Tag: Clinical-Nursing

  • NURS 6053 DISCUSSION # 2: Transitioning From Closed to Open Systems sample essay

    NURS 6053 DISCUSSION # 2: Transitioning From Closed to Open Systems sample essay

    How do effective nurse leaders and others approach problem solving and decision making in organizations? As suggested in this week’s Learning Resources, systems theory provides a valuable way to assess situations and prepare to address problems.

    For this week’s Discussion, you identify an issue or process that could be improved and apply knowledge and strategies related to systems theory.

    BUY A PLAGIARISM-FREE PAPER HERE

    To prepare:

    Review the information presented in this week’s Learning Resources on systems theory and the difference between open and closed systems.

    Reflect on the practices and processes with which you are familiar in your organization. Identify one problematic issue or process that could be improved.

     Consider the problem from a closed-system perspective. Then think about how the issue or process you selected could be addressed by viewing it from an open-system perspective. How would the transition from a closed- to an open-system view help you and others to address the problem and improve outcomes? NURS 6053 DISCUSSION # 2: Transitioning From Closed to Open Systems sample essay.

    Post a description of the problem that you identified in your selected organization. Explain the problem from a closed-system perspective. Then, describe how the problem could be addressed by viewing it from an open-system perspective, and explain how this modification would help you and others improve health care outcomes.

    Learning Resources

    Required Readings

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

    Review Chapter 7, “Organizational Planning”. See especially Figure 7.1.

    Chapter 8, “Planned Change”

    Organizational Change Associated With Nonlinear Dynamics. Read this section of Chapter 8 on planned change. Consider the role of leaders in effectively managing planned change.

    Chapter 12, “Organizational Structure”. “Organizational Culture”. There are many structures organizations take, and these structures influence how the organization functions. This chapter discusses many different organizational structures and provides insights into how these structures influence the change process, as well as leadership and management. NURS 6053 DISCUSSION # 2: Transitioning From Closed to Open Systems sample essay.

    Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf

    This article addresses the importance of systems-based practice (SBP) in health care workplaces. The authors state that SBP knowledge is one of six core competencies that physicians have to know in order to provide safe and proper care for their patients.

    Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: Organisational transformation using practice development methodology. FoNS 2014 International Practice Development Journal 4-(1).

    Retrieved from the Walden Library databases.

    Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838.

    Retrieved from the Walden Library databases.

    In this article, the authors examine the effects of nursing services delivery theory in large-scale organizations. Among other benefits, this theory supports multilevel phenomena and cross-level studies, and it can guide future research and the management of nursing services.

    Optional Resources

    Glennister, D. (2011, July). Towards a general systems theory of nursing: A literature review. Paper presented at the 55th Annual Meeting of the International Society for the System Sciences, Hull, United Kingdom. Retrieved from http://journals.isss.org/index.php/proceedings55th/article/viewFile/1717/569

    Hayajneh, Y. (2007). Management for health care professionals series: Systems & systems theory. Retrieved from http://www.hayajneh.org/a/readings/Systems-Theory.pdf

    NURS 6053 Week 2 Discussion

    To prepare:

    Review the information presented in this week’s Learning Resources on systems theory and the difference between open and closed systems.

    Reflect on the practices and processes with which you are familiar in your organization. Identify one problematic issue or process that could be improved. NURS 6053 DISCUSSION # 2: Transitioning From Closed to Open Systems sample essay.

    Consider the problem from a closed-system perspective. Then think about how the issue or process you selected could be addressed by viewing it from an open-system perspective. How would the transition from a closed- to an open-system view help you and others to address the problem and improve outcomes?

    On the Week 2 Discussion Board, post 1 page on 
    a description of the problem that you identified in your selected organization. Explain the problem from a closed-system perspective. Then, describe how the problem could be addressed by viewing it from an open-system perspective, and explain how this modification would help you and others improve health care outcomes.

    Read 
    a selection of your colleagues’ responses

    REFERENCES

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

    Review Chapter 7, “Strategic and Operational Planning”

    See especially Figure 7.1 on page 147.

    Chapter 8, “Planned Change”

    Chapter 12, “Organizational Structure”

    “Organizational Culture” (pp. 274–276)

    Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Retrieved from 
    http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf

    Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: Organisational transformation using practice development methodology. 
    FoNS 2014 International Practice Development Journal 4 
    (1) [2].

    Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. 
    Journal of Advanced Nursing, 66
    (12), 2828–2838.

    Retrieved from the Walden Library databases. NURS 6053 DISCUSSION # 2: Transitioning From Closed to Open Systems sample essay.

  • Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Concept Analysis Paper

    This assignment is designed for the student to examine the antecedents, attributes, and consequences of a concept. The student will identify a strong definition of this concept. If there is none, the student will develop one. The student will explore a concept, and then analyze that descriptive word and its use in literature. Steps from Wilson’s Concept and Analysis will be used (Walker & Avant, 2011).

    The body of the paper should not exceed 10 pages.

    ORDER A PLAGIARISM-FREE PAPER HERE

    Follow these steps while completing the project:

    1. Introduction

    2. Select a concept relevant to nursing.

    3. Determine the purposes of analysis.

    4. Identify the uses of the concept (Literature Review).

    5. Determine the concept’s defining attributes, antecedents, and consequences.

    6. Construct a model case.

    7. Conclusion

    Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Grit in Nursing: Concept Analysis

    Grit is a relatively new concept. Some researchers see it as similar to other constructs, but it is unique. This paper explores the concept of grit in nursing. The concept analysis utilizes steps from Wilson’s Concept Analysis. Purposes of the analysis are identified for nursing practice, education, and research. Its uses, and definitions are outlined based on the available literature. Based on the literature review, there are five defining attributes of grit in nursing: resilience, perseverance, passion, conscientiousness, and compassion. Antecedents of nursing grit include discovery of interest, setting the goal, and presence of adversity. Consequences of nursing grit are excellence in practice, personal growth, and happiness. A model case is presented for a better illustration of grit in nursing.

    Purposes of the Grit Analysis

    The purpose of this concept analysis is to explore the meaning of grit in the context of nursing. The enhanced understanding will then contribute to its use in nursing education, practice, and research. Improved awareness of the concept will enable nurses to exercise and grow their grit to provide excellent care to their patients. It will help nursing educators to incorporate methods to foster grit in nursing students. Researchers report that grit can be taught, but there is lack of evidence about what interventions may be helpful. It addition, it may prompt researchers to develop evidence-based recommendations about fostering grit. Nursing administrators may seek grittier nurses to achieve better patients’ outcomes.

                                                                    The Uses of Grit

    A thorough data research using keywords
    grit
    ,
    grit in nursing
    was performed. Major databases CINAHL, ProQuest, and Google Scholar were utilized. According to Merriam-Webster dictionary (2018),
    grit
    is a “sand, gravel”, “a hard sharp granule (as of sand), “any of several sandstones”, “the structure of a stone that adapts it to grinding”, “firmness of mind or spirit: unyielding courage in the face of hardship or danger”.

    Psychologist Duckworth has been studying grit. According to her definition, grit is a “perseverance and passion for long-term goals” (Duckworth et al., 2007, para. 1). Sustained interest gives motivation for achieving long-term goals. People with grit are consistent with their goals, they do not give up and trade them in the face of difficulties and failure. Grit, not talent or intellect, is a predictor of high achievements in different fields like education, military, sports or any professional development. Grit predicts personal success. Conscientiousness implies self-control in a given moment, grit represents pursuing long-term goals, persistency and consistency of grit differ it from other similar constructs. To achieve their long-term goals, gritty people choose more effective methods to practice over more enjoyable but less effective activities (Duckworth et al., 2007).

    Maddi, Matthews, Kelly, Villarreal, and White (2012) characterize grit as “a sustained pursuit of a given interest or goal” (p.23). They measured grit by the grit scale developed by Duckworth and Quinn, which includes assessment of two main factors of grit: consistency of interests and perseverance of effort. Among other variables that were measured, grit had a more predictive value than other variables on retention in difficult circumstances (Maddi et al., 2012).

    Cosgrove, Chen, and Castelli (2018) use the Duckworth definition of grit as well. Grit is viewed as a measure of behavior and goal achievement that leads to outstanding behavioral outcomes. Grit is a stable, but modifiable persistence toward long-term goals. Higher grit predicted better academic scores, but it did not predict higher fitness testing (Cosgrove et al., 2018).

    Stoffel and Cane (2018) also define grit as sustained commitment toward achieving long-term objectives despite obstacles, failures and setbacks. Grit Scales by Duckworth are used to compare academic performance of students, the total grit score was a predictor for a higher grade point average (Stoffel & Cane, 2018). Robinson uses the Grit Scale to evaluate the relationship between grit and nursing student academic engagement and found association of higher grit and stronger course engagement (as cited in Stoffel & Cane, 2018). Measuring grit is very challenging because it is based on self-reporting and has social desirability bias (Stoffel & Cane, 2018).

    Hellman and Gwinn (2017) also characterize grit as perseverance and passion for long-term goals, which can be significantly increased along with other character strengths (zest, self-control, optimism, gratitude, social intelligence, and curiosity) after brief hope intervention. Bolton, Praetorius, and Smith-Osborne (2016) associate grit with nine themes: frailty (ability to adapt to physical impairments positively), determination (the will to survive and refusal to be defeated, refusal to be helpless), perseverance, self-reliance, head-on approach to challenges, moving forward with life, will to live, strengths that buffer the impact of well-being, and anticipating one’s future losses. Crede, Tynan, and Harms (2017) have conducted a meta-analysis of grit research and have found that grit is strongly related to conscientiousness. Perseverance has a stronger effect on performance than consistency of interests (Crede et al., 2017).

    Vainio and Daukantait (2016) state that grit positively relates to well-being factors: psychological well-being, satisfaction with life and harmony in life since people are naturally motivated to realize their highest potential. Substance of grit is not a strict determination to pursue goals no matter the costs, but to pursue the goals that are consistent with one’s inner values relying on consistency of self (Vainio & Daukantait, 2016).

    Jin and Kim (2017) have also explored how grit relates to the subjective side of life, such as well-being. They state that “grit means dedication to long-term goals with enthusiasm, which is closely related to success in objective terms” (para. 1). Grit increases satisfying the autonomy and competence needs, autonomy then reduces depression, and competence increases life satisfaction, and both in turn lead to better well-being (Jin & Kim, 2017).

    Payne (2017) suggests that grit in nursing is about looking forward, setting and achieving goals, seeking excellence rather than perfection. Nurses express passion and love for their work as they find joy in helping patients to recover or being there for them at their death or bringing a new life into the world, being able to support patients and families in crisis. When nurses go back to school, there is excitement about learning new things, becoming technically proficient, reinforcing, and expanding skills. Gritty nurses have goals, courage (managing fear of failure), they take risks every day, conscientious (meticulous attention to detail, counting on each other) while moving from novice to expert. Nurses with grit are resilient in bouncing back from failures or problems. Nursing ethics are about purpose as well as supporting good decisions, which also promote resilience. Grit is a mindset or an attitude about striving for something good and virtuous like nursing (Payne, 2017).

    McCabe (2016) emphasizes that grit has a great benefit to nursing practice. Nurses with grit practice with excellence, determination, and compassion. She suggests that grit in nurses develops with more clinical experience and role modeling and that grit can be nurtured through communication with experienced nurses and reflecting on own experiences. She believes that characteristics of grit (conscientiousness, establishment of long-term goals, resiliency, and excellence) can be developed in nursing students and new nurses (McCabe, 2016).

    Attributes, Antecedents, and Consequences  

    Attributes

    Walker and Avant (2011) define attributes as the most frequent characteristics associated with the concept. The attributes of grit in nursing are: resilience, perseverance, passion, conscientiousness, and compassion.

    Resilience is one’s ability to go on after negative experiences and adversity (Stoffel & Cane, 2018). Traditional resilience is applied to severe psychological trauma and adversary experience, but current society has used the term resilience in broader and less extreme context, such as daily setbacks, negative experiences (Stoffel & Cane, 2018). Protective factors are influences that change responses to negative experiences from maladaptive to adaptive outcomes (Stoffel & Cane, 2018). Protective factors may include coping mechanisms, social and family support, role modeling and mentorship, and intellectual stimulation (Stoffel & Cane, 2018) Nursing Concept Analysis Paper – Grit in Nursing Sample Essay. Resilient nurses have an ability to withstand, adapt, and learn something positive from barriers and adversity (Meyer & Shatto, 2018). Maturity and drive are factors for greater resilience (Meyer & Shatto, 2018).

    Perseverance is working hard, finishing what was started, or mastering skill despite adversity or discouragement (Duckworth et al., 2007). Being passionate towards long-term goals is when one is focused on projects that take years to finish without losing interest or being distracted (Duckworth et al., 2007). Conscientiousness is a personality trait of being “self-controlled, responsible to others, hardworking, orderly, and rule abiding” (Roberts, Lejuez, Krueger, Richards, & Hill, 2014, para. 2).

    Compassion is an attribute mentioned only in studies of nursing grit. Nursing is a righteous endeavor, a profession of compassion. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay Nurses with grit strive to provide excellent care. Excellent nursing care is possible only with compassion. There is no true nursing without compassion.

    Antecedents

    Antecedents are the events that must take place before the concept can occur and they cannot also be the defining attribute for the concept (Walker & Avant, 2011). The first antecedent of grit is discovery and development of consistent interests. Then, based on the consistent interests, the second antecedent is understanding and setting the long-term vision or goal. For development of grit, there must be some adverse circumstances or barriers present. It is impossible to reach long-term goals that take years to accomplish without some barriers, boredom, or negative circumstances.Nursing Concept Analysis Paper – Grit in Nursing Sample Essay So, the third antecedent is setbacks, boredom, or barriers in achieving the goal.

    Consequences

    Consequences are the events that happen as a result of the concept occurrence and also cannot be defining attributes (Walker & Avant, 2011). The outcomes of grit in nursing are excellence, personal growth, and happiness. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay.

    Nurses with high grit have a better potential to reach excellence. Excellence in nursing practice is related to practical wisdom based on scientific knowledge (Flaming, 2002). The grittier the nurse, the more motivated she/he is to be an excellent nurse, the more years of hard work is invested into it, the more potential she/he would have to do it.

    Personal growth is a reflection of a person’s development. Gritty nurses have positive attitudes, higher expectations about themselves, their lives and the nursing profession. These nurses view adversities and difficulties differently from those with low grit, which improves their subjective well-being. They lead a more meaningful and engaged life that makes them happier people than those with lower grit. Grit improves life satisfaction (Vainio & Daukantait, 2016)

    Model Case

    A model case demonstrates how the concept is used with all the defining attributes at display (Walker & Avant, 2011). Ann’s mom was diagnosed with breast cancer when Ann was 12 years old. What followed were two years of fighting, hope and desperation. By the age of 14 Ann was left without her mother Nursing Concept Analysis Paper – Grit in Nursing Sample Essay. Somewhere along those two years Ann had decided that she wanted to be a nurse, not just a nurse, but a nurse who makes a real difference in the lives of people and families, who eases their pain, supports them in their decisions, and understands what they are going through. After finishing high school Ann went to a community college for an associate degree in nursing while working full time to help her father financially with bringing up her two little sisters and her education. Nursing school was tough with full time work, evening classes and clinicals. But it did not discourage her, she worked through it, meticulously finishing all her homework and assignments, and looking forward to an ultimate goal to become an excellent nurse. After graduation, she started working in a hospital on a medical-surgical unit. It was an urban hospital, nursing staffing ratios were unfair, patient acuity was high, and supplies were scarce. Ann was the only new graduate who did not quit during the first year of employment on that unit. She found support and guidance in one of the experienced nurses who was like a mentor to Ann. After a year she got involved in the hospital governance, she joined a quality improvement committee and advocated for safe staffing and better working conditions to be able to provide quality patient care. After several years of working as a nurse, she decided to go back to school and earn her baccalaureate degree in nursing and get her certification in oncology nursing. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay. Over the years, her knowledge and expertise grew along with her curiosity to know more. Ann is still a compassionate nurse, she loves what she does, she cares about her patients and families, and she has expertise from the years of nursing practice. In retrospective, Ann realizes that she has been “fortunate” to discover her passion to nursing early on in life, it is her calling. Her work has a purpose beyond herself.

    Conclusion 

    Grit is relatively new and confusing concept. This paper about grit in nursing has a purpose to improve understanding of the concept. Enhanced understanding may lead to wider awareness and use of grit in nursing practice, education, and research. Literature review showed that the concept is well defined in psychology, but not in nursing. Further research related to grit in nursing and how to foster grit in nurses would be beneficial since consequences of grit include excellence in practice, personal growth and happiness. There are five attributes of grit in nursing: resilience, perseverance, passion, conscientiousness, and compassion. Compassion is a unique attribute of nursing grit. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay In order for grit in nursing to happen, the following antecedents are needed: discovery of the field of interest for future passion, understanding and setting the long-term goal, and finally, some setbacks or barriers in the path to the goal. Nursing grit is characterized by sustained interest and passion for nursing and working with perseverance towards excellent and compassionate care throughout the years, which is reflected in the constructed model case.

     

    References

    Bolton, K. W., Praetorius, R. T., & Smith-Osborne, A. (2016). Resilience protective factors in an older adult population: A qualitative interpretive meta-synthesis.
    Social Work Research
    ,
    40
    (3), 171-182. doi: 10.1093/swr/svw008

    Cosgrove, J. M., Chen, Y. T., & Castelli, D. M. (2018). Physical fitness, grit, school attendance, and academic performance among adolescents.
    Biomed Research International
    , 1-7. doi:10.1155/2018/9801258 Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Credé, M., Tynan, M. C., & Harms, P. D. (2017). Much ado about grit: A meta-analytic synthesis of the grit literature.
    Journal of Personality and Social Psychology, 113
    (3), 492-511. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1037/pspp0000102

    Duckworth, A. L., Peterson, C., Matthews, M. D., & Kelly, D. R. (2007). Grit: Perseverance and passion for long-term goals.
    Journal of Personality and Social Psychology, 92
    (6), 1087-1101. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1037/0022-3514.92.6.1087

    Flaming, D. (2002). Using nursing science does not guarantee nursing excellence.
    Research and Theory for Nursing Practice, 16
    (3), 147-59. Retrieved from https://ezproxy.wilkes.edu/login?url=https://search-proquest-com.ezproxy.wilkes.edu/docview/207665858?accountid=62703

    Jin, B., & Kim, J. (2017). Grit, basic needs satisfaction, and subjective well-being.
    Journal of Individual Differences, 38
    (1), 29-35. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1027/1614-0001/a000219

    Hellman, C., & Gwinn, C. (2017). Camp HOPE as an intervention for children exposed to domestic violence: A program evaluation of hope, and strength of character.
    Child & Adolescent Social Work Journal
    ,
    34
    (3), 269-276. doi: 10.1007/s10560-016-0460-6

    Maddi, S. R., Matthews, M. D., Kelly, D. R., Villarreal, B., & White, M. (2012). The role of hardiness and grit in predicting performance and retention of USMA cadets.
    Military Psychology (Taylor & Francis Ltd)
    ,
    24
    (1), 19-28. doi: 10.1080/08995605.2012.639672

    McCabe, E. (2016). Can grit be nurtured in undergraduate nursing students?
    NASN School Nurse, 31
    (3), 144-146. doi: 10.1177/1942602X16634440

    Merriam-Webster. (2018). Grit. Retrieved from https://www.merriam-webster.com/dictionary/grit Nursing Concept Analysis Paper – Grit in Nursing Sample Essay

    Meyer, G., & Shatto, B. (2018). Resilience and transition to practice in direct entry nursing graduates.
    Nurse Education in Practice, 28
    , 276-279. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1016/j.nepr.2017.10.008

    Payne, K. (2017). Grit: Passion and perseverance in nursing.
    Tennessee Nurse
    ,
    80
    (4), 12. Retrieved from
    http://web.b.ebscohost.com.ezproxy.wilkes.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=56eba355-9c12-41f4-9894-eb34683e31cd%40sessionmgr101

    Roberts, B. W., Lejuez, C., Krueger, R. F., Richards, J. M., & Hill, P. L. (2014). What is conscientiousness and how can it be assessed?
    Developmental Psychology, 50
    (5), 1315-1330. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1037/a0031109

    Stoffel, J. M., & Cain, J. (2018). Review of grit and resilience literature within health professions education.
    American Journal of Pharmaceutical Education, 82
    (2), 124-134. Retrieved from https://ezproxy.wilkes.edu/login?url=https://search-proquest-com.ezproxy.wilkes.edu/docview/2051219775?accountid=62703

    Vainio, M. M., & Daukantait, D. (2016). Grit and different aspects of well-being: Direct and indirect relationships via sense of coherence and authenticity.
    Journal of Happiness Studies, 17
    (5), 2119-2147. doi: http://dx.doi.org.ezproxy.wilkes.edu/10.1007/s10902-015-9688-7

    Walker, L. O., & Avant, K. C. (2011).
    Strategies for theory construction in nursing
    (5
    th
    ed.). Upper Saddle River, NJ: Prentice Hall. Nursing Concept Analysis Paper – Grit in Nursing Sample Essay,

  • NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations

    NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations

    Main Question Post

    Discussion Week 1

    Organizational Foundations

    An organizations vision, mission, and values act as guidance to where the organization is going and provides purpose to the work and services they provide (Marquis & Huston, 2015).  A fundamental concept that leaders must embrace is that an organization can only aspire to vision it has established as the acts as a path to the destination (Marquis & Huston, 2015).  NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations. The purpose of this post is to describe my organization’s mission, vision, and values, outline how leaders in the organization support the mission, vision, and values, discuss the culture and climate of the organization and differences between them and lastly, discuss the significance of understanding this information as a nursing leader.

    BUY A PLAGIARISM-FREE PAPER HERE

    Mission, Vision, and Values

    ThedaCare has a long standing history of serving the community and enriching the lives of the people it serves.  The mission statement that guides the organization is centered on improving the health of the communities that they serve (ThedaCare, 2017).  The vision is “peace of mind for all we serve” (ThedaCare, 2017). NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.  The values that align and support the mission and the vision include putting the customer first, possessing a thirst for learning, being courageous, and loving our work (ThedaCare, 2017).

    Congruency Leadership with Organization

    Leaders within the ThedaCare organization not only know and understand the mission, vision, and values of the organization they live them.  An action that demonstrates the mission, vision, and values includes volunteer work in the community.  Additionally, leader’s aid in shaping a culture through front line staff that represents and lives our mission, vision, and values.  Daily huddles are held where information is shared relating to system work that is happening and how it correlates with our outlined values NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations. Leaders hold themselves and the employees that they are leading accountable for their actions and patient outcomes. ThedaCare is transparent not only to the 7,000 employees but to the community and the people it serves.  The examples provided are just a few ways that demonstrate how leadership supports the organization’s mission, vision, and values.

    Culture and Climate

    Culture and climate are two fundamental key concepts that differ greatly, but both play a critical role in shaping an organization.  Culture is collectively custom and value driven (Marquis & Huston, 2015).  Climate refers to the perception of employees regarding the organization (Marquis & Huston, 2015).  Culture and climate are often blurred, but it is essential as a leader to understand the differences and the role that leadership plays in creating and influencing each of them. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    Culture

    Business Dictionary.com (2013) stated: “organizational culture includes an organization’s expectations, experiences, philosophy, and values that hold it together, and it is expressed in its self-image, inner workings, interactions with the outside world, and future expectations” (para, 1).  ThedaCare has an expectation that employees will demonstrate the mission, vision, and values part of development planning is discussion and developing individualized plans with employees to understand and grow in alignment with the organization.  NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations Values guide the trajectory of behaviors acting as guidelines for those who are in the organization to follow (Nelson & Gardent, 2011).  Having a community focus and servant attitude towards the people we serve has enriched our community and made the organization more than just a job, but instead created a synergistic positive atmosphere where people are helping people, and we all are better because of it.

    Climate

                
    An organizations climate refers to the employee’s perception of the organization (Marquis & Huston, 2015).  Currently, within ThedaCare the adoption of the shared governess model as aided is shaping a positive climate.  Employees feel engaged and valued as they have decision making power related and a voice in implementing evidence-based practice (EBP) into workflows and standards. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations The culture heavily influences Employee’s perception of the organization.

    Significance as Nurse Leader

    It is critical that leaders understand the mission, vision, and values of an organization.  The individuals that the leader is mentoring to are watching and following their example.  It is essential that leaders are conducting their actions and behaviors in a manner that is congruent with the organization.  An organizations culture and climate are closely related and impact one another.  A leader needs to possess a firm grasp on the climate and culture to lead effectively ultimately shaping and molding both in a positive direction to create a positive environment that steers followers closer to the mission, vision, and values. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    Summary

                
    An organization’s mission, vision, and values set the trajectory of where they are going.  ThedaCare has a long standing history of serving and enriching the community it serves.  Leaders within ThedaCare understand and support the mission, vision, and values as demonstrated by their leadership in daily work and operations. Culture relates to expectations, values, and philosophy whereas climate relates to employee perception. Nurse leaders play a fundamental role in shaping culture and climate along with upholding their followers towards the organization’s mission, vision, and values NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    References

    Business Dictionary.com. (2013). 
    Organizational culture: Definition. 
    Retrieved from http://www.businessdictionary.com/definition/organizational-culture.html

    Laureate Education, Inc. (Executive Producer). (2012c). Factors that influence organizational cultures: Coastal Medical Associates, Salisbury, MA. Baltimore, MD. Author.

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

    Nelson, W. A., & Gardent, P. B. (2011).  Organizational values statements. 
    Healthcare Executive, 26
    (2), 56-59.

    ThedaCare. (2017). Mission, Vision, Values. Retrieved May 29, 2017, from https://www.thedacare.org/about-us/Mission%20Vision%20Values.aspx NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

     

    NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations

    As you strive to grow in your leadership skills and abilities, you will find that the context in which you work influences your motivation and areas of focus. In a similar vein, your commitment to developing professionally can contribute toward organizational effectiveness.

    To that end, it is critical to recognize the importance of organizational culture and climate. In particular, through this week’s Learning Resources, you may consider several questions: How do an organization’s mission, vision, and values relate to its culture? What is the difference between culture and climate? NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations. Moreover, how are culture and climate manifested within the organization?

    For this Discussion, you explore the culture and climate of your current organization or one with which you are familiar. You also consider decisions and day-to-day practices and the way they relate to the organization’s mission, vision, and values.

    To prepare:

    Review the information related to planning and decision making in health care organizations presented in the textbook, Leadership Roles and Management Functions in Nursing: Theory and Application. Consider how planning and decision making relate to an organization’s mission, vision, and values, as well as its culture and its climate.

    Familiarize yourself with the mission, vision, and values of your organization or one with which you are familiar. Consider how the statements and actions of leaders and others within the organization support or demonstrate the organizational mission, vision, and values. In addition, note any apparent discrepancies between word and deed. Think about how this translates into expectations for direct service providers. Note any data or artifacts that seem to indicate whether behaviors within the organization are congruent with its mission, vision, and values NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    Begin to examine and reflect on the culture and climate of the organization. How do culture and climate differ?

    Why is it important for you, as a master’s-prepared nurse leader, to be cognizant of these matters?

    Post a description of your selected organization’s mission, vision, and values. Describe relevant data, or artifacts, words, and actions of leaders and others in the organization that support, or perhaps appear to contradict the organization’s mission, vision, and values statement. In addition, discuss the organization’s culture and its climate, differentiating between the two. Explain why examining these matters is significant to your role as a nurse leader NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    Learning Resources

    Required Readings

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

    Chapter 1, “Decision Making, Problem Solving, Critical Thinking, and Clinical Reasoning: Requisites for Successful Leadership and Management” . Chapter 1 provides information relevant to this week’s Discussion and serves as a foundation for topics explored in future weeks of the course NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations. The authors note that decision making, problem solving, critical thinking, and critical reasoning are integral to both leadership and management and beneficial as one examines leadership and management issues. As you read this chapter, focus primarily on the “Decision Making in Organizations” section.

    Chapter 7, “Organizational Planning” . This chapter introduces planning and highlights some of the trends that are likely to impact health care organizations now and in the future. It also addresses vision and mission statements, which are essential for guiding planning and decision making in health care settings. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    Chapter 12, “Organizational Structure”. This chapter addresses organizational culture.

    Business Dictionary.com. (2013) Organizational culture: Definition. Retrieved from http://www.businessdictionary.com/definition/organizational-culture.html

    Nelson, W. A., & Gardent, P. B. (2011). Organizational values statements. Healthcare Executive, 26(2), 56–59.

    Retrieved from the Walden Library databases.

    This article focuses on the impact that organizational values statements have on an organization’s mission. For employees to follow value statements, leaders must effectively model those values day in and day out.

    Plath, D. (2013). Organizational processes supporting evidence-based practice. Administration in Social Work, 37(2), 171–188. doi:10.1080/03643107.2012.672946

    Retrieved from the Walden Library databases. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    Rai, G. S. (2013). Job satisfaction among long-term care staff: Bureaucracy isn’t always bad. Administration in Social Work, 37(1), 90–99. doi:10.1080/03643107.2012.657750

    Retrieved from the Walden Library databases.

    Watkins, M. (2013, May). What is organizational culture? Retrieved from https://hbr.org/2013/05/what-is-organizational-culture

    This site offers several descriptions of organizational culture. These perspectives provide the kind of holistic, nuanced view of organizational culture that is needed by leaders in order to truly understand their organizations—and to have any hope of changing them for the better.

    Online Assessments

    Note: Results from the following assessment are required for the course.

    Keirsey Temperament Sorter (KTS-II). (n.d.). Retrieved from http://www.keirsey.com/

    Please complete the online assessment and receive a free mini report. Additionally, more extensive reports are available for purchase and are optional. You should complete the Keirsey Temperament Sorter assessment early in the course so you will be prepared to discuss the results in Week 9 NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    Required Media

    Laureate Education (Producer). (2012e). Foundations of an organization and organizational assessment. Baltimore, MD: Author.

    In this week’s media presentation, experts from a diverse group of health care organizations share insights on how an organization’s mission, vision, and values influence its daily practices.

    Laureate Education (Producer). (2012c). Factors that influence organizational cultures: Coastal Medical Associates, Salisbury, MA. Baltimore, MD: Author.

    Laureate Education (Producer). (2012d). Factors that influence organizational cultures: Huntington Hospital, Pasadena, CA. Baltimore, MD: Author. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    Optional Resources

    You may find the following online assessments useful as you proceed through the course:

    Appraisal 360. (n.d.). Retrieved from http://www.appraisal360.co.uk/

    HumanMetrics. (n.d.). Jung Typology Test. Retrieved from http://www.humanmetrics.com/cgi-win/jtypes2.asp

    Leadership-Tools.com. (2012). 360 degree feedback leadership tool. Retrieved from http://www.leadership-tools.com/360-degree-feedback-leadership.html

    Union Rescue Mission. (Executive Producer). (2012). Stories from Skid Row [Video file]. Retrieved from http://urm.org/solution/stories-from-skid-row/ NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations

    NURS 6053 INTERPROFESSIONAL ORGANIZATIONAL AND SYSTEMS LEADERSHIP

    MAIN QUESTION POST

    Mission, Vision, and Values

    The mission of my organization, the University of Maryland Baltimore Washington Medical Center (BWMC), “is to provide the highest quality health care services to the communities we serve” (“Mission & Vision”, 2016).  The vision statement of the organization is “to be the preferred regional medical center through nationally recognized quality, personalized service and outstanding people” (“Mission & Vision”, 2016) NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.  The organization did not have a values statement.  In support of the mission statement, the organization is active in the community.  They have established community health services that provide flu shot clinics, blood drives, blood pressure screenings, and health education classes about various topics and health conditions.  Based on my research, the organization falls short of being the preferred regional medical center and appears to contradict its vision statement currently.  “A vision presents what the organization wants to become and gives direction for the organization’s future” (Nelson & Gardent, 2011, p. 56).  The organization could reach its goal with the vision statement in the future.

    In addition to not being rated one of the highest quality health organizations, there is relevant data and actions of leaders and others in the organization that contradict this organization’s mission and values.  Patients have complained about care received within the organization coupled with medication and surgical errors that occur, contradicts providing the highest quality healthcare.  Patients admitted to the inpatient floors complain of being stuck 10 to 15 times by staff attempting to initiate IV access.  The vascular access team (VAT) arrives at the bedside of these patients due to them being labeled as ‘hard sticks’ and are establishing IV access/drawing blood in one attempt.  Patients are also arriving from the emergency department with EJ’s (an IV in the neck in the external jugular) and the VAT is placing multiple IV’s in these same patients without difficulty.  Floor nurses are attempting to access implanted ports in their patients but are accessing the subcutaneous tissue in the chest instead.  There is an overwhelming amount of infiltrated IV’s left in patients, most of which are still left infusing.    Nurses are not familiar with the policies and procedures of the organization and therefore, are susceptible to unethical practices.  Nursing leaders within the organization are far removed from the clinical aspect of nursing and would prefer not to be made aware of issues until patients are injured or worse NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.  A values statement is missing from the organization, which according to Nelson & Gardent (2011) represents the core principles within an organization’s culture and should be integrated in nursing decisions and behaviors.

    Organizational Culture and Climate

    “Organizational culture is the total of an organization’s values, language, traditions, customs, and sacred cows—those few things present in an institution that are not open to discussion or change” (Marquis & Huston, 2017, p. 305).  Comparably, BusinessDictionary.com (2016) defines organizational culture as “the values and behaviors that contribute to the unique social and psychological environment of an organization.  Organizational culture includes an organization’s expectations, experiences, philosophy, and values that hold it together, and is expressed in its self-image, inner workings, interactions with the outside world, and future expectations. It is based on shared attitudes, beliefs, customs, and written and unwritten rules that have been developed over time and are considered valid” (para. 1).  Organizational climate differs from culture, in that, it’s how employees perceive an organization and could be accurate or inaccurate (Marquis & Huston, 2017, p. 306) NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

    BWMC’s culture has been that of ‘that’s how we’ve always done it’ when it comes to critical thinking skills from the nursing staff.  It has been increasingly difficult to establish a culture where evidence-based practice (EBP) is used.  This culture stems from management not emphasizing the importance of EBP (Marquis & Huston, 2017, p. 306).  The culture of the organization does not adapt well to change.  The climate of the organization varies with most staff feeling not supported by management in general.  Staff of the organization brought in a union at one point to try establishing a better rapport between nursing staff and management.  The climate and culture are similar when it comes to the VAT.  Most hospital staff cannot initiate IV access nor maintain access appropriately, yet the culture and climate has been that of abuse and taking their VAT for granted.  Nursing staff would consult the VAT for combative patients, inmates, patients with difficult family members, patients on isolation and patients with HIV/AIDS diagnosis just because they did not want to attempt IV access in these populations. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations The previous culture, prior management established, was that of two people attempting two times and if without success, a VAT consult would be placed.  The current manager has changed the culture to nursing staff not having to attempt at all, just place a VAT consult.  The climate began to change on the VAT and on the floors.  The VAT began to feel abused and unappreciated and the floor nurses became increasingly needy and were losing their IV skills.  The hospital’s culture began to change, and nurses began thinking and behaving in a disrespectful and demeaning way towards the VAT nurses.  Eventually management sent out emails in hopes of changing the culture and climate of the organization, to become appreciative of the work VAT nurses accomplish.  The climate and culture improved slightly, and the VAT nurses noticed a difference in treatment by the floor nurses. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations “Ultimately the most important way to spread organizational values is by having leadership behaviors reflect those values day in and day out” (Nelson & Gardent, 2017, p. 59).

    Significance as Nurse Leader

    Examining these matters is significant to my role as a nurse leader, assuming the position of creating the kind of organizational culture that will guarantee success (Marquis & Huston, 2017).  Individuals from all levels of the organization should be involved in developing the mission statement for an organization, so that all levels agree with the mission statement (Marquis & Huston, 2017).  As a nurse leader, utilizing the organizations mission statement as a decision-making tool will give the organization purpose (Marquis & Huston, 2017).  Analyzing  the culture and climate of my organization to emphasize EBP is significant in providing the highest quality care in our healthcare delivery system. NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.
     

    References

    Business Dictionary.com. (2013)
    Organizational culture: Definition
    . Retrieved from http://www.businessdictionary.com/definition/organizational-culture.html

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

    Mission & Vision. (2016, October 06). Retrieved November 26, 2017, from https://www.mybwmc.org/mission-vision

    Nelson, W., & Gardent, P. (2011). Organizational values statements. 
    Healthcare Executive,
     
    26
    (2), 56-59. Retrieved November 27, 2017, from https://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=1&sid=07075686-c76a-44b1-b4db-9423df4fa049%40sessionmgr4007 NURS 6053 Week 1 DISCUSSION #1: Organizational Foundations.

  • NURS 6531 : Practice Care of Adults – Practicum Experience Journal

    NURS 6531 : Practice Care of Adults – Practicum Experience 
    Journal

    Practicum Experience Journal

     
    Student Name: Jxx

    E-mail Address:

    Practicum Placement Agency’s Name:

    Preceptor’s Name:

    Preceptor’s Telephone:

    Preceptor’s E-mail Address:

    As I begin my practicum, I believe it is important to familiarize myself with and utilize established nursing theories to maximize the experience. As I pondered on which theory to use I thought about what theory I would want a healthcare provider to use as they are caring for me. I feel that Paterson & Zderad’s Humanistic Nursing Theory will assist me and guide my practicing. It portrays the potential to mold me into the practitioner I hope to become. NURS 6531 : Practice Care of Adults – Practicum Experience Journal.

    The Humanistic Nursing Theory rose up out of Paterson’s and Zderad’s desire for an approach to improve things for healthcare professionals and their patients as they interacted with and performed the day to day activities of nursing practice (Parker & Smith, 2010). They felt the need to offer a method for reacting to the call of human needs NURS 6531 : Practice Care of Adults – Practicum Experience Journal. At the point when a healthcare professional reacts to a call of a health-related concern, she enters the universe of another, offering to, figuratively, experiences existence with that individual. From these experiences, they can encourage patients or their friends and family to be as much as they can be in the circumstances in which they are in. Humanistic Nursing Theory offers nurses an approach to light up the qualities and implications central to their lived encounters, so they may impart them to other healthcare providers and coordinate them into their nursing practice (Parker & Smith, 2010) NURS 6531 : Practice Care of Adults – Practicum Experience Journal.

    ORDER A PLAGIARISM-FREE PAPER HERE

    Practicum Objectives

    The accompanying objective for this practicum encounter are framed from the Humanistic Nursing Theory while including the professionals seven domains of practice.

     
    Objective 1 – Scientific Foundation Competence

    Demonstrate competence in the utilization of scientific foundation. This objective will be fulfilled by thinking critically, pondering on research information, applying this evidence to enhancing practice methods and improving patient outcomes NURS 6531 : Practice Care of Adults – Practicum Experience Journal.

    Objective 2 – Leadership Competencies

               
    Demonstrate competence in application of leadership skills. This objective will be fulfilled by embracing leadership skills to facilitate change, establish a working relationship with an interdisciplinary team and other parties to improve healthcare, and portraying the ability to effectively communicate.

    Objective 3 – Quality Care Competencies

               
    Demonstrate competence in the application of quality care. this objective will be fulfilled by applying the best and most contemporary research discoveries to clinical practice, tailor care to each situation and utilize intercessions as necessary, and thinks about the complex connections between cost, safety, access, and quality in healthcare conveyance. NURS 6531 : Practice Care of Adults – Practicum Experience Journal.

    Objective 4 – Ethical Competencies

    Demonstrate competence in the application of ethics. This objective will be fulfilled by using ethics in decision-making, analyzing the ethical impact of all decisions, and comprehending moral complexities in healthcare conveyance to people and populaces.

    Objective 5 – Health Delivery System Competencies

               
    Demonstrate competence in the understanding of health care delivery system. This objective will be fulfilled by minimizing patient/provider risks, developing culturally competent care, dissecting effect of health care on all partners, incorporating knowledge of associations and systems to enhance healthcare and working with others to enhance the continuum of healthcare.

    Objective 6 – Policy Competencies

               
    Demonstrate competence in the application of health policy. This objective will be fulfilled by understanding the association of clinical practice and policy, analyzing cross-disciplinary effect of approach, and elevating ethical ways to deal with enhancing access, cost, and quality.

    Objective 7 – Technology & Information Literacy Competencies

    Demonstrate competence in the application of technology. This objective will be fulfilled by appropriately using technology to manage information, to evaluate the care delivered and translate health information to other members of the healthcare team.

     

    Weekly Goals

    The following are goals that I hope to adequately achieve during this practicum experience over these next ten weeks.

     

    Week 1
    – Establish a relationship with preceptor, develop an understanding of the expectations of the clinical site, observe basic workflow and population of patients seen and set realistic and achievable goals with preceptor.

    Week 2
    – Demonstrate the ability to adequately communicate with preceptor and other members of the health care team at clinical site.

    Week 3
    – Begin to effectively demonstrate the ability to perform a physical assessment on patients and document findings within the electronic medical record.

    Week 4
    – Demonstrate the capacity to successfully evaluate patient side effects, determine the conceivable intercessions required and apply those indications to justifications for interventions.

    Week 5
    – Demonstrate the capacity to perform a problem centered appraisal and aid in the patient specific care plan development NURS 6531 : Practice Care of Adults – Practicum Experience Journa.

    Week 6
    – Demonstrate the ability to apply assessment findings to a treatment plan and document interventions/plan

    Week 7
    – Demonstrate the ability to assess and give suitable recommendations to interventions and additional treatments.

    Week 8
    – Assess objectives/goals set with preceptor and have effectively finished or partially finished 80% of those objective/goals.

    Week 9
    –
    Conduct thorough assessment and documentation of an established/returning individual and suggest fitting treatment or mediations.

    Week 10
    – Perform and document a complete and thorough assessment of a patient that is new to the clinical site and suggest suitable medications and additional intercessions.

     

    References

    Consensus Model for ARNP Regulation. Retrieved from

    http://www.nursecredentialing.org/APRNConsensusModelReport.aspx

    Parker, M. E., & Smith, M. C. (2010). Nursing theories & nursing practice. 3rd ed.

    Philadelphia: F.A. Davis Co.

    The National Organization of Nurse Practitioner Faculties. (2017). Nurse practitioner

    core competencies content. Retrieved from https://cdn.ymaws.com/www.nonpf.

    org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf NURS 6531 : Practice Care of Adults – Practicum Experience Journal

  • Child and Family Health Assessment Test Bank

    Child and Family Health Assessment Test Bank

    Burns: Pediatric Primary Care, 6
    th
    Edition

    Chapter 2: Child and Family Health Assessment

     

    Test Bank

     

    Multiple Choice

     

    The parent of a toddler is concerned that the child may have autism. The primary care pediatric nurse practitioner completes a Modified Checklist for Autism in Toddlers (M-CHAT) tool, which indicates several areas of concern. What will the nurse practitioner do?

    a.         Administer a Childhood Autism Rating Scale (CARS) in the clinic.

    b.         Consult a specialist to determine appropriate early intervention strategies.

    c.         Refer the child to a behavioral specialist for further evaluation. Child and Family Health Assessment Test Bank.

    d.         Tell the parent that this result indicates that the child has autism.

     

    ANS:   C

    The M-CHAT is a screening tool and is useful for detecting behaviors that may indicate autism. This instrument has been found to have acceptable sensitivity, specificity, and significant positive predictive value. If these behaviors are detected, the PNP should refer the child to a specialist for further assessment, using more diagnostic tools. The CARS may be used but requires specialty training and proper credentials. Until the diagnosis is determined, strategies for intervention are not discussed. The M-CHAT is a screening tool and is not diagnostic. Child and Family Health Assessment Test Bank.

     

     

    The mother of a newborn tells the primary care pediatric nurse practitioner that she is worried that her child will develop allergies and asthma. Which tool will the nurse practitioner use to evaluate this risk?

    a.         Three-generation pedigree

    b.         Review of systems

    c.         Genogram

    d.         Ecomap

     

    ANS:   A

    The three-generation pedigree is used to map out risks for genetic diseases in families, as well as conditions with modifiable risk factors. The review of systems is used to evaluate the history of the child’s body systems. The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The ecomap is used to identify relationships in the family and community that are supportive or harmful.

     

     

    The primary care pediatric nurse practitioner is performing a well child check-up on a 20-month-old child. The child was 4 weeks premature and, according to a parent-completed developmental questionnaire, has achieved milestones for a 15-month-old infant. Which action is correct? Child and Family Health Assessment Test Bank.

    a.         Perform an in-depth developmental assessment screen at this visit to evaluate this child.

    b.         Reassure the parent that the child will catch up to normal development by age 2 years.

    c.         Re-evaluate this child’s development and milestone achievements at the 2-year visit.

    d.         Refer the child to a specialty clinic for evaluation and treatment of developmental delay.

     

    ANS:   A

    This child should be at a 19-month adjusted age for prematurity so, according to the parent screen, is 4 months behind. The PNP should perform a more in-depth screen to evaluate this delay. Waiting to see if the child will “catch up” or assuring the parent that this will happen will cause the delays to become more severe. A referral to a specialty clinic should not be made solely on the basis of the parent-completed questionnaire but only after further evaluation of possible delays.

     

     

    When formulating developmental diagnoses for pediatric patients, the primary care pediatric nurse practitioner may use which resource?

    a.         DC: 0-3R

    b.         ICD-10-CM

    c.         ICSD-3

    d.         NANDA International

     

    ANS:   A

    The DC: 0-3R refers to the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood and is useful for developmental problem diagnosis. The ICD-10-CM is the International Classification of Diseases-Tenth Revision, Clinical Modification and is useful for identifying physiologic diseases. The ICSD-3 is the International Classification of Sleep Disorders – 3rd edition. NANDA International is used to label problems in the functional health domain. Child and Family Health Assessment Test Bank.

     

     

    The primary care pediatric nurse practitioner is evaluating health literacy in the mother of a new preschool-age child. How will the nurse practitioner assess this?

    a.         Ask the child how many books he has at home.

    b.         Ask the mother about her highest grade in school.

    c.         Ask the mother to determine the correct dose of a drug from a label.

    d.         Ask the mother to read a health information handout aloud.

     

    ANS:   A

    The “newest vital sign,” or health literacy, can be determined quickly by asking the parent how many children’s books are in the home. Greater than 10 books in the home is an independent positive predictor of adequate parent health literacy. The other questions may determine a specific level of literacy in general but are not as efficient.

     

     

    The primary care pediatric nurse practitioner learns that the mother of a 3-year-old child has been treated for depression for over 5 years. Which aspect of this child’s development will be of the most concern to the nurse practitioner?

    a.         Fine motor

    b.         Gross motor

    c.         Social/emotional

    d.         Speech and language

     

    ANS:   D

    Maternal depression in the first year of life has been associated with poorer language development at 3 years of age.

     

     

    The primary care pediatric nurse practitioner sees a 3-year-old child who chronically withholds stools, in spite of the parents’ attempts to stop the behavior, requiring frequent treatments with laxative medications. Which diagnosis will the nurse practitioner use to facilitate third-party reimbursement? Child and Family Health Assessment Test Bank.

    a.         Altered elimination pattern

    b.         Elimination disorder

    c.         Encopresis

    d.         Parenting alteration

     

    ANS:   C

    Encopresis is a medical diagnosis, classified in the ICD-10-CM, and is recognized for reimbursement purposes. “Altered elimination pattern” and “Parenting alteration” are NANDA International diagnoses and are not recognized for reimbursement. “Elimination disorder” is a developmental diagnosis.

     

     

    A child is in the clinic for evaluation of an asthma action plan. The primary care pediatric nurse practitioner notes that the child’s last visit was for a pre-kindergarten physical and observes that the child is extremely anxious. What will the nurse practitioner do initially?

    a.         Ask the child’s parent why the child is so anxious.

    b.         Perform a physical assessment to rule out shortness of breath.

    c.         Reassure the child that there is nothing to be afraid of.

    d.         Review the purpose of this visit and any anticipated procedures.

     

    ANS:   D

    The PNP should remember that young children are learning “scripts” for health care visits and may be stressed when recalling previous visits, especially if those involved immunizations. The PNP should explain the purpose and any anticipated procedures for this visit to help put the child at ease. Child and Family Health Assessment Test Bank.

     

     

    When meeting with a new family, the primary care pediatric nurse practitioner develops a database that identifies family members and others living in the household, relationships with others outside the household, and significant behavioral and emotional problems. Which tool will the nurse practitioner use to record this information?

    a.         CRAFFT

    b.         Ecomap

    c.         Genogram

    d.         Pedigree

     

    ANS:   C

    The genogram is an approach to developing a family database to provide a graphic representation of family structure, roles, and problems of recurring significance in a family. The CRAFFT tool is used to assess substance abuse in adolescents. The ecomap is used to identify relationships in the family and community that are supportive or harmful. The pedigree is used to identify potential genetic disorders.

     

     

    The primary care pediatric nurse practitioner evaluates a school-age child whose body mass index (BMI) is greater than the 97th percentile. The nurse practitioner is concerned about possible metabolic syndrome and orders laboratory tests to evaluate this. Which diagnosis will the nurse practitioner document for this visit?

    a.         Metabolic syndrome

    b.         Nutritional alteration: more than required

    c.         Obesity

    d.         Rule out type 2 diabetes mellitus

     

    ANS:   C

    A problem should never be included on the problem list that is not supported by subjective and objective data found and recorded in the database. This child has a BMI that suggests obesity, so this may be used as a diagnosis. Metabolic syndrome is a diagnosis that is determined by laboratory data, which has not been evaluated yet. Nutritional alteration is a NANDA diagnosis and not acceptable for reimbursement. “Rule out” should not be used as a diagnosis, but may be considered part of a plan. Child and Family Health Assessment Test Bank.

     

     

    The primary care pediatric nurse practitioner performs a developmental assessment on a 3-year-old child and notes normal cognitive, fine-motor, and gross-motor abilities. The child responds appropriately to verbal commands during the assessment but refuses to speak when asked questions. The parent tells the nurse practitioner that the child talks at home and that most other adults can understand what the child says. The nurse practitioner will :

    a.         ask the parent to consider a possible speech delay and report any concerns.

    b.         continue to evaluate the child’s speech at subsequent visits.

    c.         refer the child for a speech and hearing evaluation.

    d.         tell the parent to spend more time in interactive conversations with the child.

     

    ANS:   B

    Development should be monitored over time and within the context of the child’s overall well-being, rather than at an isolated testing session. The child has normal development in observed measures and appears to hear and understand well. By parental report, the child is able to speak. The PNP should continue to evaluate speech over time, since this refusal to speak may be associated with shyness or intimidation in the clinic. It is not necessary to tell the parent that the child has a possible speech delay. Unless an actual speech delay is observed, a referral is not indicated, nor is it necessary to implement a home therapy.

     

     

    The primary care pediatric nurse practitioner is performing a well child assessment on an adolescent and is concerned about possible alcohol and tobacco use. Which assessment tool will the nurse practitioner use? Child and Family Health Assessment Test Bank.

    a.         CRAFFT

    b.         HEEADSSS

    c.         PHQ-2

    d.         RAAPS

     

    ANS:   A

    The CRAFFT tool is a six-question tool used to screen for adolescent substance abuse. The HEEADSSS is used as a psychosocial screening tool. The PHQ-2 is a rapid screen for depression. The RAAPS is used to assess risk behaviors that contribute to most morbidity, mortality, and social problems in teens.

     

     

    The primary care pediatric nurse practitioner is assessing a toddler whose weight and body mass index (BMI) are below the 3rd percentile for age. The nurse practitioner learns that the child does not have regular mealtimes and is allowed to carry a bottle of juice around at all times. The nurse practitioner plans to work with this family to develop improved meal patterns. Which diagnosis will the nurse practitioner use for this problem?

    a.         Failure to thrive

    b.         Home care resources inadequate

    c.         Nutrition alteration – less than required

    d.         Parenting alteration

     

    ANS:   D

    Because the PNP is planning to intervene by helping the parents to provide appropriate food habits, the correct diagnosis should be “Parenting alteration.” “Failure to thrive” is a medical diagnosis and requires a medical and social evaluation to rule out organic causes or detect neglect. “Home care resources inadequate” would be used if the PNP suspects that the family lacks adequate funds to purchase food. “Nutrition alteration” is a NANDA diagnosis and would be used if the PNP planned to consult with a dietician or give nutritional information. Child and Family Health Assessment Test Bank.

     

     

     

    Week 9 Quiz

     

    Question 1

    0 / 1 point

    A client presents to clinic for the first time. The provider discovers that the client was diagnosed with Prader-Willi Syndrome. What symptoms does the provider expect to find during this encounter?

    Hyperphasia, obesity, and strabismus

    Lethargy, stridor, and irritability

    Low-set ears, short stature, and webbed neck

    Flat nasal bridge, epicanthal folds, and heart murmur

    Question 2

    Child and Family Health Assessment Test Bank

    0 / 1 point

    A client with Prader-Willi syndrome, well-known to the clinic, presents today for an annual physical. This client is at higher risk and should be screened for what medical condition?

    Depression

    Pyloric Stenosis

    Celiac disease

    Type 2 diabetes mellitus

    Question 3

    0 / 1 point

    A new client presents to the clinic to establish care. On exam, the provider notes the following: a long narrow face, high-arched palate and dental crowding, prominent ears, strabismus, macroorchidism, short stature, cognitive impairments and stereopathies. What would be the most likely diagnosis?

    Fragile X

    Prader-Willi

    Angelman

    Beckwith-Weidemann

    Question 4

    1 / 1 point

    If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Failure to thrive, Central obesity, Enamel hypoplasia, Scoliosis, Motor delays, Mild intellectual disability and Compulsive hyperphagia; what would be the most likely diagnosis?

    Fragile X

    Prader-Willi

    Angelman

    Beckwith-Weidemann

    View Feedback

    Child and Family Health Assessment Test Bank

     

    Question 5

    0 / 1 point

    If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Seizures, Global developmental delays, Abnormal gait, arms held high/flexed elbows, Hypotonic trunk with hypertonic limbs (commando crawl), Feeding/growth problems, Acquired microcephaly, Speech delay, Spontaneous (persistent) social smile/fits of laughter, and Loves water. What would be the most likely diagnosis?

    Fragile X

    Prader-Willi

    Angelman

    Beckwith-Weidemann

    Question 6

    0 / 1 point

    If a client is positive for any of the following categorical clinical findings and developmental deficiencies: Omphalocele or umbilical hernia, macroglossia, facial features: Nevus flammeus, helical pits, prominent eyes, anterior ear lobe creases, Large placenta/long umbilical cord, Hypoglycemia, Cardiomegaly, Dental malocclusion with maxillary underdevelopment, and Articulation issues. What would be the most likely diagnosis? Child and Family Health Assessment Test Bank.

    Fragile X

    Prader-Willi

    Angelman

    Beckwith-Weidemann

    Question 7

    1 / 1 point

    If a client is positive for any of the following categorical clinical findings and developmental deficiencies: tall, long limbs, aortic root dilatation, mitral valve prolapse/regurgitation, ectopia lentis, myopia, retinal detachment, exotropia/strabismus, spontaneous pneumothorax, connective tissue problems, pectus deformities, joint hyperextensibility. What would be the most likely diagnosis?What would be the most likely diagnosis?

    Turner

    DiGeorge

    Marfan

    Huntington

    View Feedback

     

    Question 8

    0 / 1 point

    What is true about diploid cells? (select all that apply)

    Each contains 23 paired chromosomes.

    Each one contains 23 chromosomes.

    Replication produces two identical cells.

    They replicate via the process of mitosis.

    View FeedbackChild and Family Health Assessment Test Bank

     

    Question 9

    0 / 1 point

    Cystic fibrosis is a genetic disorder that affects the cells that produce mucus, sweat, and digestive juices. It is considered a recessive disease caused by a gene mutation on both alleles inherited from the parents. Which type of genetic disorder is this?

    Chromosome

    Mitochondrial

    Monogenetic

    Multifactorial

    Question 10

    1 / 1 point

    Which diagnostic test is most appropriate when a provider wishes to identify and evaluate the size, shape, and number of chromosomes of a client? Child and Family Health Assessment Test Bank

    Chromosomal microarray

    Fluorescence in-situ hybridization

    Karyotype

    Molecular testing

    Hide Feedback

    Karyotype testing is used to identify and evaluate the size, shape, and number of chromosomes

     

     

    The primary care pediatric nurse practitioner is obtaining a medical history about a child. To integrate both nursing and medical aspects of primary care, which will be included in the medical history?

    a.         Complementary medications, alternative health practices, and chief complaint

    b.         Developmental delays, nutritional status, and linear growth patterns

    c.         Medication currently taking, allergy information, and family medical history

    d.         Speech and language development, beliefs about health, and previous illnesses

     

    ANS:   D

    An assessment model that integrates the nursing and medical aspects of primary care uses three domains: developmental problems (speech and language development), functional health problems (beliefs about health), and diseases (chief complaint). The other examples all use domains associated with the traditional medical model and do not contain nursing aspects associated with functional health problems. Child and Family Health Assessment Test Bank.

  • The man whose antidepressants stopped working

    Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

    Questions

    One of the most effective medical interventions to significantly improve the health of patients doesn’t require the latest technology or expensive medication, but it involves helping them take their existing medicines as prescribed.

    When you feel like your depression is under control, do you sometimes stop taking your medicine? The patient discontinued his Effexor although it appeared to be effective. It is essential to find out the patient’s reason for not adhering to prescribed medication and come up with a solution together.

    ORDER A PLAGIARISM-FREE PAPER HERE

    Taking medication every day is a real inconvenience for some people. Do you ever feel hassled about sticking to your antidepressant? It is difficult to come up with a schedule to take medications every day for some patients. Collaboratively we need to come up with a convenient time to take the antidepressant and the other prescribed medication for them to be effective. The man whose antidepressants stopped working.

    How often do you have difficulty remembering to take your antidepressant medication? Health literacy plays a key role as well. It is difficult for patients to take a medicine when they do not understand why it is prescribed, what conditions or diseases it treats, or what preventive effects it provides.

    As a Nurse practitioner, when patients reveal nonadherence, it is essential to assure them that it is a positive step that they felt comfortable talking about it.  Emphasis should be on collaboration to identify the challenges and decide how to achieve mutually agreed-upon goals (Brown, & Bussell, 2011).

    Family

    The patient is married, the questions I would ask the wife specifically,

    Do you know what medication your husband is taking? And do you know why he is taking it? Family support is vital in patients with depression, in situations when patients forget or are not motivated to take the medication. What side effects is the patient experiencing? The patient’s family may notice symptoms that the patient is not reporting that may need to be addressed. The man whose antidepressants stopped working.

    Physical examination and diagnostic tests

    Appearance and affect

    Most patients with major depressive disorder present with a normal appearance. In patients with more severe symptoms, a decline in grooming and hygiene can be observed, as well as a change in weight. Patients may show psychomotor retardation, which manifests as a slowing or loss of spontaneous movement and reactivity, as well as demonstrate a flattening or loss of reactivity in the patient’s affect, i.e., emotional expression (Halverson,2018).

    Speech may be normal, slow, monotonic, or lacking in spontaneity and content. Pressured speech may suggest anxiety or mania, whereas disorganized speech should prompt an evaluation for psychosis. Racing thoughts could also be an indication of anxiety, mania, or hypomania (Halverson, 2018).

    These laboratory studies might include the following: Complete blood cell (CBC) count, thyroid-stimulating hormone (TSH), Vitamin B-12, Dexamethasone suppression test (Cushing disease, but also positive in depression), Electrolytes, including calcium, phosphate, and magnesium levels (Halverson,2018) The man whose antidepressants stopped working.

    Differential diagnosis

    Hypothyroidism:  is often associated with altered cognitive function and depression. The patient is experiencing psychomotor retardation, fatigue, and sluggishness, all of that may cause depression.

    Manic-depressive episode

    Hyperthyroidism

    Pharmacological agents and dosing

    Add Seroquel as an augment.  Seroquel is also used together with antidepressant medications to treat major depressive disorder in adults (Drugs, com, 2018). Seroquel 50 mg/day and increased the dose as recommended in increments of 50 mg/day depending on the clinical response and tolerability of the patient up to 300 mg a day (Drugs.com, 2018). 1st day 50 mg, 2nd day 100 mg, 3rd day 200 mg and 4th day 300 mg (Drugs.com 2018). According to drugs.com (2018). Seroquel acts on numerous receptors in the brain to calm and help diminish psychotic thoughts. It is can also be used in addition to antidepressants and anxiety (Drugs.com, 2018). It may be beneficial for this patient because of the patient’s anxiety and sleep difficulties. Patients on Seroquel show improvement within one week although it may take several weeks for behavior and cognition to stabilize (Stahl, 2013).

    Increase Buspirone to 60 mg/day, 30 mg in the morning and 30 mg in at bed time. BuSpar is used to treat symptoms of anxiety (Drugs.com, 2018). Certain people respond well to lower doses, while others require higher dosages to get a good effect. In this particular case, the patient is on a low dose; dose may need to be increased for a therapeutic effect The man whose antidepressants stopped working.

    Contraindications

    There are no specific contraindications related to ethnicity in buspirone but, the CNS effects in any individual patient affects function. Therefore, individuals may not operate machinery or automobile (drugs.com, 2018).

    No specific contraindication related to ethnicity that I found with Seroquel, but Anaphylactic reactions have been reported in patients treated with Seroquel. Therefore, Seroquel should not be used in patients hypersensitive to quetiapine (Drugs.com, 2018).

     

    Check points

    The patient needs to follow up in 4 weeks to check on symptom improvement and a blood pressure check due to Seroquel. Quetiapine may cause a lowering of blood pressure when rising from a sitting or lying position, or a racing heart rate (Stahl, 2013). Another follow up check is for fasting plasma glucose, fasting lipids within three months and then annually, but earlier and more frequently if the patient has gained more than 5% of initial weight (Stahl, 2013).

    Taper off Ativan to 1 mg daily for one week, 0.5 mg daily for one week then discontinue medication to prevent withdrawal symptoms.  The man whose antidepressants stopped working Ativan needs to be discontinued because of its sedation effects. With added Seroquel and clonazepam on medication list, the patient does not need another sedative to the regimen. Another reason to discontinue Ativan is, can intensify cognitive slowing, cause dependence and produce changes in equilibrium that can contribute to increased risk of falls and fractures. Long-term use can lead to habituation and dependence (drug.com, 2018).

    Lessons learned

    Ethnic or regional differences can potentially contribute to differences in drug response (Yasundu, Zhang, & Huang, 2008). As a nurse practitioner, application of this information will be one factor that can contribute to the consideration of the risk-benefit ratio of drug therapy in a specific patient (Yasundu et al., 2008).

    Major depression seems to be a recurrent illness that needs to be managed like any other chronic disease such as diabetes. Therefore, the patient may need to stay on an antidepressant for the rest of their life. And at the point of resistance, patients may need their medications augmented with other antidepressants.

    Along with medications, talk therapy like cognitive-behavioral, psychodynamic, and interpersonal therapy is one of the first approaches that a person with treatment-resistant depression might try (Griffin, 2018).

    Research has shown that therapy can help with treatment-resistant depression specifically. The best evidence is with cognitive-behavioral therapy (CBT), which encourages people to see how their thoughts and behaviors contribute to their depression (Griffin, 2018). The man whose antidepressants stopped working.

     

    References

    Brown, M. T., & Bussell, J. K. (2011). Medication Adherence: WHO Cares? Mayo Clinic Proceedings, 86(4), 304–314.
    http://doi.org/10.4065/mcp.2010.0575

    Daly, E. J., & Trivedi, M. H. (2007). A review of quetiapine in combination with antidepressant therapy in patients with depression. Neuropsychiatric Disease and Treatment, 3(6), 855–867.

    Drugs.com, (2018) Buspirone. Retrieved from https://www.drugs.com/buspar.html

    Drugs.com, (2018). Seroquel. Retrieved from 
    https://www.drugs.com/tips/seroquel-patient-tips

    Halverson, L. J (2018). Depression. Retrieved from https://emedicine.medscape.com/article/286759-overview

    Griffin, R. M (2018). Treatment-Resistant Depression: Your Continuum of Care. Retrieved from https://www.webmd.com/depression/features/treatment-resistant-depression-your-continuum-of-care#1 The man whose antidepressants stopped working

    Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press

    Yasundu, S. U., Zhang, L. & Huang, S. M., (2008). The role of ethnicity in variability in response to drugs. focus on clinical pharmacology studies. Clinical pharmacology & Therapeuticsm, 84(3). 417-423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf The man whose antidepressants stopped working

    Hi Mary,

    Great discussion this week, I agree nurse practitioners must be aware of the risks of antidepressant resistance in some patients, then treat patients accordingly. Treatment-resistant depression can leave patients feeling hopeless and discouraged and demoralized because they are not getting any better.  Patients with the diagnosis of severe depression Electroconvulsive Therapy (ECT) can be a life-changing procedure. According to Miller, (2017), medications have a success rate of 50-60% of patients getting better, while ECT succeeds at a rate of 70-90%. ECT also works faster; medications typically take up to eight weeks to show improvement, while with ECT, patients start feeling better in two weeks or less (Miller, 2017).  Pop culture has long represented the procedure as painful and involuntary, most notably in Ken Kesey’s novel-turned-film “One Flew Over the Cuckoo’s Nest,” in which ECT was performed without anesthesia. Fortunately, the stigma has begun to fade away, perhaps due in part to endorsement by public figures such as Kitty Dukakis and the late Carrie Fisher, who both experienced personal success with ECT (Familydoctor.org, 2017). I believe in inviting family members into the procedure room helps to reduce the stigma and fear. Also continues to break down misunderstanding and advocate for this life-saving treatment in patients for whom multiple medications have failed. And when it comes to suicidality, its effectiveness can mean the difference between life and death. The man whose antidepressants stopped working

    References

    Familydoctor.org, (2017). Electroconvulsive Therapy (ECT). Retrieved from https://familydoctor.org/how-electroconvulsive-therapy-works/

    Miller. S. (2017). Treating Mental Illness with Electroconvulsive Therapy. Retrieved from https://healthcare.utah.edu/healthfeed/postings/2017/02/ect.php

     

    Reply # 2

    Hi

    Thank you for a great discussion this week. The patient continues to have the depression after remission. He may also benefit from cytochrome P450 (CYP450) tests to help determine how the body metabolizes a drug (Mayoclinic, 2018). The human body uses cytochrome P450 enzymes to process medications. The variations in these enzymes, medications may affect each person differently (Mayoclinic, 2011) The man whose antidepressants stopped working.

    Drug-gene testing also called pharmacogenomics or pharmacogenetics is the study of how genes affect the body’s response to medication (CDC,2011). The test looks for changes or variations in the genes that determine whether a drug could be an effective treatment for or whether the patient could have side effects from a specific medication (Mayoclinic,2018).

    The cytochrome P450 enzyme includes the CYP2D6 enzyme, which processes many antidepressants and antipsychotic medications. By checking DNA for certain gene variations, CYP450 tests can offer clues about how the body may respond to a particular antidepressant. CYP450 tests can also identify changes in other enzymes, such as the CYP2C19 enzyme (Mayoclinic, 2018). The man whose antidepressants stopped working.

    Genotyping tests, such as cytochrome P450 tests, may speed up the identification of medications that are more likely to be better processed by the body. Ideally, better processing would lead to fewer side effects and improved effectiveness (Mayoclinic, 2018).

    References

    Center for Disease Control and Prevention, (CDC). CYP450 Genotyping to Predict Response to SSRIs Used to Treat Non-psychotic Depression in Adults: EGAPP Recommendation. Retrieved from https://www.cdc.gov/genomics/gtesting/egapp/recommend/cyp450.htm.

    Mayoclinic, (2018) Cytochrome P450 (CYP450) tests. Retrieved from  https://www.mayoclinic.org/tests-procedures/cyp450-test/about/pac-20393711 The man whose antidepressants stopped working

  • MN568 Unit 6 Exam

    MN568 Unit 6 Exam Question 1 2 / 2 points

    A patient is seen with a sudden onset of flank pain accompanied by nausea, vomiting, and diaphoresis. In addition to nephrolithiasis, which of the following should be added to the list of differential diagnoses?

    Question options:

    a) Pancreatitis

    b) Peptic ulcer disease

    c) Diverticulitis

    ORDER A PLAGIARISM-FREE PAPER HERE

    d) All of the above

    Question 2 2 / 2 points

    Which of the following would be an appropriate treatment for a patient with mild BPH?

    Question options:

    a) Refer to a urologist for surgery.

    b) Prescribe a trial of tamsulosin.

    c) Recommend cranberry supplements.

    d) Reevaluate symptoms in 1 to 3 months. MN568 Unit 6 Exam.

    Question 3 2 / 2 points

    The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions?

    Question options:

    a) Repeat the test.

    b) Refer to a nephrologist.

    c) Measure the serum protein.

    d) Obtain a blood urea nitrogen (BUN) and creatinine.

    Question 4 2 / 2 points

    Which is the most potent and irritating dose of tretinoin?

    Question options:

    a) 0.05% liquid formulation

    b) 0.1% cream

    c) 1% foam

    d) 0.02% cream

    Question 5 2 / 2 points

    Which of the following clinical manifestations are consistent with a patient in ARF?

    Question options:

    a) Pruritis

    b) Glycosuria

    c) Irritability

    Question 6 2 / 2 points

    Which of the following is an infraorbital fold skin manifestation in a patient with atopic dermatitis?

    Question options:

    a) Keratosis pilaris

    b) Dennie’s sign

    c) Keratoconus

    d) Pityriasis alba

    Question 7 2 / 2 points

    The patient with BPH is seen for follow-up. He has been taking finasteride (Proscar) for 6 months. The clinician should assess this patient for which of these side effects?

    Question options:

    a) Erectile dysfunction

    b) Glaucoma

    c) Hypotension

    d) Headache

    Question 8 2 / 2 points

    When using the microscope for an intravaginal infection, you see something translucent and colorless. What do you suspect? MN568 Unit 6 Exam

    Question options:

    a) A piece of hair or a thread

    b) Hyphae

    c) Leukocytes

    d) Spores

    Question 9 2 / 2 points

    Your patient is in her second trimester of pregnancy and has a yeast infection. Which of the following is a treatment that you usually recommend/order in nonpregnant patients, but is listed as a Pregnancy category D?

    Question options:

    a) Vagistat vaginal cream

    b) Monistat combination pack

    c) Terazol vaginal cream

    d) Diflucan, 150 mg

    Question 10 2 / 2 points

    A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria?

    Question options:

    a) NSAIDs

    b) Beets

    c) Vitamin A

    d) Red meat

    Question 11 2 / 2 points

    Which of the following tests is most useful in determining renal function in a patient suspected of CRF? MN568 Unit 6 Exam

    Question options:

    a) BUN and creatinine

    b) Electrolytes

    c) Creatinine clearance

    d) Urinalysis

    Question 12 2 / 2 points

    Eighty percent of men have noticeable hair loss by what age?

    Question options:

    a) 35

    b) 50

    c) 70

    d) 85

    Question 13 0 / 2 points

    When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes.What do you suspect they are?

    Question options:

    a) Spores

    b) Leukocytes

    c) Pseudohyphae

    d) Epithelial cells

    Question 14 2 / 2 points

    Which of the following information is essential before prescribing Bactrim DS to a 24-year-old woman with a UTI?

    Question options:

    a) Last menstrual period

    b) Method of birth control

    c) Last unprotected sexual contact

    d) All of the above

    Question 15 2 / 2 points

    What is the treatment of choice for a patient diagnosed with testicular cancer?

    Question options:

    a) Radical orchidectomy

    b) Lumpectomy

    c) Radiation implants

    d) All of the above

    Question 16 2 / 2 points

    Which test is used to confirm a diagnosis of epididymitis?

    Question options:

    a) Urinalysis

    b) Gram stain of urethral discharge

    c) Complete blood cell count with differential

    d) Ultrasound of the scrotum

    Question 17 2 / 2 points

    Sally, age 25, presents with impetigo that has been diagnosed as infected with Staphylococcus. The clinical presentation is pruritic tender, red vesicles surrounded by erythema with a rash that is ulcerating. Her recent treatment has not been adequate. Which type of impetigo is this?

    Question options:

    a) Bullous impetigo

    b) Staphylococcal scalded skin syndrome (SSSS)

    c) Nonbullous impetigo

    d) Ecthyma

    Question 18 2 / 2 points

    An example of ecchymosis is:

    Question options:

    a) A hematoma

    b) A keloid

    c) A bruise

    d) A patch

    Question 19 2 / 2 points

    An 82-year-old man is seen in the primary care office with complaints of dribbling urine and difficulty starting his stream. Which of the following should be included in the list of differential diagnoses?

    Question options:

    a) Benign prostatic hyperplasia (BPH)

    b) Parkinson’s disease

    c) Prostate cancer

    d) All of the above

    Question 20 0 / 2 points

    A 30-year-old man is seen with a chief complaint of loss of libido. Which of the following laboratory tests would help establish a diagnosis?

    Question options:

    a) Testosterone level

    b) Prostate-specific antigen

    c) Nocturnal penile tumescence and rigidity

    d) Prolactin level

    Question 21 2 / 2 points

    A 35-year-old man presents with complaints of painful erections, and he notices his penis is crooked when erect. What is the most likely diagnosis? MN568 Unit 6 Exam

    Question options:

    a) Peyronie’s disease

    b) Damage to the pudendal artery

    c) Scarring of the cavernosa

    d) All of the above

    Question 22 2 / 2 points

    A 78-year-old man is diagnosed with C2 prostate cancer, and he asks the clinician what that means. In order to answer the patient, the clinician must have which of these understandings of the Jewett rating system?

    Question options:

    a) The cancer involves the seminal vesicles.

    b) There is metastatic disease to regional lymph nodes.

    c) The cancer is confined to the capsule.

    d) There is metastasis to distant organs.

    Question 23 0 / 2 points

    During a DRE on a 75-year-old man, the clinician suspects the patient has prostate cancer. What physical finding should make the clinician suspicious?

    Question options:

    a) An enlarged rubbery gland

    b) A hard irregular gland

    c) A tender gland

    d) A boggy gland

    Question 24 2 / 2 points

    Tinea unguium is also known as:

    Question options: MN568 Unit 6 Exam

    a) Onychomycosis

    b) Tinea versicolor

    c) Tinea manuum

    d) Tinea corporis

    Question 25 2 / 2 points

    The patient is diagnosed with acute renal failure (ARF).Which of the following data obtained from the history should alert the provider that this is a case of prerenal azotemia?

    Question options:

    a) Recent heat stroke

    b) Nephrolithiasis

    c) Recent infection where gentamicin was used in treatment

    d) All of the above

    Question 26 2 / 2 points

    Which of the following statements is accurate when you are removing a seborrheic keratosis lesion using liquid nitrogen? MN568 Unit 6 Exam

    Question options:

    a) Do not use lidocaine as it may potentiate bleeding.

    b) Pinch the skin taut together.

    c) Use gel foam to control bleeding.

    d) This should be performed by a dermatologist only.

    Question 27 2 / 2 points

    A patient is diagnosed with urge incontinence. Before prescribing Detrol XL, the provider should question the patient about which of these contraindications to this medication?

    Question options:

    a) Diarrhea

    b) Parkinson’s disease

    c) Closed-angle glaucoma

    d) Breast cancer

    Question 28 2 / 2 points

    Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. MN568 Unit 6 Exam How do you respond when he asks you the cause?

    Question options:

    a) “You must be under a lot of stress lately.”

    b) “It is hereditary. Did your father experience this also?”

    c) “The cause is unknown, but we suspect it is due to an immunologic mechanism.”

    d) “We’ll have to do some tests.”

    Question 29 2 / 2 points

    A 58-year-old patient has been receiving leuprolide as treatment for prostate cancer. The clinician should instruct the patient about which of these side effects?

    Question options:

    a) Risk of osteoporosis

    b) May have hot flushes

    c) May have impotence

    d) All of the above

    Question 30 2 / 2 points

    Josh, aged 22, has tinea versicolor. Which description is the most likely for this condition?

    Question options:

    a) There are round, hypopigmented macules on his back.

    b) Josh has red papules on his face.

    c) There are crusted plaques in Josh’s groin area.

    d) There are white streaks on his neck.

    Question 31 2 / 2 points

    The most common precancerous skin lesion found in Caucasians is:

    Question options:

    a) A skin tag

    b) Actinic keratosis

    c) A melanoma

    d) A basal cell lesion

    Question 32 2 / 2 points

    Which scalp problem can be caused by a fever and certain drugs?

    Question options:

    a) Telogen effluvium (TE)

    b) Trichotillomania

    c) Psoriasis

    d) Alopecia areata

    Question 33 2 / 2 points

    A 46-year-old man presents with urinary hesitancy and low back pain. He has no history of UTI. Digital rectal examination (DRE) reveals a normal prostate, and a diagnosis of prostatodynia is made. Which is the appropriate treatment? MN568 Unit 6 Exam.

    Question options:

    a) Terazosin 2 mg PO once a day

    b) Ice pack to the scrotal area

    c) Saw palmetto 320 mg per day

    d) All of the above

    Question 34 2 / 2 points

    A 30-year-old patient presents with pain on urination. The urine microscopy of unspun urine shows greater than 10 leukocytes/mL, and a dipstick is positive for nitrites. What is the probable diagnosis?

    Question options:

    a) Lower urinary tract infection

    b) Chlamydia infection

    c) Candidiasis

    d) Pyelonephritis

    Question 35 2 / 2 points

    Which of the following foods should be limited in a patient with CRF?

    Question options:

    a) Milk

    b) Bananas

    c) Soy sauce

    d) All of the above

    Question 36 2 / 2 points

    An example of a primary skin lesion is a/an:

    Question options:

    a) Bulla

    b) Scale

    c) Excoriation

    d) Fissure

    Question 37 2 / 2 points

    A 76-year-old man is seen in the office for complaints of urinary incontinence. The clinician should explore which of these causes of incontinence in men?

    Question options:

    a) Urethral polyps

    b) Urinary tract infection (UTI)

    c) Anticholinergic medication

    d) All of the above

    Question 38 2 / 2 points

    A patient is seen in the clinic with a chief complaint of hematuria. To make a differential diagnosis, which of the following questions should be asked?

    Question options:

    a) “Do you have a history of liver disease?”

    b) “What medications are you currently taking?”

    c) “Have you noticed swelling in your ankles?”

    d) All of the above

    Question 39 2 / 2 points

    A 78-year-old man is diagnosed with Stage D bladder cancer and asks the provider what that means. Which is the best response?

    Question options:

    a) “There is no such thing as Stage D cancer.”

    b) “You have cancer that has spread to the surrounding tissue.”

    c) “Your cancer has spread to other organs.”

    d) “Your cancer can be cured by removing your bladder.”

    Question 40 2 / 2 points

    Treatment for epididymitis includes which of the following?

    Question options:

    a) Warm sitz baths

    b) Scrotal elevation

    c) Masturbation

    d) All of the above

    Question 41 2 / 2 points

    A patient is seen in the office complaining of severe flank pain. The clinician should assess this patient for which risk factor for kidney stones?

    Question options:

    a) Hypertension

    b) Constipation

    c) Tubal ligation

    d) Diabetes

    Question 42 2 / 2 points

    A 63-year-old man is seen in the clinic with a chief complaint of nocturia. Which of the following should be included in the differential diagnosis? MN568 Unit 6 Exam

    Question options:

    a) Psychogenic nocturia

    b) Urethral polyp

    c) Irritative posterior urethral lesion

    d) Benign prostatic hypertrophy

    Question 43 0 / 2 points

    A patient with testicular cancer is being followed after completing treatment 1 year ago. He has been symptom-free with no evidence of disease. How often should he have a CT scan?

    Question options:

    a) Every month

    b) Every 3 to 4 months

    c) Every 6 to 12 months

    d) Every year

    Question 44 2 / 2 points

    Mark has necrotizing fasciitis of his left lower extremity.Pressure on the skin reveals crepitus due to gas production by which anaerobic bacteria?

    Question options:

    a) Staphylococcal aureus

    b) Clostridium perfringens

    c) S. pyrogenes

    d) Streptococcus

    Question 45 2 / 2 points

    Ian, age 62, presents with a wide, diffuse area of erythematous skin on his lower left leg that is warm and tender to palpation.There is some edema involved. You suspect:

    Question options:

    a) Necrotizing fasciitis

    b) Kaposi’s sarcoma

    c) Cellulitis

    d) A diabetic ulcer

    Question 46 2 / 2 points

    Why do people of African descent have a lower incidence of non-melanoma skin cancer?

    Question options:

    a) They have an increased number of melanocytes.

    b) Their darker skin protects from ultraviolet radiation.

    c) Their skin is thicker.

    d) Their immune system is stronger.

    Question 47 2 / 2 points

    A 23-year-old sexually active man is seen in the clinic with unilateral painful testicular swelling, and he is diagnosed with epididymitis.In order to prescribe the correct drug, the clinician must understand that which of these is the most common causative organism?

    Question options:

    a) Escherichia coli

    b) Staphylococcus aureus

    c) Chlamydia trachomatis

    d) Pseudomonas aeruginosa

    Question 48 2 / 2 points

    When instructing your elderly client about treating her xerosis, what do you tell her?

    Question options:

    a) A daily hot bath may help the associated pruritus.

    b) Rub the skin briskly to make sure it is completely dry after bathing.

    c) Only take short tepid showers.

    d) Use a gel that is alcohol-based after bathing to soften the skin.

    Question 49 2 / 2 points

    Which of the following instructions should be given to the patient with nephrolithiasis?

    Question options:

    a) Take ibuprofen, 600 mg every 8 hours.

    b) Take Tums? for stomach upset.

    c) Drink more black tea.

    d) Increase intake of vegetables, like spinach.

    Question 50 2 / 2 points

    The 56-year-old man with chronic prostatitis should be treated with trimethoprim 80 mg-sulfamethoxazole 400 mg (TMP-SMX, Bactrim) for how long?

    Question options:

    a) 3 to 7 days

    b) 14 to 21 days

    c) 3 to 6 weeks

    d) 6 to 12 weeks

    MN568 Unit 6 Exam

  • NSG 6001 Week 5 Final Exam

    NSG 6001 Week 5 Final Exam Question 1

    More than half of all cardiac arrhythmias involve the atria.

    True

    False

    Question 2.

    What are the most common symptoms caused by tachyarrhythmias?

    Sweating

    Thirst

    Palpitations

    Headaches

    Question 3.

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

    ETT

    Coronary bypass surgery

    Coronary catheterization

    ORDER A PLAGIARISM-FREE PAPER HERE

    ETT with imaging

    Question 4.

    Of the following, which is the best answer when asked for an advantage of echocardiogram exercise testing over thallium stress testing? NSG 6001 Week 5 Final Exam.

    Does not depend on operator experience

    Costs are the same

    Results are available more quickly

    Doesn’t matter because there are no advantages

    Question 5.

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

    E. Coli

    Gardnerella Vaginalis

    Mycoplasma Hominis

    Chlamydia

    Question 6.

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

    Ensures that providers honor their commitments to the patient

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

    Ensures that patients receive whatever they want

    Maintains costs in the healthcare arena

    Question 7.

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

    True

    False

    Question 8.

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

    True

    False

    Question 9.

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

    Prostate cancer

    Lung cancer

    Lymphoma

    Lupus

    Question 10.

    What ECG changes can reduce the specificity of the ETT?

    Exercise induced bundle branch blocks

    Paced rhythm and resting bundle branch block

    Paced rhythm and exercise induced bundle branch blocks

    Low voltage up sloping of the ST-segment

    Question 11.

    You have confirmed that your patient does indeed have an abdominal aortic aneurysm. In teaching your patient about symptoms to report immediately to the vascular surgeon, you instruct the patient to report which of the following? NSG 6001 Week 5 Final Exam.

    Newly diagnosed diabetes

    Back pain or flank pain

    Visual disturbances

    Headaches

    Question 12.

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

    Poor kidney functioning

    Age

    Drugs: illicit and prescribed

    Trauma

    Question 13.

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

    Women having thinner ventricular and septal muscles

    Women usually have single vessel or non-obstructive disease

    Women cannot exercise as vigorously as men

    Women typically have multiple vessel disease

    Question 14.

    Population disease management is a term used to describe:

    High specificity disease states

    Low specificity diseases states

    Low prevalence specific diseases

    High prevalence specific diseases

    Question 15.

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

    Thoracic aneurysm

    Budging sac aneurysm

    Saccular aneurysm

    Fusiform aneurysm

    Question 16.

    Your practice partner just ordered an exercise echocardiography 2DE for a patient with suspected cardiovascular risk. NSG 6001 Week 5 Final Exam This patient has known resting wall motion abnormalities.Why would this not be the best test to assess this patient’s cardiac risk?

    Sensitivity is increased

    Sensitivity is decreased

    Specificity is increased

    Specificity is decreased

    Question 17.

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

    Acute viral prostatitis

    Stomach virus

    Acute bacterial prostatitis

    BPH only

    Question 18.

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

    Between the nurse practitioner and their physician mentor

    Between two healthcare providers about a single patient

    Between the patient and their family

    Between the patient and the nurse practitioner

    Question 19.

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

    Rapid heart rates and coronary artery narrowing

    Decrease in coronary blood flow

    Decreased heart rate and increased systolic blood pressure

    Increased coronary flow and increased systolic blood pressure

    Question 20.

    A 47-year old female with general complaints of fatigue and shortness of breath shows up in your clinic as a referral from another nurse practitioner. NSG 6001 Week 5 Final Exam Several blood tests and chest x-rays have been completed without any diagnosis or outstanding abnormalities.You decide to order an ETT despite the fact that the recent ECG does not show any abnormalities. From the answers below, which would be the best answer to support your decision?

    You are out of other options

    CAD in women is under diagnosed

    To please the patient

    Women present with the same pattern of CAD as do males

    Question 21.

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

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

    These changes are predictive of myocardial infarction

    These changes have minimal predictive value for CAD

    These changes predict dire outcomes

    Question 22.

    When there is a consequential loss of structural integrity of the abdominal aorta, the resulting issue is what condition? NSG 6001 Week 5 Final Exam

    Bloated stomach

    Kidney failure

    Bleeding ulcers

    Abdominal aortic aneurysm

    Question 23.

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

    1.5 g/day

    No added table salt

    3.0 g/day

    2.3 g/day

    Question 24.

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

    Produces QRS changes that cannot be interpreted

    Produces persistent ST-segmental changes and T-wave abnormalities

    Causes ST-segment changes and P-wave abnormalities

    Will not produce any changes in ECG

    Question 25.

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

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

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

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

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

    Question 26.

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

    Relative and absolute

    Absolute and pending

    Refractory and non-refractory

    Relative and dynamic

    Question 27.

    You see a 75-year old female in your clinic today complaining of urinary incontinence. She is otherwise healthy based upon her last visit NSG 6001 Week 5 Final Exam. She states that her mother told her this would happen someday because it happens to every woman at some age. What would you tell this patient?

    This happens to all women as they age

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

    This is not an expected condition related to aging.

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

    Question 28.

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

    ETT cannot be used for detection

    Difficult to detect by ETT

    Requires both for detection of changes by ETT

    Easier to detect by ETT

    Question 29.

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

    Obesity, rapid heart rate and lung disease

    Diabetes, kidney disease and tooth decay

    Obesity, slow heart rates and hypertension

    Previous MI, hypotension and diabetes

    Question 30.

    Specifically, when is an ETT considered to be negative?

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

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

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

    Patient exercises until tired without evidence of induced ischemia

    Question 31.

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

    A smoker of 3 weeks

    A member of congress

    Sedentary and wishes to begin aggressive exercise NSG 6001 Week 5 Final Exam

    Developmentally challenged

    Question 32.

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

    True

    Question 33.

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

    True

    False(not confirm)

    Question 34.

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

    40%

    20%

    10%

    75%

    Question 35.

    Improvements in the delivery and management of healthcare are necessary if we are to improve the overall health of this nation’s population. Which of the following are identified in your readings as strategic in the movement to improve the healthcare system?NSG 6001 Week 5 Final Exam

    President and Congress

    Population management and healthcare practice

    Socialized medicine and governmental controls

    Monetary savings and limited disruption in healthcare delivery

    Question 36.

    What are the two main types of heart failure?

    Systolic and diastolic

    Hopeless and severe

    Left sided and main

    End diastolic and pressure related

    Question 37.

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

    True

    False

    Question 38.

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

    True

    False

    Question 39.

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

    A normal heart

    Hypo profusion

    An abnormal heart

    CAD

    Question 40.

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

    Engage patients in their own care

    Engage insurance providers in patient care

    Engage providers in patient care

    Engage government in greater involvement in patient care

    Question 41.

    Your 56-year old patient presents with bradycardia with a rate of 55 and first degree AV block. The patient is hemodynamically stable and is not experiencing any syncope or chest pain. History includes previous myocardial infarction. Home medications include beta blockers, daily aspirin. Lab work is non-significant for electrolyte imbalance. You decided to treat this patient for the arrhythmia to prevent future destabilization. From the choices below, which might be the appropriate first measure to consider? NSG 6001 Week 5 Final Exam.

    Add digitalis to control the heart rate

    Consult cardiologist immediately for guidance

    Discontinue Beta Blocker and replace with another therapy if necessary

    Atropine injections

    Question 42.

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

    Sensitivity would be increased because of lung disease

    Specificity would be increased because of obesity

    Sensitivity would be reduced because of obesity and lung disease

    Specificity would be reduced because of obesity and lung disease

    Question 43.

    You are in the clinic with your mentor observing the Echocardiogram exercise test of a 45-year old male that has been experiencing slight chest pressure almost daily during exercise.While observing your patient, your mentor points out that the left ventricle wall is thinning and there is some hyperkinesias of the ventricular wall NSG 6001 Week 5 Final Exam. From your time in the clinic, you know that this test will be considered to be what type of result?

    Negative

    Impossible

    Positive

    Non-readable

    Question 44.

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

    X-Ray of chest

    Tranesophageal echocardiography

    Ultrasound of chest

    CT Scan

    Question 45.

    Tachyarrhythmias cause a drop in commonly blood pressure, cardiac output, syncope, shortness of breath, and chest pain. What phenomenon most often occurs during these arrhythmias to cause these symptoms? NSG 6001 Week 5 Final Exam

    Shortened diastole

    Lengthened diastole

    Lengthened systole

    Shortened systole

    Question 46.

    At what age is atria fibrillation most common?

    In childhood

    60 years or older

    30 years

    45 years

    Question 47.

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

    True

    False

    Question 48.

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

    Stroke

    Significant CAD

    Impending death

    Low risk of CAD

    Question 49.

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

    Turbulent flow of blood

    High pressures caused from HTN

    There is no reason, it just happens

    Almost always from a sclerotic valve

    Question 50.

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

    TMP-SMZ

    Any antibiotic will treat this diagnosis

    Amoxicillin

    Penicillin

    Question 51.

    Any patient presenting with symptomatic bradycardia should be referred

    to a cardiologist for management NSG 6001 Week 5 Final Exam. Is this statement true or false?

    True

    False

    Question 52.

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

    Self-management support

    Interprofessional support

    Physician or provider-driven care

    Family care givers

    Question 53.

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

    Enhances sensitivity and specificity of CAD detection

    Enhances sensitivity while reducing specificity of CAD detection

    Enhances specificity while not changing sensitivity of detection for CAD

    You like pretty pictures of wall motion

    Question 54.

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

    True

    False

    Question 55.

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

    Chlamydia

    Gonorrhea

    Syphilis

    HIV/AIDS

    Question 56.

    Your preceptor decides to add Doppler Flow studies to the echocardiogram exercise test for a patient with a recent history of a holistic murmur best auscultated at the left steral boarder. The patient has no history of cardiac surgeries. He asks you what might be the main advantages of adding Doppler Flow for this particular patient. You know from your readings that there are several reasons to add Doppler Flow and below are listed more than one correct reason. Your best response for this specific case, however, would be that Doppler Flow studies would be of what additive value during the echocardiogram study? NSG 6001 Week 5 Final Exam.

    Detect and evaluate blood shunting from a septal defect

    No advantage is seen for this patient

    Gives better screen shots of wall abnormalities

    Provides assessment of prosthetic valve function

    Question 57.

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

    True

    False

    Question 58.

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

    Ventricular tachycardias

    Premature junctional contractions

    Atria fibrillation

    Ventricular fibrillation

    Question 59.

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

    Chronic bowel obstruction

    Meglacolon

    Appendicitis

    Abdominal aortic aneurysm

    Question 60.

    What are the most common mechanisms to produce cardiac arrhythmias?

    Decreased automaticity, triggered activity or reentry

    Reentry, electrical dysfunction or activity

    Stress, hard work or swimming

    Enhanced automaticity, triggered activity or reentry NSG 6001 Week 5 Final Exam.

  • Alterations of Cardiovascular Function Essay

    Alterations of Cardiovascular Function Essay

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

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

    Which inflammatory cytokines are released when endothelial cells are injured?

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

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

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

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

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

    ORDER A PLAGIARISM-FREE PAPER HERE

    What is the usual source of pulmonary  emboli?

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

    Which statement best describes thromboangiitis obliterans (Buerger disease)?

    Which statement best describes Raynaud  disease?

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

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

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

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

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

    Nicotine increases atherosclerosis by the release of which neurotransmitter?

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

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

    Which laboratory test is an indirect measure of atherosclerotic   plaque?

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

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

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

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

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

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

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

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

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

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

     

    Which condition is a cause of acquired aortic  regurgitation?

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

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

    What is the most common cause of infective  endocarditis?

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

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

    What cardiac pathologic condition contributes to ventricular   remodeling?

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

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

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

    What is the trigger for angina  pectoris?

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

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

    Fatty streaks are capable of producing toxic oxygen radials.

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

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

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

    Altered body chemistry

    Drug action of certain antihypertensive agents

    Prolonged immobility

    Effects of aging on postural  reflexes

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

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

    Match the descriptions with the corresponding  terms.

    A. Impairs flow from left atrium to left  ventricle

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

    C. Backflow into left atrium

    D. Backflow into right atrium

    E. Backflow into left ventricle

    Aortic stenosis

    Aortic regurgitation

     

    Mitral stenosis

    Tricuspid regurgitation

    Mitral regurgitation

  • NURS 6512 FINAL EXAM

    NURS 6512 FINAL EXAM: WALDEN UNIVERSITY

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

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

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

    4. Auscultation of borborygmi is associated with:

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

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

    ORDER A PLAGIARISM-FREE PAPER OR EXAM HERE

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

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

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

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

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

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

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

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

    17. Visible intestinal peristalsis may indicate: –

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

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

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

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

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

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

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

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

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

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

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

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

    30. Temporalis and masseter muscles are evaluated by:-

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

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

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

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

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

    36. Ligaments are stronger than bone until: –

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

    38. The Thomas test is used to detect: –

    39. A goniometer is used to assess: –

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

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

    42. The dowager hump is: –

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    71. Cerebrospinal fluid serves as a: – –

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

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

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

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

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

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

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

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

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

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

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

    83. A normal vas deferens should feel: – –

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

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

    86. Thrombosed hemorrhoids are: – –

    87. Pregnancy-related cervical changes include: –

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    105. An ophthalmoscopic eye examination involves: – –

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

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

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

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

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

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

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

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

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

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

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

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

     

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

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

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

    4. Percussing at the right midclavicular line, below the umbilicus, and continuing upward is the correct technique for locating the: NURS 6512 FINAL EXAM

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

    6. Peritonitis produces bowel sounds that are

    7. Brittle nails are typical findings in:

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

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

    10. A 5-year-old child presents with nasal congestion and a headache to assess for sinus tenderness you should palpate over the:

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

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

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

    14. Mrs. Webb is a 38-year old patient who has been changing her lifestyle to eat in a healthy way and lose weight: during your health promotion education regarding her nutritional status, you explain the function of dietary protein as:

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

    16. The most superior part of the stomach is the

    17. Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia? NURS 6512 FINAL EXAM

    18. A 51-y/o woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:

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

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

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

    22. Nasal symptoms that imply an allergic response include:

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

    24. When taking a history, you should:

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

    26. Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:

    27. Which question would be considered a leading question? NURS 6512 FINAL EXAM

    28. Mr. Black is a 44y/o patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry.  As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at?

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

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

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

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

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

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

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

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

    37. Which cranial nerves innervate the face?

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

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

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

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

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

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

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

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

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

    47. You are examining a pregnant patient and have noted a vascular lesion. When you blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a?

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

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

    50. Expected normal percussion tones include?

    51. Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You ate concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to?

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

    53. Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet?

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

    55. Mrs. Britton is a 34-year-old patient who presents to the office with complaints of skin rashes. You have noted a 4’3cm, rough, elevated area of psoriasis. This is an example of a?

    56. Penicillin is considered a? NURS 6512 FINAL EXAM

    57. Small, minute bruises are called?

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

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

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

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

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

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

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

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

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

    67. Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?

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

    69. Cherry angiomas are a common finding in:

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

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

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

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

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

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

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

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

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

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

    80. The attitudes of the health care professional:

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

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

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

    84. Differential diagnoses belong in the:

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

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

    87. Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia due to:

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

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

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

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

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

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

    94. Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?

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

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

    97. Mrs. G. reports an increase in her alcohol intake over the past 5 years. To screen her for problem drinking, you would use the: NURS 6512 FINAL EXAM

    98. Mr. D. complains of a headache. During the history he mentions his use of alcohol and illicit drugs. This information would most likely belong in the:

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

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

    101
    . 
    Periods of silence during the interview can serve important purposes, such as:

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

     

    Which of the following is an expected change in the assessment

    of the thyroid during pregnancy?

     

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

     

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

    Peritonitis produces bowel sounds that are:

     

    Sweat glands, hair, and nails are all formed:

     

    The adult recommended dietary fat intake

     

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

    ____ %.

     

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

     

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

     

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

     

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

     

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

     

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

     

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

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

     

    Fluorescing lesions are best distinguished using a(n):

     

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

     

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

     

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

     

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

     

    Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet?

     

    The most superior part of the stomach is the:

     

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

     

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

     

    Which cranial nerves innervate the face? NURS 6512 FINAL EXAM