Costovertebral angle tenderness should be assessed whenever you suspect the patient may have: – Polynephritis
In older adults, overflow fecal incontinence is commonly due to: -Fecal impaction
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? – The infant has regurgitation with pyloric stenosis
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Auscultation of borborygmi is associated with: – Gastroenteritis, early intestinal obstruction, or hunger
When auscultating the abdomen, which finding would indicate collateral circulation between the portal and systemic venous systems? – Venous hum. nurs 6512 final exam.
Conversion of fat-soluble wastes to water-soluble material for renal excretion is a function of the: – Liver
The major function of the large intestine is: -Water absorption
Which structure is located in the hypogastric region of the abdomen? –Ileum, bladder, and pregnant uterus
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): -Positive Helicobacter pylori result
You are caring for a patient with trigeminal neuralgia. During the assessment, the patient would describe the pain as: – Burning or shocklike
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: – The pain gets better when she sits
A 5 year old is complaining of nondescriptive “belly pain.” Your next action should be to ask him to: – Point to the area of pain nurs 6512 final exam
The perception of pain: – Is variable and is affected by emotions, and cultural background
Patients presenting with ascites, jaundice, cutaneous spider veins, and nonpalpable liver exhibit signs of: – Cirrhosis
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? – Spleen
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? – Hydronephrosis
Visible intestinal peristalsis may indicate: – Intestinal obstruction nurs 6512 final exam
Infants born weighing less than 1500g are at higher risk for: – Necrotizing enterocolitis
Which of the following factors is not known to affect patient compliance with his or her treatment regimen? – The patient’s age and social status
One of the most important aspects to consider in the orthopedic screening examination is: – Symmetry
The sequence of the physical examination should be individualized to: – Minimize the number of times the patient has to change positions to conserve the patient’s energy
As you greet the patient, which examination technique is first implemented? – Inspection
Which of the following is most likely to enhance examiner reliability? – The examiner attempts to qualify data
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? – This is common misconception, and the finger may be broken. An x-ray is indicated nurs 6512 final exam.
A patient presenting for the first time with typical low back pain should receive which of the following diagnostic tests? – None of the above. X-ray is not indicated because lumbar pain is usually musculoskeletal etiology.
Skeletal changes in older adults are the result of: -Increased bone resorption
A positive straight leg raise test usually indicates: – Lumbar nerve root irritation
What technique is performed at every infant examination during the first year of life to detect hip dislocation? – Barlow-Ortolani maneuvers
Expected normal findings during inspection of spinal alignment include: – Convex lumbar curve
Temporalis and masseter muscles are evaluated by: – Having the patient clench his or her teeth
When palpating joints, crepitus may be caused when: – Irregular bony surfaces rub together
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: – Radial head subluxation. nurs 6512 final exam.
Light skin and thin body habitus are risk factors for: – Osteoporosis
Risk factors for sports-related injuries include: – Failure to warm up before activity
Injuries to long bones and joints are more likely to result in fractures than in sprains until: – Adolescence
Ligaments are stronger than bone until: – Adolescence
The family history for a patient with joint pain should include information about siblings with: -Genetic disorders nurs 6512 final exam.
The Thomas test is used to detect: – Flexion contractures of the hip
A goniometer is used to assess: – Range of motion
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. – Valgus stress
You note that a child has a positive Gower Sign. You know that this indicates generalized: – Muscle weakness
The dowager hump is: – The hallmark of osteoporosis
What temporary disorder may be experienced by pregnant women during the third trimester because of fluid retention? –Carpal tunnel syndrome
A common finding in markedly obese and pregnant women is: – Lordosis
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? – Positive straight leg raise result nurs 6512 final exam.
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? – Huntington chorea
Testing of cranial nerve ________ is not routinely performed unless a problem is suspected. – I
The patient is able to rapidly touch each finger to his thumb in rapid sequence. What does this finding mean? – The patient has appropriate cerebellar function
Which question asked by the examiner may hellp to determine prevention strategies for seizures that a patient is experiencing? – “Are there any factors or activities that seem to start the seizures?”
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? – Inner ear dysfunction affecting the acoustic nerve
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? – Peripheral nerve sensory function
Which of the following findings should an examiner consider a normal finding if associated with pregnancy? – Acroparesthesia nurs 6512 final exam.
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: – Cerebrovascular accident
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? – Lumbosacral plexopathy
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? – 2+
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: – A late symptom of Parkinson’s disease nurs 6512 final exam.
Motor maturation proceeds in an orderly progression from: – Head to toe
The thalamus is the major integration center for perception of: – Pain
The examiner should be concerned about neurologic competence if a social smile cannot be elicited by the time a child is ________old. – 3 months
Normal changes of the aging brain include: – Diminished perception of touch. — this is by process of elimination/educated guess. I could not find direct information addressing this in Seidel
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: -Mini-mental state examination
The area of body surface innervated by a particular spinal nerve is called a: – Dermatome
If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation? – CN XI, spinal accessory nurs 6512 final exam.
The finger-to-nose test allows assessment of: – Coordination and fine motor function
You ask the patient to follow a series of short commands to assess: – Attention span
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: – Cerebellar ataxia
When is the mental status portion of the neurologic system examination performed? – Constantly throughout the entire interaction with a client
An aversion to touch or being held, along with delayed or absent language development, is a characteristic of: -Autism
The autonomic nervous system coordinates which of the following? – Internal environment of the body
The major function of the sympathetic nervous system is to: – Orchestrate the stress response
The parasympathetic nervous system maintains the day-to-day function of: – Digestion
Cerebrospinal fluid serves as a: – Shock absorber
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: -Finger tips
Which type of hallucination is most commonly associated with alcohol withdrawal? – Visual-bugs, pink elephants. nurs 6512 final exam,
On a scale of 0 to 4+, which deep tendon reflex score is appropriate for a finding of clonus in a patient? –3+
Which statement is true regarding mental status changes in older adults? – There is an increased risk of delirium with acute illness or metabolic derangement.
A characteristic related to syphilis or diabetic neuropathy is testicular: -Insensitivity to painful stimulation
When collecting personal and social history data from a woman complaining of breast discomfort, you should question her regarding: – Alcohol, tobacco, and caffeine use
What risk factor is associated with cervical cancer? – HPV
A 23 year old female presents with severe right lower quadrant tenderness. All of the following should be considered in the differential except: – Classis diverticulitis
What is the initial diagnostic radiology test that should be ordered if you suspect a ruptured ovarian cyst? – Abdominal and transvaginal ultrasound
A 17 year old male was brought into the emergency room with testicular/scrotal pain. The differential diagnosis should include all except: – Inguinal herniation
The nursing mother complains that her breasts are tender. You assess hard, shiny, and erythremic breasts bilaterally. You should advise the patient to: – Massage gently and continue nursing
A normal vas deferens should feel: – Smooth
In a woman complaining of a breast lump, it is most important to ask about: – Its relationship to menses
The finding of a painless indurated lesion on the glans penis is most consistent with: – Chancre
Pregnancy-related cervical changes include: – Softening and bluish coloring
You are inspecting the genitalia of an uncircumcised adult male. The foreskin is tight and cannot be easily retracted. You should: – Inquire about previous penile infections. nurs 6512 final exam.
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: – Establish absent cremasteric reflex
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. nurs 6512 final exam Your further response to this finding is: – Suggest pregnancy testing
What accommodations should be used in the position of a hearing-impaired woman for a pelvic examination? – The head of the table should be elevated
Sexual differentiation in the fetus has occurred by _______weeks gestation. – 12
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: -Ask the patient to turn her head toward that side
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: -Record the finding in the patient’s record
A therapeutic technique for dealing with grieving individuals is to: – Tell them that is good to cry and to share feelings
The examination of the newborn should begin with: – Inspection noting skin color, flaccidity, tension, gross deformities, or distortions of facies
Which one of the following patient characteristics is most likely to limit patient reliability during history taking? – Patient is sleep and sensory deprived
In crying infants, it is often difficult to: – Auscultate heart sounds
Which of the following statements accurately reflects the sensitivity and specificity of laboratory tests? – No test has 100% sensitivity and specificity
Which medical condition would exclude one from sports participation? – Fever
Your 15 year old patient is athletic and thin. Radiography of an ankle injury reveals a stress fracture. You question this patient about her: – Menstrual cycles
Which of the following are examined with the patient in a reclining 45 degree position? –Jugular venous pulsation and pressure. nurs 6512 final exam,
Functional assessment is most important during the examination of a(n): -Older adult
The best way to ease the apprehension of a 3 year old child before a physical examination is to: – Encourage child’s participation
An ophthalmoscopic eye examination involves: – Lens inspection
When conducting a geriatric assessment, basic activities of daily living (ADLs) include: – Bathing
The checkout station for preparticipation physical evaluation (PPE) is critical because at this point: – The coordination of follow-ups is reviewed
Which of the following is true regarding the relationship between the examiner and the patient? – The patient is a full partner with the examiner. nurs 6512 final exam,
Which of the following factors is not known to affect patient compliance with his or her treatment regimen? – The patient’s age and social status
One of the most important aspects to consider in the orthopedic screening examination is: – To look for symmetry of muscle, stature, and joint movement
As you greet the patient, which examination technique is first implemented? – Inspection
Which portion of the physical examination is best done with the patient standing? –Spinal
Which patient position facilitates inspection of the chest and shoulders? – Sitting
The least reliable indicator of newborn distress is: – Color
Proprioception should be assessed while the patient is: – Standingnurs 6512 final exam.
Part of the screening orthopedic component of the examination includes evaluating the person while: – Duck walking nurs 6512 final exam.
HCA 501 – Health Care in America essays, exam questions and answers
51. What financial benefit does a small rural hospital reap by qualifying for the designation, Critical Access Hospital?
It can receive specific federal grants for serving vulnerable populations
It can use its beds for either acute care or long-term care as needed
It can increase its profitability by receiving special payments for emergency services
It can receive cost-plus reimbursement under Medicare Part A
52. Which principle of ethics requires caregivers to involve the patient in medical decision making?
Paternalism
Fidelity
Beneficence
Autonomy
53. What is the main drawback of a living will?
It cannot cover all possible situations
The patient’s agent may not act in the patient’s best interest
The person formulating a living will must have a court appointed
guardian HCA 501 – Health Care in America essays, exam questions and answers
It becomes invalid when the patient becomes incompetent
54. To participate in Medicare and Medicaid, a health care facility must be
conditioned
accredited
certified
licensed
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55. Which entity oversees the licensure of health care facilities?
The Joint Commission
Federal government
State government
Local county or city government
HCA 501 – Health Care in America essays, exam questions and answers
56. Institutional theory predicts that
for-profit and nonprofit organizations will imitate each other when faced with similar regulatory and legal constraints
as an enterprise increases in size, its unit overhead costs would
decrease
as a hospital increases in size, its economies of scale dissipate
in competitive markets, both for-profit and nonprofit organizations HCA 501 – Health Care in America essays, exam questions and answers
would deliver certain essential community benefits
57. Under this method, a primary care physician decides whether or not to refer a patient to a specialist.
Preauthorization
Prospective uti I ization review
Disease management
Closed-panel utiIization
58. When an MCO adopts capitation as the primary method of payment, which service is likely to be carved out?
Surgery
Gatekeeping
Mental health
Primary care
59. Which HMO model is likely to require heavy capital outlays to expand into new markets?
Staff model
Group model
Network model
IPA model
60. PPOs were created by __ in response to HMOs’ growing market share.
physicians
insurance companies
hospitals
independent contractors
61. Which of these organizations was specifically created to bring management expertise to physician group practices?
Virtual organizations
Physician-hospital organizations
Provider-sponsored organizations
Management services organizations
62. Where two organizations cease to exist, and a new corporation is formed:
Acquisition
Merger
Joint venture
Alliance
HCA 501 – Health Care in America essays, exam questions and answers
63. Regional health systems are often:
horizontally integrated
vertically integrated
formed into virtual organizations
formed into alliances
64. requires that any health care need is recognized, evaluated, and addressed.
long-term care
health care
individual care
total care
65. What is the primary goal of long-term care?
help patients with increased pain
cure deadly diseases
preventing institutionalization
providing socialization
66. This type of clinical category for long-term care is non-medical care provided to support and requires no active medical treatments. HCA 501 – Health Care in America essays, exam questions and answers.
personal care
nursing care
custodial care
subacute care
67. What is the most common cause of mental retardation in America?
Down’s syndrome
autism
spina bifida
epilepsy
68. The prevalence of HIV in the population has:
increased
decreased
stayed the same
none of the above
69. Which law created two categories for nursing home certification purposes?
Nursing Home Reform Act
Medical Advancement Act
Nursing Home Alternatives Act
None of the above
70. Who is the primary payer for health care services for the elderly?
Medicaid
Medicare
private insurance
none of the above
71. What was the sixth leading cause of death for Hispanic males in 2003?
heart disease
malnutrition
diabetes
homicide
72. What factor has been found to be associated with the highest injury-related mortality rate among Indian children?
cultural
prenatal care
social
poverty
73. Most medically uninsured adults are employed but are not covered because:
their employer does not offer health benefits
they do not work enough hours to qualify for health benefits
they cannot afford the premium HCA 501 – Health Care in America essays, exam questions and answers
all of the above.
74. Education and psychotherapy for children with HIV is an example of:
heatlh-related support services
population-based community health services
personal medical and preventive services
none of the above
75. Who is the principal user of the health care system?
men
children
elderly
women
76. What is defined as a “high-impact” area?
areas with over 3,000 rural health clinics
areas that serve at least 4,000 migrant workers for at least two months per year.
areas that serve at least 12,000 community members per year
none of the above.
77. Which type of patient is most likely to experience disability and more severe medical illnesses?
diabetic
cancer
depressed
elderly
78. All of the following are factors effecting the growth in health spending EXCEPT:
uninsured patients
hospital services
prescription drugs
physician services
79. What is partly responsible for the surplus of specialists in the US?
greater access to financial aid
technology
increased population
none of the above
80. Defensive medicine leads to:
decreased cesarean sections
legal risks
unnecessary tests and services
none of the above
8l. What was the most sweeping price-control initiative for Medicare?
Economic Stabilization Program HCA 501 – Health Care in America essays, exam questions and answers
Balanced Budget Act
Omnibus Budge Reconciliation
none of the above
82. What is NOT an implication for access to health and health care delivery?
access to medical care is one of the key determinants of health
measures of access reflect changes across the board
access is increasingly linked to quality of care
access is a significant benchmark in assessing effectiveness
83. Which main type of access refers to the type, site, and purpose of health services?
potential
realized
equitable
inequitable
84. What do proponents believe regarding clinical practice guidelines?
it reduces utilization
decreases scientific research
it promotes lower costs and better outcomes
increases technology
85. When public policy pertains to or influences the pursuit of health they become:
health policy
population policy
prevention policy
none of the above
86. A problem associated with government involvement in US Health Is: HCA 501 – Health Care in America essays, exam questions and answers
escalating costs
bureaucratic inflexibility
excessive regulation
all of the above
87. An insurance risk pool:
helps people acquire private insurance otherwise unavailable
helps insurance companies decrease their costs
helps employers obtain insurance for their employees
none of the above
88. All BUT which of the following presidents is mentioned in the text as contributing major changes in health policies:
President Lyndon Johnson
President John Kennedy
President Harry Truman
President Bill Clinton
89. Which branch of government is the most active in policymaking?
executive
judicial
legislative
none of the above
90. Which group have policies been created to provide access to health care?
elderly
poor children
poor adults
all of the above
9l. What is the third main concern of health care policy?
cost
research
qualify of care
technology
92. The majority of employers currently offer:
long-term plan
defined benefit plan
deductible health plan
none of the above
93. The greatest challenge in insurance is:
maintaining a balance between healthy and sick enrollees
maintaining a balance between young and elder enrollees
maintaining a balance between premium and nonpremium enrollees
none of the above
94. What is a disadvantage of managed competition?
the medical infrastructure fluctuates
increased government bureaucracy
it cannot guarantee that everyone would have equal access to care
all of the above
95. Infectious diseases and health care must be viewed from a
perspective.
cost
cultural
global
multi-faceted
96. What is a strategy used to deal with nurse shortages?
investments in training
improvement in work environments
opening new schools
all of the above
97. What approach will be used in order to improve quality and productivity? HCA 501 – Health Care in America essays, exam questions and answers
collaborative team approach
collaboration
cross-training
all of the above
98. What is the goal of evidence-based medicine?
increase the amount of patients
increase the availabilty of prescription medicine
increase the value of medicine
none of the above
99. What type of integration is represented by a chain of nursing homes?
Ve integration
Network
Horizontal integration
Diversification
100. Where a new corporation created by two partnering organizations remains independent:
Acquisition
Merger
Joint venture
Alliance
HCA 501 – Health Care in America essays, exam questions and answers
Your older clinic patient is being seen today as a follow-up for a 2-day history of pneumonia. The patient continues to have a productive cough, shortness of breath, and lethargy and has been spending most of the day lying in bed. You should begin the chest examination by:
nurs 6512 week 6 midterm exam
Response Feedback:
Because the patient has consolidation and has been recumbent and fatigued, the most appropriate first step is to listen to the lung bases before the patient gets exhausted. The lung bases would be the most likely sites for adventitious sounds.
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Question 2
2 out of 2 points
The difference in blood pressure readings between the right and the left arms is considered normal up to _____ mm Hg.
Response Feedback:
Blood pressure readings between the left and right arms may vary by as much as 10 mm Hg and tend to be higher in the right arm.
Question 3
2 out of 2 points
Fat deposits in the circulatory system of an older adult can lead to:
Response Feedback:
Atherosclerosis is a disease in which fat deposits (cholesterol) accumulate in the walls of the arteries, which can lead to heart failure or stroke. nurs 6512 week 6 midterm exam.
Question 4
2 out of 2 points
Which dysrhythmia is a physiologic event during childhood?
Response Feedback:
Sinus arrhythmia is a physiologic event during childhood. The heart rate varies in a cyclic pattern, usually faster on inspiration and slower on expiration. The heart rates of children react with wider swings to stress, exercise, fever, or tension.
Question 5
2 out of 2 points
Normal cardiac changes that occur during pregnancy include: nurs 6512 week 6 midterm exam.
Response Feedback:
The maternal blood volume increases by 40% to 50% due to an increase in plasma volume. The heart works harder to accommodate the increased heart rate and stroke volume (both equal cardiac output), therefore resulting in the increase in left ventricle wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally and there is a slight axis rotation.
Question 6
2 out of 2 points
An idiopathic spasm of arterioles in the digits is called:
Response Feedback:
Raynaud disease is idiopathic, intermittent spasm of the arterioles in the digits, which causes skin pallor. Arteriosclerosis obliterans is the occlusion of the blood supply to the extremities by atherosclerotic plaques. Giant cell arteritis is a generalized inflammatory disease that affects arteries of the carotid, temporal, and occipital arteries. Arteriovenous fistula is a pathologic communication between an artery and a vein. An aneurysm is dilation of an artery caused by a weakness in the arterial wall. They occur in the aorta, renal, femoral, and popliteal arteries.
Question 7
2 out of 2 points
nurs 6512 week 6 midterm exam
The level at which the jugular venous pulse is visible gives an indication of:
Response Feedback:
The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart.
Question 8
2 out of 2 points
A bounding pulse in an infant may be associated with:
Response Feedback:
A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities, or between femoral and radial pulses, and absence of the femoral pulse suggests a coarctation of the aorta. Painful swollen extremities are usually a sign of venous occlusion. nurs 6512 week 6 midterm exam.
Question 9
2 out of 2 points
Chest pain in a child with an organic cause is more likely the result of:
Response Feedback:
Unlike chest pain in adults, children and adolescents seldom are caused by a cardiac problem. More likely the case is related to trauma, exercise-induced asthma, or cocaine use.
Question 10
2 out of 2 points
In the adult, the apical impulse should be most visible when the patient is in what position?
Response Feedback:
In most adults, the apical impulse should be visible at about the midclavicular line in the fifth left intercostal space, but it is easily obscured by obesity, large breasts, or muscularity. The apical impulse may become visible only when the patient sits upright and the heart is brought closer to the anterior wall. A visible and palpable impulse when the patient is supine suggests an intensity that may be the result of a problem. nurs 6512 week 6 midterm exam.
Question 11
2 out of 2 points
The best time to observe and count respirations is:
Response Feedback:
Respiratory patterns change as the patient speaks and sleeps. Attempting to count during weighing would make the patient self-conscious and affect respiratory rate. Counting respirations while you palpate the pulse does not make the patient self-conscious because the patient expects you to be counting the pulse.
Question 12
2 out of 2 points
As you take vital signs on Mr. B., age 78, you note that his respirations are 40 per minute. He has been resting and his mucosa is pink. Concerning Mr. B. s respirations, you would:
Response Feedback:
The normal adult respiratory rate is 12 to 20, with a ratio of respiratory to heartbeats of 1:4. Always note any variations in respiratory rate.
Question 13
2 out of 2 points
A musical squeaking noise heard on auscultation of the lungs is called:
Response Feedback:
Wheezes are continuous, high-pitched musical sounds that can be heard on inspiration and expiration.
Question 14
2 out of 2 points
The diaphragm of the stethoscope is better than the bell for auscultation of the lungs because it:
Response Feedback:
Unless specially modified, the stethoscope does not amplify sound, nor does it filter sound or pinpoint focal sounds. The stethoscope does transmit sound waves from the source to the ear. The diaphragm is the better source because it transmits the normally high-pitched sounds of the lung and it has a broader area to listen from.
Question 15
2 out of 2 points
An increase in heart rate during inspiration, with a decrease in this rate during expiration, is an expected finding in:
Response Feedback:
Sinus arrhythmia is a physiologic event during childhood. The heart rate of a child (4 year old) varies in a cyclic pattern, usually faster on inspiration and slow on expiration.
Question 16
2 out of 2 points
A split second heart sound is: nurs 6512 week 6 midterm exam,
Response Feedback:
Splitting of S2 is an expected event, because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill.
Question 17
2 out of 2 points
Closure of the ductus arteriosus usually occurs:
Response Feedback:
Closure of the ductus arteriosus usually occurs within 24 to 48 hours after birth.
Question 18
2 out of 2 points
A sound similar to a murmur that is heard over arteries is a:
Response Feedback:
A bruit is the sound of turbulent blood flow auscultated over arteries and heard best with the bell of the stethoscope. Thrills, as well as a heave, are palpated findings. A friction rub is a distinct sound heard when two surfaces are rubbed together as occurs with pericardial or pleural inflammation. Hums are low-pitched sounds associated with the venous system.
Question 19
2 out of 2 points
You are examining Mr. S., a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of arterial occlusion?
Response Feedback:
An individual with peripheral artery disease or claudication will have thin skin with localized pallor and cyanosis, a loss of body warmth in the affected area, and loss of hair over the extremity. There may be collapsed superficial veins with delayed filling. nurs 6512 week 6 midterm exam.
Question 20
2 out of 2 points
On a CXR, which of the following is true of the diaphragm?
Monday, October 9, 2017 1:03:17 AM EDT
Question 1
2 out of 2 points
On a CXR, which of the following is true of the diaphragm?
Selected Answer:
The right diaphragm is usually higher.
Correct Answer:
The right diaphragm is usually higher.
Question 2
2 out of 2 points
Tactile fremitus is best felt:
Selected Answer:
posteriorly and laterally at the bifurcation of the bronchi
Correct Answer:
posteriorly and laterally at the bifurcation of the bronchi
Response Feedback:
Fremitus is best palpated at the second intercostal space, which also corresponds to the bifurcation of the bronchi. nurs 6512 week 6 midterm exam.
Question 3
2 out of 2 points
The middle lobe of the right lung is best auscultated over the:
Selected Answer:
axilla.
Correct Answer:
axilla.
Response Feedback:
The sounds of the middle lobe of the right lung are best heard in the right axilla.
Question 4
2 out of 2 points
Expected respiratory changes of normal aging include:
Selected Answer:
more prominent bony structures.
Correct Answer:
more prominent bony structures.
Response Feedback:
In older adults, chest expansion is decreased and there is less use of respiratory muscles due to muscle weakness. The dorsal curve of the thoracic spine is prominent with flattening of the lumbar curve with bony landmarks becoming more prominent due to loss of subcutaneous tissue. nurs 6512 week 6 midterm exam.
Question 5
2 out of 2 points
You are listening to a patient s heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. The prevalent heart sound to this area is most likely which of the following?
Selected Answer:
S2
Correct Answer:
S2
Response Feedback:
S2 marks the closure of the semilunar valves, which indicates the end of systole, and is best heard in the aortic and pulmonic areas. It is higher pitched and shorter than S1. S2 typically splits during inspiration.
Question 6
2 out of 2 points
A bounding pulse in an infant may be associated with:
Selected Answer:
patent ductus arteriosus.
Correct Answer:
patent ductus arteriosus.
Response Feedback:
A bounding pulse is associated with a large left-to-right shunt produced by a patent ductus arteriosus. A weaker or thinner pulse represents diminished cardiac output or peripheral vasoconstriction. A difference in pulse amplitude between upper extremities, or between femoral and radial pulses, and absence of the femoral pulse suggests a coarctation of the aorta. Painful swollen extremities are usually a sign of venous occlusion. nurs 6512 week 6 midterm exam.
Question 7
2 out of 2 points
An apical PMI palpated beyond the left fifth intercostal space may indicate:
Selected Answer:
left ventricular hypertrophy.
Correct Answer:
left ventricular hypertrophy.
Response Feedback:
An apical impulse that is more forceful and widely distributed, fills systole, or is displaced laterally and downward may be indicative of left ventricular hypertrophy. Obesity, large breasts, and muscularity can obscure the visibility of the apical impulse. In dextrocardia the PMI would be displaced to the right.
Question 8
2 out of 2 points
A palpable rushing vibration over the base of the heart at the second intercostal space is called a:
Selected Answer:
thrill.
Correct Answer:
thrill.
Response Feedback:
A thrill is a fine, palpable, rushing vibration; a palpable murmur. Cardiac thrills generally indicate a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect. A heave or lift is a more vigorous apical impulse. A thrust is to move forward suddenly and forcibly. A murmur is an auscultated sound caused by turbulent blood flow.
Question 9
2 out of 2 points
Bradypnea may accompany:
Selected Answer:
an excellent level of cardiovascular fitness.
Correct Answer:
an excellent level of cardiovascular fitness.
Response Feedback:
Bradypnea, a rate slower than 12 breaths per minute, may result from cardiorespiratory fitness. The other choices accompany tachypnea.
Question 10
0 out of 2 points
Ms. R., age 74, has no known health problems or diseases. You are doing a preventive health care history and examination. Which symptom is associated with intrathoracic infection?
Selected Answer:
Pectus carinatum
Correct Answer:
Malodorous breath
Question 11
2 out of 2 points
The apex of a 2-month-old baby s heart typically lies closest to the:
Selected Answer:
fourth left intercostal space.
Correct Answer:
fourth left intercostal space.
Response Feedback:
In infants and young children, the heart lies more horizontally in the chest. The apex of the heart is located higher, sometimes well out into the fourth left intercostal space.
Question 12
0 out of 2 points
Closure of the ductus arteriosus usually occurs:
Selected Answer:
24 to 48 hours after birth.
Correct Answer:
just prior to the initiation of labor.
Question 13
2 out of 2 points
Nancy is a 16-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that Nancy, apart from occasional colds, is not prone to respiratory problems. What potential risk factor is most important to assess concerning Nancy s present problem?
Selected Answer:
Illegal drug use
Correct Answer:
Illegal drug use
Response Feedback:
Illegal drug use, particularly cocaine, is especially important to prioritize as a social history question for all adolescents and adults who complain of severe chest pain. Cocaine can lead to tachycardia, hypertension, coronary arterial spasm with infarction, and pneumothorax.
Question 14
2 out of 2 points
Laryngeal obstructions would elicit which breath sound? nurs 6512 week 6 midterm exam.
Selected Answer:
Stridor
Correct Answer:
Stridor
Response Feedback:
Obstructions high in the respiratory tree are characterized by stridor.
Question 15
2 out of 2 points
A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history interview of his family history, he relates that his father had died of heart trouble. The most important follow-up question you should pose is which of the following?
Selected Answer:
What age was your father at the time of his death?
Correct Answer:
What age was your father at the time of his death?
Response Feedback:
A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one s chance of a similar occurrence. nurs 6512 week 6 midterm exam.
Question 16
2 out of 2 points
In the fetus, the right ventricle pumps blood through the:
Selected Answer:
ductus arteriosus.
Correct Answer:
ductus arteriosus.
Response Feedback:
The right ventricle of a fetal heart pumps blood through the patent ductus arteriosus rather than into the lungs.
Question 17
2 out of 2 points
A third heart sound is created by:
Selected Answer:
diastolic filling.
Correct Answer:
diastolic filling.
Response Feedback:
Diastole is a relatively passive interval until ventricular filling is almost complete. Diastole occurs when the ventricle is filling with blood from the atria and the filling sometimes produces a third heart sound S3.
Question 18
2 out of 2 points
The level at which the jugular venous pulse is visible gives an indication of:
Selected Answer:
right atrial pressure.
Correct Answer:
right atrial pressure.
Response Feedback:
The level at which the jugular venous pulse is visible indicates right atrial pressure. The jugular veins empty into the superior vena cava, which empties into the right atria. The jugular venous system reflects the competency of the right side of the heart. The other four possible answers reflect the competency of the left side of the heart.
Question 19
2 out of 2 points
What term would you use to document a respiratory rate greater than 20 per minute in an adult?
Selected Answer:
Tachypnea
Correct Answer:
Tachypnea
Response Feedback:
Tachypnea is the correct term for respirations greater than 20. Dyspnea, orthopnea, and platypnea are terms that describe respiratory effort, not rate. Cheyne-Stokes refers to a particular abnormal pattern of respiration. nurs 6512 week 6 midterm exam.
Question 20
2 out of 2 points
An expected finding from chest palpation in the adult would be:
Selected Answer:
inflexibility of the xiphoid.
Correct Answer:
inflexibility of the xiphoid.
Response Feedback:
The sternum and xiphoid in adults are relatively inflexible, without cracking; the expected normal costal angle is 90 degrees and the chest moves symmetrically. Crepitus is always an abnormal finding.
Nancy is a 16-year-old girl who presents to the clinic with complaints of severe, acute chest pain. Her mother reports that Nancy, apart from occasional colds, is not prone to respiratory problems. What potential risk factor is most important to assess concerning Nancy s present problem?
Response Feedback:
Illegal drug use, particularly cocaine, is especially important to prioritize as a social history question for all adolescents and adults who complain of severe chest pain. Cocaine can lead to tachycardia, hypertension, coronary arterial spasm with infarction, and pneumothorax. nurs 6512 week 6 midterm exam.
Question 2
2 out of 2 points
A split second heart sound is:
Response Feedback:
Splitting of S2 is an expected event, because pressures are higher and depolarization occurs earlier on the left side of the heart. Ejection times on the right are longer, and the pulmonic valve closes a bit later than the aortic valve. Splitting of S2 is greatest at the peak of inspiration. During expiration, the split may disappear. It is never accompanied by a thrill.
Question 3
2 out of 2 points
During auscultation of heart tones, you are uncertain whether the sound you hear is an S2 split. You should ask the patient to inhale deeply while listening at the _____ area. nurs 6512 week 6 midterm exam.
Response Feedback:
Splitting results from the failure of the mitral and tricuspid valves or the pulmonic and aortic valves to close simultaneously. Splitting of S1 is usually not heard because the closing of the tricuspid valve is too faint. Rarely, it may be audible in the tricuspid area on deep inspiration. Splitting of S2 is greatest at the peak of inspiration and best heard at the pulmonic site.
Question 4
2 out of 2 points
Which finding suggests a minor structural variation?
Response Feedback:
Barrel chest, clubbed fingers, chest wall retractions, and tachypnea result from compromised respirations; pectus carinatum (pigeon chest) is a minor structural variation. nurs 6512 week 6 midterm exam.
Question 5
2 out of 2 points
A patient you are seeing in the emergency department for chest pain is suspected of having a myocardial infarct. During the health history interview of his family history, he relates that his father had died of heart trouble. The most important follow-up question you should pose is which of the following?
Response Feedback:
A family history of sudden death, particularly in young and middle-aged relatives, significantly increases one s chance of a similar occurrence.
Question 6
2 out of 2 points
Which two structures together form the primary muscle mass of the heart?
Response Feedback:
The ventricles are large, thick-walled chambers that pump blood to the lungs and throughout the body. The right and left ventricles together form the primary muscle mass of the heart. The left ventricle pumps blood through the aortic valve into the aorta, which provides blood to the rest of the body. The right and left atrium pumps blood through the tricuspid and mitral valves to the ventricles. The pulmonary vein pumps oxygenated blood from the lungs to the left atria.
Question 7
2 out of 2 points
In pregnancy, blood pressure is at its nadir at:
Response Feedback:
Nadir is the lowest measured value. In pregnancy, the lowest level of blood pressure occurs in the second trimester (16 to 20 weeks). nurs 6512 week 6 midterm exam.
Question 8
0 out of 2 points
Closure of the ductus arteriosus usually occurs:
Correct answer: 24 to 48 hours after birth
Question 9
2 out of 2 points
The pregnant woman is expected to develop:
Response Feedback:
In the pregnant woman, tidal volume and vital capacity increase, functional residual capacity decreases, and she breathes more deeply but not more frequently.
Question 10
2 out of 2 points
When there is consolidation in the lung tissue, the breath sounds are louder and easier to hear while healthy lung tissue produces softer sounds. This is because:
Response Feedback:
Air is a poor conductor of sound whereas more dense consolidation promotes louder sounds and is a better conductor of sound.
Question 11
2 out of 2 points
Normal cardiac changes that occur during pregnancy include:
Response Feedback:
The maternal blood volume increases by 40% to 50% due to an increase in plasma volume. The heart works harder to accommodate the increased heart rate and stroke volume (both equal cardiac output), therefore resulting in the increase in left ventricle wall thickness and mass. The blood volume returns to prepregnancy levels within 3 to 4 weeks after delivery. As the uterus enlarges and the diaphragm moves upward, the heart is shifted horizontally and there is a slight axis rotation. nurs 6512 week 6 midterm exam.
Question 12
2 out of 2 points
Which arterial pulse is most useful in evaluating heart activity?
Response Feedback:
Carotid arteries provide the most easily accessible arterial pulse and are closest to the heart and therefore are most useful in evaluating heart activity.
Question 13
0 out of 2 points
Which of the following statements is true regarding the examination of peripheral arteries?
Correct answer: the pulses are most readily felt on arteries that lie over bones
Question 14
0 out of 2 points
Which dysrhythmia is a physiologic event during childhood?
Correct answer: Sinus Arrhythmia
Question 15
0 out of 2 points
The earliest sign of heart failure in an infant is frequently:
Correct answer: Liver enlargement
Question 16
2 out of 2 points
The major heart sounds are normally created by:
Response Feedback:
At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1 lub. When the pressure in the ventricles falls, when the ventricles are almost empty, below that of the aorta and pulmonary artery, the aortic and pulmonic valves close, producing the second heart sound S2 dub. Valve opening is usually a silent event.
Question 17
0 out of 2 points
The American Thoracic Society suggests replacing the term rales with:
Correct Answer: Crackles
Question 18
0 out of 2 points
During chest assessment, you note the patient s voice quality while you are auscultating the lung fields. The voice sound is intensified, there is a nasal quality to the voice, and e s sound like a s. This sound described is called:
Correct answer: Egophony
Question 19
0 out of 2 points
The carotid pulse should coincide with which heart sound? nurs 6512 week 6 midterm exam.
Correct answer: S1
Question 20
0 out of 2 points
On a CXR, which of the following is true of the diaphragm?
Correct answer: The right diaphragm is usually higher
On a CXR, which of the following is true of the diaphragm?
Question 2
2 out of 2 points
A condition that is likely to present with dizziness and fainting is:
Response Feedback:
Sick sinus syndrome (SSS) is a sinoatrial dysfunction that occurs secondary to hypertension, arteriosclerotic heart disease, or rheumatic heart disease. SSS causes arrhythmias with subsequent fainting, transient dizzy spells, lightheadedness, seizures, palpitations, angina, or congestive heart failure (CHF). Bacterial endocarditis presents with prolonged fever, signs of neurologic dysfunctions, and sudden onset of CHF. Chest pain is an initial symptom in acute pericarditis along with a triphasic friction rub. Hyperlipidemia is a risk factor for myocardial infarction that commonly presents with chest pain. nurs 6512 week 6 midterm exam.
Question 3
2 out of 2 points
To hear diastolic heart sounds, you should ask patients to:
Response Feedback:
Left lateral recumbent is the best position to hear the low-pitched filling sounds in diastole with the bell of the stethoscope. Sitting up and leaning forward is the best position to hear relatively high-pitched murmurs with the diaphragm of the stethoscope. Right lateral recumbent position is the best position for evaluating right rotated heart of dextrocardia.
Question 4
2 out of 2 points
The patient tells you that she uses herbal and other alternative therapies to maintain health. This information will be recorded in the:
Response Feedback:
Patient data concerning the use of herbal or other remedies and other complementary or alternative therapies are recorded within the social history component of the history and physical.
Question 5
0 out of 2 points
Normal heart sounds are best heard:
Question 6
2 out of 2 points
The carotid pulse should coincide with which heart sound?
Response Feedback:
S1 marks the beginning of systole. S1 coincides with the rise (upswing) of the carotid pulse. Instruct patients to breathe normally and then hold their breath on expiration. Listen for S1 while you palpate the carotid pulse. S2 marks the start of diastole. S3-4 is an abnormal summation gallop sound. nurs 6512 week 6 midterm exam.
Question 7
2 out of 2 points
The condition in which a patient s heart is either rotated or displaced to the right or is situated as a mirror image of the expected position is called:
Response Feedback:
Dextrocardia occurs when the heart is displaced or rotated to the right or is a complete mirror image of the expected finding. Amyloidosis is a metabolic disorder marked by amyloid deposits in organs and tissues. Cardiomyopathy is the deterioration of heart muscle function. Coarctation is the compression of the walls of a vessel such as an aortic coarctation. Situs inversus occurs when the heart and stomach are displaced to the right and the liver is located to the left.
Question 8
0 out of 2 points
Ms. R., age 74, has no known health problems or diseases. You are doing a preventive health care history and examination. Which symptom is associated with intrathoracic infection?
Question 9
2 out of 2 points
In what position can the mediastinal crunch (Hamman sign) be heard best?
Response Feedback:
Hamman sign occurs with mediastinal emphysema. The adventitious breath sounds are synchronous with the heartbeat and are heard best when the patient leans to the left or lies down on the left side (these maneuvers bring the heart muscle closer to the chest wall).
Question 10
2 out of 2 points
Expected respiratory changes of normal aging include:
Response Feedback:
In older adults, chest expansion is decreased and there is less use of respiratory muscles due to muscle weakness. The dorsal curve of the thoracic spine is prominent with flattening of the lumbar curve with bony landmarks becoming more prominent due to loss of subcutaneous tissue. nurs 6512 week 6 midterm exam.
Question 11
2 out of 2 points
The major heart sounds are normally created by:
Response Feedback:
At the beginning of systole, ventricular contraction raises the pressure in the ventricles and forces the mitral and tricuspid valves closed, which produces the first heart sound S1 lub. When the pressure in the ventricles falls, when the ventricles are almost empty, below that of the aorta and pulmonary artery, the aortic and pulmonic valves close, producing the second heart sound S2 dub. Valve opening is usually a silent event.
Question 12
2 out of 2 points
Breath odors may clue the examiner to certain underlying metabolic conditions. The odor of ammonia on the breath may signify:
Response Feedback:
The breath smell described as ammonia-like suggests uremia, a renal condition; cinnamon suggests tuberculosis; musty fish or clover suggests hepatic failure; sweet and fruity suggests diabetic ketoacidosis; and foul or feculent suggests intestinal obstruction.
Question 13
2 out of 2 points
The respiratory rate of a sleeping newborn is expected to range from _____ breaths per minute.
Response Feedback:
The expected respiratory rate for infants is from 40 to 60 breaths per minute. nurs 6512 week 6 midterm exam.
Question 14
2 out of 2 points
Chest pain in a child with an organic cause is more likely the result of:
Response Feedback:
Unlike chest pain in adults, children and adolescents seldom are caused by a cardiac problem. More likely the case is related to trauma, exercise-induced asthma, or cocaine use.
Question 15
2 out of 2 points
Which of the following information belongs in the past medical history section related to heart and blood vessel assessment?
Response Feedback:
Previous unexplained fever should be included in the past medical history of a heart and blood vessel assessment. This incidence may be related to acute rheumatic fever, with potential heart valve damage.
Question 16
2 out of 2 points
In which patient situation would you expect to assess tachypnea?
Response Feedback:
In metabolic acidosis, the body compensates by increasing the respiratory rate in order to blow off the excess carbon dioxide. The other choices cause respiratory depression.
Question 17
2 out of 2 points
The American Thoracic Society suggests replacing the term rales with:
Response Feedback:
The term rales is suggested to be replaced with crackles in order for the term to more precisely describe the sound.
Question 18
2 out of 2 points
The spread of the impulse through the ventricles (ventricular depolarization) is depicted on the ECG as the: nurs 6512 week 6 midterm exam.
Response Feedback:
The QRS complex is the spread of a stimulus through the ventricles and is measured as less than 0.10 second. The P wave is the spread of a stimulus through the atria. The PR interval is the time from the initial stimulation of the atria to initiation of stimulation of the ventricles. The T wave is the return of stimulated ventricular muscle to a resting state. The U wave is a small deflection sometimes seen just after the T wave.
Question 19
2 out of 2 points
Contraction of the ventricles causes:
Response Feedback:
When the ventricles contract the semilunar valves, the pulmonic and aortic valves open, causing blood to rush into the pulmonary artery and the aorta. At this time the tricuspid and mitral valves close, preventing backflow into the atria. When the atria contract, the tricuspid and mitral valves open, allowing blood flow into the ventricles. When the ventricles relax during diastole (ventricles are filling), the aortic and pulmonic valves close, preventing backflow into the ventricles. nurs 6512 week 6 midterm exam.
University of Missouri-Kansas City School of Nursing & Health Studies – Bachelor of Health Sciences HLSC 430 Health Program Management Quizzes
.
Unit 3
• Question 1
The inception of _____ was used as a trial balloon for the idea of government-sponsored universal health insurance.
• Question 2
Which of the following factors was particularly important in promoting the growth of office-based medical practice in the postindustrial period?
• Question 3
The beliefs and values that form American ideology represent the sentiments of
• Question 4
Initially, what was the main purpose of private health insurance in the US?
• Question 5
Historically, which interest group was the most powerful in opposing national health insurance?
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• Question 6
E-health has resulted in
• Question 7
Hospitals in the United States evolved from
• Question 8
When hospitals first emerged in the United States, they were used primarily by the wealthy.
• Question 9
In its historical context, which of the following has played a major role in revolutionizing health care delivery?
• Question 10
The private medical sector in the US has been heavily regulated by the government mainly because
• Question 11
In the preindustrial era, _____ often functioned as surgeons.
• Question 12
What was the function of a pesthouse in the preindustrial period?
• Question 13
In the US, public health and private practice of medicine developed separately because. University of Missouri-Kansas City School of Nursing & Health Studies – Bachelor of Health Sciences HLSC 430 Health Program Management Quizzes.
• Question 14
Wage freezes during World War II helped promote employer-based health insurance in the United States.
• Question 15
The US Supreme Court decision in Olmstead v. L.C. directed US states to
• Question 16
As the health care delivery system developed in the US, right from its inception primary care physicians were assigned a gatekeeping role.
• Question 17
Middle-class Americans have historically opposed proposals for a national health insurance program.
• Question 18
During the World War II period, the US Supreme Court ruled that
• Question 19
On what grounds have middle-class Americans generally opposed proposals for a national health insurance program?
• Question 20
What main purpose was served by an almshouse in the preindustrial period? University of Missouri-Kansas City School of Nursing & Health Studies – Bachelor of Health Sciences HLSC 430 Health Program Management Quizzes.
Unit 4
• Question 1
The main difference between Clinical Nurse Specialists (CNSs) and Nurse Practitioners (NPs) is:
• Question 2
Patients requiring services from occupational therapists need help with performing tasks in their daily living and working environments.
• Question 3
Which of the following is a major criticism of managed care?
• Question 4
When patients have multiple health problems, this is called:
• Question 5
Primary care is:
• Question 6
Which type of health care facility employs the most people in the U.S.?
• Question 7
Physician maldistribution occurs by:
• Question 8
There is an imbalance between primary and specialty care services in the U.S. health care delivery system.
• Question 9
A major factor influencing growth in the health care sector of the U.S. economy is:
• Question 10
Nonphysician practitioners (NPPs) include:
• Question 11
The number of specialists is increasing because:
• Question 12
The number of active nurses has steadily increased over time.
• Question 13
MCO stands for:
• Question 14
The health care sector constituted what percentage of the U.S. gross domestic product in 2005?
• Question 15
The principal source of funding for graduate medical education is:
• Question 16
More than half of MDs are specialists.
• Question 17
There has been a decreasing number of international medical graduates (IMGs) in the U.S. since 1980.
• Question 18
The roles and responsibilities of health services administrators include:
• Question 19
Fill in the blank: Compared to metropolitan and suburban areas, there is a/an _____ of physicians in rural areas.
Unit 5
• Question 1
What is the main function of the National Institutes of Health?
• Question 2
Cost-efficiency evaluates marginal benefits in relation to
• Question 3
What is the main intent of the Stark laws?
• Question 4
Telemedicine technology that allows a specialist located at a distance to directly interview and examine a patient is referred to as
• Question 5
This made additional resources available to the FDA, and resulted in a shortened approval process for new drugs.
• Question 6
The utilization of technology has a greater impact on total health care expenditures than the cost of acquiring technology.
• Question 7
The ACA of 2010 places some restrictions on the licensing of new biological products.
• Question 8
What is the main advantage of interoperability within an electronic health records (EHR) system?
• Question 9
The asynchronous form of telemedicine uses _____ technology.
• Question 10
The point at which marginal benefits equal marginal costs.
• Question 11
What is the role of an institutional review board (IRB)?
• Question 12
Which of the following has the greatest impact on system-wide health care costs?
• Question 13
The Health Insurance Portability and Accountability Act requires
• Question 14
What main purpose do Clinical Practice Guidelines serve?
• Question 15
Supply-side rationing.
• Question 16
Which department of the DHHS supports research on health care quality, cost, and access?
• Question 17
The FDA was given the authority to review the effectiveness and safety of a new drug before it could be marketed.
• Question 18
Limitations on the diffusion and utilization of technology generally result in harmful effects on a nation’s population. University of Missouri-Kansas City School of Nursing & Health Studies – Bachelor of Health Sciences HLSC 430 Health Program Management Quizzes.
• Question 19
Evaluation of the appropriateness of medical technology.
• Question 20
American beliefs and values favor the development and use of new medical technology despite its cost.
• Question 21
At the flat of the curve,
____________________________________________
Unit 6
• Question 1
_____ reimbursement is based on the assumption that health care is provided in a set of identifiable and individually distinct units of services.
• Question 2
To receive payment for services delivered, providers must file a ____ with third-party payers.
• Question 3
To finance Medicare Part A,
• Question 4
The phenomenon called ‘moral hazard’ results directly from
• Question 5
A set monthly fee per enrollee.
• Question 6
Medicare Part B premiums are
• Question 7
People in older age groups represent a higher risk than those in lower age groups.
• Question 8
A copayment is generally paid
• Question 9
What is the central role of health services financing in the United States?
• Question 10
What is the main advantage of group insurance?
• Question 11
The amount of reimbursement is determined before the services are delivered.
• Question 12
Preferred providers are paid
• Question 13
What was the main conclusion of the Rand Health Insurance Experiment
• Question 14
Major medical plans do not include dental coverage.
• Question 15
Under the DRG method of reimbursement, an acute care hospital is paid
• Question 16
State governments are required to partially finance the Medicaid program.
• Question 17
The majority of beneficiaries receiving health care through Medicare are
• Question 18
Under the Medicaid program, eligibility criteria and benefits are consistent throughout the US.
• Question 19
Medicare provides comprehensive health care services.
• Question 20
If national health expenditures amount to 16% of the GDP, what does this mean?
• Question 21
Under the Medicare program, eligibility criteria and benefits are consistent throughout the US.
• Question 22
The primary criterion to become eligible for Medicaid is
• Question 23
The government plays a significant role in financing health care services in the United States.
• Question 24
A health insurance plan pays for medical care only after the insured has first paid $500 out of pocket on an annual basis. The $500 annual cost is called
• Question 25
What is the primary mechanism that enables people to obtain health care services? University of Missouri-Kansas City School of Nursing & Health Studies – Bachelor of Health Sciences HLSC 430 Health Program Management Quizzes.
• Question 26
Tax policy in the U.S. provides an incentive to obtain employer-paid health insurance.
• Question 27
A DRG represents
• Question 28
CHIP is available to children without any health insurance in families whose incomes are at or below ____ of the federal poverty level.
• Question 29
Public (government) share of the total health care spending in the United States is approximately
• Question 30
What is the primary reason that a segment of the U.S. population is uninsured?
• Question 31
Health insurance increases the demand for health care services.
• Question 32
In a general sense, what is the primary purpose of insurance?
Unit 7
• Question 1
One reason women’s health centers were created is:
• Question 2
The demand for home health care services is likely to decrease in the future.
• Question 3
The proliferation of health care delivery through managed care created a decreased demand for primary care physicians. University of Missouri-Kansas City School of Nursing & Health Studies – Bachelor of Health Sciences HLSC 430 Health Program Management Quizzes.
• Question 4
Which of the following is a reason for the growth in outpatient services?
• Question 5
Compared to tertiary care, primary care services are more complex and specialized.
• Question 6
Which of the following is an example of a secondary care service?
• Question 7
The most prominent reason for the decline in the number of procedures performed in hospitals is:
• Question 8
There is little distinction between the terms “outpatient” and “ambulatory.”
• Question 9
Men report more chronic illness than women.
• Question 10
Fill in the blank: Historically, inpatient care developed ________ outpatient care.
• Question 11
Countries whose health systems are oriented more toward primary care achieve:
• Question 12
What is gatekeeping?
• Question 13
Outpatient care accounts for what percent of gross patient revenue for all US hospitals?
• Question 14
Hospice services are primarily for people with:
• Question 15
Emergency departments, in most cases, are equipped to provide:
• Question 16
What does “PPS” stand for?
• Question 17
Fill in the blank: The percentage of medical school graduates choosing careers in primary care is ______________.
• Question 18
Community health centers serve primarily:
• Question 19
Primary care may play an important role in mitigating the adverse health effects of income inequality. University of Missouri-Kansas City School of Nursing & Health Studies – Bachelor of Health Sciences HLSC 430 Health Program Management Quizzes.
NURS 6512 Avanced Health Assessment Week 2 Quiz Answers
Informing a patient that he or she has a terminal illness is most likely to be discouraged in which cultural group?
Which statement is true regarding the impoverished?
The infant should be placed in which position to have his or her height or length measured?
A naturalistic or holistic approach to health care often assumes:
Which of the following describes a physical, not a cultural, differentiator?
Axillary measurement of temperature correlates best with core temperatures of:
You are performing a vaginal examination for a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation?
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Which statement is true regarding the relationship of physical characteristics and culture?
You are auscultating a patient s chest. The sounds are not clear, and you are having difficulty distinguishing between respirations and heartbeats. What technique can you use to facilitate your assessment?
During percussion, the downward snap of the striking fingers should originate from the:
Which technique should be used to stabilize the stethoscope during auscultation?
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:
A fixed image of any group that rejects its potential for originality or individuality is known as a(n):
When monitoring serial measures, such as head circumference or abdominal girth, which procedure is best to ensure that the tape measure is placed in the same position each time? NURS 6512 Avanced Health Assessment Week 2 Quiz Answers.
Observing the rise and fall of the abdomen usually facilitates calculation of respiratory rate in the:
A patient in the emergency department has a concussion to the head. You suspect the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient?
Which lying position is useful for auscultating heart tones?
A nonambulatory 80-year-old male patient tells the female nurse that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate? NURS 6512 Avanced Health Assessment Week 2 Quiz Answers.
Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group?
When percussing, a dull tone is expected to be heard over: NURS 6512 Avanced Health Assessment Week 2 Quiz Answers.
Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions
Question 1
1 out of 1 points
Underestimation of blood pressure will occur if the blood pressure cuff’s width covers:
Question 2
1 out of 1 points
Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions
Question 3
1 out of 1 points
The most superior part of the stomach is the:
Question 4
ORDER A PLAGIARISM-FREE PAPER HERE
1 out of 1 points
When recording physical findings, which data are recorded first for all systems?
Question 5
1 out of 1 points
Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence?
Question 6
1 out of 1 points
To perform the Rinne test, place the tuning fork on the:
Question 7
1 out of 1 points
When are open-ended questions generally most useful?
Question 8
0 out of 1 points
The review of systems is a component of the:
Question 9
1 out of 1 points
Fluorescing lesions are best distinguished using a(n):
Question 10
1 out of 1 points
Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 11
1 out of 1 points
Mr. Franklin is speaking with you, the health care provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate for enhancing communication? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 12
1 out of 1 points
The term denoting the caregiver’s need to do no harm to the patient is:
Question 13
0 out of 1 points
Recommended carbohydrate content of total dietary intake (% total calories) is ____%.
Question 14
1 out of 1 points
Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:
Question 15
1 out of 1 points
Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 16
1 out of 1 points
When examining the skull of a 4-month-old baby, you should normally find:
Question 17
1 out of 1 points
Ms. G. is being seen for her routine physical examination. She is a college graduate and president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G.’s _____ history.
Question 18
1 out of 1 points
During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially, you should:
Question 19
1 out of 1 points
Before performing an abdominal examination, the examiner should:
Question 20
1 out of 1 points
The adult recommended dietary fat intake should be _____ g/day.
Question 21
1 out of 1 points
Nuchal rigidity is most commonly associated with:
Question 22
1 out of 1 points
A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:
Question 23
1 out of 1 points
A flat, nonpalpable lesion is described as a macule if the diameter is:
Question 24
1 out of 1 points
Bulging of an amber tympanic membrane without mobility is most often associated with:
Question 25
1 out of 1 points
The position on a clock, topographic notations, and anatomic landmarks:
Question 26
1 out of 1 points
When assessing abdominal pain in a college-age woman, one must include:
Question 27
1 out of 1 points
The infant should be placed in which position to have his or her height or length measured? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 28
1 out of 1 points
A fixed image of any group that rejects its potential for originality or individuality is known as a(n):
Question 29
1 out of 1 points
Sweat glands, hair, and nails are all formed from:
Question 30
1 out of 1 points
Mr. Walters, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the:
Question 31
1 out of 1 points
Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would be:
Question 32
1 out of 1 points
Tracheal tug suggests the presence of a(n):
Question 33
1 out of 1 points
Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 34
1 out of 1 points
The most common form of birth trauma of the scalp is:
Question 35
1 out of 1 points
Which question would be considered a leading question?
Question 36
1 out of 1 points
A brief statement of the reason the patient is seeking health care is called the:
Question 37
1 out of 1 points
Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to:
Question 38
1 out of 1 points
A tool used to screen adolescents for alcoholism is the:
Question 39
1 out of 1 points
Expected hair distribution changes in older adults include:
Question 40
1 out of 1 points
Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 41
1 out of 1 points
When hearing is evaluated, which cranial nerve is being tested?
Question 42
1 out of 1 points
Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia?
Question 43
1 out of 1 points
Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?
Question 44
1 out of 1 points
You are examining a pregnant patient and have noted a vascular lesion. When you blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a:
Question 45
1 out of 1 points
A blood pressure cuff bladder should be long enough to:
Question 46
1 out of 1 points
A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that consumes mostly:
Question 47
1 out of 1 points
After thorough inspection of the abdomen, the next assessment step is:
Question 48
1 out of 1 points
Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On examination, you have noted a bruit heard over the thyroid. This is suggestive of:
Question 49
1 out of 1 points
During percussion, a dull tone is expected to be heard over:
Question 50
1 out of 1 points
Which of the following occurs when firm pressure is used to apply the stethoscope’s bell end-piece to the skin?
Question 51
1 out of 1 points
When communicating with older children and teenagers, you should be sensitive to their:
Question 52
1 out of 1 points
To approximate vocal frequencies, which tuning fork should be used to assess hearing?
Question 53
1 out of 1 points
You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data would indicate:
Question 54
1 out of 1 points
When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate?
Question 55
1 out of 1 points
Expected normal percussion tones include:
Question 56
1 out of 1 points
Subjective and symptomatic data are:
Question 57
1 out of 1 points
You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 58
1 out of 1 points
Which technique is most likely to result in the patient’s understanding of questions?
Question 59
1 out of 1 points
Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:
Question 60
1 out of 1 points
Unusual white areas on the skin may be due to:
Question 61
1 out of 1 points
George Michaels, a 22-year-old patient, tells the nurse that he is here today to “check his allergies.” He has been having “green nasal discharge” for the last 72 hours. How would the nurse document his reason for seeking care? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 62
0 out of 1 points
To correctly document absent bowel sounds, one must listen continuously for:
Question 63
1 out of 1 points
Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?
Question 64
1 out of 1 points
Which type of speculum should be used to examine a patient’s tympanic membrane?
Question 65
1 out of 1 points
Ms. Jones is a 31-year-old female patient who presents for a routine physical examination. Which examination technique will be used first?
Question 66
1 out of 1 points
In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for:
Question 67
1 out of 1 points
Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the:
Question 68
0 out of 1 points
Peritonitis produces bowel sounds that are:
Question 69
1 out of 1 points
The recommended minimum daily protein requirement for the normal adult is ______.
Question 70
1 out of 1 points
As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include:
Question 71
1 out of 1 points
Which is the best way to position a patient’s neck for palpation of the thyroid? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 72
1 out of 1 points
When taking a history, you should:
Question 73
1 out of 1 points
Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which medication is frequently associated with weight gain?
Question 74
1 out of 1 points
Which of the following is an expected change in the assessment of the thyroid during pregnancy?
Question 75
1 out of 1 points
Brittle nails are typical findings in:
Question 76
1 out of 1 points
Regardless of the origin, discharge is described by noting:
Question 77
1 out of 1 points
Nasal symptoms that imply an allergic response include:
Question 78
1 out of 1 points
Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence?
Question 79
1 out of 1 points
Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADLs) is part of a(an):
Question 80
1 out of 1 points
Tangential lighting is best used for inspecting skin:
Question 81
1 out of 1 points
A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness you should palpate over the:
Question 82
1 out of 1 points
Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure:
Question 83
1 out of 1 points
Which statement is true regarding the relationship of physical characteristics and culture?
Question 84
1 out of 1 points
A guideline for history taking is for caregivers to:
Question 85
1 out of 1 points
A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 86
1 out of 1 points
During an interview, you have the impression that a patient may be considering suicide. Which action is essential?
Question 87
1 out of 1 points
Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia due to:
Question 88
1 out of 1 points
Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical. This visit would be documented by creating a(n):
Question 89
1 out of 1 points
You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration?
Question 90
1 out of 1 points
In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of the tracheal cartilage is at the: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
Question 91
1 out of 1 points
You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for:
Question 92
1 out of 1 points
Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?
Question 93
1 out of 1 points
Under normal circumstances, how much water is lost daily by the body?
Question 94
0 out of 1 points
Tympanic thermometers measure body temperature when a probe is placed:
Question 95
1 out of 1 points
Which cranial nerves innervate the face?
Question 96
1 out of 1 points
Which of the following is an “ABCD” characteristic of malignant melanoma?
Question 97
1 out of 1 points
Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her fingernails are not growing. Which structure is the site of new nail growth?
Question 98
1 out of 1 points
Which of the following is the most accurate reflection of an individual’s food intake?
Question 99
1 out of 1 points
A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:
Question 100
1 out of 1 points
White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are:
Question 101
0 out of 0 points
When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.
– Types of histories: Complete, inventory (touches up on major points), Problem (focused, acute life-threatening problem), Interim (designed to chronicle events that have occurred since last meeting)
• Recording and documenting patient information Chapter 26
– Write out abbreviations Copy and paste or carry forward (CPCF)
– International Classification of Disease (ICD): diagnostic coding system that classifies diseases and injuries and u used to track mortality and morbidity NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
– Geriatric screening tool: Katz Index consists of six items (bathing, dressing, toileting, transferring, continence and feeding
– Geriatric screening tool: Lawton Instrumental ADL-scale consists of eight items in women (ability to use the telephone, shopping, cooking, housekeeping, doing laundry, taking own medication, making transports, and ability to handle finances)
§ Functional impairment was defined as dependency on at least one domain of ADL (score <6) or IADL (a score <8 from women or <5 for men). Functional decline was defined as deterioration on at least one domain of ADL or IADL compared to baseline (decline ≥1 point). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
– Sullivan Book:
§ CPTP is a listening of descriptive terms and identifying code for reporting medical services and procedures
SOAP note documentation
– S: subjective (what patient tells you)
– O: objective (observations)
– A: assessment (interpretation and conclusions)
– P: plan (diagnostic testing, rationale for decisions)
• Subjective vs objective information when documenting
– S: pain (use pain score)
– O: relate findings to the process of inspection, palpation, auscultation, percussion. “no masses on palpation” “tympanic membranes are pearly gray”
– O: Use anatomic landmarks to add precision
– O: Findings that vary by degrees are customarily graded or recorded in an incremental scale format (pulse amplitude, heart murmur intensity, muscle strength, DTR NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
– Illustrations useful in describing the origin of pain and where it radiates and the size, shape and location of a lesion
– HX of present illness: OLDCARTS: onset, location, duration, character, aggravating factors, relieving factors, temporal factors, severity of symptoms
Ethical decision making and beneficence
– Beneficence: doing good
Diversity and Health Assessment – Bullets 6, 7, 8
Cultural Awareness and Diversity
Achieving cultural competence is a learning process that requires self-awareness, reflective practice, and knowledge of core cultural issues
A culturally competent health care provider adapts to the unique needs of patients of backgrounds and cultures that differ from his or her own
Culture
, in its broadest sense, reflects the whole of human behavior, including ideas and attitudes; ways of relating to one another; manners of speaking; and the material products of physical effort, ingenuity, and imagination. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
The
stereotype,
a fixed image of any group that denies the potential of originality or individuality within the group
Multiple studies have shown that health care providers activate these implicit stereotypes, or non-conscious bias, when communicating with and providing care to minority patients
Members of racial and ethnic groups are not uniform. Each group is highly heterogeneous and includes a diverse mix of immigrants, refugees, and multigenerational Americans who have vastly different histories, languages, spiritual practices, demographic patterns, and cultures
Culturally competent care requires that health care providers be sensitive to patients’ heritage, sexual orientation, socioeconomic situation, ethnicity, and cultural background
When cultural differences exist, be certain that you grasp exactly what the patient means and know exactly what the patient thinks you mean in words and actions
The definition of “ill” or “sick” is based on the individual’s belief system and is determined in large part by his or her enculturation.
Socioeconomic, spiritual, and lifestyle factors affecting diverse populations
Age, gender, race, ethnic group and, with these variables, cultural attitudes, regional differences, and socioeconomic status influence the way patients seek medical care and the way clinicians provide care
A patient who knows the English language, however well, cannot be assumed to know the culture.
Poverty and inadequate education disproportionately affect various cultural groups (e.g., ethnic minorities and women); socioeconomic disparities negatively affect the health and medical care of individuals belonging to these groups
Age, gender, race, ethnic group and, with these variables, cultural attitudes, regional differences, and socioeconomic status influence the way patients seek medical care and the way clinicians provide care.
Black and Latino children in the United States also experience health disparities, including lower overall health status and lower receipt of routine medical care and dental care compared to white children NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
Functional Assessments
Functional Assessment for All Patients
Quite simply, functional assessment is an attempt to understand a patient’s ability to achieve the basic activities of daily living. This assessment should be made for all older adults and for any person limited by disease or disability, acute or chronic. A well-taken history and a meticulous physical examination can bring out subtle influences, such as tobacco and alcohol use, sedentary habits, poor food selection, overuse of medications (prescribed and nonprescribed), and less than obvious emotional distress. Even some physical limitations may not be readily apparent (e.g., limitations of cognitive ability or of the senses). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide. Keep in mind that patients tend to overstate their abilities and, quite often, to obscure reality.
When performing a functional assessment consider a variety of disabilities: physical, cognitive, psychologic, social, and sexual. An individual’s social and spiritual support system must be as clearly understood as the physical disabilities. There are a variety of physical disabilities, including:
Mobility
Difficulty walking standard distances: ½ mile, 2 to 3 blocks, 1/3 block, across a room
Difficulty climbing stairs, up and down
Problems with balance
Upper extremity function
Difficulty grasping small objects, opening jars
Difficulty reaching out or up overhead, such as taking something off a shelf
Housework
Heavy (vacuuming, scrubbing floors)
Light (dusting)
Meal preparation
Shopping
Medication use
Money management
Instrumental activities of daily living
Bathing
Dressing
Toileting
Moving from bed to chair, chair to standing
Eating
Walking in home
Any limitations, even mild, in any of these areas will affect a patient’s independence and autonomy and, to the extent of the limitation, increase reliance on other people and on assistive devices. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide. These limitations indicate the loss of physical reserve and the potential loss of physical function and independence that indicate the onset of frailty. The patient’s social support system and material resources are then integral to the development of reasonable management plans.
#9 Growth and Development Ch 6 of text book
Growth Hormone-Releasing Hormone stimulates the pituitary to release the growth hormone.
70% of secretion of the growth hormone occurs during sleep
Critical brain growth between conception and 3 yrs old.
P
uberty- Dependent on the GH and androgens (Sex Steroids). They stimulate and increase in the growth Hormone.
Lymphatic tissues reach adult size by 6 yrs old and double by 10-12 yrs old.
Pregnancy Weight
Child- 6-8lbs of wt blood-3-4lbs Maternal Fat/protein 4-6lbs
Uterus 2lbs breast 1-2 lbs
Fluid 2-3lb Amniotic fluid 2lbs
Older Adults
Physical Stature decrease at 50 yrs
60 yrs – decrease HT, WT, BMI
Increase Body Fat
Children and Adolescence
Sexual Maturation Girls
Early < 7 yrs Delayed > 13 yrs
• *Macronutrient is required in significant amounts of the diet. Macronutrient includes proteins, carbohydrates, and lipids.
*Macronutrients are so named because they are required in LARGE AMOUNTS.
Micronutrients
The nutrient which is required in smaller amounts in the body is called micronutrients. Two categories of micronutrients are vitamins and minerals.
• Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency?
Ans. Rickets, a disease manifested by spinal curvature and bowed legs NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Nutrition
• *The nutrients that are deficient in vegetarian diet are protein, Calcium, Iron, Vitamin B12, and vitamin D.
*Carbohydrates and proteins supply 4 calories per gram while fats supply 9 calories. Alcohol provides 7 calories per gram.
Carbohydrate
The body handles excess carbohydrate by storing as fat.
Protein
*Mrs. Webb is a 38-year-old patient who has been changing her lifestyle to eat in a healthy way and lose weight. During your health promotion education regarding her nutritional status, you explain the function of dietary protein as:
a. providing an energy source for the brain.
b. building and maintaining tissues.
c. participating in specific detoxifying metabolic pathways.
d. synthesizing and regulating hormones.
The correct Ans is b
*Which of the following are major functions of dietary protein?
Building and maintain tissues;
Regulating water and acid-base balance;
Working as a precursor for enzymes, antibodies, and several hormones
*The recommended minimum daily protein requirement for the normal adult is? Ans. 14%-20% of total calorie or 45 grams for adults.
Fat
*The recommended dietary fat intake for the normal adult is? About 20 to 35 grams per day.
*Advising a person to reduce which macronutrient will produce the greatest caloric reduction per gram of reduction?
o Ans. Fat
Which age group requires the highest percentage of dietary fat intake?
Ans. Before 2 years of age, fat intake may reach 35% 40% of calories.
Water
*Which one of the following would be assessed first in the patient with sustained respiration?
Ans. Hydration/ water
Rationale: A person can exist without food or vitamins for several weeks but without water for only a few days.
2-2.5 L water loss occurs daily by the body in a healthy person under normal circumstances.
Food Diary
• *The food diary is recorded as it happens, making this method the most accurate reflection of an individual’s food intake NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
#13 BMI
BMI is calculated by the weight in pounds multiplied by 703 divided by the height in inches squared.
*Monitoring a patient’s waist to hip ratio provides data concerning patient’s disease risk in cardiovascular term.
*When obesity occurs mostly in lifetime?
Obesity occurs during adolescents 70% of the time. Obesity occurs before skeletal growth or sexual maturation is complete.
*A scale is used to assess patient’s weight need to be calibrated every time before using.
*When monitoring serial measures, such as head circumference or abdominal girth, which procedure is best to ensure that the tape measure is placed in the same position each time?
Ans. Mark the borders of the tape at several intervals on the skin with a pen.
*You are using rule of thumb for advising a 150-pound person decrease calorie intake for weight loss. How many calorie intakes is appropriate per day?
ANS. 150 pounds/2.2 = 68 kg
68×25= 1700 calories.
Rule of thumb for weight loss equals 25 multiply each kg body weight.
*What medication may cause weight gain?
Steroids, oral contraceptives, antidepressants, and insulin
In a pregnant woman, 5-10 pounds of the total gained weight is considered fetus weight in a normal pregnancy. The remainder results from placenta, blood and fluid volume, amniotic fluid, uterus, breasts, and fat. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that contains mostly:
a.fruit and vegetables.
b.lean meat and fish.
c.sandwiches and diet drinks.
d.pasta and chicken.
Correct ANS: B
Carbohydrates are the only source of fuel for the brain and central nervous system. A diet low in carbohydrates, such as a diet mostly of meat and fish, could affect brain function. Fruits and vegetables, sandwiches and diet drinks, and pasta and chicken have moderate levels of needed carbohydrates.
When using “rule of thumb” estimates of energy needs of healthy adults, how many kcal/kg are required to maintain the individual’s current weight?
30 kcal/kg is required for weight maintenance. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
#14 Pernicious anemia:
-B12 deficiency is usually the result of impaired B12 uptake caused by a lack of intrinsic factor that is caused by a loss of parietal cells in the stomach lining. The loss of these cells can be caused by partial or full gastrectomy, Crohn’s disease, autoimmune disorders such as DM1 and immunocompromised diseases such as HIV
-A smooth red tongue with a slick appearance may indicate NIACIN or Vit. B12 deficiency.
Pernicious Anemia can result in Vitamin B12 deficiency!!! (image attached in group)
Examination techniques and equipment #15
Student Laboratory Manual
Seidel’s Guide to physical Examination 8
th
edition Page 10, 11 and 168.
Tape measure
– use to examine multiple raised lesions.
Transilluminate
– An appropriate examination technique to assess vesicle in the skin. It also a source of light with a narrow beam.
Otoscope
– use to visualize the lower and middle turbines of the nose.
Inspection –
is applied throughout the entire examination and interview process.
Auscultation
– is carried out last except when examining kidney or abdomen . it is also used to listen for sounds produced by the body
Fist
– use for indirect finger percussion involves striking the middle finger of the nondominant hand
Deep abdominal palpation of the kidney
is used to assess tenderness over the kidney.
Ulnar surface of the hand
is used to palpate Mass in the skin
Diaphragm
– pressed lightly against skin to detect high frequency.
Scoliometer- measures the degree of rotation of the spine to screen for scoliosis. Pg. 49 8
th
edition.
Pneumatic attachment of an otoscope
– use to evaluate the cone of light reflex in adult and kids.
Red – free light
-seen through the ophthalmoscope to estimate the size and location of lesion. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Dorsal surface of the hand
– sensitive to vibration
Amsler grid
– use to screen patient at risk for macular degeration
Pederson speculum
– use for women with small vaginal opening
Near-vision (Rosenbaum
) or
Jaeger chart
– Use for screening near vision
Dermatoscope
– is a skin surface microscope used to inspect the surface of pigmented skin lesions
Bell of stethoscope
– detects low frequency sound.
Wood lamp-
black light used to detect fungal infection.
Pan-optic ophthalmoscope
– larger field of view in eye examination.
Palpation-
gathering information through touch.
Monofilament
– help identify a patient with decreased sensation and increased risk for injury
Percussion Tone Expected
Stomach-
Tympanic
Sternum
-flat
Liver
-Dull
Lung with patient with Pneumonia
-Dull
Abdomen with lung tumor
-Dull
Diagnostic Assessment tools and tests to include tuning forks, BP monitoring, use of stethoscope, otoscope, ophthalmoscope
Tuning Fork
i. Weber Testà Place base of tuning fork on top of the head and see if the patient hears it equally in both ears. If not, this is considered conductive hearing loss and they will hear the sound in the impaired ear.
ii. Rinne Test à Base of the tuning fork is placed on the mastoid bone, count how long they hear it. Then move it in front of the ear and count how long they hear that. Normally the sound is heard longer through air than through bone. In conductive hearing loss, sound is heard through bone as long as or longer than it is through air (BC>AC). In sensorineural hearing loss, sound is heard longer through air (AC>BC). NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
b. Ophthalmoscope
i. Examine patient right eye with your right eye
ii. Visualize the RED reflex (caused by light illuminating the retina, opacities will stand out)
c. Otoscope
i. External auditory canal and tympanic membrane (should be translucent, pearly gray color) (middle ear)
1. Adult: pull ear up and back
2. Child: pull ear down and back
#17
Covers skin, pharmacology,GI, Nervous system, and MUCH MORE
information located in the files of this group. A large table.
Skin lesion characteristics
Maculeà flat discoloration, usual <1 cm in diameter (freckle/ measles)
b. Patchà flat area of skin discoloration, larger than a macule (vitiligo)
c. Papuleà raised lesion, <1 cm same or different color than surrounding skin (raised nevus)
d. Vesicleà fluid filled, <1 cm (varicella/ chicken pox)
e. Plaqueà raised lesion, >1 cm may be same or different color from surrounding skin (Psoriasis)
f. Purpuraà lesions caused by RBCs leaving circulation and becoming trapped in skin (Petechiae, ecchymosis)
g. Pustuleà vesicle like lesion with purulent content (impetigo, acne)
h. Whealàcircumscribed area of skin edema (Hive)
i. Noduleà raised lesion, >1 cm usually mobile (epidermal cyst)
j. Bullaà fluid-filled, >1 cm (blister with 2nd degree burn)
k. Excoriationà marks from scratches (pruritic skin disease)
l. Lichenificationà skin thickening resembling callus formation (chronic dermatitis)
m. Fissureà narrow linear crack into epidermis (split lip, athletes’ foot)
n. Erosionà partial focal loss of epidermis, heals without scarring (areas exposed after bullous lesion opens)
o. Ulcerà loss of epidermis and dermis, heals with scarring (pressure sore)
p. Scaleà raised, flaking lesion (dandruff, psoriasis)
q. Atrophyà loss of skin markings and full skin thickness (area tx excessively with higher potency corticosteroids) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
#18- ABCD assessment of skin lesions:
A -asymmetry of lesion.
B- border (regular or irregular)
C- Color (is it uniform or varying colors)
D- Diameter (anything larger than 6mm)
Images posted in group
#19 Anatomy and physiology of skin layers
Epidermis
i. Outermost portion (stratum corneum & cellular stratum)
ii. Avascular
iii. Stratum Corneum: packed dead squamous cells, contain keratin, keratin cells formed in stratum germinativum (where melanocytes synthesize melanin)
iv. Cellular stratum: in thicker layers of palms and soles
b. Dermis
i. Very vascular connective tissue layer (supports and separates epidermis from adipose)
ii. Elastin, collagen and reticulum fibers, sensory nerve fibers NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
c. Hypodermis
i. Loose connective tissue filled with fatty cells (generates heat/insulation/ shock absorption)
ii. Connected to underlying organs
d. Appendages
i. Eccrine sweat glandsà regulate body temp through water secretion
ii. Apocrine sweat glandsà found in axilla, nipple, areolae, genital, eyes and external ears
iii. Sebaceous glandsà lipid rich substance, stimulated by sex hormones (testosterone)
The skin is the largest organ of the body, with a total area of about 20 square feet. The skin protects us from microbes and the elements, helps regulate body temperature, and permits the sensations of touch, heat, and cold.
Skin has three layers:
Epidermis
Your skin’s top layer, the epidermis, is super thin on some parts of your body (your eyelids) and thicker on others (the bottoms of your feet). The epidermis is the layer of skin in charge of:
• Making new skin cells: This happens at the bottom of the epidermis. The skin cells travel up to the top layer and flake off, about a month after they form.
• Giving skin its color: The epidermis makes melanin, which is what gives your skin its color (find out more about this in What gives skin its color?).
• Protecting your body: The epidermis has special cells that are part of your immune system and help you stay healthy.
Dermis
A lot happens in the next layer, the dermis. The jobs of the dermis include:
• Making sweat: There are little pockets called sweat glands in the dermis. They make sweat, which goes through little tubes and comes out of holes called pores. Sweating keeps you cool and helps you get rid of bad stuff your body doesn’t need.
• Helping you feel things: Nerve endings in the dermis help you feel things. They send signals to your brain, so you know how something feels if it hurts (meaning you should stop touching it), is itchy or feels nice when you touch it.
• Growing hair: The dermis is where you’ll find the root of each tiny little hair on your skin. Each root attaches to a tiny little muscle that tightens and gives you goose bumps when you are cold or are scared.
• Making oil: Another type of little pocket, or gland, in your skin makes oil. The oil keeps your skin soft, smooth and waterproof. Sometimes the glands make too much oil and give you pimples. (See Acne: Pimples and Zits.
• Bringing blood to your skin: Blood feeds your skin and takes away bad stuff through little tubes called blood vessels.
Subcutaneous fat
The bottom layer of skin is the subcutaneous fat layer. This layer plays an important role in your body by:
• Attaching the dermis to your muscles and bones: This layer has a special connecting tissue that attaches the dermis to your muscles and bones.
• Helping the blood vessels and nerve cells: Blood vessels and nerve cells that start in the dermis get bigger and go to the rest of your body from here.
• Controlling your body temperature: The subcutaneous fat is the layer that helps keep your body from getting too warm or too cold.
• Storing your fat: This fat pads your muscles and bones and protects them from bumps and falls.
#20 Abnormal nail findings in older adults
Nail changes associated with aging are common in the elderly and include characteristic modifications of color, contour, growth, surface, thickness, and histology. The calcium content of the aging nail increases and iron decreases.
keratinocytes of the nail plate are increased in size with an increased number of ‘pertinax bodies’ (remnants of keratinocyte nuclei)
• nail bed dermis also shows thickening of the blood vessels and elastic tissue, especially beneath the pink part of the nail.
• Nail growth decreases by approximately 0.5% per year between 20 and 100 years of age.
• Prominent longitudinal ridges were the most common change
• Brittleness of the nail is a common condition related to aging.
• Onychauxis which is an age-associated thickening of the nail plate
• changes in nail contour, increased transverse curvature
White banding (Terry Nails) is a nail disorder that is specifically linked to age – p. 158.
Pathophysiology: associated with cirrhosis, CHF, adult-onset diabetes mellitus, and age.
Appearance: transverse white bands cover the nail except for narrow zone at the distal tip
Onychomycosis is a fungal infection that causes the nail plate to crumble – p. 156.
Pathophysiology: this is not specifically related to older adults but is associated with loss of manual dexterity (interfere with exercise or walking).
Appearance: distal nail plate turns yellow or white as hyperkeratotic debris accumulates, causing the nail to separate from the nail bed
#21 PSORIATIC SKIN LESIONS
Psoriasis is a common skin condition that speeds up the life cycle of skin cells. It causes cells to build up rapidly on the surface of the skin. The extra skin cells form scales and red patches that are itchy and sometimes painful.
Psoriasis is a chronic disease that often comes and goes. The main goal of treatment is to stop the skin cells from growing so quickly.
There is no cure for psoriasis, but you can manage symptoms. Lifestyle measures, such as moisturizing, quitting smoking and managing stress, may help
here are several types of psoriasis. These include:
• Plaque psoriasis. The most common form, plaque psoriasis causes dry, raised, red skin lesions (plaques) covered with silvery scales. The plaques might be itchy or painful and there may be few or many. They can occur anywhere on your body, including your genitals and the soft tissue inside your mouth.
• Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe cases may cause the nail to crumble.
• Guttate psoriasis. This type primarily affects young adults and children. It’s usually triggered by a bacterial infection such as strep throat. It’s marked by small, water-drop-shaped, scaling lesions on your trunk, arms, legs and scalp.
The lesions are covered by a fine scale and aren’t as thick as typical plaques are. You may have a single outbreak that goes away on its own, or you may have repeated episodes.
• Inverse psoriasis. This mainly affects the skin in the armpits, in the groin, under the breasts and around the genitals. Inverse psoriasis causes smooth patches of red, inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
• Pustular psoriasis. This uncommon form of psoriasis can occur in widespread patches (generalized pustular psoriasis) or in smaller areas on your hands, feet or fingertips.
It generally develops quickly, with pus-filled blisters appearing just hours after your skin becomes red and tender. The blisters may come and go frequently. Generalized pustular psoriasis can also cause fever, chills, severe itching and diarrhea.
• Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover your entire body with a red, peeling rash that can itch or burn intensely.
• Psoriatic arthritis. In addition to inflamed, scaly skin, psoriatic arthritis causes swollen, painful joints that are typical of arthritis. Sometimes the joint symptoms are the first or only manifestation of psoriasis or at times only nail changes are seen. Symptoms range from mild to severe, and psoriatic arthritis can affect any joint. Although the disease usually isn’t as crippling as other forms of arthritis, it can cause stiffness and progressive joint damage that in the most serious cases may lead to permanent deformity.
Causes
The cause of psoriasis isn’t fully understood, but it’s thought to be related to an immune system problem with T cells and other white blood cells, called neutrophils, in your body.
T cells normally travel through the body to defend against foreign substances, such as viruses or bacteria.
But if you have psoriasis, the T cells attack healthy skin cells by mistake, as if to heal a wound or to fight an infection.
Overactive T cells also trigger increased production of healthy skin cells, more T cells and other white blood cells, especially neutrophils. These travel into the skin causing redness and sometimes pus in pustular lesions. Dilated blood vessels in psoriasis-affected areas create warmth and redness in the skin lesions.
The process becomes an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Skin cells build up in thick, scaly patches on the skin’s surface, continuing until treatment stops the cycle.
Just what causes T cells to malfunction in people with psoriasis isn’t entirely clear. Researchers believe both genetics and environmental factors play a role.
Psoriasis triggers
Psoriasis typically starts or worsens because of a trigger that you may be able to identify and avoid. Factors that may trigger psoriasis include:
• Infections, such as strep throat or skin infections
• Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
• Stress
• Smoking
• Heavy alcohol consumption
• Vitamin D deficiency
• Certain medications — including lithium, which is prescribed for bipolar disorder, high blood pressure medications such as beta blockers, antimalarial drugs, and iodides
Risk factors
Anyone can develop psoriasis, but these factors can increase your risk of developing the disease:
• Family history. This is one of the most significant risk factors. Having one parent with psoriasis increases your risk of getting the disease, and having two parents with psoriasis increases your risk even more.
• Viral and bacterial infections. People with HIV are more likely to develop psoriasis than people with healthy immune systems are. Children and young adults with recurring infections, particularly strep throat, also may be at increased risk.
• Stress. Because stress can impact your immune system, high stress levels may increase your risk of psoriasis.
• Obesity. Excess weight increases the risk of psoriasis. Lesions (plaques) associated with all types of psoriasis often develop in skin creases and folds.
• Smoking. Smoking tobacco not only increases your risk of psoriasis but also may increase the severity of the disease. Smoking may also play a role in the initial development of the disease.
Complications
If you have psoriasis, you’re at greater risk of developing certain diseases. These include:
• Psoriatic arthritis. This complication of psoriasis can cause joint damage and a loss of function in some joints, which can be debilitating.
• Eye conditions. Certain eye disorders — such as conjunctivitis, blepharitis and uveitis — are more common in people with psoriasis.
• Obesity. People with psoriasis, especially those with more severe disease, are more likely to be obese. It’s not clear how these diseases are linked, however. The inflammation linked to obesity may play a role in the development of psoriasis. Or it may be that people with psoriasis are more likely to gain weight, possibly because they’re less active because of their psoriasis.
• Type 2 diabetes. The risk of type 2 diabetes rises in people with psoriasis. The more severe the psoriasis, the greater the likelihood of type 2 diabetes.
• High blood pressure. The odds of having high blood pressure are higher for people with psoriasis.
• Cardiovascular disease. For people with psoriasis, the risk of cardiovascular disease is twice as high as it is for those without the disease. Psoriasis and some treatments also increase the risk of irregular heartbeat, stroke, high cholesterol and atherosclerosis.
• Metabolic syndrome. This cluster of conditions — including high blood pressure, elevated insulin levels and abnormal cholesterol levels — increases your risk of heart disease.
• Other autoimmune diseases. Celiac disease, sclerosis and the inflammatory bowel disease called Crohn’s disease are more likely to strike people with psoriasis.
• Parkinson’s disease. This chronic neurological condition is more likely to occur in people with psoriasis.
• Kidney disease. Moderate to severe psoriasis has been linked to a higher risk of kidney disease.
• Emotional problems. Psoriasis can also affect your quality of life. Psoriasis is associated with low self-esteem and depression. You may also withdraw socially.
#22 Vesicular Skin Characteristics
o Vesicles are small, clear, fluid-filled blisters. (page 127)
o A vesicle is elevated, superficial and less than 1cm. The vesicle does not go into the dermis. (page 127)
o Examples of a vesicle are varicella (chickenpox) and herpes zoster (shingles) viruses. (page 127)
o A bulla is a vesicle (blister) that is greater than 1cm. (page 128).
23 hair loss
youtube video
#24 Characteristics of Hair Distribution
Quantity and distribution of hair vary according to individual genetic makeup
Hair is commonly on the scalp, lower face, neck, nares, ears, chest, axillae, back and shoulders, arms, legs, toes, pubic area, and around the nipples
Hair loss is generalized or localized
Hair loss on toes may indicate poor circulation or nutritional deficit
Diffuse hair loss usually occurs without inflammation and scarring
Note if the hair shafts are broken off or completely absent
Scarring is helpful in diagnosis
During adulthood men who are genetically predisposed often display gradual symmetric hair loss on the scalp as a response to androgens
Asymmetric hair loss may indicate pathologic condition
Women in their 20s and 30s can also develop adrenal androgenic female pattern alopecia (hair loss), gradual hair loss from the central scalp
Fine vellus hair covers the body
Coarse terminal hair occurs on the scalp, pubic, axillary area, arms, legs (to some extent), and a man’s beard
Male pubic hair configuration is upright triangle with the hair extending midline to umbilicus
Female pubic hair configuration is an inverted triangle; hair may extend midline to the umbilicus
Assess for hirsutism in women- the growth of terminal hair in a male distribution pattern on the face, body, and pubic area. Hirsutism, alone or with other signs of virilization, may indicate an endocrine disorder
Ball et al., 2015, p. 133-134
Hair loss on lateral eyebrows and scalp may indicate a thyroid dysfunction
Dains et al., 2016, p. 251
Evaluate hair loss that is diffuse or localized and compare areas such as temporal and crown region to the occiput
Hair pull test will reveal any increased hairs shed with a gentle pull
Dains et al., 2016, p. 335
Hair disorders
Alopecia Areata
o Sudden, rapid, patchy loss of hair, usually from face or scalp
o Unknown cause may be triggered by genetic-environmental interactions
o Any hair may be affected
o Regrowth begins in 1-3 months
o Subjective data: sudden, rapid, patchy hair loss, may report nail pitting, may have family history
o Objective data: hair loss sharply defined round areas, hair shaft is poorly formed and break off at skin surface
Ball et al., 2015, p. 154
Scarring Alopecia
o Replacement of hair follicles with scar tissue
o Skin disorders of the scalp or follicles resulting in scarring and destruction of hair follicles and permanent hair loss
o Subjective data: may have other concurrent skin or systemic disorders
o Objective data: patchy hair loss, scalp may be inflamed, hair follicles may be pustular or plugged
Ball et al., 2015, p. 155
Traction Alopecia
o Hair loss that is the result of prolonged tightly pulled hairstyles
o Prolonged tension of the hair from traction breaks the hair shaft
o Follicle is not damaged, loss is reversible
o Subjective data: history of wearing certain hairstyles: braids, hair rollers, or hot combs
o Objective data: patchy hair loss that corresponds directly to the area of stress
o Scalp may or may not be inflamed
Ball et al., 2015, p. 155
Hirsutism
o Caused by high androgen levels (from ovaries or adrenal glands) or by hair follicles that are more sensitive to normal androgen levels, free testosterone causes hair growth
o Causes: genetic, physiologic, endocrine, drug-related, and systemic disorders
o Subjective data: excessive hair growth on face or body; onset, severity, and rate depend on underlying cause
o Objective data: thick dark terminal hairs in androgen-sensitive sites: face, chest, areola, external genitalia, upper and lower back, buttocks, inner thigh, and linea able; may or may not be accompanied by other signs of virilization
Ball et al., 2015, p.155
Hair-Pulling (Trichotillomania)
o Loss of scalp hair caused by physical manipulation
o Hair is twisted around the finger and pulled or rubbed until it breaks off; the act of manipulation is usually an unconscious habit
o Subjective data: may report tension, anxiety, emotional stressors
o Objective data: affected area has an irregular border, and hair density is greatly reduced, but the site is not bald
Ball et al., 2015, p. 163
Tinea capitits- the triad of hair loss, scaling, and lymphadenopathy in children
Dains et al., 2016, p. 334
#25 Cranial Nerves associated with HEENT exam
CN1: Olfactoryà sniff testà Sensory* O
• CN2: Opticà Vision (Snellen eye chart)àSensory* O
• CN3: Oculomotorà 6 cardinal gazes, pupils constrict, opening/closing of eyesà Motor O
• CN4: Trochlearà 6 cardinal gazes, downward/lateral of eye movementà Motor To
• CN5: Trigeminalà facial sensation- temp, pain, tactile (Tri/3), taste, mastication, corneal reflex à Both Touch
• CN6: Abducensà 6 cardinal gazes, lateral movement of eyesà Motor And
• CN7: Facial à dysfunction (Bell’s palsy) puffing out cheeks, smile/frown, facial symmetry* Both Feel
• CN9: Glossopharyngeal à tongue (glosso) throat (pharynx) gag reflex, swallowàBoth Good
• CN10: Vagus à aortic pressure, regulating BP, slowing HR, taste and digestionà Both Vagina
• CN11: Accessory/Spinalà shoulder shrug/ lateral neck movementà Motor* A
• CN12: Hypoglossal à tongue movement/strengthà Motor*
God gave you 1 nose (Olfactory) and 2 eyes (Optic). Nerves 3,4, and 6 make your eyes do tricks (3 Occularmotar, 4 Trochlear, and 6 Abducens). FIVE rhymes with TRI (5 Trigeminal). 7 is like an “F” backwards (F for Facial). 8 looks like earrings (8 Vestibulocochlear (Auditory)). “9 and10, under my chin” (IX Glossopharyngeal (Swallowing, saliva, taste), X Vagus (Control of PNS e.g. smooth muscles of GI tract) (just check gag reflex), 12 for swallowing (XII Hypoglossal (Tongue muscles – speech & swallowing)), and the number 11 looks like the neck (XI Accessory (Moving head & shoulders).
In the pic of the face attached, each part of the number 5 the crosses the face (3 lines) corresponds with the first, second, and third segments of the Trigeminal nerve (Forhead, maxila and mandible).
Here is a quick, meat and potatoes crainial nerve assessment video that is to point:
As the video suggests, the 1st crainial nerve is not tested during routine exam, but you could blindfold the patient and hold coffee, alchohol, etc under the nose and test like you would a taste for sugar and salt.
Now, to remember the order, a “clean” acronym for remembering the crainial nerve order would be,
“Oh Oh Oh To Touch And Feel Very Good Velvet, Such Heaven.” Take the first letter of this acronym for the order of the nerves. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
There is another acronym that helps you determine whether the nerve is sensory, motor, or both. This acronym is, “Some Say Marry Money But My Brother Says Big Brains Matter Most.”
sutures palpable with small separation between each.
Common variations: Caput succedaneum: swelling of the soft tissue in the scalp caused by pressure of the fetal head on a cervix that is not fully dilated. Swelling crosses suture line and decreases rapidly in a few days.
Examination findings of a patient with hypothyroid and hyperthyroid
Palpate lower trachea w thumbs at each side to eval space between trachea and sternocleidomastoid muscles on each side (uneven indicates displacement) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Palpate movement with swallowing (smooth and nontender) movement of cartilages should be felt under finger
ROM 193/516/578: Flex, extend, rotation without pain, resistance or dizziness
Palpation for tenderness in the paravertebral musculature and spinous processes (upper/lower back) coupled with ROM of neck for eval of stiff neck
Take note of any mass, webbing, skin folds (excessive posterior cervical skin)
Thyroid 194:
inspection, palpation, and auscultation for bruit if enlarged
Gently extend neck, use water for swallowing, gentle touch
Can be done from front or behind (learn and be consistent with your method)
Palpation for size, shape, configuration, pain, nodules
Lymph nodes 174-175:
Palpation (so much info pictures, I wasn’t sure how to break it down)
Eyes 208-209:
Near vision- Rosenbaum pocket vision screen (14 inch from face)
Distant Vision- Snellen eye chart/Pin hole (no glasses first) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Peripheral Vision- Confrontation test (bringing fingers in from the side)
Eyebrows 210:
Inspect texture, size, extension to temporal canthus
Eyelids 210-211:
Open and closes completely?
Eyelash position (should curve away)
Ptosis (drooping eyelid)
Fasciculation (twitching/tremor)
Flakey, redness, swelling?
Palpate for nodules -closed lids w gentle push into orbit (should be no discomfort)
Pull lower lid down to assess for color, discharge, lacrimal gland punctum, pterygium
Orbits 210:
Inspect for edema, puffiness, excess tissue
External Eye 212-214:
Corneal clarity using a pen light
Corneal sensitivity using a cotton wisp (slight touch across the cornea)
Corneal arcus: circle around the cornea
Color of irises should be the same
Pupils should be round, regular, equal size, and reactive to light
Pupillary defect with swing flashlight test (checks optic nerve)
Nystagmus- have patient follow your finger to check for involuntary movement
Muscle balance & movement 214-216:
Corneal light reflex 215: light source (used to check strabismus) Cover-uncover test 215, Six cardinal fields of gaze: assess extraocular muscles and cranial nerves, Nasal- straight, up, and down, Temporal- straight, up, and down
Opthalmic examination 216-218:
Give rest periods between tests using bright light, Dim the lights, Ophthalmoscope in the hand with corresponding eye (right hand-right eye), Instill dilating medications as necessary
Ears 239:
Inspect for size, shape, symmetry, landmarks, color, abnormalities.
Position- pull ear up and back
Palpate auricles and mastoid area for pain, swelling or nodules
Auditory canal 240: otoscope 1-1.5 cm depth- color, cerumen, abnormalities
Tympanic membrane 240-241: otoscope- movement (w positive pressure), color, landmarks, abnormalities
Hearing 240-242:
Response to questions during history, whispered voice, and tuning forks (top of head and mastoid area) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Nose and Sinuses 242-244:
Inspect external nose
Palpate bridge and soft tissues of nose
Nares -nasal speculum and light source
Palpate maxillary and frontal sinuses for swelling or pain
Transillumination 244: of sinuses if tender or infection is present
Mouth 245-249:
Inspect lips, teeth, and oral cavity for abnormalities
Palpate and inspect gingivae and buccal mucosa for color, lesions, and pain
Inspect and palpate the tongue
Elicit a gag reflex
Inspect tonsils and pharynx
#30 Examination findings for a patient with sinus symptoms
Seidel page 231, 243-244
Inspect the external nose, noting the shape, size, color, and nares.
Palpate the bridge and soft tissues of the nose, noting tenderness, displacement, and masses.
Evaluate the patency of the nares
Inspect the nasal mucosa and nasal septum for the following: color, alignment, discharge, selling of turbinates, or perforation.
Inspect the frontal and maxillary sinus area for swelling
Palpate the frontal and maxillary sinuses for any tenderness, pain, or swelling
Signs and Symptoms
Sinus infections often follow a cold and cause pain and pressure in your head and face. Palpating over the infected sinus will cause tenderness.
Sinusitis can be either acute or chronic. With chronic sinusitis, the infection or inflammation does not completely go away for 12 weeks or more.
Sinusitis can be caused by three things: viruses, bacteria, fungi. The same viruses that cause the common cold cause most cases of sinusitis. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
-Viral Sinusitis: When the lining of the sinus cavities gets inflamed from a viral infection like a cold, it swells. The swelling can block the normal drainage of fluid from the sinuses into the nose and throat.
-If the fluid cannot drain and builds up over time, bacteria or fungi (plural of fungus) may start to grow in it. These bacterial or fungal infections can cause more swelling and pain.
-Nasal allergies or other problems that block the nasal passages and allow fluid to build up in the sinuses can also lead to sinusitis.
Other common symptoms of sinusitis may include: headache, bad breath, cough that produces mucus, fever, pain in your teeth and a reduced sense of taste or smell.
Viral infections normally resolve without antibiotics within 14 days. Bacterial infections may require antibiotics. OTC medications can be obtained to relieve discomforts and sinus symptoms. Fungal infections (less common) require anti-fungals, these infections can require additional interventions (surigal).
Transillumination of the sinuses:
A transilluminator or small, bright light can be used.
Darken the room.
Maxillary sinuses: place the light source lateral to the nose, just beneath the medial aspect of the eye. Look through the patients open mouth for immunination of the hard palate.
Frontal sinuses: place the light source against the medial aspect of each supraorbital rim. Look for a dim red glow just above the eyebrow. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
The sinuses may differ in degree of illumination
-Opaque: no transillumination
-Dull: reduced transillumination
-Glow (expected): transillumination.
-An opaque response may indicate the sinus is filled with secretions or never developed.
-Asymmetry of transillumination is a significant finding.
#31 appropriate tuning fork frequencies to approximate vocal frequencies
Seidel page 241-242
Weber test: helps assess unilateral hearing loss. Place the base of the vibrating tuning fork on the midline of the patients head. Ask the patient if the sound is heard equally in both ears or is better in one ear. If the sounds is heard better in one ear, have the patient identify which ear.
-To test reliability have the patient occlude one ear. Repeat the test, the sound should be heard better in the occluded ear.
Rinne test: helps to distinguish if the patient hears better by air or bone conduction. Place the base of the vibrating tuning fork against the patients mastoid bone and ask the patient to tell you when the sound is no longer heard. Time this interval of bone conduction, noting the number of seconds. Quickly position the still vibrating tines 1-2 cm from the ear, and again ask the patient to tell you when the sound in no longer heard. Time the interval of sound conduction as well. Compare the seconds recorded for both bone and air conduction.
-Air conduction should be heard twice as long as bone conduction. (see figure 12-16 on page 242 in Seidel)
*Placing the base of a vibrating tuning fork on the midline vertex of the patient’s head is a test for? Lateralization of sound
*To approximate vocal frequencies, which tuning fork should be used to assess hearing?
The oral cavity is the first component of the digestive tract, which is delimited by the lips anteriorly and the oropharynx posteriorly. The oral cavity functions as a protective barrier and is an essential component for speech and swallowing, mastication, digestion, and taste sensation. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
To exam of the oral cavity:
Inspect the dorsum of the tongue: Note any swelling or variation in size or color
Ask the patient to extend the tongue while you inspect for limited movement: test CN XII
Tongue should maintain at midline
Normal tongue: dull red, moist, and glistening; smooth surface with papillae with small fissures is visualized on the anterior surface; Posterior tongue: should have rugae
ABNORMAL: smooth red tongue with slick appearance may indicate B12 deficiency; hairy tongue with yellow-brown or black elongated papillae may follow ABT therapy NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Ask the patient to touch the tip of the tongue to the palate area behind the upper incisor
Inspect the roof of the mouth
Inspect the ventral surface of the tongue
A ranula (mucocele) may be seen on the floor of the mouth when an obstruction of the sublingual salivary gland duct
Wrap the tongue in a piece of gauze and gently pull it to each side while inspecting the lateral border
Scrape and white or red margins to distinguish between food particles and leukoplakia
Palpate the tongue and the floor of the mouth for lumps, nodules or ulcerations
Ask the patient to tilt the head back for inspection of the palate and uvula NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Normal: The whitish hard palate should be domed shaped with transverse rugae
Assess the movement of the soft palate by asking the patient to say “ahh” – as the patient vocalizes, observe the soft palate rise symmetrically with the uvula remaining midline – this test CN IX and X
ABNORMAL: A bifid uvula can be associated with Loey-Dietz syndrome
Oral Manifestations with HIV:
Oral hairy leukoplakia: white irregular lesion on lateral side of tongue or buccal
Angular cheilitis: red, unilateral, or bilateral fissures at the corner of the mouth
Candidiasis: creamy white plaque on oral mucosa that bleed when scraped
Herpes Simplex: recurrent vesicular crusting lesions on the lips
Herpes Zoster: Vesicular lesions distributed on the trigeminal nerve
Human papillomavirus: sessile or pedunculated nodules in the oral cavity
Aphthous ulcer: recurrent circumscribed ulcers with erythematous margins
Periodontal disease: gingivitis with bone and soft tissue degeneration with pain
Kaposi sarcoma: incomplete formed blood vessels proliferate, forming lesions
#33 hearing loss findings when examining the elderly patient
Textbook chapter 12 pg. 236
Findings include:
~Conductive hearing loss in older adults may result from an excess deposition(amount) of bone cells along the ossicle (bone in the middle ear)
~ a fixation of the stapes in the oval window(stapes are bones in the middle ear that focuses on conduction of sound vibrations in the inner ear) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Elaborating on what I read on the fixation of stables…. when doing the test with the tuning fork these patients may have abnormal results bc the vibrations are diminished
~cerumen (earwax) impaction
~sclerotic tympanic membrane (sclerotic= becoming rigid, unresponsive, or losing the ability to adapt)
#34 Thyroid Exam
Physical exam:
-inspection of neck
-palpation of paratracheal area
-palpation of lateral neck
-pulse rate
Looking for: exophthalmos, hoarseness of voice, distant mass
Examination techniques used to examine the trachea and thyroid
b. Inspect then Palpate trachea with thumb along each side (sternocleidomastoid muscle on each side)
i. A tugging sensation, synchronous with the pulse is evidence of tracheal tug sign (Cardarelli sign or Oliver sign) suggesting an aortic aneurysm
c. Thyroid: extend neck, have the patient take a sip of water
i. *The estimation of thyroid size by lateral inspection is the most sensitive test for determining the presence of a goiter
ii. FRONT: place thumb over trachea 3 cm beneath thyroid cartilage, to examine RIGTH lobe use left thumb and press trachea towards patients left with your left thumb. Place first 3 fingers of your right hand in the right thyroid bed- leave fingers still while the patient swallows. To examine LEFT lobe, move your fingers o the reverse positions NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
iii. BEHIND: 2 fingers on each sides of the trachea- swallow (feeling for movement of the isthmus) displace trachea to left (with fingers from right hand) with fingers from left hand palpate left lobe as patient swallows.
#35 Organs involved in the alimentary tract
The alimentary tract is 27 feet long and runs from the mouth to the anus including:
Esophagus
• collapsible 10 inches’ longs connecting the pharynx to the stomach
Stomach
• three sections fundus, body, and pylorus
• secretes hydrochloric acid and digestive enzymes that break down fats and proteins
• Pepsin digests proteins
• Gastric lipase emulsifies fat
• Little absorption takes place here
Small intestines
• 21 feet long
• coiled in the abdominal cavity
• first 12 inches’ duodenum forms a C shaped curve around the head of the pancreas
• Next 8 feet is the jejunum that gradually becomes larger and thicker
• Last 12 feet are the ileum
• Ileocecal valve lies between the ileum and the large intestines to prevent backflow
• Nutrients are absorbed through the mucosa of the small intestines
Large intestines
• Begins with the cecum, a blind pouch about 2-3 inches long that hold ileal contents
• vermiform appendix extends from the cecum
• Ascending colon extends from the cecum along the right posterior abdominal wall- under surface of the liver
• Transverse colon crosses the abdominal cavity toward the spleen and down toward the splenic flexure
• Descending colon runs along the left abdominal wall to the rim of the pelvis turning medially and inferiorly
• Sigmoid colon is the S shaped that connects to the rectum extending from the sigmoid to the pelvic floor through the anal canal and terminates at the anus NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
The alimentary tract functions to digest food; absorb nutrients, electrolytes, and water; and excrete waste products
# 36
Correct assessment order for the abdomen
Patient remains supine. Cover chest with the patients gown. Arrange draping to expose the abdomen from the pubis to the epigastrium.
• Inspect skin characteristics, contour, pulsations, and movement
• Auscultate all quadrants for bowel sounds
• Auscultate the aorta and renal, iliac, and femoral arteries for bruits or venous hums
• Percuss all quadrants for tones
• Percuss liver borders and estimate span
• Percuss left midaxillary line for splenic dullness
• Lightly palpate all quadrants
• Deeply palpate all quadrants
• Palpate right costal margin for liver borders
• Palpate left costal margin for spleen
• Palpate laterally at the flanks or right and left kidneys
• Palpate midline for aortic pulsation
• Test abdominal reflexes
• Have your patient raise their head as you inspect the abdominal muscles
#37 Examination of the Liver pg. 385-386
Assessment YouTube Video:
Liver palpation
The lower edge of the liver can be palpable on inspiration about 3 cm below the right rib cage. The liver palpation can be performed with one hand or bimanually, and in the case of obese patients, the so-called “hooking” technique might be helpful as well.
One-hand liver palpation
Place your right hand on patient’s abdomen, lateral to the rectus muscle, well below the level of percussed border of liver dullness.
Orient your fingers towards the patient’s head or slightly diagonally towards the midline. Press your fingers firmly in and up (towards the patient’s head).
Ask the patient to take a deep breath. On inspiration, the liver descends, and its edge meets the fingertips of the palpating hand.
Continue palpating, moving your hand toward the coastal margin until you feel the liver edge (usually a few cm below right costal margin). Note liver edge texture and regularity. Slight tenderness on palpation is normal. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
When your fingers meet the liver edge, slightly reduce the pressure on the abdominal wall while the patient is still taking a deep breath in. This maneuver allows the examiner to feel the anterior liver surface as it slips under the finger pads. Make a note of the consistency of the liver surface-nodes, granularity, etc. (Figure 2)
Bimanual liver palpation
Place your left hand posteriorly at the level of the patient’s two lower ribs, and gently press upward to elevate the liver into a more accessible position.
Ask the patient to take a deep breath and perform palpation with your right hand as described above.
The “hooking” technique
This can be helpful when the liver is not palpable by the standard techniques.
Stand on the right of the patient, facing the patient’s feet.
Place your flexed fingers over the edge of costal margin.
Ask the patient to take a deep breath and try to feel the liver edge as you press downward and upward (towards the patient’s head).
Signs and symptoms of liver disease include:
Skin and eyes that appear yellowish (jaundice)
Abdominal pain and swelling
Swelling in the legs and ankles
Itchy skin
Dark urine color
Pale stool color, or bloody or tar-colored stool
Chronic fatigue
Nausea or vomiting
Loss of appetite
Tendency to bruise easy
Question # 38 – Examination findings associated with appendicitis
Appendicitis
The incidence of appendicitis peaks at age 10 to 20 years, although it can occur at any age.
The patient reports sudden onset of colicky pain that progresses to a constant pain.
The pain can begin in the epigastrium or periumbilicus and later localize to the RLQ.
The pain worsens with movement or coughing.
Vomiting after the onset of pain sometimes occurs.
On physical examination, the patient will be lying still and demonstrate involuntary guarding.
Classically, tenderness occurs in the RLQ.
The other tests for peritoneal irritation will be positive.
Rebound tenderness may be present. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
Variation in presentation is common, particularly with infants, children, and the elderly.
Diagnostic testing includes complete blood count (CBC) with differential to confirm or rule out infection and the use of either ultrasonography, CT scan, or laparoscopy.
Psoas sign, McBurney point pain, rebound tenderness, and periumbilical pain that migrates to the right lower quadrant are signs of appendicitis.
Conditions that cause irritation of the obturator muscle are late findings usually associated with a ruptured appendix or pelvic abscess.
An accurate diagnosis based on history and physical examination can facilitate immediate surgical evaluation and definitive treatment and prevent unnecessary use of radiologic imaging.
In adults, historical symptoms that increase the likelihood of appendicitis are right lower quadrant (RLQ) pain, initial periumbilical pain with migration to the RLQ, and the presence of pain before vomiting.
The presence of rigidity, a positive psoas sign, fever, and/or rebound tenderness are physical examination findings that increase the likelihood of appendicitis.
EVIDENCE-BASED PRACTICE
Clinical Diagnosis of Appendicitis
In a review of clinical decision rules to assist in diagnosing appendicitis, the authors concluded that decision models that score combinations of findings from the history and clinical examination are more powerful than any single finding.
They point to the Alvarado model as one that balances accuracy with ease of use and familiarity to clinicians.
It combines the results for eight findings; a score of 7 or more out of a potential 10 indicates the need for surgical intervention. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
The Alvarado model has a sensitivity of 81% and a specificity of 74%.
ALVARADO SCORE FOR EARLY DIAGNOSIS OF ACUTE APPENDICITIS
VARIABLE
SCORE
Migration of pain
1
Anorexia-acetone
1
Nausea/vomiting
1
Tenderness in RLQ
2
Rebound pain
1
Elevation of temperature
1
Leukocytosis
2
Shift to the left on differential (neutrophils >75%)
1
Maximum total score
10
Positive score
≥7
*
*A score of 7 or more indicates the need for surgical intervention
#39
Examining Mc Burney’s sign:
McBurney’s Point:
– Lies 2 inches from anterior superior point of ileum along a line drawn to the umbilicus.
– Localized tenderness at/around area is indicative of appendicitis. (youtube video attached in group)
a. Find umbilicus, find ASIS (Anterior superior iliac spine/hip bone)
b. Draw imaginary line from umbilicus to ASIS- go 2/3 up line from ASIS!
a. Localized tenderness at/around area is indicative of appendicitis.
#40 Assessment of abdominal pain in women
*Key Points
Auscultation should be done last when examining the abdomen
Example question found through Elsevier online: Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to: inspect for ecchymosis of the flank.
When assessing abdominal pain in college-aged women always ask when the first day of their last menstrual period was!!! NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
Before performing an abdominal exam have the patient empty their bladder!
After abdominal inspection then AUSCULTATE
Inspection of the abdomen should begin with the patient SUPINE
Advanced Health Assessment and Clinical Diagnosis in Primary Care (Dains, Baumann, & Scheibel: Chapter 3 pg. 11
Pg. 20: Perform a pelvic exam in women to rule out STI, PID, ovarian pain, ectopic pregnancy, and uterine fibroids. Cervical motion tenderness (CMT) is the hallmark of PID.
Pg. 28-32 table with common causes of acute abdominal pain
Examples for women:
Ectopic Pregnancy:
women of childbearing age, sudden onset of spotting and persistent cramping in lower quadrant that begins shortly after missed period.
Dysmenorrhea:
typical premenstrual pain onset soon after menarche, gradually diminishes with age. Gynecology consult is needed with pelvic ultrasound. (pg. 30)
Uterine Fibroids:
pain related to menses or intercourse. (
Physical Findings:
Palpable myomas. Pelvic ultrasound is needed with gynecology consult (pg. 27, 31)
Ovarian Cyst:
common with younger women. (pg. 27, 31)
Physical Findings:
adnexal pain and palpable ovarian cysts especially later in cycle
Cholecystitis:
more common in women. Pain located in RUQ and radiates to right scapular area, dark urine, N/V, light stools, and may be aggravated by certain foods. (pg. 29)
Pelvic Inflammatory Disease (PID):
common in women younger than 35 who are sexually active usually with more than one partner. Often caused by chlamydia trachomatis and Neisseria gonorrhoeae with onset occurring after menses. Patients present with lower abdominal pain that progressively becomes severe. Upon examination: tender abdomen, CMT, and adnexal tenderness. Patients may guard and have rebound tenderness, fever, irregular bleeding, vaginal discharge, and vomiting, WBC and ESR are usually elevated. (pg. 25) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
Causes of lower abdominal or pelvic pain
Lower abdominal or pelvic pain, refers to discomfort that occurs at or below your belly button. Most women will experience pain in the
lower abdomen
from time to time. More often than not this is due to menstruation.
The bladder and reproductive organs are often where pelvic pain occurs. In many cases it is difficult to diagnose the exact cause of the pain, but noting certain symptoms will help come to a diagnosis.
The most common lower abdominal pain causes are:
A urinary disorder, such as bladder or kidney problems.
A bowel problem.
A problem with the reproductive system – the uterus, fallopian tubes and ovaries.
Abdominal pain arising from the urinary system
Urine infections
are common and present symptoms, such as burning when you pass urine and going to the toilet more often.
Infection can spread to the kidneys (pyelonephritis) and can make you feel unwell with a high temperature and back pain.
If you have pain that spreads from your back down to your groin and is severe – your doctor may be more concerned that you have
kidney stones
. The doctor will test your urine if you have any of the above symptoms.
Abdominal pain arising from the digestive system
Pain arising from the large intestine is a particularly common cause of lower abdominal pain in both men and women. Features suggesting your pain may be to do with the bowel are:
Pain associated with bowel movement
A change in bowel habit
Blood with bowel movement
Bloating
Both
constipation
and
diarrhea
can give you pain. The pain they are often associated with is described as crampy or ‘colicky.’ This means that it comes and goes in waves. Large bowel pain is characteristically relieved on opening the bowels.
Potential causes of pain arising from the bowel include
irritable bowel syndrome
(IBS), which can give you alternating diarrhea, constipation and bloating.
Other conditions include diverticular disease and its complications which are more frequent in older patients. Inflammatory bowel disease (ulcerative colitis or Crohn’s). A rare but important diagnosis is colorectal cancer.
Bloating and swelling is also a common symptom that people report and can be due to a problem affecting the bowels. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
Abdominal pain arising from the reproductive organs
Pain can originate from your uterus (womb), fallopian tubes or ovaries. It’s usually felt in the middle of the lower abdomen.
Pain that is felt more to the side can be more typical of a pain coming from the ovary.
Pain coming from the uterus is often worse during your period and is called dysmenorrhea.
Some conditions affecting the reproductive system can also cause pain during intercourse. This is called
dyspareunia
and it is important to let your doctor know if you are concerned.
Examples of conditions of the reproductive organs include:
Endometriosis
Fibroids
Pelvic inflammatory disease
Ovarian cysts
Problems related to the early stage of pregnancy, such as a miscarriage or ectopic pregnancy.
*Seek immediate medical assistance if your symptoms include a fever, vomiting blood, passing dark or bloody stools or acute and worsening pain.
Questions about a person’s emotional life-family, home, work and sex life are appropriate.
Further abdominal pain investigations
Depending on the exact symptoms and duration, referral to the appropriate specialist is often required. These may include:
Gynecological causes may require vaginal swabs, cervical smears or pelvic ultrasound examination. Ultrasound may also be performed from within the vagina. Specialized blood test for ovarian cancer, CA-125, are usually performed. More invasive tests will depend upon the doctor’s suspicion of the cause of the pain.
Urinary causes can be investigated by urine culture, ultrasound or CT scan.
Colonic causes may require internal endoscopic examination of the bowel by Flexible Sigmoidoscopy or Colonoscopy. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
A CT (Computerized Tomography Scan) may be appropriate for all three major sites of pain.
#41
Landmarks for Abdominal Examination
Have the patient void before performing abdominal examination because a full bladder may interfere with an accurate examination of organs and makes the exam uncomfortable. Approach patient from the right side.
• Four Quadrants of the abdomen: RUQ, LUQ, RLQ, LLQ
• Refer to the nine regions of the abdomen. Figure 17-4 in Ball et al., 2015 p. 378. 1: Epigastric; 2: Umbilical; 3: Hypogastric; 4 & 5: right and left hypochondriac;6 & 7: right and left lumbar; 8 & 9: right and left inguinal.
• Refer to Box 17-1 in Ball et al., p. 379 for landmarks of abdominal exam
o Right Upper Quadrant (RUQ)
• Liver & Gallbladder NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
• Pylorus
• Duodenum
• Head of Pancreas
• Right Adrenal Gland
• Portion of the Right Kidney
• Hepatic Flexure of Colon
• Portions of ascending and transverse colon
o Left Upper Quadrant (LUQ)
• Left lobe of liver
• Spleen
• Stomach
• Body of Pancreas
• Left Adrenal Gland
• Portion of the Left Kidney
• Splenic flexure of colon
• Portions of transverse and descending colon
o Right Lower Quadrant (RLQ)
• Lower pole of right kidney
• Cecum and appendix
• Portion of ascending colon
• Bladder (if distended)
• Ovary and Salpinx
• Uterus (if enlarged)
• Right Spermatic cord
• Right ureter
o Left Lower Quadrant (LLQ)
• Lower pole of left kidney
• Sigmoid Colon
• Portion of descending colon
• Bladder (if distended)
• Ovary and Salpinx
• Uterus (if enlarged)
• Left Spermatic Cord
• Left Ureter
• Refer to Box 17-1 on page 379 of Ball et al., 2015 to refer to the anatomic correlates of the nine regions of the abdomen.
#42 Characteristics of bowel sounds heard on auscultation
Always perform auscultation of the abdomen prior to percussion and palpitation as these maneuvers can change the frequency and intensity of the bowel sounds NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide
• Listen for bowel sounds and note frequency and character
• Usually heard as clicks and gurgle that occur irregularly and range from 5-35 sounds per minute.
• They are generalized so often can just be assessed by listening in one area.
• Increased bowel sounds can happen with gastroenteritis, early obstruction, or hunger
• High-pitched tinkling sounds can be indicative intestinal fluid and air under pressure, ie early obstruction.
• Decreased bowel sounds occur with peritonitis and paralytic ileus (auscultate in all 4 quads, if there is a concern) NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
• Absent bowel sounds- inability to hear bowel sounds after 5 minutes of continuous listening-associated with abdominal pain/rigidity and is considered a surgical emergency. (Seidle’s Guide to Physical Examination, pg 381)
• You should listen over all 4 quadrants and be able to recognize what is in what quad. (RUQ-lower margin of the liver, gallbladder, part of the large intestine, few loops of the small intestine), (RLQ- appendix, connection between the large and small intestine and loops of bowel), (LUQ- lower margin of the spleen, part of the pancreas and some of the stomach and duodenum), (LLQ- bowel loops and descending colon)
• Important to chart location, quality, intensity, and frequency of bowel sounds. NURS 6512 – Advanced Health Assessment and Diagnostic Reasoning Midterm exam study guide.
A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs.
A.
Triphasic OC
B.
Ortho Tri-Cyclen
C.
Biphasic OC
D.
Monophasic
1 points
QUESTION 2
A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the
A.
rectus femoris muscle.
B.
ventrogluteal muscle.
C.
dorsogluteal muscle.
D.
deltoid muscle.
1 points
QUESTION 3
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
A.
electrocardiogram (ECG).
B.
electrophysiologic study (EPS).
C.
electromyelogram (EMG).
D.
electroencephalogram (EEG).
1 points
ORDER A PLAGIARISM-FREE PAPER HERE
QUESTION 4
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
A.
“Every year, thousands of Americans end up in emergency departments with marijuana overdoses.”
B.
“Most people don’t know that marijuana can be just as addictive as heroin or cocaine over time.”
C.
“Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes.” NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
D.
“Marijuana can easily interact with other drugs and cause potentially fatal reactions.”
1 points
QUESTION 5
A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient?
A.
“Take this drug once each day on an empty stomach.”
B.
“It’s best to take a dose of sibutramine after each meal.”
C.
“This drug will help you to lose weight without having to exercise or change your normal diet.”
D.
“Take a dose when you feel like you are tempted to binge on food.” NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
1 points
QUESTION 6
A preterm neonate received caffeine for the treatment of apnea. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. The nurse should monitor the neonate for which of the following?
A.
Constipation
B.
Hypoglycemia
C.
Bloody stools
D.
Bradycardia
1 points
QUESTION 7
A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to
A.
increased heart rate and subsequently rapid drug distribution among infants and children.
B.
the inability of infants and children and describe symptoms of adverse drug reactions.
C.
increased body surface area relative to body volume in infants and children.
D.
immature liver and kidney function in infants and children.
1 points
QUESTION 8
A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?
A.
That there is less body surface area to be concerned about
B.
That there is a lower concentration of water in an infant’s body compared with an adult
C.
That the infant’s skin has greater permeability than that of an adult
D.
That there is decreased absorption rates of topical drugs in infants
1 points
QUESTION 9
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
A.
deep muscle pain.
B.
sleep deprivation.
C.
orange-tinged urine.
D.
staining of permanent teeth.
1 points
QUESTION 10
A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
A.
The health status of the other children
B.
Where the medications will be stored
C.
How clean the house is
D.
The mother and grandmother’s understanding about the drugs
1 points
QUESTION 11
A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals
trichomonas vaginalis
. The nurse practitioner is aware that
A.
asymptomatic women are diagnosed with trichomoniasis by a routine pap smear.
B.
trichomoniasis is an incurable disease.
C.
trichomoniasis discharge is typically thin and clear.
D.
it is unusual to have an odor with trichomoniasis.
1 points
QUESTION 12
A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
A.
“How much do you weigh?”
B.
“Do you ever use alcohol or drugs?”
C.
“Did Tylenol or other over-the-counter pain remedies ever relieve your pain?”
D.
“On a scale of zero to ten, what level of pain is acceptable to you?”
1 points
QUESTION 13
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be
A.
height and weight.
B.
Vision.
C.
body temperature.
D.
blood pressure.
1 points
QUESTION 14
A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of
A.
grapefruit juice.
B.
trans fat.
C.
alcohol.
D.
caffeine.
1 points
QUESTION 15
A patient asks the nurse practitioner about food sources such as soybeans and soy products. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. The nurse practitioner understands that these foods are considered
A.
taboo.
B.
phytoestrogens.
C.
monotherapy.
D.
inappropriate.
1 points
QUESTION 16
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?
A.
Drink plenty of fluids.
B.
Take the drug for one full week before coming in contact with allergens
C.
Avoid high noise levels
D.
Take the drug on a full stomach
1 points
QUESTION 17
A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should
A.
use sterile technique when applying the medication.
B.
allow the child to apply the medication if possible.
C.
use clean technique only when applying the medication.
D.
cool the medication prior to administration.
1 points
QUESTION 18
A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. The breast tenderness occurs primarily during her menstrual cycle. The nurse practitioner probably suspects
A.
breast cancer.
B.
PMS.
C.
pain in the heart.
D.
cancerous breast tenderness.
1 points
QUESTION 19
A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)
A.
Disease process
B.
Age
C.
Weight
D.
Route of administration
E.
Diet
1 points
QUESTION 20
To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?
A.
A 34-year-old woman with a diagnosis of gastric ulcerations
B.
A school-age child with severe ADHD
C.
A preterm neonate who has apnea
D.
A 52-year-old man with narcolepsy
1 points
QUESTION 21
The recommended treatment for trichomoniasis is
A.
Amoxicillan.
B.
Flagyl.
C.
Meclizine.
D.
Diflucan.
1 points
QUESTION 22
A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should
A.
involve the child in a play therapy session, and then tell the child that the medicine is candy.
B.
offer the child a flavored ice chip or ice pop prior to administering the drug.
C.
have the parent gently force the child’s mouth open.
D.
give the drug in a pill form.
1 points
QUESTION 23
A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem?
A.
Obesity
B.
ADHD
C.
Respiratory depression
D.
Anxiety
1 points
QUESTION 24
A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication
A.
every day until the infection is gone.
B.
once a day.
C.
for 20 days.
D.
for 30 days.
1 points
QUESTION 25
The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?
A.
Having nurses check their math calculations with a colleague before administering a drug.
B.
Avoiding intravenous administration of drugs whenever possible.
C.
Ensuring that a full assessment takes place no more than 30 minutes before giving a drug.
D.
Recording drug administration in both the nurse’s notes and the medication administration record (MAR)
1 points
QUESTION 26
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
A.
Nephrotoxicity
B.
Hypertensive crisis
C.
Hypokalemia
D.
Cardiac dysrhythmia
1 points
QUESTION 27
A 12-year-old boy is being discharged from the hospital after major surgery. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to
A.
the mother regarding why the boy needs to take the medications.
B.
the mother and be sure to reinforce the need to force the medications, if her son does not want to take them.
C.
the boy by telling him not to worry about the medications and to take them as directed.
D.
both the boy and his mother regarding all medication issued.
1 points
QUESTION 28
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?
A.
Decreased myocardial contraction
B.
Increased cardiac conduction
C.
Decreased heart rate
D.
Increased intranodal conduction time
1 points
QUESTION 29
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should
A.
offer a choice between liquid and chewable medications, if possible.
B.
have the mother hold the child firmly and sooth him while the drugs are administered.
C.
teach the boy about the fact that he will feel much better after he takes his medications.
D.
insert a central intravenous line.
1 points
QUESTION 30
A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose?
A.
2000 mg
B.
4000 mg
C.
3000 mg
D.
1000 mg
1 points
QUESTION 31
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary?
A.
“We live in a two-story house.”
B.
“My mother is going to give me my insulin.”
C.
“I am on the middle school track team.”
D.
“I walk two blocks to school every day.”
1 points
QUESTION 32
A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?
A.
A 60-year-old African-American man who experiences angina
B.
A 28-year-old African-American woman with hyperthyroidism
A 48-year-old Caucasian man who has adult-onset diabetes
1 points
QUESTION 33
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using
A.
body surface area.
B.
age in years.
C.
weight.
D.
age in months.
1 points
QUESTION 34
A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops
A.
under the tongue.
B.
on top of the tongue.
C.
in the buccal pouch.
D.
at the back of the mouth.
1 points
QUESTION 35
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?
A.
Vasoconstriction leading to reduced placental blood flow
B.
Hypoxia as a result of a prolonged second stage of labor
C.
Impaired maternal nutrition as a result of drug use
D.
Changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity
1 points
QUESTION 36
An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation?
A.
Knowledge Deficit
B.
Delayed Growth and Development
C.
Ineffective Family Therapeutic Regimen Management
D.
Caregiver Role Strain
1 points
QUESTION 37
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
A.
A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects.
B.
A child’s gastric pH is decreased, causing less of the drug to be absorbed from the subcutaneous skin, therefore producing more adverse effects.
C.
A child has an erratic blood flow from an immature peripheral circulation, which increases drug absorption, causing an increase in adverse effects.
D.
A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects.
1 points
QUESTION 38
A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. The nurse will inform the patient that during sibutramine therapy she should
A.
use adequate contraception.
B.
take a pregnancy test every month.
C.
abstain from sex.
D.
obtain a pap smear .
1 points
QUESTION 39
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate?
A.
Hepatic function
B.
Renal function
C.
Respiratory function
D.
Cardiac function
1 points
QUESTION 40
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
A.
a paradoxical response.
B.
an allergic response.
C.
a hepatotoxic response.
D.
an idiosyncratic response.
Question 1
1 out of 1 points
A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs.
Question 2
1 out of 1 points
A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the
Response Feedback:
The ventrogluteal site is the best choice because it is free of major nerves and blood vessels and is characterized by deep muscle mass. The drug is injected into the gluteus medius muscle, which is in the ventrogluteal site. Injection in the gluteus medius is less painful than injection in the vastus lateralis. The dorsogluteal site should be used only as a last resort because of potential damage to the sciatic nerve if the site is not chosen with precision. The scalp veins are never used for injections; they are used only as intravenous sites in infants.
Question 3
1 out of 1 points
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
Response Feedback:
In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.
Question 4
1 out of 1 points
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
Response Feedback:
Although smoking marijuana is often thought to be relatively safe compared with smoking tobacco, the smoke is virtually identical in both cases. Smoking marijuana involves inhaling larger volumes of smoke and holding the breath as much as four times longer than with tobacco, which ultimately makes smoking three to four marijuana joints a day equivalent to smoking one pack of tobacco cigarettes a day. Marijuana is not considered to highly addictive and it is not normally associated with a potential for overdose or potentially fatal drug interactions.
Question 5
1 out of 1 points
A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient?
Response Feedback:
Patients should take sibutramine on an empty stomach to maximize peak concentration levels. They should take it only once a day. It is important to remember that sibutramine should be used in conjunction with a low-calorie diet and daily exercise routine for maximum results. It is not taken on an “ass-needed” basis to control food cravings.
Question 6
1 out of 1 points
A preterm neonate received caffeine for the treatment of apnea. The nurse should monitor the neonate for which of the following?
Response Feedback:
In neonates, there is a possible association between the use of caffeine and the development of necrotizing enterocolitis. All preterm neonates treated with caffeine should be monitored for the development of gastric related adverse effects such as abdominal distension, vomiting, and bloody stools. Sinus tachycardia and diarrhea are adverse effects of caffeine, and hyperglycemia can indicate intolerance or overdose of caffeine. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Question 7
1 out of 1 points
A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to
Response Feedback:
Children are more at risk of the deleterious effects of drug errors because they have not physiologically matured. Immature liver or renal function, for example, can increase the circulating level of a drug beyond what would be expected in adults. This characteristic supersedes differences in body surface area, cardiac function, and ability to verbalize complaints.
Question 8
1 out of 1 points
A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?
Response Feedback:
Compared to adult skin, infants’ skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult patient. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Question 9
1 out of 1 points
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
Response Feedback:
Tetracycline is an example of a drug that can adversely affect a body system during a phase of child development. If administered to a child between the ages of 4 months and 8 years, it can stain the child’s permanent teeth. Discolored urine, deep muscle pain, and sleep deprivation are not associated with tetracycline.
Question 10
1 out of 1 points NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment?
Response Feedback:
An important question that should be asked during the assessment is whether there is a safe place to keep drugs out of the reach of the patient and the other children. Many drugs have serious adverse and toxic effects in children if taken without adult supervision. Although factors like health status of other family members, the cleanliness of the house, and the parent’s understanding about the medications are important considerations, the most important consideration is the safety of the child who is taking the medication and the other children.
Question 11
1 out of 1 points NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals
trichomonas vaginalis
. The nurse practitioner is aware that
Question 12
1 out of 1 points
A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?
Response Feedback:
In school-aged children and adolescents, assess for the use and abuse of substances such as caffeine, alcohol, tobacco, and street drugs. During drug therapy, these substances cause the same complications in children as in adults. Adolescence is a time of experimentation, which may include experimentation with legal and illegal substances. The boy’s subjective report of his weight, his response to over-the-counter drugs, and acceptable pain level do not directly address the potential for adverse drug reactions.
Question 13
1 out of 1 points
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be
Response Feedback:
The nurse should assess blood pressure, body temperature, and vision at each clinic visit as routine nursing measures in caring for a pediatric patient. However, the priority assessment would be of height and weight. Monitoring the growth and development of children taking amphetamines is extremely important because these drugs have been associated with growth suppression.
Question 14
1 out of 1 points
A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of
Response Feedback:
Caffeine-containing drinks such as tea, coffee, and cola may increase the adverse effects associated with dextroamphetamine. Intake of trans fat and grapefruit does not impact the use of dextroamphetamine. A history of drug and alcohol abuse may contribute a risk of dextroamphetamine abuse, but the concurrent use of dextroamphetamine and alcohol is not necessarily contraindicated.
Question 15
1 out of 1 points
A patient asks the nurse practitioner about food sources such as soybeans and soy products. The nurse practitioner understands that these foods are considered
Question 16
1 out of 1 points
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers
Response Feedback:
To maximize the therapeutic effects of the drug, the patient should take cromolyn sodium for one full week before coming in contact with allergens. Taking the drug on a full stomach is inappropriate, since the drug is in the form of a nasal spray. Neither avoiding high noise levels nor drinking plenty of fluids would help maximize the therapeutic effects of the drug.
Question 17
0 out of 1 points
A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should
Response Feedback:
In second- and third-degree burns, the skin is often broken, and the nurse needs to use sterile technique when applying a topical drug to prevent introducing bacteria and other organisms into the body. Do not cool medications unless instructed to do so. Children should not be instructed to apply medications to burned areas of their body. Using clean technique will not be as effective as sterile technique in decreasing the risk of infection when applying the medication.
Question 18
1 out of 1 points
A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. The breast tenderness occurs primarily during her menstrual cycle. The nurse practitioner probably suspects
Question 19
1 out of 1 points
A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)
Response Feedback:
Age, disease process, dosage form, route of administration, and foods and drugs present in the child’s body have an effect on drug absorption. Weight is used to calculate the correct dosage to administer and does not affect absorption.
Question 20
1 out of 1 points
To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?
Response Feedback:
The nurse would most likely administer the caffeine to the preterm neonate with apnea. Caffeine stimulates gastric secretions and would aggravate gastric ulcerations. Caffeine is not used to treat ADHD or narcolepsy. Dextroamphetamine is the drug of choice for these conditions.
Question 21
1 out of 1 points
The recommended treatment for trichomoniasis is
Question 22
1 out of 1 points
A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should
Response Feedback:
Children can be offered a flavored ice pop or ice chips prior to administering the drug to help numb the taste buds and promote cooperation to take a foul-tasting drug. Most 5-year-old children cannot swallow pills, and only certain pills can be crushed and dissolved in small amounts of liquid or soft food, such as applesauce, gelatin, or ice cream, to mask the flavor of the drug. Medication should never be forced on a child; it increases the risk of aspiration. Play therapy reduces the anxiety related to drug therapy, but you should never tell the children that the medicine is candy. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Question 23
1 out of 1 points
A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem?
Response Feedback:
Methylphenidate is clinically used to treat ADHD and narcolepsy. The drug is not indicated in the treatment of obesity, respiratory depression, or anxiety.
Question 24
1 out of 1 points
A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication
Question 25
1 out of 1 points
The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?
Response Feedback:
Of all the problems that may contribute to an incorrect dose, the most common involve errors in math during dosage calculation. Dosage calculation can involve several steps, and a mathematical error can occur at each step. Documentation in multiple locations, rigorous assessment, and avoidance of IV administration are not practices that appreciably reduce the potential for incorrect doses.
Question 26
1 out of 1 points
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Response Feedback:
Because of its pressor effects, dextroamphetamine is contraindicated during the first 14 days after discontinuing monoamine oxidase inhibitor (MAOI) therapy, because MAOI therapy itself may predispose the patient toward elevated blood pressure. Therefore, this 14-day washout period for MAOIs must be observed to prevent hypertensive crisis. This particular combination of drugs does not constitute a risk for a dysrhythmias, kidney damage, or electrolyte imbalances.
Question 27
1 out of 1 points
A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to
Response Feedback:
Both children and their parents need to be provided with an honest and detailed explanation and rationales regarding any medications that the child takes. Children should be given information regarding their drug therapy, especially before an invasive procedure; otherwise, their fears and anxiety will escalate. Answers and explanations should be provided in terms that both the child and the parents can understand. Never assume that children do not want to know about their medications or brush them off by telling them not to worry. A mother should never force a child to take medication but should encourage the child to do so. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Question 28
1 out of 1 points
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?
Question 29
1 out of 1 points
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should
Response Feedback:
Preschoolers are often uncooperative during drug administration. Strategies for enlisting cooperation include offering choices (e.g., between liquid medicines or chewable tablets) when feasible. This is preferable to forcibly administering a medication. Teaching is unlikely to influence a 3-year-old child’s reluctance. A central IV line would not be a preferred strategy if oral medications are available.
Question 30
1 out of 1 points
A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose?
Question 31
1 out of 1 points
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary?
Response Feedback:
Because the patient is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age patient, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.
Question 32
1 out of 1 points
A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?
Response Feedback:
Dextroamphetamine is contraindicated in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and glaucoma. Use of this drug could place the patients at risk for hypertension and increased intraocular pressure. The only patient that the nurse could administer this drug to would be the 48-year-old Caucasian man who has adult-onset diabetes.
Question 33
1 out of 1 points
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using
Response Feedback:
Body surface area is the external surface of the body expressed in square meters. The ratio of body surface area to weight is inversely proportional to length. Drug calculation using body surface area is more accurate than using the weight of the child alone. The methods of using the child’s age in months and years are no longer recommended to calculate drug dosages for pediatric patients.
Question 34
1 out of 1 points
A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops
Response Feedback:
By placing the medication in the buccal pouch, the child is less likely to spit the medicine out than when placing it under or on top of the tongue and at the back of the mouth. Also, placing the medication in an area other than the buccal pouch could cause aspiration.
Question 35
1 out of 1 points
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?
Response Feedback:
Cocaine use during pregnancy has disastrous effects on the fetus; it causes potent vasoconstriction that reduces placental blood flow by about 50%. This reduction results in fetal hypoxia and alters the maternal–fetal nutrient exchange. The deleterious effects on the infant are not primarily a result of toxins, impaired maternal nutrition, or changes in the process of labor.
Question 36
1 out of 1 points
An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Response Feedback:
An inability to safely and effectively manage the child’s drug regimen is evident by the mother’s actions that likely introduced microorganisms into the child’s vasculature. A knowledge deficit likely contributed to this problem, but the essence of the situation is the parent’s mismanagement of the IV line.
Question 37
1 out of 1 points
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
Response Feedback:
Increased absorption of topical drugs is common in pediatric patients because children have a greater body surface area and a child’s skin exhibits greater permeability. Increased absorption of topical drugs can result in adverse effects that do not occur in adult patients. Erratic blood flow would affect an intramuscular or subcutaneous route of drug administration. Gastric pH would not affect topical absorption.
Question 38
0 out of 1 points
A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. The nurse will inform the patient that during sibutramine therapy she should
Response Feedback:
Before sibutramine therapy is started, the nurse should assess the female patient for pregnancy or the intention to become pregnant. This drug is classified as pregnancy category C. Patients should be told to use adequate contraception and to advise their physician if they become or intend to become pregnant during sibutramine therapy. It would not be appropriate to tell the patient to abstain from sex, and a pregnancy test would not be necessary once a month. However, it would be advisable to have a pregnancy test before therapy begins if the patient is unsure if she is pregnant or if the patient has irregular menstrual periods. A pap smear is not necessarily related to the use of sibutramine but should be done on a regular basis as a normal disease-prevention measure for women.
Question 39
1 out of 1 points
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate? NURS 6521 Advanced Pharmacology Week 11 Quiz – questions and answers.
Response Feedback:
The nurse should evaluate the patient’s hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lungs with acetaminophen.
Question 40
1 out of 1 points
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
An allergic response is an immune system response. If the body interprets the drug as a foreign substance (antigen) and forms antibodies against the drug, the antigen–antibody response of the immune system is initiated when the drug is taken again. This response involves the release of histamine, which is responsible for many symptoms of allergy—redness, itching, swelling, rash, and hives. Idiosyncratic responses are related to an individual’s unique response to a drug, rather than to the dose of a drug. Idiosyncratic responses are unusual and in fact may be the opposite of what is anticipated, which is sometimes called a paradoxical response.
NURS 6521 WK11 QUIZ – Exam study guide questions and answers
.
Question 1
A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?
A.
That the infant’s skin has greater permeability than that of an adult
B.
That there is less body surface area to be concerned about. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
C.
That there is decreased absorption rates of topical drugs in infants
D.
That there is a lower concentration of water in an infant’s body compared with an adult
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1 points
Question 2
A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
Monophasic
B.
Triphasic OC
C.
Ortho Tri-Cyclen
D.
Biphasic OC
1 points
Question 3
A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
“Take this drug once each day on an empty stomach.”
B.
“It’s best to take a dose of sibutramine after each meal.”
C.
“This drug will help you to lose weight without having to exercise or change your normal diet.”
D.
“Take a dose when you feel like you are tempted to binge on food.”
1 points
Question 4
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
Increased intranodal conduction time
B.
Increased cardiac conduction
C.
Decreased heart rate
D.
Decreased myocardial contraction
1 points
Question 5
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using
A.
body surface area.
B.
age in months.
C.
age in years.
D.
weight.
1 points
Question 6
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
A.
Nephrotoxicity
B.
Hypokalemia
C.
Hypertensive crisis
D.
Cardiac dysrhythmia
1 points
Question 7
A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The nurse will inform the patient that during sibutramine therapy she should
A.
abstain from sex.
B.
use adequate contraception.
C.
obtain a pap smear .
D.
take a pregnancy test every month.
1 points
Question 8
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be
A.
body temperature.
B.
blood pressure.
C.
Vision.
D.
height and weight.
1 points
Question 9
A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
ADHD
B.
Anxiety
C.
Respiratory depression
D.
Obesity
1 points
Question 10
The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. What measure addresses the most common cause of incorrect doses in the care of infants and children?
A.
Having nurses check their math calculations with a colleague before administering a drug
.
B.
Recording drug administration in both the nurse’s notes and the medication administration record (MAR)
C.
Avoiding intravenous administration of drugs whenever possible.
D.
Ensuring that a full assessment takes place no more than 30 minutes before giving a drug.
1 points
Question 11
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
A.
A child has an erratic blood flow from an immature peripheral circulation, which increases drug absorption, causing an increase in adverse effects.
B.
A child has a greater body surface area, creating greater permeability resulting in an increase in absorption of topical agents, which may result in more adverse effects.
C.
A child’s gastric pH is decreased, causing less of the drug to be absorbed from the subcutaneous skin, therefore producing more adverse effects. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
D.
A child has a smaller body surface area, resulting in an increase in topical absorption, which can cause more adverse effects.
1 points
Question 12
A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of
A.
trans fat.
B.
grapefruit juice.
C.
caffeine.
D.
alcohol.
1 points
Question 13
A patient asks the nurse practitioner about food sources such as soybeans and soy products. The nurse practitioner understands that these foods are considered
A.
monotherapy.
B.
taboo.
C.
inappropriate.
D.
phytoestrogens.
1 points
Question 14
A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should.NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
use clean technique only when applying the medication.
B.
use sterile technique when applying the medication.
C.
cool the medication prior to administration.
D.
allow the child to apply the medication if possible.
1 points
Question 15
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should
A.
offer a choice between liquid and chewable medications, if possible.
B.
insert a central intravenous line.
C.
have the mother hold the child firmly and sooth him while the drugs are administered.
D.
teach the boy about the fact that he will feel much better after he takes his medications.
1 points
Question 16
A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?
A.
“How much do you weigh?”
B.
“On a scale of zero to ten, what level of pain is acceptable to you?”
C.
“Did Tylenol or other over-the-counter pain remedies ever relieve your pain?” NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
D.
“Do you ever use alcohol or drugs?”
1 points
Question 17
A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to
A.
the mother and be sure to reinforce the need to force the medications, if her son does not want to take them.
B.
the mother regarding why the boy needs to take the medications.
C.
the boy by telling him not to worry about the medications and to take them as directed.
D.
both the boy and his mother regarding all medication issued.
1 points
Question 18
A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. The breast tenderness occurs primarily during her menstrual cycle. NURS 6521 WK11 QUIZ – Exam study guide questions and answers The nurse practitioner probably suspects
A.
PMS.
B.
breast cancer.
C.
pain in the heart.
D.
cancerous breast tenderness.
1 points
Question 19
A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication
A.
for 20 days.
B.
once a day.
C.
every day until the infection is gone.
D.
for 30 days.
1 points
Question 20
The recommended treatment for trichomoniasis is
A.
Flagyl.
B.
Diflucan.
C.
Meclizine.
D.
Amoxicillan.
1 points
Question 21
A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the
A.
rectus femoris muscle.
B.
ventrogluteal muscle.
C.
dorsogluteal muscle.
D.
deltoid muscle.
1 points
Question 22
A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.) NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
Diet
B.
Route of administration
C.
Age
D.
Weight
E.
Disease process
1 points
Question 23
An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation?
A.
Ineffective Family Therapeutic Regimen Management
B.
Caregiver Role Strain
C.
Delayed Growth and Development
D.
Knowledge Deficit
1 points
Question 24
A preterm neonate received caffeine for the treatment of apnea. The nurse should monitor the neonate for which of the following? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
Constipation
B.
Bloody stools
C.
Hypoglycemia
D.
Bradycardia
1 points
Question 25
A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should
A.
give the drug in a pill form.
B.
have the parent gently force the child’s mouth open.
C.
offer the child a flavored ice chip or ice pop prior to administering the drug.
D.
involve the child in a play therapy session, and then tell the child that the medicine is candy.
1 points
Question 26
A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment?
A.
The health status of the other children
B.
Where the medications will be stored
C.
The mother and grandmother’s understanding about the drugs
D.
How clean the house is
1 points
Question 27
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
staining of permanent teeth.
B.
sleep deprivation.
C.
orange-tinged urine.
D.
deep muscle pain.
1 points
Question 28
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
A.
“Marijuana can easily interact with other drugs and cause potentially fatal reactions.”
B.
“Every year, thousands of Americans end up in emergency departments with marijuana overdoses.”
C.
“Smoking marijuana is just as bad, or worse, for your lungs as smoking cigarettes.”
D.
“Most people don’t know that marijuana can be just as addictive as heroin or cocaine over time.”
1 points
Question 29
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?
A.
Hypoxia as a result of a prolonged second stage of labor
B.
Changes in blood chemistry as a result of nephrotoxicity and hepatotoxicity
C.
Impaired maternal nutrition as a result of drug use
D.
Vasoconstriction leading to reduced placental blood flow
1 points
Question 30
A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The nurse practitioner is aware that
A.
trichomoniasis discharge is typically thin and clear.
B.
it is unusual to have an odor with trichomoniasis.
C.
trichomoniasis is an incurable disease.
D.
asymptomatic women are diagnosed with trichomoniasis by a routine pap smear.
1 points
Question 31
A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to
A.
increased heart rate and subsequently rapid drug distribution among infants and children.
B.
increased body surface area relative to body volume in infants and children.
C.
the inability of infants and children and describe symptoms of adverse drug reactions.
D.
immature liver and kidney function in infants and children.
1 points
Question 32
A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops
A.
at the back of the mouth.
B.
on top of the tongue.
C.
in the buccal pouch.
D.
under the tongue.
1 points
Question 33
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The most likely cause of this response is
A.
a paradoxical response.
B.
an allergic response.
C.
a hepatotoxic response.
D.
an idiosyncratic response.
1 points
Question 34
A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose?
A.
1000 mg
B.
2000 mg
C.
3000 mg
D.
4000 mg
1 points
Question 35
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?
A.
Take the drug for one full week before coming in contact with allergens
B.
Drink plenty of fluids.
C.
Avoid high noise levels
D.
Take the drug on a full stomach
1 points
Question 36
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
A.
electroencephalogram (EEG).
B.
electrocardiogram (ECG).
C.
electromyelogram (EMG).
D.
electrophysiologic study (EPS).
1 points
Question 37
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
“I am on the middle school track team.”
B.
“My mother is going to give me my insulin.”
C.
“I walk two blocks to school every day.”
D.
“We live in a two-story house.”
1 points
Question 38
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate?
A.
Cardiac function
B.
Hepatic function
C.
Respiratory function
D.
Renal function
1 points
Question 39
To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
A.
A preterm neonate who has apnea
B.
A 52-year-old man with narcolepsy
C.
A school-age child with severe ADHD
D.
A 34-year-old woman with a diagnosis of gastric ulcerations
1 points
Question 40
A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine?
A.
A 48-year-old Caucasian man who has adult-onset diabetes
B.
A 28-year-old African-American woman with hyperthyroidism
C.
A 60-year-old African-American man who experiences angina
Please answer each question below and click Submit when you have completed the Quiz.
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Question 1
1 out of 1 points
A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
Compared to adult skin, infants’ skin exhibits greater permeability. This can result in increased absorption, which may result in adverse effects that usually do not occur in the adult patient. The nurse must consider this fact before administering skin ointment. Infants have greater, not lesser, body surface area. Greater body surface area plus increased permeability results in increased absorption of topical agents. Infants tend to have a higher concentration of water in their bodies than do adults.
Question 2
1 out of 1 points
A 21-year-old female has a history of irregular menses. She recently became sexually active, and would like to begin taking oral contraceptives (OCs). The nurse practitioner recognizes that most likely this patient would benefit from taking which category of OCs.
Question 3
1 out of 1 points
A 30-year-old man with a BMI of 59 has recently been diagnosed with type 2 diabetes mellitus. In light of the man’s lack of success with weight loss programs in the past, his care provider has prescribed sibutramine (Meridia). What instructions should the nurse consequently provide to this patient? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
Patients should take sibutramine on an empty stomach to maximize peak concentration levels. They should take it only once a day. It is important to remember that sibutramine should be used in conjunction with a low-calorie diet and daily exercise routine for maximum results. It is not taken on an “ass-needed” basis to control food cravings.
Question 4
1 out of 1 points
A 13-year-old female took a weight loss drug that activated the sympathetic nervous system. Which of the following assessment findings would the nurse expect?
Question 5
1 out of 1 points
A nurse working in a cancer center is preparing to administer medication to a 5-year-old child. The nurse will calculate the drug dosage by using
Response Feedback:
Body surface area is the external surface of the body expressed in square meters. The ratio of body surface area to weight is inversely proportional to length. Drug calculation using body surface area is more accurate than using the weight of the child alone. The methods of using the child’s age in months and years are no longer recommended to calculate drug dosages for pediatric patients.
Question 6
1 out of 1 points
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
Response Feedback:
Because of its pressor effects, dextroamphetamine is contraindicated during the first 14 days after discontinuing monoamine oxidase inhibitor (MAOI) therapy, because MAOI therapy itself may predispose the patient toward elevated blood pressure. Therefore, this 14-day washout period for MAOIs must be observed to prevent hypertensive crisis. This particular combination of drugs does not constitute a risk for a dysrhythmias, kidney damage, or electrolyte imbalances.
Question 7
1 out of 1 points
NURS 6521 WK11 QUIZ – Exam study guide questions and answers
A 35-year-old woman is on a weight-loss program and is to begin taking sibutramine (Meridia). After baseline physical data are obtained, the nurse will assess the patient’s childbearing potential. The nurse will inform the patient that during sibutramine therapy she should
Response Feedback:
Before sibutramine therapy is started, the nurse should assess the female patient for pregnancy or the intention to become pregnant. This drug is classified as pregnancy category C. Patients should be told to use adequate contraception and to advise their physician if they become or intend to become pregnant during sibutramine therapy. It would not be appropriate to tell the patient to abstain from sex, and a pregnancy test would not be necessary once a month. However, it would be advisable to have a pregnancy test before therapy begins if the patient is unsure if she is pregnant or if the patient has irregular menstrual periods. A pap smear is not necessarily related to the use of sibutramine but should be done on a regular basis as a normal disease-prevention measure for women.
Question 8
1 out of 1 points
A 10-year-old boy is taking dextroamphetamine (Dexedrine) daily for ADHD. At each clinic visit, the nurse’s priority assessment would be
Response Feedback:
The nurse should assess blood pressure, body temperature, and vision at each clinic visit as routine nursing measures in caring for a pediatric patient. However, the priority assessment would be of height and weight. Monitoring the growth and development of children taking amphetamines is extremely important because these drugs have been associated with growth suppression.
Question 9
1 out of 1 points
A nurse who provides care on a pediatric medicine unit has conducted a medication reconciliation of a recently-admitted patient. In light of the fact that the child takes methylphenidate (Ritalin), the nurse is justified in considering a history of what health problem? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
Methylphenidate is clinically used to treat ADHD and narcolepsy. The drug is not indicated in the treatment of obesity, respiratory depression, or anxiety.
Question 10
1 out of 1 points
The clinical nurse educator who oversees the emergency department in a children’s hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?
Response Feedback:
Of all the problems that may contribute to an incorrect dose, the most common involve errors in math during dosage calculation. Dosage calculation can involve several steps, and a mathematical error can occur at each step. Documentation in multiple locations, rigorous assessment, and avoidance of IV administration are not practices that appreciably reduce the potential for incorrect doses.
Question 11
1 out of 1 points
A nurse is explaining to the parents of a 6-year-old child suffering from angina why nitroglycerin patches for chest pain would not be appropriate. Which of the following will the nurse include in an explanation?
Response Feedback:
Increased absorption of topical drugs is common in pediatric patients because children have a greater body surface area and a child’s skin exhibits greater permeability. Increased absorption of topical drugs can result in adverse effects that do not occur in adult patients. Erratic blood flow would affect an intramuscular or subcutaneous route of drug administration. Gastric pH would not affect topical absorption.
Question 12
1 out of 1 points
A 29-year-old woman who is morbidly obese has recently begun a comprehensive, medically-supervised program of weight reduction. Prior to adding dextroamphetamine (Dexedrine) to her regimen, the patient should be questioned about her intake of
Response Feedback:
Caffeine-containing drinks such as tea, coffee, and cola may increase the adverse effects associated with dextroamphetamine. Intake of trans fat and grapefruit does not impact the use of dextroamphetamine. A history of drug and alcohol abuse may contribute a risk of dextroamphetamine abuse, but the concurrent use of dextroamphetamine and alcohol is not necessarily contraindicated.
Question 13
1 out of 1 points
A patient asks the nurse practitioner about food sources such as soybeans and soy products. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The nurse practitioner understands that these foods are considered
Question 14
1 out of 1 points
A child is admitted to the burn unit with second and third degree burns on both arms and part of his or her face. When administering topical medications to the burned areas, the nurse should
Response Feedback:
In second- and third-degree burns, the skin is often broken, and the nurse needs to use sterile technique when applying a topical drug to prevent introducing bacteria and other organisms into the body. Do not cool medications unless instructed to do so. Children should not be instructed to apply medications to burned areas of their body. Using clean technique will not be as effective as sterile technique in decreasing the risk of infection when applying the medication.
Question 15
1 out of 1 points
A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should
Response Feedback:
Preschoolers are often uncooperative during drug administration. Strategies for enlisting cooperation include offering choices (e.g., between liquid medicines or chewable tablets) when feasible. This is preferable to forcibly administering a medication. Teaching is unlikely to influence a 3-year-old child’s reluctance. A central IV line would not be a preferred strategy if oral medications are available. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Question 16
1 out of 1 points
A 15-year-old boy has been diagnosed with bone cancer after several months of fatigue and pain. What question should the nurse include in an assessment when trying to minimize the potential for adverse drug reactions?
Response Feedback:
In school-aged children and adolescents, assess for the use and abuse of substances such as caffeine, alcohol, tobacco, and street drugs. During drug therapy, these substances cause the same complications in children as in adults. Adolescence is a time of experimentation, which may include experimentation with legal and illegal substances. The boy’s subjective report of his weight, his response to over-the-counter drugs, and acceptable pain level do not directly address the potential for adverse drug reactions.
Question 17
1 out of 1 points
A 12-year-old boy is being discharged from the hospital after major surgery. The boy will be taking two medications at home for an extended period. The nurse who is discharging the patient should provide medication teaching specifically to
Response Feedback:
Both children and their parents need to be provided with an honest and detailed explanation and rationales regarding any medications that the child takes. Children should be given information regarding their drug therapy, especially before an invasive procedure; otherwise, their fears and anxiety will escalate. Answers and explanations should be provided in terms that both the child and the parents can understand. Never assume that children do not want to know about their medications or brush them off by telling them not to worry. A mother should never force a child to take medication but should encourage the child to do so.
Question 18
1 out of 1 points
A patient reports to a clinic with complaints of breast tenderness, a right lumpy breast, and no breast discharge. The breast tenderness occurs primarily during her menstrual cycle. The nurse practitioner probably suspects
Question 19
1 out of 1 points
A nurse practitioner orders 150 mg of oral fluconazole for a patient with vulvovaginal candidiasis. The patient should expect to take medication
Question 20
1 out of 1 points
The recommended treatment for trichomoniasis is
Question 21
1 out of 1 points
A 5-year-old boy needs an IM injection. The least painful and most effective injection site would be the
Response Feedback:
The ventrogluteal site is the best choice because it is free of major nerves and blood vessels and is characterized by deep muscle mass. The drug is injected into the gluteus medius muscle, which is in the ventrogluteal site. Injection in the gluteus medius is less painful than injection in the vastus lateralis. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. The dorsogluteal site should be used only as a last resort because of potential damage to the sciatic nerve if the site is not chosen with precision. The scalp veins are never used for injections; they are used only as intravenous sites in infants.
Question 22
1 out of 1 points
A nurse is administering drugs to a 10-year-old child who has multiple health problems. The child is underweight and is on a special diet. Which of the following will the nurse consider when planning for the best absorption of the prescribed drugs? (Select all that apply.)
Response Feedback:
Age, disease process, dosage form, route of administration, and foods and drugs present in the child’s body have an effect on drug absorption. Weight is used to calculate the correct dosage to administer and does not affect absorption.
Question 23
1 out of 1 points
An immunocompromised 7-year-old child was recently discharged home with a peripherally-inserted central line (PIC line) for home antibiotic therapy. He has now been brought to the emergency department by his mother and father with signs and symptoms of line sepsis. Upon questioning, the mother states that she has been removing the PIC dressing daily and washing the site with warm water and a cloth. What nursing diagnosis is most appropriate in this situation? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
An inability to safely and effectively manage the child’s drug regimen is evident by the mother’s actions that likely introduced microorganisms into the child’s vasculature. A knowledge deficit likely contributed to this problem, but the essence of the situation is the parent’s mismanagement of the IV line.
Question 24
1 out of 1 points
A preterm neonate received caffeine for the treatment of apnea. The nurse should monitor the neonate for which of the following?
Response Feedback:
In neonates, there is a possible association between the use of caffeine and the development of necrotizing enterocolitis. All preterm neonates treated with caffeine should be monitored for the development of gastric related adverse effects such as abdominal distension, vomiting, and bloody stools. Sinus tachycardia and diarrhea are adverse effects of caffeine, and hyperglycemia can indicate intolerance or overdose of caffeine.
Question 25
1 out of 1 points
A nurse is having difficulty administering a bitter drug to a 5-year-old child. The nurse should
Response Feedback:
Children can be offered a flavored ice pop or ice chips prior to administering the drug to help numb the taste buds and promote cooperation to take a foul-tasting drug. Most 5-year-old children cannot swallow pills, and only certain pills can be crushed and dissolved in small amounts of liquid or soft food, such as applesauce, gelatin, or ice cream, to mask the flavor of the drug. Medication should never be forced on a child; it increases the risk of aspiration. Play therapy reduces the anxiety related to drug therapy, but you should never tell the children that the medicine is candy.
Question 26
1 out of 1 points
A 2-year-old child is diagnosed with a minor ailment and is to be administered medications at home for 2 weeks. The child lives with his mother, grandmother, and four other children between the ages of 14 months and 7 years. The home health nurse is asked to assess the home environment to determine if it is appropriate for the child to take his medication at home. Which of the following will have the greatest impact on the nurse’s assessment? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
An important question that should be asked during the assessment is whether there is a safe place to keep drugs out of the reach of the patient and the other children. Many drugs have serious adverse and toxic effects in children if taken without adult supervision. Although factors like health status of other family members, the cleanliness of the house, and the parent’s understanding about the medications are important considerations, the most important consideration is the safety of the child who is taking the medication and the other children.
Question 27
1 out of 1 points
A 7-year-old child has been taking tetracycline for a bacterial infection. The nurse will be sure to inform the parents that this drug could cause
Response Feedback:
Tetracycline is an example of a drug that can adversely affect a body system during a phase of child development. If administered to a child between the ages of 4 months and 8 years, it can stain the child’s permanent teeth. Discolored urine, deep muscle pain, and sleep deprivation are not associated with tetracycline.
Question 28
1 out of 1 points
A school nurse has been teaching high school students about the risks associated with marijuana use. However, the nurse has been met with considerable skepticism on the part of students, most of whom believe that marijuana is a benign drug. Which of the following teaching points should the nurse provide?
Response Feedback:
Although smoking marijuana is often thought to be relatively safe compared with smoking tobacco, the smoke is virtually identical in both cases. Smoking marijuana involves inhaling larger volumes of smoke and holding the breath as much as four times longer than with tobacco, which ultimately makes smoking three to four marijuana joints a day equivalent to smoking one pack of tobacco cigarettes a day. Marijuana is not considered to highly addictive and it is not normally associated with a potential for overdose or potentially fatal drug interactions.
Question 29
1 out of 1 points
A 22-year-old woman has given birth to an infant who exhibits the signs and symptoms of maternal cocaine use during pregnancy. These signs and symptoms are a result of what pathophysiological effect of opioid use during pregnancy?
Response Feedback:
Cocaine use during pregnancy has disastrous effects on the fetus; it causes potent vasoconstriction that reduces placental blood flow by about 50%. This reduction results in fetal hypoxia and alters the maternal–fetal nutrient exchange. The deleterious effects on the infant are not primarily a result of toxins, impaired maternal nutrition, or changes in the process of labor. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Question 30
1 out of 1 points
A 19-year-old patient reports to a clinic with vaginal discharge with a foul odor. A microscopic exam reveals trichomonas vaginalis. The nurse practitioner is aware that
Question 31
1 out of 1 points
A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to
Response Feedback:
Children are more at risk of the deleterious effects of drug errors because they have not physiologically matured. Immature liver or renal function, for example, can increase the circulating level of a drug beyond what would be expected in adults. This characteristic supersedes differences in body surface area, cardiac function, and ability to verbalize complaints.
Question 32
1 out of 1 points
A nurse is going to administer medication to an infant using a medicine dropper. The best method is to open the child’s mouth by gently squeezing the cheeks and placing the drops
Response Feedback:
By placing the medication in the buccal pouch, the child is less likely to spit the medicine out than when placing it under or on top of the tongue and at the back of the mouth. Also, placing the medication in an area other than the buccal pouch could cause aspiration.
Question 33
1 out of 1 points
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
Response Feedback:
An allergic response is an immune system response. If the body interprets the drug as a foreign substance (antigen) and forms antibodies against the drug, the antigen–antibody response of the immune system is initiated when the drug is taken again. This response involves the release of histamine, which is responsible for many symptoms of allergy—redness, itching, swelling, rash, and hives. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. Idiosyncratic responses are related to an individual’s unique response to a drug, rather than to the dose of a drug. Idiosyncratic responses are unusual and in fact may be the opposite of what is anticipated, which is sometimes called a paradoxical response.
Question 34
1 out of 1 points
A nurse practitioner orders a single dose of 2 g Metronidazole orally. How many milligrams will the patient receive in one dose? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Question 35
1 out of 1 points
A 16-year-old boy is prescribed cromolyn sodium nasal spray to treat a nasal allergy. To maximize the therapeutic effects of the drug, which of the following will the nurse include in instructions to the patient?
Response Feedback:
To maximize the therapeutic effects of the drug, the patient should take cromolyn sodium for one full week before coming in contact with allergens. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. Taking the drug on a full stomach is inappropriate, since the drug is in the form of a nasal spray. Neither avoiding high noise levels nor drinking plenty of fluids would help maximize the therapeutic effects of the drug.
Question 36
1 out of 1 points
A nurse is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. NURS 6521 WK11 QUIZ – Exam study guide questions and answers. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
Response Feedback:
In addition to baseline physical data including height, weight, and vital signs, the nurse should prepare the patient for an ECG. This would be important for ruling out any cardiovascular abnormalities that CNS stimulants might exacerbate, especially in this patient who is 7 years old. An EMG measures the electrical activity of muscle and is used to differentiate between neuropathy and myopathy. This test is not indicated in this patient. An EEG is a recording of the electrical activity of the brain and is used to help identify a focus of disturbance in the brain. An EEG may be performed to evaluate narcolepsy, sleeping patterns, and sleep apnea. However, it would not be indicated in this patient with ADHD. EPS is similar to a cardiac catheterization and can monitor the entire conduction system with mapping of normal and abnormal pathways of the heart. This test would not be needed unless the patient had a serious cardiac condition.
Question 37
1 out of 1 points
A nurse is providing patient education to a 13-year-old girl who was just diagnosed with type 1 diabetes mellitus. Which of the following statements by the patient will alert the nurse that special instructions regarding insulin are necessary?
Response Feedback:
Because the patient is on the track team, she will have increased exercise at various times that will require increased insulin and special instructions related to hypoglycemia that may come hours after she has ceased exercising. Walking two blocks every day and walking up stairs would not be considered increased physical exercise and would not be a factor. Wanting to have her mother administer the insulin is not uncommon for this age patient, and the nurse would normally instruct both the mother and the daughter in the administration of the drug.
Question 38
1 out of 1 points
A nurse is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
The nurse should evaluate the patient’s hepatic function. Severe hepatotoxicity can occur from overuse of acetaminophen. Significant interferences do not occur in the kidney, heart, or lungs with acetaminophen.
Question 39
1 out of 1 points
To which of the following patients would a medication nurse most likely administer caffeine as part of the treatment plan?
Response Feedback:
The nurse would most likely administer the caffeine to the preterm neonate with apnea. Caffeine stimulates gastric secretions and would aggravate gastric ulcerations. Caffeine is not used to treat ADHD or narcolepsy. Dextroamphetamine is the drug of choice for these conditions.
Question 40
1 out of 1 points
A nurse works at a weight management clinic. To which of the following overweight patients could the nurse safely administer dextroamphetamine? NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Response Feedback:
Dextroamphetamine is contraindicated in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and glaucoma. Use of this drug could place the patients at risk for hypertension and increased intraocular pressure. The only patient that the nurse could administer this drug to would be the 48-year-old Caucasian man who has adult-onset diabetes. NURS 6521 WK11 QUIZ – Exam study guide questions and answers.
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013).
Pharmacotherapeutics for advanced practice: A practical approach
(3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Chapter 2, “Pharmacokinetic Basis of Therapeutics and Pharmacodynamic Principles” (pp. 15–29)This chapter examines concepts related to pharmacokinetics and pharmacodynamics. It also explores patient factors that health care providers consider when prescribing drug therapy to patients.
Chapter 3, “Impact of Drug Interactions and Adverse Events on Therapeutics” (pp. 30–48)This chapter explains drug-drug, drug-food, drug-herb, and drug-disease interactions. Nurs 6521 Week 1 Discussion Question It also reviews patient factors that influence drug interactions and then covers adverse drug reactions.
Chapter 4, “Principles of Pharmacotherapy in Pediatrics” (pp. 49–59)
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This chapter explores concepts relating to drug selection, administration, and interaction for pediatric patients. It also compares age-related pharmacokinetic differences in children and adults.
Chapter 6, “Principles of Pharmacotherapy in Elderly Patients” (pp. 66–78)This chapter describes issues and factors that affect drug therapy for elderly patients. It then explores concepts relating to drug selection, administration, and management for elderly patients.
Hilmer, S. N., McLachlan, A. J., & Le Couteur, D. G. (2007). Clinical pharmacology in the geriatric patient.
Fundamental & Clinical Pharmacology
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(3), 217–230. Nurs 6521 Week 1 Discussion Question.
Retrieved from the Walden Library databases.This article explores issues that health care providers consider when prescribing drug treatment to geriatric patients. It also examines the role of polypharmacy in adverse drug reactions and the importance of managing patient response to drug treatment.
Scott, S. A. (2011). Personalizing medicine with clinical pharmacogenetics.
Genetics in Medicine
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(12), 987–995. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290900/
This article examines pharmacogenetic testing in relation to personalized drug therapy plans and explores evidence-based guidelines and recommendations on pharmacogenetic testing.
Drugs.com. (2012). Retrieved August 22, 2012, from
http://www.drugs.com/
This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.
Media
Laureate Education, Inc. (Executive Producer). (2012).
Introduction to advanced pharmacology
. Baltimore, MD: Author. Nurs 6521 Week 1 Discussion Question.