at any reasonable time if she meets the criteria of administration. If the injection is given within the 7 first days of menstruation no additional contraceptive is needed Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576. If it is started more then 7 days since menstruation a patient should abstain from sexual intercourse or use another form of contraception (Curtis et al., 2016).

Affordability: Depo Provera starts at about $100 and be as affordable as $40.13 with Good RX. Since the injection is given every 3 months this can be an affordable choice for patients. The administration can be done by the provider medical assistant staff. Just like the Mirena, a patient’s insurance may cover all or some of these costs (Depro Provera, 2018).

References

Curtis, K. M., Jatlaoui, T. C., Tepper, N. K., Zapata, L. B., Horton, L. G., Jamieson, D. J., & Whiteman, M. K. (2016). U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR. Recommendations And Reports: Morbidity And Mortality Weekly Report. Recommendations And Reports, 65(4), 1-66. doi:10.15585/mmwr.rr6504a1 ttps://www.cdc.gov/mmwr/volumes/65/rr/rr6504a1.htm?s_cid=rr6504a1_w

Depo Provera. (2018). Good Rx. Retrieved from
https://www.goodrx.com/depo-provera?drug-name=depo+provera

Highlights of Prescribing Information. (2018). Food and Drug Administration. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020246s036lbl.pdf

Summary Chart of U.S. Medical Eligibility Criteria for Contraceptive Use. (2017). Centers for Disease Control and Prevention. Retrieved from
https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf 

Patient Information Mirena (June, 2017). Food and Drug Administration. Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576. Retrieved from
https://labeling.bayerhealthcare.com/html/products/pi/Mirena_PPI.pdf

Mirena. (2018). Good Rx. Retrieved at
https://www.goodrx.com/mirena?drug-name=mirena

 

Response

Miriah, thank you for your insightful response to this week’s discussion board. I chose to read and respond to your post because I spent my time researching Mirena and Depo-Provera. I found it intriguing the exact since behind why combined oral contraception (COC) is contraindicated for patients with dyslipidemia. The study was done on women who were taking COC, 665 hypertensive women and 665 normotensive women. Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576. In general, women who have hypertensive have a higher risk of mixed hyperlipidemia or dyslipidemia than those that are normotensive. The study results show that dyslipidemia and the long-term use of COC increase the risk of hypertension, which we know leads to stroke. Results also reviled that patients that took COC longer than 15 years and have dyslipidemia had an increased higher risk of hypertension. The study also offered a solution; if the patient stopped taking the COC then this can be considered an effective antihypertensive measure (Wei et al., 2011).

Reference

Wei, W., Li, Y., Chen, F., Chen, C., Sun, T., Sun, Z., & … Ba, L. (2011). Dyslipidaemia, combined oral contraceptives use and their interaction on the risk of hypertension in Chinese women.
Journal of Human Hypertension,
25(6), 364-371. doi:10.1038/jhh.2010.67 Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576

Responses

Debbie, thank you for your response of this week’s discussion. I am glad that you chose to write about the Nexplanon. I don’t know about your clinical rotation but during contraception counseling my provider seems to shy away from having women opt to have this implanted due to the issue. One of the biggest concerns that woman worry about and that they have heard through other friends and family is that the Nexplanon travels. I came across this very interesting case study of a 17 year old female that had the Nexplanon implanted by her general practitioner. She was having irregular bleeding, so the plan was for her to have it removed. Once they went in to remove it the implant was no where to be found. The provider contacted the manufacturer who suggested that she have a CT done of her thorax. The CT thorax reviled that the implant had traveled to the left lower lobe of the pulmonary artery branch occluding the pulmonary vessel with no necrosis or infection. The options for removal of the device came with high risk and included a lobectomy. The providers and patient opted to leave the implant in place since it was suspected that the implant had been in her left lower lobe for the last 2 years, since the patient felt it was missing. This is an extreme case yet one that we as new nurse practitioner should take into consideration if we ever implant this device (Barlow-Evans, Jaffer, & Balogun, 2017). Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576.

Reference

Barlow-Evans, R., Jaffer, K., & Balogun, M. (2017). Migration of a Nexplanon contraceptive implant to the pulmonary artery. BMJ Case Reports, 2017doi:10.1136/bcr-2017-219259 Contraception compare and contrast -Intra uterine device (Mirena) and Depo-Provera – MN 576

Cognitive Behavioral Therapy: Family Settings Versus Individual Settings Sample Essay

Review the media, Johnson Family, I am sending the transcript.

Compare the use of cognitive behavioral therapy for families to cognitive behavioral therapy for individuals

Analyze challenges of using cognitive behavioral therapy for families.

Johnson Family Episode 3 Program Transcript

[PEOPLE SOCIALIZING AT PARTY]

MALE SPEAKER: Hey there. How you feeling?

FEMALE SPEAKER: I’m drunk.

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MALE SPEAKER: Yes, you are. Here, have some more.

FEMALE SPEAKER: I need to lay down. I don’t feel so good.

MALE SPEAKER: No, no, no, no. Not here. Not here.

FEMALE SPEAKER: Take me home.

MALE SPEAKER: I can’t leave. It’s my frat party. I actually– But I’ll tell you what, let me take you upstairs. You can use my bed. OK? Cognitive Behavioral Therapy: Family Settings Versus Individual Settings Sample Essay.

FEMALE SPEAKER: Sure.

MALE SPEAKER: All right. Come on, Talia. I got you.

FEMALE SPEAKER: I remember him lying me down on a bed and then he started kissing me. I think I kissed him back. And then he started taking off my pants. I told him to stop, but I must have passed out. When I woke up later, I didn’t have anything on. I just grabbed my clothes and got the hell out of there. I feel like such a fool. I had too much to drink. I don’t know why I let it happen.

FEMALE SPEAKER: Thank you for sharing. It sounds like you still feel responsible for what happened. Has anyone else had similar feelings about something that’s happened to them?

FEMALE SPEAKER: There was this guy once, I told him no just like you. I told him really loud, but it didn’t matter. He did what he wanted anyway. He raped me. And for some reason, I blamed myself for it. It took a long time and a lot of help to realize I was wrong. It wasn’t my fault. Just like it’s not your fault. That frat boy, he’s the one to blame. Cognitive Behavioral Therapy: Family Settings Versus Individual Settings Sample Essay.

FEMALE SPEAKER: When it happened to me some of the people in my life, people I loved, they said it was my fault. Said that I shouldn’t have been where I was. Said it wouldn’t have happened otherwise. But it wasn’t my fault. It wasn’t. But to have people that you trust say those things about you, it’s confusing. It hurts.

FEMALE SPEAKER: Thank you for sharing your thoughts and being supportive. It’s important in a group like this.

FEMALE SPEAKER: Is it? Is it really? I’m not so sure. It hurts talking about it like this. It just, it keeps hurting

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a low-intensity psychosocial treatment approach that focuses on addressing the psychological symptoms on the understanding that eliminating them would effectively treat the condition. In essence, CBT works under the premise that the expressed psychological symptoms are all linked to the interaction between emotions, behavior, and thoughts. As such, specifically targeting emotions, behavior, and thoughts will reduce the psychological symptoms expressed (Orgeta et al., 2015; Whitaker & Cosgrove, 2015). The implication is that applying the CBT approach would entail the client working with a therapist to identify and change the emotions, behavior, and thoughts that have been maintaining the depression symptoms. Cognitive Behavioral Therapy: Family Settings Versus Individual Settings Sample Essay.

At the core of CBT action is the comprehension that addressing the symptoms and underlying conditions is best achieved by accepting that there is a close link between emotions, behavior, and thoughts. Although CBT has found success for individuals, it is postulated that it would achieve better results in a family setting. That is because the majority of psychological problems that individuals face transpire in a family setting and accordingly, the members of the family play a part in initiating, maintaining and exacerbating the problem (Acton, 2013). Still, CBT application in the family setting (unlike the individual setting) has some unique features. Firstly, the decision to undertake CBT for the whole family is typically made by a single family member who is a position of authority. The members not in a position of authority will infrequently refer themselves for therapy (Ekkekakis, 2013). Cognitive Behavioral Therapy: Family Settings Versus Individual Settings Sample Essay. Secondly, a family setting presents reinforcers and creates adequate contingencies to bring about enduring and generalizable changes. The family members have more regular interactions (compared to CBT sessions that may occur once or twice in a week) that are more influential and could either sabotage or support therapeutic gains. This is unlike individual therapy that may lack enough reinforcers and does not create adequate contingencies (Cautin & Liliekfeld, 2015). In this respect, CBT application in individual setting is distinctive from its application in a family setting. Cognitive Behavioral Therapy: Family Settings Versus Individual Settings Sample Essay.

References

Acton, A. (2013).
Major depressive disorders: new insights for the healthcare professional
. Atlanta, GA: Scholarly Editions.

Cautin, R. & Lilienfeld, S. (2015).
The encyclopedia of clinical psychology, volume II Cli-E
. Hoboken, NJ: John Wiley & Sons.

Ekkekakis, P. (2013).
Routledge handbook of physical activity and mental health
. New York, NY: Routledge.

Orgeta, V., Qazi, A., Spector, A. & Orrell, M. (2015). Psychological treatments for depression and anxiety in dementia and mild cognitive impairment: systematic review and meta-analysis.
The British Journal of Psychiatry
, 207(4), 293-298.

Whitaker, R. & Cosgrove, L. (2015).
Psychiatry under the influence: institutional corruption, social injury, and prescriptions for reform
. New York, NY: Palgrave Macmillan. Cognitive Behavioral Therapy: Family Settings Versus Individual Settings Sample Essay.

MN 576 Quiz Submissions – Unit 5 Midterm

Submission View

Random Section 1

 

Question 1

2 / 2 points

Which HPV types are most often associated with cervical and anogenital cancer?

Question options:

1)

1, 2, and 3

2)

6 and 11

3)

16 and 18

4)

22 and 24

Question 2

2 / 2 points

During a breast exam you note all of the findings below as normal except:

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Question options:

1)

asymetrical size

2)

a supernumerary nipple

3)

hyperpigmentation

4)

breasts that move up symmetrically with raising the arms

Question 3

2 / 2 points

A 30-year-old woman presents without symptoms but states that her male partner has dysuria without penile discharge MN 576 Quiz. Examination reveals a friable cervix covered with thick yellow discharge. This description is most consistent with an infection caused by:

Question options:

1)

Chlamydia trachomatis.

2)

Neisseria gonorrhoeae.

3)

human papillomavirus (HPV).

4)

Trichomonas vaginalis.

Question 4

2 / 2 points

The vaccine Gardasil that is used to prevent some strains of HPV infection is recommended in both males and females.

Question options:

1) True

2) False

Question 5

2 / 2 points

Lesbians may experience which of the following barriers to health care?

Question options:

1)

Homophobia from the healthcare provider

2)

Incorrect knowledge about health care needs of lesbians by healthcare providers

3)

Lack of insurance and/or access under partner’s coverage MN 576 Quiz

4)

All of the above

Question 6

2 / 2 points

Which of the following best describes lesions associated with condyloma acuminatum?

Question options:

1)

verruciform

2)

plaque-like

3)

vesicular-form

4)

bullous

Question 7

2 / 2 points

Presumptive treatment for PID should be initiated in sexually active young women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum clinical criteria are present on pelvic examination:

Question options:

1)

cervical motion tenderness

2)

uterine tenderness

3)

adnexal tenderness.

4)

All of the above

Question 8

2 / 2 points

How long after contact do clinical manifestations of syphilis typically occur?

Question options:

1)

less than 1 week

2)

1 to 3 weeks

3)

2 to 4 weeks

4)

4 to 6 weeks

Question 9

2 / 2 points

In assessing a woman with disabilities, which of the following terms should be avoided?

Question options:

1)

Crippled

2)

Handicapped

3)

Mentally retarded MN 576 Quiz

4)

All of the above

Question 10

2 / 2 points

The definition of menopause is

Question options:

1)

Frequently skipping period for one year

2)

One year without a period

3)

Onset of hot flashes and night sweats with irregular menstruation

4)

None of the above

Question 11

2 / 2 points

MN 576 Quiz Treatment options for bacterial vaginosis include all of the following except:

Question options:

1)

oral metronidazole.

2)

clindamycin cream.

3)

oral clindamycin.

4)

oral azithromycin.

Question 12

2 / 2 points

Physical examination of a 19-year-old woman with a 3-day history of vaginal itch reveals moderate perineal excoriation, vaginal erythema, and a white, clumping discharge. Expected microscopic examination findings include:

Question options:

1)

a pH greater than 6. 0.

2)

an increased number of lactobacilli.

3)

hyphae.

4)

an abundance of white blood cells.

Question 13

2 / 2 points

Which of the following is a contraindication to estrogen/progestin-containing methods (combined oral contraception [COC], patch [Ortho Evra], or ring [NuvaRing]) MN 576 Quiz?

Question options:

1)

mother with a history of breast cancer

2)

personal history of hepatitis A at age 10 years

3)

presence of factor V Leiden mutation

4)

cigarette smoking one pack per day in a 22-year-old

Question 14

2 / 2 points

Recommendations for adolescents with disabilities include a comprehensive sex education program that should be tailored to fit their specific needs.

Question options:

1) True

2) False

Question 15

0 / 2 points

In assessing a 13 year old female, you know that the presence of breast bud  with elevation of breast and papilla; enlargement of areola indicate which Tanner Stage?

Question options:

1)

Stage1

2)

Stage 2

3)

Stage 3

4)

Stage 4

Question 16

2 / 2 points

The Pap test should not be considered a screening test for STDs.

Question options:

1) True

2) False

Question 17

2 / 2 points

Which of the following agents is most active against C. trachomatis?

Question options:

1)

amoxicillin

2)

metronidazole

3)

azithromycin

4)

ceftriaxone

Question 18

2 / 2 points

When performing a bimanual exam all of the following are noted as normal findings except:

Question options:

1)

retoverted uterus

2)

anteflexed uterus

3)

fixed immobile uterus

4)

smooth, firm ovary

Question 19

2 / 2 points

Routine screening for C. trachomatis on an annual basis is recommended for all sexually active females aged <25 years . Question options: 1) True 2) False Question 20 2 / 2 points When performing a pelvic examination the first part of the external genitalia exam is Question options: MN 576 Quiz 1) speculum examination 2) palpation 3) inspection 4) cervical sampling Question 21 2 / 2 points In women who have experienced a spinal cord injury, temporary cessation of menses is normal for up to one year following the injury. Question options: 1) True 2) False Question 22 2 / 2 points When counseling a woman about COC use, you advise that: Question options: 1) long-term use of COC is discouraged because the body needs a “rest” from birth control pills from time to time. 2) fertility is often delayed for many months after discontinuation of COC. 3) there is an increase in the rate of breast cancer after protracted use of COC. 4) premenstrual syndrome symptoms are often improved with use of COC. Question 23 2 / 2 points Which of the following terms describes the mechanism of action of imiquimod (Aldara)? Question options: 1) keratolytic 2) immune modulator 3) cryogenic 4) cytolytic Question 24 2 / 2 points Treatment of vulvovaginitis caused by Candida albicans includes: Question options: 1) metronidazole gel. 2) clotrimazole cream. 3) hydrocortisone ointment. 4) clindamycin cream. Question 25 2 / 2 points Screening for osteoporosis with DEXA scan should begin Question options: 1) age 50 2) one year after menopause 3) age 65 4) age 60 Question 26 2 / 2 points What is the approximate incubation period for Neisseria gonorrhoea? Question options: 1) 1 to 5 days 2) 7 to 10 days 3) 18 days 4) 28 days Question 27 2 / 2 points What percentage of anogenital and cervical cancers can be attributed to HPV infection? Question options: 1) less than 30% 2) at least 50% 3) at least 70% 4) 95% or greater Question 28 2 / 2 points Universal screening for chlamydia and gonorrhea in women ≤35 years entering juvenile and adult correctional facilities has been a long-standing recommendation. Question options: 1) True 2) False Question 29 2 / 2 points A 22-year-old woman taking a 35-mcg ethinyl estradiol COC calls after forgetting to take her pills for 2 consecutive days. She is 2 weeks into the pack. You advise her to: Question options: 1) take the last pill missed immediately, even if this means taking 2 pills today. 2) discard two pills and take two pills today. 3) discard the rest of the pack and start a new pack with the first day of her next menses. 4) continue taking one pill daily for the rest of the cycle. Question 30 2 / 2 points HCV infection is the most common chronic bloodborne infection in the United States, with an estimated 2.7 million persons living with chronic infection Question options: 1) True 2) False Question 31 2 / 2 points Adolescent girls are not candidates for IUD use for contraception Question options: 1) True 2) False Question 32 2 / 2 points About ____ of patients with genital warts have spontaneous regression of the lesions? MN 576 Quiz Question options: 1) 10% 2) 25% 3) 50% 4) 75% Question 33 2 / 2 points Complementary and alternative medicine (CAM) is defined as a group of therapies that are not considered part of Western culture and include all of the following except: Question options: 1) Congugated estrogen 2) Aromatherapy 3) Tai Chi 4) Yoga Question 34 2 / 2 points Which HPV types are most likely to cause genital condyloma acuminatum? Question options: 1) 1, 2, and 3 2) 6 and 11 3) 16 and 18 4) 22 and 24 Question 35 2 / 2 points Which test is performed around the time of ovulation to diagnose the basis of infertility? Question options: 1) Hysterosalpingogram 2) Ultrasonography 3) Laparoscopy 4) Follicle-stimulating hormone (FSH) level Question 36 2 / 2 points The NP is seeing a 30-year-old woman before her routine gynecologic examination, the NP questions that patient about her recent menstrual cycles. Which statement made by the patient should prompt further investigation? Question options: 1) “My flow is very heavy all the time.” 2) “I have occasionally spot in between cycles” 3) “My menstrual cycles varies from 25 to 30 days.” 4) “I have cramping prior to my cycle starting” Question 37 2 / 2 points Women with bacterial vaginosis typically present with: Question options: 1) vulvitis. 2) pruritus. 3) dysuria. 4) malodorous discharge. Question 38 2 / 2 points Treatment options for patients with condyloma acuminatum include all of the following except: Question options: 1) topical acyclovir. 2) cryotherapy. 3) podofilox. 4) trichloroacetic acid. Question 39 0 / 2 points The average onset of perimenopause is between the ages of: Question options: 1) 35 to 40 years. 2) 40 to 45 years. 3) 45 to 50 years. 4) 50 to 55 years. Question 40 2 / 2 points Which of the following is not representative of the presentation of primary syphilis? Question options: 1) painless ulcer 2) localized lymphadenopathy 3) flu-like symptoms 4) spontaneously healing lesion Question 41 2 / 2 points Noncontraceptive benefits of COC use include a decrease in all of the following except: Question options: 1) iron-deficiency anemia. 2) pelvic inflammatory disease (PID). 3) cervicitis. 4) ovarian cancer. Question 42 2 / 2 points MN 576 Quiz In patients who are allergic to azithromycin, an alternative treatment to chlamydia is Question options: 1) Doxycycline 100mg twice daily for 7 days 2) Macrobid 100mg twice daily for 5 days 3) BactimDS  1 PO BID for 3 day 4) All of the above Question 43 2 / 2 points Puberty consists of a series of predictable events, and the sequence of changes in secondary sexual characteristics has been categorized by several groups. The staging system utilized most frequently used to describe these events is Tanner staging. Question options: 1) True 2) False Question 44 2 / 2 points Which of the following may be a useful tool in screening for Female Sexual Disorder (FSD)? Question options: 1) The Female Sexual Function Index 2) The Female Sexual Distress Scale 3) The Orgasmic Disorder Scale 4) A and B Question 45 2 / 2 points Which of the following is found in tertiary syphilis? Question options: 1) arthralgia 2) lymphadenopathy 3) macular or papular lesions involving the palms and soles 4) gumma Question 46 2 / 2 points A patient presents to you with a chief complaint of primary dysmenorrhea, which nonpharmacologic intervention might you recommend she try first? Question options: 1) participating in physical activity 2) increase iron rich foods to replace blood that is lost 3) use of a heating pad on the pelvis for cramping 4) use of an NSAID Question 47 2 / 2 points Which of the following agents is active against N. gonorrhoeae? Question options: 1) ceftriaxone 2) metronidazole 3) ketoconazole 4) amoxicillin Question 48 0 / 2 points A recommended treatment for rectal gonorrhea is: Question options: 1) oral amoxicillin. 2) oral azithromycin. 3) oral ciprofloxacin. 4) ceftriaxone injection. Question 49 2 / 2 points When charting on a patient whom you have noted a breast lump it is important to document Question options: 1) tenderness 2) size 3) location 4) mobility 5) all of the above MN 576 Quiz Question 50 2 / 2 points A 24-year-old woman presents with a 1-week history of thin, green-yellow vaginal discharge with perivaginal irritation. Physical examination findings include vaginal erythema with petechial hemorrhages on the cervix, numerous white blood cells, and motile organisms on microscopic examination. These findings most likely represent: Question options: 1) motile sperm with irritative vaginitis. 2) trichomoniasis. 3) bacterial vaginosis. 4) condyloma acuminatum. Bottom of Form

Application: Taking a Stand

Effective leaders have a high degree of self-awareness and know how to leverage their strengths in the workplace. Assessments are a valuable tool that professionals can use to learn more about themselves and consider how their temperament and preferences influence their interactions with others.

As you engage in this learning process, it is important to remember that everyone—regardless of temperament type or related preferences—experiences some challenges with regard to leadership. The key to success is being able to recognize and leverage your own strengths while honoring differences among your colleagues.

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At some point in your leadership career, you will encounter an ethical or moral dilemma that requires you to take a stand and defend your position. Application: Taking a Stand.

For this Assignment, you evaluate an issue and consider how you could act as a moral agent or advocate, facilitating the resolution of the issue for a positive outcome.

To prepare:

·        Consider the examples of leadership demonstrated in this week’s media presentation and the other Learning Resources. Application: Taking a Stand.

·        To further your self-knowledge, you are required to complete the Kiersey Temperament as indicated in this week’s Learning Resources. Consider your leadership style, including your strengths for leading others and include your results from Kiersey Temperament Sorter to describe potential challenges related to your leadership style.

·        Mentally survey your work environment, or one with which you are familiar, and identify a timely issue/dilemma that requires you to perform the leadership role of moral agent or advocate to improve a situation (e.g., speaking or acting on behalf of a vulnerable patient, the need for appropriate staffing, a colleague being treated unfairly). Application: Taking a Stand.

·        What ethical, moral, or legal skills, dispositions, and/or strategies would help you resolve this dilemma? Define the differences between 
ethical, moral, and legal leadership.

·        Finally, consider the values and principles that guide the nursing profession; the organization’s mission, vision, and values; the leadership and management competencies addressed in this course; and your own values and reasons for entering the profession. What motivation do you see for taking a stand on an important issue even when it is difficult to do so? Application: Taking a Stand.

To complete:

Write a 4 to 5 page paper (page count does not include title and reference page) that addresses the following:

·        Introduce the conceptual frameworks of the ethical constructs of ethics, moral, or legal standards and the purpose of the Application: Taking a Stand paper.

·        Consider  an ethical, moral, or legal dilemma that you have encountered in your work environment and describe it.

·        Analyze the moral, ethical, and legal implications utilized in this situation. Describe your role as a moral agent or advocate for this specific issue.

·        Consider your leadership styles identified by your self-assessment and determine if they act as a barrier or facilitation during this dilemma.

Self Assessment results

Guardians (SJ’s)
are the cornerstone of society, for they are the temperament given to serving and preserving our most important social institutions. Guardians have natural talent in managing goods and services–from supervision to maintenance and supply — and they use all their skills to keep things running smoothly in their families, communities, schools, churches, hospitals, and businesses Application: Taking a Stand.

Guardians can have a lot of fun with their friends, but they are quite serious about their duties and responsibilities. Guardians take pride in being dependable and trustworthy; if there’s a job to be done, they can be counted on to put their shoulder to the wheel. Guardians also believe in law and order, and sometimes worry that respect for authority, even a fundamental sense of right and wrong, is being lost. Perhaps this is why Guardians honor customs and traditions so strongly — they are familiar patterns that help bring stability to our modern, fast-paced world.

Practical and down-to-earth, Guardians believe in following the rules and cooperating with others. They are not very comfortable winging it or blazing new trails; working steadily within the system is the Guardian way, for in the long run loyalty, discipline, and teamwork get the job done right. Guardians are meticulous about schedules and have a sharp eye for proper procedures. They are cautious about change, even though they know that change can be healthy for an institution. Better to go slowly, they say, and look before you leap.

Guardians make up as much as 40 to 45 percent of the population, and a good thing, because they usually end up doing all the indispensable but thankless jobs everyone else takes for granted.

You are most comfortable when your life is structured. As a result you usually prefer a workplace that lets you create a routine you can settle into. Because you are dependable and exacting, your colleagues and customers rely on your work. Your ideal job offers you a clear chain of command, and lets you progress through a hierarchy based on your meeting expectations Application: Taking a Stand.

The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references.

 Course Readings

·        Marquis, B. L., & Huston, C. J. (2015). 
Leadership roles and management functions in nursing: Theory and application
 (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

o   Chapter 4, “Ethical Issues”

This chapter examines ethical frameworks for decision making and principles of ethical reasoning. You are also introduced to the ANA Code of Ethics and Professional Standards, MORAL decision-making model, and ethics committees. Application: Taking a Stand.

o   Chapter 5, “Legal and Legislative Issues”

Chapter 5 provides an overview of the many legal and legislative issues of which leaders and managers need to be aware. As you read this chapter, keep these issues in mind.

o   Chapter 6, “Patient, Subordinate, and Professional Advocacy”

Nurses are the best advocates for patients and the profession. This chapter examines more closely the role of becoming an advocate, patient rights, subordinate advocacy, whistle-blowing, professional advocacy, advocacy in legislation and public policy, and media.

·        Cianci, A. M., Hannah, S. T., Roberts, R. P., & Tsakumis, G. T. (2014). The effects of authentic leadership on followers’ ethical decision-making in the face of temptation: An experimental study. 
The Leadership Quarterly
, 
25
(3), 581-594. doi:10.1016/j.leaqua.2013.12.001

Abstract excerpt: The present research investigates the impact of authentic leadership on followers’ morality, operationalized as ethical decision-making, in the face of temptation. This experiment finds that authentic leadership and temptation interacted to affect individuals’ ethical decision-making. Specifically, authentic leadership significantly inhibited individuals’ from making unethical decisions in the face of temptation, whereas followers of neutral or less authentic leaders were more likely to succumb to temptation. Application: Taking a Stand.

·        Disch, J. (2014). Using Evidence-Based Advocacy to Improve the Nation’s Health. 
Nurse Leader
, 
12
(4), 28-31. doi:10.1016/j.mnl.2014.05.003

Abstract excerpt: Evidence-based practice is 1 of the 5 competencies that the Institute of Medicine has identified for all health professionals. Its intent is to employ evidence-based practice and integrate best research results, clinical expertise, and patient values to make patient care decisions. Application: Taking a Stand. This article will explore the concept of evidence-based advocacy and describe ways in which one prominent nursing organization, the American Academy of Nursing, uses evidence-based advocacy to positively impact the nation’s health and advance the nursing profession

·        Martin, M. B. (2014). Transcultural Advocacy and Policy in the Workplace: Implications for Nurses in Professional Development. 
Journal for nurses in professional development
, 
30
(1), 29-33.  doi: 10.1097/NND.0000000000000027

Abstract: This article introduces the role of nursing professional development specialists in serving as a resource for both patient and staff advocacy regarding cultural and linguistic matters. The impact of changing demographics, support for civil rights, and established policy related to culture and linguistics is emphasized. An overview of policy at local, state, and national levels is suggested to promote nursing professional development in the interest of culturally and linguistically compliant nursing practice. Application: Taking a Stand.

·        Woods, M. (2014). Beyond moral distress preserving the ethical integrity of nurses. 
Nursing Ethics
, 
21
(2), 127-128.

This guest editorial discusses the difficulties involved in dealing with those sometimes-painful moral problems encountered in practice. Application: Taking a Stand.

ccmh 551 week 5 client termination and evaluation reflection sample essay

Client Termination and Evaluation Reflection

Termination should be discussed at the same time the goals are being created so that the client understands the process of the relationship and the realization that this is not a forever relationship sets in. Once the client has adapted to the processes and utilizes the interventions to better themselves and is successful at it, then the job of the counselor is over, and termination of the relationship must be implemented.

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The process of terminating the counselling relationship is the official term employed when a therapist and a client stop working together. I would think it could be a rather difficult time for both myself the counselor and the client, due to the emotional state of mind that comes when all things end, good or bad. It may, stir perhaps the feelings of past loss and preceding endings for both client and counselor. Termination may also represent time of positive replication and a feeling of achievement by reviewing the work accomplished together. Additionally, some healing about previous losses and/or conclusions might well be achieved when these sentiments and prior occurrences are brought out into the light of day ccmh 551 week 5 client termination and evaluation reflection sample essay.

I think that termination can and will end with mixed emotions on both ends of the spectrum. On the positive side, with some patients, as we discuss and review the work we have completed together, I am sure I will see some amazing changes that have taken place inside this relationship that will truly amaze me and leave me and the client feeling gratified. Once you have reached the clients goals termination is a must, to keep the relationship viable after that point is a disservice to the client and is unethical on the part of the counselor.

Thinking about parallel processing, I suspect that is just a part of the difficulty in saying good-bye to clients, it will represent the reflection of the feelings shared between the client and myself. I assume it will be very hard for me to part from some of my future patients, and undoubtedly I will always wonder where there are in their lives and if I truly made the difference for them.  Finally, after all I have read, I have come to believe that termination might also be viewed as a new beginning and not so much an ending.  I will try in future endeavors to view client’s as graduating to a point where they no longer need therapy, or perhaps they are moving on to a relationship with a new therapist of which can provide a service outside the scope of my abilities.

Without regard of what the new foundation might be, I believe that we both will certainly grow and transform from the distinct therapeutic bond that developed between us. No matter how it all plays out in the future I will be forever grateful to those first few clients that allowed me to be a partner on their journey. ccmh 551 week 5 client termination and evaluation reflection sample essay.

References

Hackney, Harold, and L. Sherilyn Cormier. 
The Professional Counselor: A Process Guide to Helping
. Boston, Mass: Allyn & Bacon, 1996 ccmh 551 week 5 client termination and evaluation reflection sample essay.