NURSING POSTER

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I KIND OF FORGOT ABOUT THIS POSTER FOR SCHOOL AND NEED THIS DONE ASAP!!   ANYONE WILLING TO HELP WOULD BE GREAT NEED ASAP*******LMK ASAP IF YOU NEED ANY ADDITIONAL INFORMATION

Phi Nu, Walden University Chapter of Sigma Theta Tau the International Nursing Honor Society

Scholarship of Practice Poster Session

The Scholarship and Research committee invites you to submit a Scholarship of Practice Poster for the Phi Nu Scholarship and Induction Ceremony to be held during a Walden University Commencement. This is the Honor Society’s open-house celebration of Walden student scholarly activities.

Call for Posters

You will be notified of the deadlines for abstract submissions for the Annual Scholarship of Practice Poster Session by Walden University School of Nursing.

To be eligible to submit, an applicant must be:

  1. A current Walden student or Alumni who is an active Phi Nu Chapter member
  2. Able to present her/his poster at a Walden University Commencement
  3. Project must be completed by date of poster presentation

Applicants should submit abstracts based on their Scholarship of Practice.

Practicum projects are especially encouraged. This is a great opportunity to showcase your practicum work in a mentored environment.

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Please follow the direction on the attached form and submit by the due date (to be determined).

One outstanding poster in each of the three categories per program (BSN, MSN and DNP) will be selected for a $100 award.

Blind reviews will be completed by a panel of Walden University faculty.

Names will be removed from the abstracts to ensure anonymity of the applicant.

Persons who have been selected to participate will be notified.

Abstracts must follow the required format to be considered.

Travel will be at the presenter’s expense.

ABSTRACT SUBMISSION FORM

Nursing Scholarship of Practice Poster Session

Poster presentations submitted should describe innovative projects and lessons learned in the practice of nursing.

1. Authors’ names, credentials, and affiliations (primary and co-authors):

2. Corresponding author’s e-mail address and phone number:

3. Nursing Program or practice Specialization that best fits your poster presentation:

____    A.        Nursing Education

____    B.        Nursing Leadership and Management

____    C.        Nursing Informatics

____    D.        BSN Student Project

_____  E.         DNP Student Project

_____  F          Other Nursing Specialty Project

4.  Title of presentation:

5.  Beginning date of project:  __________            

6.  Ending date of project: __________ (if project is ongoing indicate that here)

Please describe your project by answering items 7–14 below.

Do not exceed 500 words total in your responses.

7.  Setting of project:

8. Problem addressed:

9. Objectives of project:

10. Intervention or change implemented, if any:

11. Actions and methods used to solve the problem and meet the objectives:

12. Evaluation Strategies used to determine whether the objectives were met:

13. Outcomes:

14. Lessons learned (conclusions and recommendations for practice):

FUNDAMENTAL OF NURSING ASSIGNMENT

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Complete each case study utilizing collegiate formatting (MLA or APA); typed in Cambria or New Times Roman 12 point font in ONE document. Citations required.

Case studies are case specific. Your answers should reflect the assessment and your analysis of the information in the case study… no generalized answers of all matter regarding the content.

QUESTION 1: Healthcare Delivery and Evidenced –Based Nursing Practice

The registered nurse working in the cardiac care clinic is tasked with implementing quality improvement measures. To educate the clinic staff, the nurse plans an in-service program to introduce concepts of quality improvement and evidence-based practice. Additionally, the role of the case manager will be included in the presentation. The nurse plans on using care of the patient with Congestive Heart Failure as a template, and prepares sample clinical pathways, care maps, and multidisciplinary action plans. (Learning Objective 3)

Describe how clinical pathways are used to coordinate care of caseloads of patients.

What is the role of the case manager in evaluating a patient’s progress?

What are examples of evidence-based practice tools used for planning patient care?

QUESTION 2: Community-Based Nursing Practice

Mrs. Johnson, a 67-year-old female patient, has recently been discharged from the hospital following an admission for COPD. She has a past medical history of a colon resection related to acute diverticulitis. She developed a surgical wound infection that requires daily wet to dry wound packing and IV Zosyn. Mrs. Johnson was discharged with home oxygen. To manage her care at home, home care visits were ordered. (Learning Objective 5).

What would be involved in setting up the first home care visit?

Describe the nursing assessments and management that would occur during the visit.

QUESTION 3: Case Study, Chapter 3, Critical Thinking, Ethical Decision Making, and the Nursing Process

1. Mrs. Elle, 80 years of age, is a female patient who is diagnosed with end-stage cancer of the small intestine. She is currently receiving comfort measures only in hospice. She has gangrene of her right foot and has a history of diabetes controlled with oral agents. She is confused and the physician has determined that she is unable to make her own informed decisions. The hospice nurse, not realizing that the weekly order for CBC and renal profile had been discontinued, obtained the labs and sent them to the nearby laboratory for processing. The abnormal lab results obtained later that day revealed that the patient needed a blood transfusion. The hospice nurse updated the patient’s medical power of attorney who was distressed at the report. The patient’s wishes were to die peacefully and to not have to undergo an amputation of her right foot. But if the patient receives the blood transfusion, she may live long enough to need the amputation. The patient’s physician had previously informed the medical power of attorney that the patient would most likely not be able to survive the amputation. The patient’s medical power of attorney had made the request to cease all labs so that the patient would receive comfort measures until she died. The patient has no complaint of shortness of breath or discomfort. (Learning Objective 4)

What ethical dilemma exists?

Who are the stakeholders and what gains or losses do each have?

What strategies should the hospice nurse take to resolve the ethical dilemma?

QUESTION 4:

Chapter 4, Health Education and Health Promotion

he community health nurse is planning a health promotion workshop for a high school PTSO (Parent-Teacher-Student Organization). The choice of topics was suggested by the high school’s registered nurse who has observed a gradual increase in student obesity. The two nurses have collaborated to develop this workshop to provide parents, students, and teachers with information about the importance of health promotion. (Learning Objectives 6, 8, and 9)

Describe the importance of a focus on health promotion.

According to the health promotion model developed by Becker (1993), what four variables influence the selection and use of health promotion behaviors?

c. Describe four components of health promotion.

QUESTION 5: Chapter 5, Adult Health and Nutritional Assessment

The registered nurse prepares to conduct a nutritional assessment on Mrs. Varner, a 52-year-old Caucasian female who describes herself as “overweight most of my adult life.” The client states that her health is good. She works part time as a receptionist and volunteers about 10 hours per week in her church. The nurse obtains Mrs. Varner’s height as 64 inches and her weight as 165 pounds. (Learning Objective 8)

What is the rationale for computing body mass index? What is Mrs. Varner’s BMI?

Calculate her ideal body weight. What is your assessment of her BMI and weight?

Based on Mrs. Varner’s BMI and weight, the nurse measures her waist circumference. Describe the proper procedure for this assessment.

Mrs. Varner’s waist circumference is 38 inches. What is your assessment?

What laboratory values would the nurse review to evaluate Mrs. Varner’s protein levels?

QUESTION 6: Chapter 6, Individual and Family Homeostasis, Stress, and Adaptation

Mary Turner stepped on a nail 5 days ago and sustained a puncture about 1 inch deep. She immediately cleaned the area with soap and water and hydrogen peroxide, and applied triple antibiotic ointment to the site. Today she comes to the clinic with complaints of increased pain and swelling in her foot. On assessment, the nurse notes that the puncture site is red and edematous, and has a moderate amount of yellowish drainage. (Learning Objective 9)

Describe the sequence of events that caused the local inflammation seen in Mary’s foot.

What is the role of histamine and kinins in the inflammatory process?

Which of the five cardinal signs of inflammation does Mary exhibit?

Because Mary’s injury occurred 5 days ago, the nurse should assess for what systemic effects?

QUESTION 7:

Chapter 7, Overview of Transcultural Nursing

The nurse manager of an ambulatory care clinic has noted an increased number of visits by patients from different countries and cultures, including patients from Mexico and other Latin American countries. Concerned about meeting the needs of this culturally diverse population, the nurse manager convenes a staff meeting to discuss this change in patient demographics, and to query the staff about any learning needs they have related to the care of these patients. (Learning Objective 3) FUNDAMENTAL OF NURSING ASSIGNMENT

What strategy to avoid stereotyping clients from other cultures should the nurse include in this meeting?

Identify culturally sensitive issues to be discussed in the staff meeting.

One technician on the staff complains that some patients never make eye contact, and this makes it difficult for him to complete his work. How should the nurse respond?

QUESTION 8: Chapter 8, Overview of Genetics and Genomics in Nursing

Mr. Wayne is a 38-year-old man with a significant family history of elevated cholesterol levels. His father died at age 42 from a massive heart attack secondary to elevated cholesterol and triglycerides, and two of his older siblings are currently taking medications to lower their cholesterol levels. Mr. Wayne makes an appointment to discuss his risk for hypercholesterolemia. The nurse recognizes that Mr. Wayne is at risk for familial hypercholesterolemia because this is an autosomal dominant inherited condition. (Learning Objective 2)

Describe the pattern of autosomal dominant inheritance.

Mr. Wayne asks what chance his children have of developing familial hypercholesterolemia. How should the nurse respond?

Explain the phenomenon of penetrance observed in autosomal dominant inheritance.

QUESTION 9: Chapter 9, Chronic Illness and Disability

Mr. Edwards is 20-year-old male patient who is admitted for treatment of recurring pyelonephritis (kidney infection) and surgical treatment of a urinary stricture, which has decreased the urinary stream. Mr. Edwards has paraplegia; he is paralyzed from the waist down secondary to an automobile accident when he was 16. He came by ambulance to the hospital, leaving his wheelchair and wheelchair pressure-relieving cushion at home. According to the nursing history, the patient is a nonsmoker and he does not drink alcohol or take any illegal drugs. (Learning Objective 5)

What nursing considerations should be made for Mr. Edwards related to his disability?

What health promotion and prevention education does Mr. Edwards need?

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QUESTION 10: Chapter 10, Principles and Practices of Rehabilitation

You are assigned to care for David Ramsey, a 22-year-old male patient who sustained a back injury secondary to being thrown from a motorcycle. He did not damage the spinal cord, but the computed tomography revealed a compression fracture at L-2 (lumbar area). David complains of severe lower back pain with numbness and tingling in the lower extremities. You identify the following nursing diagnosis: Impaired Physical Mobility.

(Learning Objective 4)

What assessments are indicated based on this nursing diagnosis?

List other major nursing diagnoses based on David’s clinical presentation.

QUESTION 11:

Chapter 11, Health Care of the Older Adult

The nurse working at the senior center notices Mrs. Jones, a 78-year-old, crying. The nurse approaches Mrs. Jones and asks if she needs help. Mrs. Jones states “I am so embarrassed. I had another accident and my pants are all wet. It’s like I’m a baby. I never should have come to the senior center.” (Learning Objectives 3 and 4)

What factors may be contributing to the urinary incontinence?

How should the nurse respond to Mrs. Jones?

QUESTION 12:

Chapter 12, Pain Management

Mr. Rogers is 2 days postoperative of a thoracotomy for removal of a malignant mass in his left chest. His pain is being managed via an epidural catheter with morphine (an opioid analgesic). As the nurse assumes care of Mr. Rogers, he is alert and fully oriented, and states that his current pain is 2 on a 1-to-10 scale. His vital signs are 37.8 – 92 – 12, 138/82. (Learning Objective 6)

What are benefits of epidural versus systemic administration of opioids?

The nurse monitors Mr. Rogers’ respiratory status and vital signs every 2 hours. What is the rationale for these frequent assessments?

The nurse monitors Mr. Rogers for what other complications of epidural analgesia?

Mr. Rogers complains of a severe headache. What should the nurse do?

Mr. Rogers’ epidural morphine and decreased mobility increase his chances of constipation. What interventions should be included in his plan of care to minimize constipation?

QUESTION 13:

Chapter 13, Fluid and Electrolytes: Balance and Disturbance

Mrs. Dean is 75-year-old woman admitted to the hospital for a small bowel obstruction. Her medical history includes hypertension. Mrs. Dean is NPO. She has a nasogastric (NG) tube to low continuous suction. She has an IV of 0.9% NS at 83 mL/hr. Current medications include furosemide 20 mg daily and hydromorphone 0.2 mg every 4 hours, as needed for pain. The morning electrolytes reveal serum potassium of 3.2 mEq/L. (Learning Objective 4)

What are possible causes of a low potassium level?

What action should the nurse take in relation to the serum potassium level?

What clinical manifestations might the nurse assess in Mrs. Dean?

Question 14:

Chapter 14, Shock and Multiple Organ Dysfunction Syndrome

Adam Smith, 77 years of age, is a male patient who was admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His respiratory rate is 28 breaths/min and the pulse oximeter reading is at 88% room air, so the physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for inflammation, is elevated. The patient is being treated with broad-spectrum antibiotics and norepinephrine (Levophed) beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-ray for correct placement. An arterial line was placed in the right radial artery to closely monitor the patient’s blood pressure during the usage of the vasopressor therapy. (Learning Objectives 6 and 7)

What predisposed the patient to develop septic shock?

What potential findings would suggest that the patient’s septic shock is worsening from the point of admission?

The norepinephrine concentration is 16 mg in 250 mL of normal saline (NS). Explain how the nurse should administer the medication. What nursing implications are related to the usage of a vasoactive medication?

Explain why the effectiveness of a vasoactive medication decreases as the septic shock worsens. What treatment should the nurse anticipate to be obtained to help the patient? FUNDAMENTAL OF NURSING ASSIGNMENT

QUESTION 15:

Chapter 15, Oncology: Nursing Management in Cancer Care

The oncology clinical nurse specialist (CNS) is asked to develop a staff development program for registered nurses who will be administering chemotherapeutic agents. Because the nurses will be administering a variety of chemotherapeutic drugs to oncology patients, the CNS plans on presenting an overview of agents, classifications, and special precautions related to the safe handling and administration of these drugs. (Learning Objectives 6 and 8)

What does the CNS describe as the goals of chemotherapy?

How should the CNS respond to the following question: “Why do patients require rounds of chemotherapeutic drugs, including different drugs and varying intervals?”

In teaching about the administration of chemotherapeutic agents, what signs of extravasation should the nurse include?

What clinical manifestations of myelosuppression, secondary to chemotherapy administration, should the CNS include in this program?

QUESTION 16:

Chapter 16, End-of-Life Care

Joe Clark, 79 years of age, is a male patient who is receiving hospice care for his terminal illnesses that include lung cancer and chronic obstructive pulmonary disease (COPD). He developed bilateral pleural effusion (fluid that accumulates in the pleural space of each lung), which has compromised his lung expansion. He states that he is short of breath and feels anxious that the next breath will be his last. The patient is admitted to the hospital for a thoracentesis (an invasive procedure used to drain the fluid from the pleural space so the lung can expand). The thoracentesis is being used as a palliative measure to relieve the discomfort he is experiencing. Low dose morphine is ordered to provide relief from dyspnea or discomfort. The patient is prescribed Proventil (albuterol) inhaler 2 puffs per day, as needed, and Flovent (fluticasone propionate) inhaler 2 puffs twice a day. The patient has 2 L/min of oxygen ordered per nasal cannula as needed for comfort. (Learning Objective 9)

a. What nursing measures should the nurse use to manage the patient’s dyspnea?

The patient complains that he has no appetite and struggles to eat and breathe. What nursing measures should the nurse implement to manage this physiologic response to the terminal illnesses?

QUESTION 17:

Chapter 17, Preoperative Nursing Management

The nurse in a gynecology clinic is completing preoperative teaching for a patient scheduled for an abdominal hysterectomy next week. The patient states that she is currently taking 325 mg of aspirin daily for chronic joint pain, along with a multivitamin. The patient has type 2 diabetes; she closely monitors her blood glucose levels. Currently, she is taking an oral hypoglycemic agent. The nurse advises her to ask the anesthesiologist whether she should take this medication the morning of surgery. (Learning Objectives 2 and 4)

The nurse instructs the patient to stop taking the aspirin. What is the rationale for this action?

Why is it important to assess the patient for use of herbal products prior to surgery?

c. The patient asks how surgery could affect her blood glucose; how should the nurse respond?

QUESTION 18: Chapter 18, Intraoperative Nursing Management

Pearl Richards, 69 years of age, is a female patient who is in the operating room for a repair of an abdominal aortic aneurysm. The patient has a history of hypertension controlled with medications, osteoporosis, chronic obstructive pulmonary disease, and has smoked two packs of cigarettes per day for 40 years. (Learning Objectives 2, 6, and 9)

What nursing interventions are instituted to reduce the surgical risk factors related to the patient’s age?

Explain the role of the nurse in providing patient safety measures during the intraoperative period.

QUESTION 19: Chapter 19, Postoperative Nursing Management

1. Rita Schmidt, 74 years of age, is a female patient who was admitted to the surgical unit after undergoing removal of a section of the colon for colorectal cancer. The patient does not have a colostomy. The patient has several small abdominal incisions and a clear dressing over each site. The incisions are well approximated and the staples are dry and intact. There is a Jackson-Pratt drain intact with minimal serous sanguineous drainage present. The patient has a Salem sump tube connected to low continuous wall suction that is draining a small amount of brown liquid. The patient has no bowel sounds. The Foley catheter has a small amount of dark amber-colored urine without sediments. The patient has sequential compression device (SCD) in place. The nurse performs an assessment and notes that the patient’s breath sounds are decreased bilaterally in the bases and the patient has inspiratory crackles. The patient’s cardiac assessment is within normal limits. The patient is receiving O2 at 2 L per nasal cannula with a pulse oximetry reading of 95%. The vital signs include: blood pressure, 100/50 mm Hg; heart rate 110 bpm; respiratory rate 16 breaths/min; and the patient is afebrile. The patient is confused as to place and time. (Learning Objectives 4 and 7)

Explain the assessment parameters used to provide clues to detect postoperative problems early and the interventions needed.

What gerontological postoperative considerations should the nurse make?

2. Mr. John Smith is admitted to the hospital for surgical incision and drainage (I&D) of an abscess on his right calf, which resulted from a farm machinery accident. The right calf has an area 3 cm × 2.5 cm, which is red, warm and hard to touch, and edematous. (Learning Objective 5)

Explain the wound healing process according to the phase of Mr. Smith’s wound?

The surgeon orders for wet-to-dry sterile saline dressing twice a day with iodoform gauze to the wound, covered with the wet-to-dry dressing. Explain how to perform this dressing change

REFERENCE TEXTBOOK:

Fundamentals of Nursing Second Edition Theory, Concepts and Applications by Judith M. Wilkinson, Leslie S Treas FUNDAMENTAL OF NURSING ASSIGNMENT.

The Law and License Investigation

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The Law and License Investigation

 Have you encountered a situation similar to the scenario in the Self-Evaluation? If so, how did you handle it? (Throughout Modules 2-3, we will cover information pertinent to this scenario and your options.)

 How does your State Nurse Practice Act address Nursing Peer Review situations?

Post your responses to the questions above on the Discussion Board by 23:59, Wednesday of Module 2. Then respond to two or more of your colleagues’ responses by asking each colleague at least two probing questions. The probing questions may ask the person to clarify statements or provide more detail, or may ask the person to consider another viewpoint. Please respond to each of the questions you are asked by your colleagues during the onlinediscussion. You will be evaluated on the quality of your summaries, questions, and responses to colleagues’ questions The Law and License Investigation.

Basic APA format is required.

Please open up the “My Groups” option on the left navigation bar and click on your group discussion link to post.

I already did the self assessment let me know thanks

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Here is the scenario:

You, the RN, arrive early on your regular orthopedic unit. Your Charge Nurse comes to you and says that you need to go to the cardiac step-down unit. You protest, but she says she has no control over the situation and that you at least need to go to the step-down unit and see what is going on. You arrive at the step-down unit. The House Supervisor is present with the unit Charge Nurse. You are told that the unit is very understaffed that day and that you must take patients. You protest that you have worked only orthopedics for the past 10 years- that you do not know the current cardiac drugs and side effects, the current treatments and post-treatment care and that you have never had to read the type of cardiac monitoring strips that are generated on all the patients on this unit. The House Supervisor tells you to not worry. She explains as follows:

· There are monitoring techs who are responsible for reading the strips.

· You have access to a PDR and Pharmacy if you have questions about the drugs.

· A nurse with recent experience on this floor will be able to go around with you to orient you for about two hours. (That nurse must return to his regular floor in two hours.)]

You again express concerns that you are not qualified to take this assignment. The House Supervisor takes you aside and says, “We need you to step up and help out here. We need team players in situations like this. If you refuse, I’m going to have to discuss your refusal with the Director of Nursing and your unit manager — it may not be good for your career here at this hospital. Besides, do you think you are the first nurse who ever had to take patients in a less than perfect circumstance? The patients are worse off if you refuse.”

Reluctantly, you accept the assignment. About 5 hours into the 12-hour shift, you mis-titrate a cardiac drug. The patient codes, never regains consciousness and is transferred to ICU. The patient dies 3 hours after being transferred.

Two weeks later, you are called to Human Resources. Your unit manager, the House Supervisor, and an HR representative are there. You are told that you are being reported to the state’s Board of Nursing due to the negative outcome of your patient The Law and License Investigation.

degree of self-awareness and know how to leverage their strengths in the workplace

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Assignment: Application: Taking a Stand

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

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

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

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

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To prepare:

  • Consider the examples of leadership demonstrated in this week’s media presentation and the other Learning Resources.
  • To further your self-knowledge, you are required to complete the Kiersey Temperament as indicated in this week’s Learning Resources. Consider your leadership style, including your strengths for leading others and include your results from Kiersey Temperament Sorter to describe potential challenges related to your leadership style.
  • Mentally survey your work environment, or one with which you are familiar, and identify a timely issue/dilemma that requires you to perform the leadership role of moral agent or advocate to improve a situation (e.g., speaking or acting on behalf of a vulnerable patient, the need for appropriate staffing, a colleague being treated unfairly).
  • What ethical, moral, or legal skills, dispositions, and/or strategies would help you resolve this dilemma? Define the differences between ethical, moral, and legal leadership.
  • Finally, consider the values and principles that guide the nursing profession; the organization’s mission, vision, and values; the leadership and management competencies addressed in this course; and your own values and reasons for entering the profession. What motivation do you see for taking a stand on an important issue even when it is difficult to do so?

To complete:

By Day 7

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

  • Introduce the conceptual frameworks of the ethical constructs of ethics, moral, or legal standards and the purpose of the paper.
  • Consider  an ethical, moral, or legal dilemma that you have encountered in your work environment and describe it.
  • Analyze the moral, ethical, and legal implications utilized in this situation. Describe your role as a moral agent or advocate for this specific issue.
  • Consider your leadership styles identified by your self-assessment and determine if they act as a barrier or facilitation during this dilemma. 

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

Nurse practitioner scope of practice laws.

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                    Practicum Journal: Checkpoint for Certification Plan

Psychiatric/mental health nurse practitioners currently have only one choice for certification, which is through the American Nurses Credentialing Center (ANCC). The ANCC offers the “psychiatric/mental-health nurse practitioner (across the lifespan)” board certification (PMHNP-BC). In many states, board certification is needed as a prerequisite to being granted an NP license. Even if board certification is not a requirement for state licensure, it may be a requirement to receive privileges in various hospitals and other health care facilities. It may also be required by malpractice insurance providers prior to issuing coverage to NPs.

                                      Learning Objectives

Students will:

Evaluate progress on certification plans

Report your progress on the Certification Plan you completed in Week 4 (SEE ATTACHED WEEK 4 CERTIFICATION PLAN DONE)

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                                Assignment 

            Write a 2- to 3-page paper in which you do the following: 

1) What have you done to prepare for your certification?

2) Have you completed the scheduled tasks assigned on your timeline as you 

     noted in week 4 ? If not, what are your plans to stay on schedule?(SEE 

    ATTACHED WEEK 4 CERTIFICATION PLAN DONE)

                            INSTRUCTION

  NB: for this Assignment (Journal Entries)

· Include references  immediately following  the content.

· Use APA style for your journal entry and references less than 5 years old.

. PLEASE INCLUDE INTRODUCTION, CONCLUSION AND REFERENCES LESS 

 THAN 5 YEARS OLD

                                             Learning Resources

Required Readings

Barton Associates. (2017). Nurse practitioner scope of practice laws. Retrieved from https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760

challenging aspects of EBP

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challenging aspects of EBP

For the Course Project, you identify and apply relevant research to a specific nursing topic or problem. You begin by formulating an answerable question that is relevant to nursing and evidence-based practice. In later weeks of this course, you continue the Course Project by conducting a literature review and then determining how the evidence from the literature can be applied to nursing practice. challenging aspects of EBP

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Before you begin, review the Course Project Overview document located in this week’s Learning Resources.

Course Project: Part 1—Identifying a Researchable Problem

One of the most challenging aspects of EBP is to actually identify the answerable question.

—Karen Sue Davies

Formulating a question that targets the goal of your research is a challenging but essential task. The question plays a crucial role in all other aspects of the research, including the determination of the research design and theoretical perspective to be applied, which data will be collected, and which tools will be used for analysis. It is therefore essential to take the time to ensure that the research question addresses what you actually want to study. Doing so will increase your likelihood of obtaining meaningful results.

In this first component of the Course Project, you formulate questions to address a particular nursing issue or problem. You use the PICOT model—patient/population, intervention/issue, comparison, and outcome—outlined in the Learning Resources to design your questions.

To prepare:

  • Review the article, “Formulating the Evidence Based      Practice Question: A Review of the Frameworks,” found in the Learning      Resources for this week. Focus on the PICOT model for guiding the      development of research questions. challenging aspects of EBP
  • Review the section beginning on page 71 of the course      text, titled, “Developing and Refining Research Problems” in the course      text, which focuses on analyzing the feasibility of a research problem.
  • Reflect on an issue or problem that you have noticed in      your nursing practice. Consider the significance of this issue or problem.
  • Generate at least five questions that relate to the      issue which you have identified. Use the criteria in your course text to      select one question that would be most appropriate in terms of      significance, feasibility, and interest. Be prepared to explain your      rationale.
  • Formulate a preliminary PICO question—one that is answerable—based      on your analysis. What are the PICO variables (patient/population,      intervention/issue, comparison, and outcome) for this question?

Note: Not all of these variables may be appropriate to every question. Be sure to analyze which are and are not relevant to your specific question.

  • Using the PICOT variables that you determined for your      question, develop a list of at least 10 keywords that could be used when      conducting a literature search to investigate current research pertaining      to the question.

To complete:

Write a 3- to 4-page paper that includes the following:

  • A summary of your area of interest, an identification      of the problem that you have selected, and an explanation of the      significance of this problem for nursing practice
  • The 5 questions you have generated and a description of      how you analyzed them for feasibility
  • Your preliminary PICOT question and a description of      each PICOT variable relevant to your question
  • At least 10 possible keywords that could be used when      conducting a literature search for your PICOT question and a rationale for      your selections challenging aspects of EBP

sychosis and schizophrenia greatly impact the brain’s normal processes

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sychosis and schizophrenia greatly impact the brain’s normal processes

 I want this assignment asap -PLAGIARISM MUST BE LESS THAN 10% 

sychosis and schizophrenia greatly impact the brain’s normal processes, which interferes with the ability to think clearly. When symptoms of these disorders are uncontrolled, clients may struggle to function in daily life. However, clients often thrive when properly diagnosed and treated under the close supervision of a psychiatric mental health practitioner. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat clients presenting with psychosis and schizophrenia. sychosis and schizophrenia greatly impact the brain’s normal processes

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Learning Objectives

Students will:
  • Assess client factors and history to develop personalized plans of antipsychotic therapy for clients
  • Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring antipsychotic therapy
  • Evaluate efficacy of treatment plans
  • Analyze ethical and legal implications related to prescribing antipsychotic therapy to clients across the lifespan

To prepare for this Assignment:

  • Review this week’s Learning Resources. Consider how to assess and treat clients requiring anxiolytic therapy.

The Assignment

Examine Case Study: Pakistani Woman with Delusional Thought Processes. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following: sychosis and schizophrenia greatly impact the brain’s normal processes

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

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  • Decision #2

    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
  • SAMPLE  ONLY 

NURS 6630 

WEEK SEVEN

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Introduction

Briefly, this is a scenario of a 42 year- old woman with a complex psychiatric history extending from depression, posttraumatic stress disorder, insomnia, visual hallucinations (little man)and impaired behavior with aggression. In the course of more than 36 months, the client was treated with Paroxetine (SSRI), Bupropion ( NDRI), Tiagabine, Ramelteon and , but finally a combination of Lexapro, Bupropion and quetiapine was able to decrease her symptoms . The client’s medical history includes diabetes, hypertension, CAD, hyperlipidemia, COPD, OSA, GERD, Glaucoma, overweight and a remote history of substance abuse.  sychosis and schizophrenia greatly impact the brain’s normal processes

  Related Professional Questions

  Certain medications or supplements can cause symptoms of mental illness and also due to her extensive medical history and usage of multiple medications I would ask the following questions:  

1. Do you take any over -the – counter, herbal supplements or remedies and I would check for interactions with current medication regimen?

2. When and how often do you use your albuterol inhaler ? Some of the side effects of albuterol include anxiety, nervousness, and insomnia ( Cunha, 2016)

Sleep Hygiene: Do you keep regular sleep schedule ? Do you drink caffeine beverages close to bedtime? 

Patient History

The patient may not be a reliable source of information, particularly that she has a significant mental illness that affects her functioning, hence verifying her responses with her direct family members, and mental social workers to get clues to the underlying or precipitating causes of mental crisis. Also checking facility records from previous encounters, or any psychiatric hospitalizations would be useful. 

Diagnostics Testing

1. Thyroid Stimulating Hormone (TSH). Based on recent evidence, the prevalence of depressive symptoms in hypothyroidism was nearly 50%, and clinical depression occurs in more than 40% of people suffering from hypothyroidism ( Bhagwat, 2017)

2. Electrocardiogram (ECG) The client has cardiovascular diseases ( HTN, CAD), with risks of cardio complications. In the setting of taking antidepressants and antipsychotics, baseline ECG and possibly every three to six months would be appropriate.  Several atypical antipsychotics including quetiapine (Seroquel) are known to cause prolongation of the QT interval, hypothesized to occur via direct inhibition of the cardiac delayed potassium rectifier channel, which extends the ventricular repolarization process (Zhai et al., 2017)

Differential Diagnoses

1. Posttraumatic Stress Disorder ( PTSD)_

2. Major Depressive Disorder  (MDD)

3. Insomnia Disorder.

  Pharmacotherapy Options for Sleep/ Wake cycle

1. Zolpidem (Ambien) 5mg oral at bedtime for Seven days. 

Zolpidem is nonbenzodiazepine hypnotic, it works by enhancing GABA inhibitory actions that provide sedative hypnotic effects more selectively than other actions of GABA (Stahl, 2017). With its side effects of sedation,  low dose prescribed as the client has respiratory problems (sleep apnea OSA)).  Studies have shown that Zolpidem did not significantly worsen OSA as measured by the numbers and duration of pauses in breathing during sleep, but in one trial, it significantly lowered minimum oxygen levels during the night when compared with placebo ( Mason & Smith, 2015). 

2. Trazadone 25 mg oral at bedtime for Thirty days. 

Trazadone is a serotonin 2 antagonist/reuptake inhibitor, used in management of depression and insomnia. It is absorbed well, metabolized by CYP 450 3A4 with average half life of 6hrs. It has less side sedative effects compared to zolpidem (Stahl, 2017) sychosis and schizophrenia greatly impact the brain’s normal processes

The best choice for the client would be Trazadone as there is no reliable evidence of dependence or withdraws and it can also work for the client’s depression. 

Conclusion

 The case was a perfect example how it is sometimes difficult to find effective pharmacological treatments of psychiatric illnesses. In the course of four years, the client was prescribed 5-6 medications targeting different neurotransmitters to improve the symptoms. Client’s polypharmacy increased risks of drug-drug interactions, and her medical comorbidities increased risks of adverse reactions. Lesson learned from this study was  that treatment  should be optimally initiated after diagnosis, and augment or switching to a new agent must be carefully  done in consideration of possible  side effects and better outcomes. 

References

Bhagwat, N., Tayde, P., Sharma, P., Sharma, B., Dalwadi, P., Sonawane, A., … Varthakavi, P. (2017). Hypothyroidism and depression: Are cytokines the link? Indian Journal of Endocrinology and Metabolism, 21(6), 886. Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=7&sid=aeb79c1d-68dc-40a4-bd10-f956796bc9e8%40sessionmgr101

Cunha, J. (2016). Common Side Effects of Ventolin HFA (Albuterol Sulfate Inhalation Aerosol) Drug Center – RxList. Retrieved from https://www.rxlist.com/ventolin-hfa-side-effects-drug-center.htm

Mason, M., & Smith, I. (2015). Effects of opioid, hypnotic and sedating medications on obstructive sleep apnoea (OSA) in adults with known OSA | Cochrane. Retrieved from http://www.cochrane.org/CD011090/AIRWAYS_effects-opioid-hypnotic-and-sedating-medications-obstructive-sleep-apnoea-osa-adults-known-osa

Zhai, D., Lang, Y., Dong, G., Liu, Y., Wang, X., Zhou, D., … Zhang, R. (2017). QTc interval lengthening in first-episode schizophrenia (FES) patients in the earliest stages of antipsychotic treatment. Schizophrenia Research, 179, 70-74. Retrieved from https://resolver-ebscohost-com.ezp.waldenulibrary.org/openurl?ID=pmid%3a27727006&genre=article&atitle=QTc+interval+lengthening+in+first-episode+schizophrenia+(FES)+patien sychosis and schizophrenia greatly impact the brain’s normal processes

clinical investigation sparked by the presence of leukocytosis

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clinical investigation sparked by the presence of leukocytosis

FNU Pathophysiology Quiz-2

Question 1 

A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect?  clinical investigation sparked by the presence of leukocytosis

Answers: 

A. “It’s likely that this will give you chronic fatigue and malaise for the rest of your life, but that will probably be the extent of your symptoms.” 

B. “Unfortunately, your leukemia will likely enter a crisis mode within a few weeks if we don’t treat it immediately.” 

C. “You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis.” 

D. “You can expect your blood results, fatigue, and susceptibility to infection to gradually worsen over a few years.” 

Question 2 

Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the  clinical investigation sparked by the presence of leukocytosis

Answers: 

A. erythrocytes. 

B. basophils. 

C. neutrophils. 

D. albumin. 

Question 3 

Which of the following diagnostic findings is likely to result in the most serious brain insult? 

Answers: 

A. Moderate decrease in brain tissue volume secondary to a brain tumor removal 

B. High intracellular concentration of glutamate 

C. Increased ICP accompanied by hyperventilation 

D. Mean arterial pressure (MAP) that equals intracranial pressure (ICP) 

Question 4 

Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production? 

Answers: 

A. A 70-year-old woman admitted with dehydration secondary to an overdose of her potassium-wasting diuretic 

B. A 21-year-old man with acute blood loss secondary to a motor vehicle accident 3 hours prior 

C. A 68-year-old man with a long-standing diagnosis of polycythemia vera 

D. A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD) 

Question 5 

A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms? 

Answers: 

A. Localized ischemia with areas of necrosis noted on CT angiography 

B. High pressure and local hemorrhage of the venous system 

C. Hydrocephalus and protein in the cerebral spinal fluid 

D. Increased tissue perfusion at the site of the malformation 

Question 6 

A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered Answers: clinical investigation sparked by the presence of leukocytosis

A. interleukin cells.  

B. Philadelphia. 

C. PSA. 

D. BRCA-1. 

Question 7 

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care? 

Answers: 

A. Regular pain assessment and administration of opioid analgesics as needed 

B. Cardiac monitoring and administration of inotropic medications 

C. Assessment and documentation of cognitive changes, including confusion and restlessness 

D. Assessment of swallowing ability and respiratory status 

Question 8 

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment? 

Answers: 

A. To increase the amount of oxygen distributed by his red blood cells 

B. To reduce the viscosity of his blood 

C. To reduce the mean size of his red cells 

D. To control his hypertension 

Question 9 

During a late night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action? 

Answers: 

A. Thalamus 

B. Cerebellum 

C. Frontal lobe 

D. Basal ganglia 

Question 10 

The family members of an elderly patient are wondering why his “blood counts” are not rising after his last GI bleed. They state, “He has always bounced back after one of these episodes, but this time it isn’t happening. Do you know why?” The nurse will respond based on which of the following pathophysiological principles? 

Answers: 

A. “Don’t worry about it. We can always give him more blood.” 

B. “Due to stress, the red blood cells of older adults are not replaced as promptly as younger people.” 

C. “Everything slows down when you get older. You just have to wait and see what happens.” 

D. “The doctor may start looking for another cause of his anemia, maybe cancer of the bone.” 

Question 11 

A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient’s bleeding? 

Answers: 

A. Hemophilia B 

B. Vitamin K deficiency 

C. Excess calcium 

D. Idiopathic immune thrombocytopenic purpura (ITP) 

Question 12 

Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56.What is the nurse’s priority action? Answers: 

A. Recheck the type of blood infusing with the chart documentation of patient’s blood type. B. Discontinue the transfusion and begin an infusion of normal saline. 

C. Slow the rate of the blood infusion to 50 mL/hour. 

D. Document the assessment as the only action. 

Question 13 

A 5th grade elementary student asks the school nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has 

Answers: 

A. 2 to 4 cups of blood in his or her body. 

B. 5 to 6 L of blood throughout his or her body. 

C. 3 pints of blood in total. 

D. 3 to 4 quarts of blood in his or her body. 

Question 14 

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client’s medication regimen. What is the most likely focus of the pharmacologic treatment of the man’s health problem?  clinical investigation sparked by the presence of leukocytosis

Answers: 

A. Preventing demyelination of the efferent cerebellar pathways 

B. Preventing axonal degradation of motor neurons 

C. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions 

D. Increasing the functional ability of the underactive dopaminergic system 

Question 15 

A student makes the statement to a colleague, “Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells.”What would be the most accurate response to this statement? 

Answers: 

A. “Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis.” 

B. “Actually, plasma plays a significant role in nutrient and waste transport.” 

C. “Actually, plasma is integral to the proper function of the liver and maintenance of acid–base balance.” 

D. “That’s not really true. Plasma is crucial in the immune and inflammatory responses.” 

Question 16 

Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced? 

Answers: 

A. Central cord syndrome 

B. Conus medullaris syndrome 

C. Brown-Séquard syndrome 

D. Anterior cord syndrome 

Question 17 

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction?

Answers: 

A. A– 

B. A 

C. B– 

D. B 

Question 18 

Which of the following clients’ signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult 

Answers: 

A. has vomited and complained of a severe headache. 

B. states that his left arm and leg are numb, and gait is consequently unsteady. 

C. has experienced a sudden loss of balance and slurred speech. 

D. has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days. 

Question 19 

Amniocentesis has suggested that a couple’s first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification? 

Answers: 

A. “Our baby’s red cells are prone to early destruction because of his or her weak membranes.” 

B. “Our son or daughter likely won’t show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies.”

C. “Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so.” 

D. “Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones.” 

Question 20 

During science class, a student asks, “What’s the difference between plasma and serum in the blood?” The nurse responds that the primary difference between plasma and serum is that plasma contains 

Answers: 

A. hydrogen ions. 

B. heparin. 

C. white blood cells. 

D. fibrinogen. 

Question 21 

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, “What is that?” How should the nursing student reply? clinical investigation sparked by the presence of leukocytosis 

Answers: 

A. “A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles” 

B. “Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot” 

C. “A degenerative disease where you have trouble walking without the help of a cane or walker” 

D. “Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well” 

Question 22 

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? 

Answers: 

A. Excess acetylcholinesterase production; treatment with thymectomy 

B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins 

C. Cerebellar lesions; surgical and immunosuppressive treatment 

D. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids 

Question 23 

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup”injury. How will the nurse explain this to the family so they can understand? 

Answers: 

A. “It’s like squeezing an orange so tight that the juice runs out of the top.” 

B. “When the bat hit his head, his neck jerked backward causing injury to the spine.” 

C. “Your son has a contusion of the brain at the site where the bat hit his head.” 

D. “Your son has a huge laceration inside his brain where the bat hit his skull.” 

Question 24 

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? Answers: 

A. Growth factors and cytokines 

B. T lymphocytes and natural killer cells 

C. Neutrophils and eosinophils 

D. Natural killer cells and granulocytes 

Question 25 

While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders? 

Answers: 

A. Immediately discontinue the heparin therapy 

B. Switch to Coumadin 2.5 mg once/day 

C. Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d 

D. Infuse FFP stat 

Question 26 

Which of the following individuals would most likely experience global ischemia to his or her brain? 

Answers: 

A. A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater 

B. A male client who has just had an ischemic stroke confirmed by CT of his head 

C. A woman who has been admitted to the emergency department with a suspected intracranial bleed 

D. A man who has entered cardiogenic shock following a severe myocardial infarction 

Question 27 

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor? 

Answers: 

A. Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA) 

B. Hepatic immaturity of the infant 

C. Hypoxia 

D. The fact that the infant is being breast-fed 

Question 28 

A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms? 

Answers: 

A. Viruses are killing some of his B cells and becoming incorporated into the genome of others. 

B. The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils. 

C. The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes. 

D. The EBV inhibits the maturation of white cells within his peripheral lymph nodes. 

Question 29 

A 16-year-old female has been brought to her primary care physician by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the physician to rule out infectious mononucleosis? 

Answers: 

A. Chest auscultation reveals crackles in her lower lung fields bilaterally. 

B. Her liver and spleen are both enlarged. 

C. Blood work reveals an increased white blood cell count. 

D. The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.  clinical investigation sparked by the presence of leukocytosis

Question 30 

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client’s husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse’s following statements best characterizes DIC? 

Answers: 

A. “The same hormones and bacteria that cause clotting also cause bleeding.” 

B. “Massive clotting causes irritation, friction, and bleeding in the small blood vessels.” 

C. “So much clotting takes place that there are no available clotting components left, and bleeding ensues.” 

D. “Excessive activation of clotting causes an overload of vital organs, resulting in bleeding.” 

Question 31 

A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate? 

Answers: 

A. “Our treatment plan will depend on whether your tumor is malignant or benign.” 

B. “This is likely a result of a combination of heredity and lifestyle.” 

C. “The major risk that you face is metastases to your lungs, liver, or bones.” 

D. “Your prognosis will depend on whether we can surgically resect your tumor.” 

Question 32 

A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be Answers: 

A. cisplatin, a chemotherapeutic. 

B. vincristine, a Vinca alkaloid. 

C. dexamethasone, a corticosteroid. 

D. doxorubicin, a cytotoxic antibiotic. 

Question 33 

Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students’ following statements best captures an aspect of the two health problems? Answers: 

A. “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme deficiency.” 

B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis. 

C. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.” 

D. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.” 

Question 34 

A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician’s explanation? 

Answers: 

A. Tissue destruction results from neutrophil deactivation. 

B. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens. 

C. Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas. 

D. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis. 

Question 35 

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?

Answers: 

A. Encephalitis 

B. Lyme disease 

C. Rocky Mountain spotted fever 

D. Spinal infection 

Question 36 

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies, 

Answers: 

A. “They are looking for the presence of antibody or complement on the surface of the RBC.” 

B. “They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis).” 

C. “They will wash your RBCs and then mix the cells with a reagent to see if they clump together.” 

D. “They will be looking to see if you have enough ferritin in your blood.” 

Question 37 

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection?  clinical investigation sparked by the presence of leukocytosis

Answers: 

A. Phagocytosis by myelocytes 

B. Increased segmented neutrophil production 

C. High circulatory levels of myeloblasts 

D. Proliferation of immature neutrophils 

Question 38 

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate? 

Answers: 

A.“We think that his spleen is inhibiting the production of platelets by his bone marrow.” 

B.“We believe that your son’s spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk.” 

C.“Your son’s spleen is holding on to too many of his platelets, so they’re not available for clotting.” 

D.“Your son’s spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation.” 

Question 39 A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems? 

Answers: 

A. Anemia 

B. Blood clots 

C. Jaundice 

D. Infections 

Question 40 

A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause? 

Answers: 

A. CLL 

B. Accelerated CML 

C. Infectious mononucleosis 

D. Stage A Hodgkin disease 

Question 41 

A nurse is providing care for several patients on an acute medical unit of a hospital.Which of the following patients would be most likely to benefit from hematopoietic growth factors? 

Answers: 

A. A 61-year-old female patient with end-stage renal cancer 

B. A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes 

C. A 51-year-old female patient with liver failure secondary to hepatitis 

D. A 44-year-old man with a newly diagnosed brain tumor 

Question 42 

Misinterpreting her physician’s instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status? 

Answers: 

A. The binding of an antibody to platelet factor IV produces immune complexes. 

B. The patient’s prostaglandin (TXA2) levels are abnormally high. 

C. Irreversible acetylation of platelet cyclooxygenase activity has occurred. 

D. She is at risk of developing secondary immune thrombocytopenic purpura (ITP). 

Question 43 Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease? 

Answers: 

A. “Make sure that you avoid taking aspirin.” 

B. “Your disease affects your platelet function rather than clot formation.” 

C. “Clotting factor VIII can help your body compensate for the difficulty in clotting.” 

D. “It’s important that you avoid trauma.” 

Question 44 

A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs

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Answers: 

A. are caused by small bleeds that can be a warning sign of an impending stroke. 

B. are a relatively benign sign that necessitates monitoring but not treatment. 

C. are an accumulation of small deficits that may eventually equal the effects of a full CVA. D. resolve rapidly but may place the client at an increased risk for stroke. 

Question 45 

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? 

Answers: 

A. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.” 

B. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.” 

C. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.” 

D. “Your daughter’s condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.” 

Question 46 

A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple’s enquiry? Stem cells can 

Answers: 

A. “be used as source of reserve cells for the entire blood production system.” 

B. “help treat some cancers and anemias, but they must come from your child himself or herself.” 

C. “be used to regenerate damaged organs should the need ever arise.” 

D. “help correct autoimmune diseases and some congenital defects.” 

Question 47 A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?  clinical investigation sparked by the presence of leukocytosis

Answers: 

A. “Ferritin is a protein–iron complex that allows your red blood cells to make use of the iron that you consume in your diet.” 

B. “Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen.” 

C. “Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it.” 

D. “Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.” 

Question 48 

A 13-year-old African American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out? 

Answers: 

A. Aplastic anemia 

B. Sickle cell anemia 

C. Thalassemia 

D. Iron deficiency anemia 

Question 49 

In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production? 

Answers: 

A. A 55-year-old man with dehydration secondary to Crohn disease 

B. An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive 

C. A 66-year-old woman with a diagnosis of lung cancer with bone metastases 

D. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia 

Question 50 

A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC? 

Answers: 

A. New platelets are released from the bone marrow into circulation. 

B. The half-life of a platelet is typically around 8 to 12 days. 

C. Platelets originate with granulocyte colony–forming units (CFU). 

D. The α-granules of platelets contribute primarily to vasoconstriction.

Practicum Journal Entry: Certification Plan

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                     Practicum Journal Entry: Certification Plan

Psychiatric/mental health nurse practitioners currently have only one choice for certification, which is through the American Nurses Credentialing Center (ANCC). The ANCC offers the “psychiatric/mental-health nurse practitioner (across the lifespan)” board certification (PMHNP-BC). In many states, board certification is needed as a prerequisite to being granted an NP license. Even if board certification is not a requirement for state licensure, it may be a requirement to receive privileges in various hospitals and other health care facilities. It may also be required by malpractice insurance providers prior to issuing coverage to NPs. Practicum Journal Entry: Certification Plan

In this Practicum Journal Assignment, you will develop a plan, which will serve as the road map for you to follow to attain your certification.

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                                            Learning Objectives

Students will:

· Analyze state restrictions or limitations for practice

· Compare PMHNP practice environments in various states

· Analyze clinical practice issues

· Create plans for passing national certification exams

                                  To prepare for this Practicum Journal

· Review the interactive nurse practitioner (NP) scope of practice law guide in 

  your Learning Resources. Practicum Journal Entry: Certification Plan

· Review your state regulations and a neighboring state or state in which you  

   would like to practice.

· Reflect on how to approach relocating licensure from one state to another.

· Review certification exam requirements for PMHNPs.

            Write a 2- to 3-page paper in which you do the following: (Assignment)

· Describe the Psychiatric and Mental Health Nurse Practitioner (PMHNP) 

   practice environment for your home state (Texas), highlighting restrictions or 

   limitations for practice.

· Compare the PMHNP practice environment in your home state (Texas) with a 

   neighboring state (Louisiana) or a state in which you would like to practice.

· Describe a professional and/or clinical practice issue a new PMHNP will need to 

  consider and address with the certification, licensure, credentialing, or relocation 

  process.

· Develop a checklist for passing the national certification exam, including a 

  detailed timeline that includes academic preparation (study plan), registration, 

  financial preparation, etc. Practicum Journal Entry: Certification Plan

NB: for this Assignment (Journal Entries)

· Include references  immediately following  the content.

· Use APA style for your journal entry and references less than 5 years old.

PLEASE INCLUDE INTRODUCTION, CONCLUSION AND REFERENCES LESS THAN 5 YEARS OLD

  •  

                                 Learning Resources

Required Readings

Barton Associates. (2017). Nurse practitioner scope of practice laws. Retrieved from https://www.bartonassociates.com/locum-tenens-resources/nurse-practitioner-scope-of-practice-laws/

American Psychiatric Association. (2016). Practice guidelines for the psychiatric evaluation of adults. Retrieved from http://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890426760 Practicum Journal Entry: Certification Plan

Hypertension Case Study

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Hypertension Case Study

No Plagiarism please, assignment will be checked with Turnitin. 

Will need minimum of 3 full content pages, plus title, and reference page APA Style, double spaced, times new romans, font 12, and and 3 references with intext citations. References within 5 years (2014-2018). 

Hypertension Case Study

C.D is a 55-year-old African American male who presents to his primary care provider with a 2-day history of a headache and chest pressure. Hypertension Case Study

PMH

Allergic Rhinitis

Depression

Hypothyroidism

Family History

Father died at age 49 from AMI: had HTN

Mother has DM and HTN

Brother died at age 20 from complications of CF

Two younger sisters are A&W

Social History

The patient has been married for 25 years and lives with his wife and two children. The patient is an air traffic controller at the local airport. He has smoked a pack of cigarettes a day for the past 15 years. He drinks several beers every evening after work to relax. He does not pay particular attention to sodium, fat, or carbohydrates in the foods he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted or exercised. Hypertension Case Study

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Medications

Zyrtec 10 mg daily

Allergies

Penicillin

ROS

States that his overall health has been fair to good during the past year.

Weight has increased by approximately 30 pounds in the last 12 months.

States he has been having some occasional chest pressure and headaches for the past 2 days. Shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysis.

Reports some shortness of breath with activity, especially when climbing stairs and that breathing difficulties are getting worse.

Denies any nausea, vomiting, diarrhea, or blood in stool.

Self treats for occasional right knee pain with OTC Ibuprofen.

Denies any genitourinary symptoms.

Vital Signs

B/P 190/120, HR 73, RR 18, T. 98.8 F., Ht 6’1”, Wt 240 lbs.

HEENT

TMs intact and clear throughout

No nasal drainage

No exudates or erythema in oropharynx

PERRLA

Funduscopy reveals mild arteriolar narrowing without nicking, hemorrhages, exudates, or papilledema

Neck

Supple without masses or bruits

Thyroid normal

No lymphadenopathy

Lungs

Mild basilar crackles bilaterally

No wheezes

Heart

RRR

No murmurs or rubs

Abdomen

Soft and non-distended

No masses, bruits, or organomegaly

Normal bowel sounds

Ext

Moves all extremities well

Neuro

No sensory or motor abnormalities

CN’s II-XII intact

DTR’s = 2+

Muscle tone=5/5 throughout

What you should do:

  • Develop an evidence-based management plan.
  • Include any pertinent diagnostics. (Screening Chest Xray/EKG, LABS, referrals to cardiologist to eval cardiovascular disease, smoking cessation education, nutritional consult) 
  • Describe the patient education plan. (lifestyle changes, weight management, AHA/DASH diet)
  • Include cultural and lifespan considerations. ( Common in African American )
  • Provide information on health promotion or health care maintenance needs.
  • Describe the follow-up and referral for this patient.
  • Prepare a 3 page paper (not including the title page or reference page). Hypertension Case Study