Assignment: Disaster Planning for Public Health

By Day 7 of Week 5

• Select a potential natural or man-made disaster that could happen in your community. Then, write a 3- to 4-page paper about the disaster from the community nurse’s perspective.

Section 1: The Disaster, Man-Made or Natural

• What disasters may strike your community and why? For example, do you live in “Tornado Alley,” or has climate change resulted in unusual cold weather snaps or blizzards in your community? Are you located in a flood plain? Include possible diseases that may result from a natural disaster, such as tetanus or cholera Disaster Planning For Public Health.

Section 2: The Nursing Response

• Formulate responses to the disaster, considering systems and community levels of intervention.
• Review websites where a disaster plan may be available for the public, or if one is not currently available, call public health department to see if a disaster plan exists for your community and what the plan contains.
• In addition to reviewing websites for information about your local disaster plan, you will need to locate best practice/evidence-based practice guidelines in professional literature to determine whether your community’s disaster plan is as sound as it might be or if there is room for improvement.

Section 3: Is My Community Prepared for a Disaster?

• What conclusions can you draw about your community’s preparedness plan from having completed this evaluation?

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Week 4: Evidence-Based Practice in Disaster Planning: Nurses as Leaders  

• Public health surveillance is one way that public health officials target intervention strategies (Turlock, 2016). Often, it is through prompt recognition of and reporting of incidents of communicable disease that a disaster can be averted (Turlock, 2016). Surveillance activities often prompt questions such as, What is causing the disease? How is it spreading? And who is at risk (Turlock, 2016)? While it is true that preparedness planning cannot eliminate all traces of threat to a community, planning assures that medical services and treatment are deployed in an effective, efficient, and rapid manner (Turlock, 2016). Public health plays a vital role in coordination of providers, assurance of supplies particularly when the Strategic National Stockpile pharmaceuticals and supplies are required, and mobilization of state and national response systems. Public health officials may also provide health care services when required (Turlock, 2016).
• Stanhope (2016) noted that evidence-based practice (EBP) has become more important in health care for many reasons: increased expectations of consumers, increased availability of information through the Internet, increased accountability for results, health care economic changes, and growing numbers of lawsuits, among other reasons. EBP is a lifelong problem-solving approach that regularly produces excellent results and often provides the theoretical underpinnings for programs to mitigate problems in the community. Once programs are in place, evaluation of their effectiveness should be conducted to determine whether they are worth the continued expenditure of resources. Use of EBP is vital to assure safe outcomes for populations during disasters, such as massive communicable disease outbreaks, and should be the foundation of disaster-planning strategies. Disaster Planning For Public Health

Required Readings

Stanhope, M., & Lancaster, J. (2016). Public health nursing: Population-centered health care in the community (9th ed.). St. Louis, MO: Elsevier.

• Chapter 15, “Evidence-Based Practice” (pp. 342–354)
• Chapter 23, “Public Health Nursing Practice and the Disaster Management Cycle” (pp. 503–528)
• Chapter 24, “Public Health Surveillance and Outbreak Investigation” (pp. 529–544)
• Chapter 25, “Program Management” (pp. 545–567)

Required Media  

• Laureate Education (Producer). (2009a). Family, community and population-based care: Emergency preparedness and disaster response in community health nursing [Video file]. Baltimore, MD: Author.      
• TED. (2012). How to step up in the face of disaster [Video file]. Retrieved from                   https://www.ted.com/talks/caitria_and_morgan_o_neill_how_to_step_up_in_the_face_of_disaster
• This Ted Talk describes the actions of two sisters who step up as leaders during a tornado disaster in their community.

STUDY GUIDE

This quiz will cover the following topics, which relate to psychotherapy with individuals in the Wheeler textbook and the Fisher textbook excerpts:

Topics

1. The Nurse Psychotherapist and a Framework for Practice

1. Confidentiality Limits in Psychotherapy: Ethics Checklists for Mental Health Professionals

1. Assessment and Diagnosis

1. The Initial Contact and Maintaining the Frame

1. Cognitive Behavioral Therapy

1. Supportive and Psychodynamic Psychotherapy

1. Stabilization for Trauma and Dissociation

1. Motivational Interviewing

1. Psychotherapeutic Approaches for Addictions and Related Disorders

Wheeler, K. (Eds.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice(2nd ed.). New York, NY: Springer Publishing Company.

1. Chapter 1, “The Nurse Psychotherapist and a Framework for Practice”

1. Chapter 3, “Assessment and Diagnosis”

1. Chapter 4, “The Initial Contact and Maintaining the Frame”

1. Chapter 5, “Supportive and Psychodynamic Psychotherapy”

1. Chapter 7, “Motivational Interviewing” (pp.299-312)

1. Chapter 8, “Cognitive Behavioral Therapy” Psychiatric Nursing

1. Chapter 13, “Stabilization for Trauma and Dissociation”

1. Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders”

Fisher, M. A. (2016). Introduction. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 3–12). Washington, DC: American Psychological Association. doi:10.1037/14860-001

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002

Question 1

1. After informing a prospective patient about limits of confidentiality, the patient consents to the “conditions” of confidentiality and signs an informed consent form. Several weeks later, a lawyer representing the patient’s spouse for a court case, asks the PMHNP for the disclosure of information about the patient. The PMHNP should:

1 points  

Question 2

1. The PMHNP is meeting with a new patient who is a young veteran back from serving two tours overseas. When reviewing the patient’s health history file that was sent from the VA, the PMHNP learns that several months ago, the patient was diagnosed with PTSD, but never followed up with treatment for it. After a comprehensive mental health assessment, the PMHNP confirms the PTSD diagnosis and understands that which therapeutic approach will be the most effective as a first-line treatment modality?

1 points  

Question 3

1. One of the strategies the PMHNP wants to try includes sleep restriction. What will the PMHNP suggest to follow sleep restriction therapy?

1 points  

Question 4

1. The PMHNP is conducting a peer review of another PMHNP’s medical charts. Upon review, the PMHNP notes that the peer often begins patient sessions late, as well as ends them later than scheduled. The PMHNP also found a comment in the chart regarding the patient sending text messages while in the middle of the session. Based on these findings, the feedback that the PMHNP will provide to the peer involves which therapeutic principle?

1 points  

Question 5

1. True or false: If after a third round of processing followed by stabilization, a patient has increased anxiety that requires further interventions aimed at stabilization, the therapeutic relationship can no longer successfully provide therapeutic change.

True

False

1 points  

Question 6

1. The PMHNP has been treating a 15-year-old patient with a history of abuse and neglect. Thirty minutes into their therapy session the patient jumps up and begins to pace around the room. Utilizing Socratic dialogue (SD) the PMHNP’s best action would be to:

1 points  

Question 7

1. The PMHNP is caring for a patient who the PMHNP believes would benefit from a relational psychodynamic approach to therapy. Which action made by the PMHNP demonstrates appropriate use and understanding of the relationship psychodynamic model?

1 points  

Question 8

1. The PMHNP is caring for a patient with borderline personality disorder. Using a psychoanalytic psychotherapy approach, the PMHNP attempts to intensify the patient’s transference to enhance emotional processing by:

1 points  

Question 9

1. An elderly patient in a nursing home has been losing interest in activities and now refuses to leave his room. After a physical exam, he is referred to a PMHNP for an initial assessment. True or false: After speaking with the patient, an appropriate screening tool for the PMHNP  to use would be the Geriatric Depression Scale. Psychiatric Nursing

True

False

1 points  

Question 10

1. A middle-aged man who works over 50 hours a week is being seen for depression and anger management. He states, “I am even more frustrated when I come home and my wife wants to argue about stupid stuff. All I want to do is come home, take a shower, and eat. Is that too much to ask?” The PMHNP explains that people can be assertive, aggressive, and passive. She encourages the patient to be more assertive and begins role-play with assertive training. The PMHNP determines that the patient is beginning to understand when he states:

1 points  

Question 11

1. The PMHNP is treating a patient with a substantial fear of feeling closed in (claustrophobia). Thus, the patient will not get into an elevator. The office where he works is on the 10th floor and this requires that he walk up and down the stairs in the morning and evening to get to his office. With permission from the patient, the PMHNP is beginning systematic desensitization to address the patient’s need to use the elevator. What is the PMHNP’s best plan of action?

1 points  

Question 12

1. A PMHNP is assessing ego functioning of his 40-year-old patient by asking what she feels is the cause of her problems. She attributes her problems to her overprotective parents not letting her have enough freedom growing up. Based on her answer, the PMHNP is testing _____________.

1 points  

Question 13

1. The PMHNP meets with a 47-year-old male patient who is fearful of leaving the house after having witnessed his neighbor getting run over by a car. When the PMHNP asks why he is afraid to leave his house, the patient replies, “Because another accident might occur.” Which cognitive behavioral therapy (CBT) strategy does the PMHNP employ?

1 points  

Question 14

1. A 62-year-old patient has been diagnosed with borderline personality disorder. Upon assessment, the PMHNP learns that he  participates in spending sprees and occasional binge eating, accompanied by rapid changes in self-image. Which evidence-based psychotherapeutic model does the PMHNP identify as effective and beneficial?

1 points  

Question 15

1. The PMHNP is working with a patient who witnessed her father pass away after suffering for several months from terminal cancer. The PMHNP sees this as a traumatic event. The patient reports sometimes feeling out of touch with surroundings; almost as if things feel like a dream. “Sometimes that sensation lingers for a while,” the patient says, “and other times I snap out of it quickly.” What does the PMHNP infer about the condition based on psychotherapy concepts for trauma?

1 points  

Question 16

1. The patient is a 56-year-old female patient diagnosed with panic disorder and reports symptoms that include heart palpitations, frequent trembling, and feelings of choking in stressful situations. What special consideration does the PMHNP make?

1 points  

Question 17

1. The PMHNP is meeting with a 38-year-old divorced, single mother who has been seeing the PMHNP for anxiety and anger management. During one of the sessions, the patient tells the PMHNP that she is having a problem getting her child support payments from her ex-husband, which is triggering increased anxiety and anger, which she admittedly takes out on her children. How does the PMHNP respond in a way that upholds the supportive psychodynamic psychotherapy approach? Psychiatric Nursing

1 points  

Question 18

1. During a session, the PMHNP asks a patient with a history of sexual abuse to recall the relationship she had as a child with her parents. The patient responds by saying she has a headache and her stomach hurts, and starts talking about her physical ailments. What is the appropriate response by the PMHNP?

1 points  

Question 19

1. The PMHNP is working with an adult patient who has somatic complaints caused by a history of childhood abuse. As part of the therapeutic process, what does the PMHNP do to assess and organize a trauma history?

1 points  

Question 20

1. During a therapy session with an 18-year-old female the PMHNP learns that she has lived in six different foster homes in the last 24 months. She states that her mother is in a correctional facility for drug abuse and prostitution. During the assessment, the PMHNP notices multiple superficial cuts to each wrist. The patient appears tearful, withdrawn, and never makes direct eye contact. The PMHNP believes that this patient may have feelings of insecurities as well as abandonment issues and is aware that which diagnosis is likely possible?

1 points  

Question 21

1. A patient named Steve is seeking therapy to get help with his home situation, stating that he has been stressed since his mother-in-law moved into the house. What can the PMHNP do to assist the patient in constructing a narrative?

1 points  

Question 22

1. A 16-year-old female patient has had a stable therapeutic relationship with the PMHNP for several months. The PMHNP notices what appears to be fresh cigarette burns on the patient’s arm. When asked, the patient admits to this self-injurious behavior. Although the patient is still depressed, her mood seems to be somewhat better this week. True or false: The PMHNP would most likely consider this patient stabilized and ready to move to Stage II.

True

False

1 points  

Question 23

1. The PMHNP is working with a patient who experiences abreactions when discussing repressed feelings of his sexual abuse as a child. What can the PMHNP do to manage the patient’s intense emotional reactions?

1 points  

Question 24

1. A PMHNP has been working with a young female patient who suffers from depression to change self-defeating behaviors Psychiatric Nursing. By creating a presence of acceptance and using good listening skills, the PMHNP’s overall goal is to __________.

1 points  

Question 25

1. During cognitive behavioral therapy (CBT), a 64-year-old male patient states, “I get so frustrated sometimes and I just blow up at everybody!” Which response by the PMHNP demonstrates translation of Socratic dialogue (SD)?

1 points  

Question 26

1. The PMHNP is mentoring a student. After working with a patient during a session, the student laments about all the things she should have, or could have, said to the patient. “I feel guilty that I didn’t speak up more about the patient’s concern toward her son,” says the student. The PMHNP understands that the student is exhibiting signs of which therapeutic concept?

1 points  

Question 27

1. A 28-year-old male patient is experiencing distress related to the workplace. What might the PMHNP ask to assess affective development?

1 points  

Question 28

1. A PMHNP is preparing confidentiality forms for his patients. What is the most appropriate first step he should take?

1 points  

Question 29

1. A PMHNP is caring for a 21-year-old woman who is suffering from anxiety and is having difficulty managing stress. Which of the following would be an appropriate step by the PMHNP?

1 points  

Question 30

1. The PMHNP is caring for a patient who has acute stress disorder after experiencing a traumatic event 1 week prior. The PMHNP wants to begin with a therapeutic framework that follows the adaptive information processing (AIP) model. What is the priority action for the PMHNP to take?

1 points  

Question 31

1. The PMHNP is working with a 43-year-old male patient who develops idiosyncratic transference over weeks of therapy. The best way for the PMHNP to respond to this patient is to ___________:

1 points  

Question 32

1. The PMHNP is working with a 56-year-old man who is being seen because of his anxiety and depression. During the therapy sessions, the PMHNP assists the patient in discussing his experiences and expanding on his thoughts and feelings. He tells the PMHNP stories about how he used to be teased by his coworkers at the office for becoming too anxious in large conference rooms. The PMHNP listens to the patient and helps focus on his strengths to promote self-understanding. Which principle best accounts for the PMHNP’s interactions with the patient?

1 points  

Question 33

1. During a therapy session the patient is asked how she currently deals with stress, and she says, “Well, I don’t. I just let it build and build.” The PMHNP responds by asking how well this has been working out for her. The patient states, “Well, to be honest, it just feels like I’m drowning, you know what I mean.” Illustrating idiosyncratic meaning, the PMHNP responds with: Psychiatric Nursing

1 points

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Question 34

1. The PMHNP is having a therapy session with Charlotte, a 20-year-old victim of date rape. The patient states, “I shouldn’t have been there; I should have just gone home. This was all my fault; how could I have been so stupid?” Using the Socratic method, what is the PMHNP’s best response?

1 points  

Question 35

1. At the initial interview with a patient, the PMHNP reviews the condition of receiving services, including limits that will be imposed on confidentiality. During the discussion, the patient shares information that the PMHNP is legally required to report. True or false: If the PMHNP does not report information that s/he is legally required to report, state laws govern the consequences which include penalties for not reporting, especially child and elder abuse.

True

False

1 points  

Question 36

1. An initial evaluation reveals that an 11-year-old patient has moved to a new school after her parents’ recent divorce, and is having trouble making friends. The patient has normal mental status and exhibits appropriate behavior. What is the most appropriate scale for the PMHNP  to use to get more information?

1 points  

Question 37

1. The PMHNP is meeting with a 42-year-old man with depression brought on by the recent passing of his wife. As he describes the circumstances surrounding his late wife’s death, the PMHNP begins to feel sad. The sadness lingers for several hours, and the PMHNP finds it difficult to focus on other patients for the rest of the day. What is the most appropriate explanation for the reaction that the PMHNP is experiencing?

1 points  

Question 38

1. The PMHNP employs psychodynamic psychotherapy with a patient who experiences anxiety and depression. As the process enters the psychoanalytic end of the psychodynamic continuum, the PMNHP will focus on:

1 points  

Question 39

1. The PMHNP is working with a patient who experiences anxiety around her parents that later leads to poor impulse control. What will the PMHNP do to employ psychodynamic psychotherapy properly for this patient?

1 points  

Question 40

1. A new patient has been informed of the limits of confidentiality, and has signed informed consent forms. No consent, however, has been obtained for voluntary “Release of Information.” The patient is 20 years old and still lives at home with his parents. He is being treated for depression, which he attributes to the trouble he’s had finding employment.  True or false: If the patient’s mother calls the PMHNP to check up on her son to see how he is doing, the therapist is required to protect patient confidentiality and not disclose information.

True

False

1 points  

Question 41

1. A PMHNP is treating a 45-year-old female patient who is upset that her brother has not been calling since his divorce. When asked to describe her brother and what prompts him not to call as frequently, she says, “Everything is about him, not me. I think he’s jealous that I have a good marriage and he wants me to be unhappy, too. So he doesn’t call to upset me and ruin my relationships.” Based on this information, the PMHNP can conclude that the patient _________.

1 points  

Question 42

1. The PMHNP is assessing a patient who grew up in a foster home because she was neglected and abused by her birth parents at a young age. The patient admits to having difficulty forming and maintaining relationships throughout her life. Understanding maladaptive schemas, which statement does the PMHNP predict that the patient is likely to make?

1 points  

Question 43

1. A patient who has borderline personality disorder is meeting with the PMHNP. When asked about future goals, the patient responds, “I’d like to go back to school to do what you do. You know, talk to people all day about their problems. It seems pretty easy.” How does the PHMNP respond to the client in a way that is free from any stigmatizing beliefs or judgments?

1 points  

Question 44

1. True or false: A PMHNP may ask his patient to describe her relationship with her father, both as a child and now, in order to assess interpersonal style.

True

False

1 points  

Question 45

1. A 41-year-old male patient is meeting with the PMHNP and reveals that he is homosexual. He begins telling the PMHNP about his feelings as a homosexual, middle-aged man. The PMHNP nods understandingly. Before long, the patient asks, “Are you gay? Are you married? Do you have kids?” What is the best response by the PMHNP?

1 points  

Question 46

1. The PMHNP is working with a veteran who has posttraumatic stress disorder (PTSD). The PMHNP believes that dual awareness will be beneficial in allowing the patient to focus on the here and now. What strategies can the PMHNP use to develop dual awareness in the patient?

1 points  

Question 47

1. The PMHNP has been assisting a shy and timid 23-year-old male patient struggling with esteem and self-concept issues. Over the weekend, this patient was given the task of completing an exercise that would usually cause him distress and shame, also called a shame-attacking exercise. The PMHNP determines that this task has successfully been achieved when the patient states:

1 points  

Question 48

1. A 35-year-old patient seeks treatment for depression and anxiety after an abusive relationship. To help empower the patient, the PMHNP wants to teach the safe-place exercise to create a feeling of calm. In order to walk the patient through the exercise, the PMHNP first says:

1 points  

Question 49

1. When conducting an initial assessment, a PMHNP has finished conducting a mental status examination with 10 minutes left in the session. The patient is distressed and would like to continue sharing her personal history. True or false: An appropriate response that the PMHNP might tell the patient is, “I understand that you are upset. [Summarizes diagnosis, treatment recommendations, and follow-up plan.] We can continue the conversation next week. How does this time next Monday work for you?”

True

False

1 points  

Question 50

1. A PMHNP’s patients have already signed confidentiality agreements, including limits that will be imposed on confidentiality. Months later, the state’s laws have changed that affect confidentiality promises the PMHNP has already made. What is an appropriate step for the PMHNP to take after finding out this information?

1 points  

Question 51

1. A 65-year-old patient has suffered the loss of his wife. He is in a state of hyperarousal with increased sympathetic nervous system arousal. One or more interventions may help the patient to deal with this arousal. To decrease sympathetic nervous system arousal, the PMHNP’s treatment strategy is ___________.

1 points  

Question 52

1. A PMHNP is treating a 50-year-old patient who suffers from depression. When he was growing up, he was often responsible for taking care of his three younger siblings. Since then, the patient puts other people’s needs before his own. Based on this information, the PMHNP would conclude that his interpersonal style is __________.

1 points  

Question 53

1. The PMHNP meets with an adolescent patient who has depression and often presents with resistance when discussing his parent’s divorce. For the past couple of sessions, the patient has been quiet, sometimes refusing to speak. To further support the therapeutic relationship, the PMNHP:

1 points  

Question 54

1. The PMHNP has a session with a patient who was injured and traumatized from an explosion at the industrial plant where he used to work. During the session, an outside noise startles the patient and he experiences a flashback of the loud boom from the explosion. The PMHNP witnesses the patient present with anxiety and belabored breathing. What is the appropriate action of the PMHNP?

1 points  

Question 55

1. In your office, you see a 58-year-old patient with PTSD who reports having nightmares, making it impossible for her to sleep Psychiatric Nursing. What recommendations based on principles of sleep hygiene will the PMHNP make?

1 points  

Question 56

1. A 35-year-old patient has been seeking treatment for depression for several months. The PMHNP does an assessment to see if processing has led to adaptive change. The patient’s self-references are positive in relation to past events, work is productive, relationships are adaptive, and there is congruence between behavior, thoughts, and affect. Based on this information, the PMHNP decides the patient ____________.

1 points  

Question 57

1. The PMHNP is working with a patient who is living in poverty and abusing substances. According to the treatment hierarchy framework, what needs does the PMHNP need to attend to first?

1 points  

Question 58

1. Your patient is a 65-year-old male who has a strained relationship with his son and daughter. His children refuse to participate in a family session. The PMHNP asks the patient to draw his family genogram as a next step to _______________.

1 points  

Question 59

1. During cognitive behavioral therapy (CBT), a 64-year-old male patient, states, “My wife hates me! She’s just waiting for me to die.” Using Socratic dialogue (SD) the PMHNP demonstrates understanding of analysis when she responds:

1 points  

Question 60

1. The PMHNP is working with a patient who has insomnia and battles going to sleep. The patient reports consistent self-defeating behaviors, and hates trying to go to sleep. Which action made by the PMHNP demonstrates the use of a paradoxical intervention?

1 points  

Question 61

1. The PMHNP is working with a patient who seems dissatisfied with the therapeutic relationship. The PMHNP invites the patient to discuss her feelings regarding the PMHNP openly and honestly. It becomes clear to the PMHNP that they are experiencing an alliance rupture. How does the PMHNP repair the therapeutic alliance?

1 points  

Question 62

1. The patient attempts the PMHNP’s sleep hygiene recommendations for 2 weeks, but does not make any progress mitigating nightmares and hyperarousal. Which behavioral strategy does the PMHNP suggest next?

1 points  

Question 63

1. A PMHNP is taking a history and wants to assess how the patient copes with adversity. To do so, the therapist asks questions about the patient’s belief system. What would be an appropriate question to ask?

1 points  

Question 64

1. An 11-year-old patient has been exhibiting low self-esteem at school and acting out. According to Maslow’s hierarchy of needs, which of the following questions would best be addressed first by the PMHNP?

1 points  

Question 65

1. The PMHNP is treating a 35-year-old male officer in the military. He discloses that both of his parents are deceased and that he loved them. However, he says that he had feelings of inadequacy because his parents held him to a standard that he could never achieve. He went on to say that nothing he did ever felt good enough. The PMHNP assesses that this patient has perfect creases in his uniform with no strings or tags out of place; she also notices that he has perfect posture and questions him about ritualistic behaviors. She suspects that this patient has maladaptive responses to the expectations placed on him as a teenager and young adult. Which statements made by the patient would verify the PMHNP’s suspicion? Psychiatric Nursing

1 points  

Question 66

1. The PMHNP is caring for a patient who seems to seek affection and attention from the PMHNP and others in the clinic, as well as displays heightened emotional responses to feelings of being excluded. What therapeutic approach does the PMHNP use to decrease autonomic arousal in the patient?

1 points  

Question 67

1. The PMHNP is caring for a patient with dissociated self-state that the PMHNP identifies as being associated with traumatic experiences in the patient’s past. What approach does the PMHNP use with the patient that is crucial to the psychodynamic therapy process?

1 points  

Question 68

1. The PMHNP understands that anxiety and depression are two disorders in which their symptoms may overlap. When discussing this, you explain that the autonomic nervous system is activated and further helps distinguish anxiety symptoms by making the following points:

1 points  

Question 69

1. The PMHNP is working with a patient who has dissociative disorder and requests pharmacological interventions for dealing with her trauma. What education does the PMHNP provide to the patient regarding medication therapy?

1 points  

Question 70

1. When a PMHNP is seeing a patient for the first time, what is an important step to assure that the patient and provider understand the limits of their discussion?

1 points  

Question 71

1. During a clinical assessment of a 15-year-old patient, the PMHNP asks, “How can I help you?” The patient answers by saying, “Honestly, I don’t really think I need any help.” Which of the following is the most appropriate response by the PMHNP?

1 points  

Question 72

1. You are seeing a 29-year-old widow whose husband recently died overseas while serving his country in the military. She has been mourning the loss of her husband for several months, and continues to grieve. She refuses to go to group grieving sessions, but reports that she is still able to go to work and her fitness classes sometimes, and even makes attempts to stay social. She says, “Sometimes it’s like he’s not even gone. Other times it feels like it’s been an eternity since I’ve seen him. It’s hard to talk about this type of stuff with my girlfriends, especially since all of their husbands are still alive.” The PMHNP understands that it is appropriate to employ which therapeutic principle?

1 points  

Question 73

1. When the patient comes into the office, she says, “I just saw a friend of mine out in the waiting room. What’s wrong with him?” The PMHNP says, “He’ll be fine. He has mild depression.” Which of the following statement is correct related to confidentiality rights?

1 points  

Question 74

1. The PMHNP is working with a school-aged child who has been diagnosed with depression. The child has attended several sessions with the PMNHP, but recently presents with avoidant behavior by showing increased distress and being late to sessions. What approach does the PMHNP need to employ with the child to continue making therapeutic progress?

1 points  

Question 75

1. A 24-year-old female patient presents for her initial appointment with the PMHNP. Which action will the PMHNP take to establish therapeutic alliance? Psychiatric Nursing

Due at 12PM CST, Monday, November 6, 2017

HCA 340 500

Discussion Board Assignment #10

Chapters12—Research:  How Health Care Advances and 13–Future of Health Care

Answer the following questions on Research: How Health Care Advances:

1.            Definitions of the quality of medical care are no longer left to clinicians who decide for themselves what technical performance constitutes “good care.”  Name one (1) other dimension of quality care and why is it important? 
2.            What is the primary method of continuous quality improvement (CQI) in health care, and what is its underlying premise?
3.            Since an ever-increasing amount of research is funded by commercial companies, what is your opinion on a requirement for authors of scientific studies who receive income from these companies to disclose funding sources in their scientific publications?

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Future of Health Care Questions:

1.            Today’s not-for-profit hospitals and health systems are commonly multi-billion dollar tax-exempt organizations. What is your position on the new federal scrutiny upon, and reporting requirements for justifying the charitable missions of not-for-profit hospitals and health systems?
2.            In 1999, the Institute of medicine report, To Err is Human,generated a brief flurry of concerns about avoidable hospital deaths.  While progress has been made in addressing system errors and deficiencies, it remains inconsistent across the nation’s hospitals.  Fourteen years after this report, is it time for the professions, payers and the public to demand corrections of system problems in an accountable, transparent and publicly disclosed manner?  What form can or should these demands take?

Mr.Williams, a 62-year-old patient, presents for a physical examination. You suspect a vitamin D deficiency. Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency? 

Question

Question 1

Mr.Williams, a 62-year-old patient, presents for a physical examination. You suspect a vitamin D deficiency. Which of the following assessment findings might lead the examiner to suspect vitamin D deficiency? 

a. Spinal curvature and bowed legs

b. Night blindness and dry eyes

c. Neuropathy and seizures

d. Nausea and insomnia

Question 2

A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that contains mostly: 

a.fruit and vegetables.

b.lean meat and fish.

c.sandwiches and diet drinks.

d.pasta and chicken.

e.cereal and breads.

Question 3

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

a. glycogen storage in the liver.
b. normal growth and development.
c. myocardial cell function.
d. building and maintaining tissues.

Question 4

Monitoring a patient’s waist-to-hip ratio provides data concerning: 

a. daily caloric requirements.
b. lung capacity.
c. stomach cancer risk.
d. cardiovascular disease risk.

Question 5

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

a. Vitamin A
b. Vitamin E
c. Vitamin D
d. Vitamin K

Question 6

A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she: 

a. binges and vomits.
b. has regular menstrual periods.
c. has constipation frequently.
d. is cold intolerant.

Question 7

Mr.Miles is a 45-year-old man who is being evaluated for obesity. Advising Mr.Miles to reduce which macronutrient will produce the greatest calorie reduction per gram? 

a. Carbohydrate
b. Protein
c. Fat
d. All provide the same number of calories per gram.

Question 8

Macronutrients are so named because they: 

a. have high molecular weights.
b. form long chemical chains.
c. tend to increase waist measurements.
d. are required in large amounts. 

Question 9

Bulging of an amber tympanic membrane without mobility is usually associated with: 

a. middle ear effusion.
b. healed tympanic membrane perforation.
c. impacted cerumen in the canal.
d. repeated and prolonged crying cycles.

Question 10

An infant’s auditory canal, compared with an adult’s, is: 

a. short, narrow, and straight.
b. short and curved upward.
c. long, narrow, and curved forward.
d. short and curved downward.

Question 11

An ear auricle with a low-set or unusual angle may indicate chromosomal aberration or: 

a. digestive disorders.
b. skeletal anomalies.
c. renal disorders.
d. heart defects.

Question 12

A 6-month-old who can hear well can be expected to: 

a. exhibit the Moro reflex.
b. stop breathing in response to sudden noise.
c. turn his or her head toward the source of sound.
d. imitate simple words.

Question 13

A hairy tongue with yellowish brown to black elongated papillae on the dorsum: 

a. is indicative of oral cancer.
b. is sometimes seen following antibiotic therapy.
c. usually indicates vitamin deficiency.
d. usually indicates anemia.

Question 14

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

a. sphenoid and frontal sinuses.
b. maxillary and frontal sinuses.
c. maxillary sinuses only.
d. sphenoid sinuses only.

Question 15

A smooth red tongue with a slick appearance may indicate: 

a. niacin or vitamin B12 deficiency.
b. oral cancer.
c. recent use of antibiotics.
d. fungal infection.

Question 16

A newborn whose serum bilirubin level is greater than 20 mg/100 mL has a risk of later: 

a. hearing loss.
b. sinusitis.
c. tooth decay.
d. meningitis.

Question 17

A clinical syndrome of failing memory and impairment of other intellectual functions, usually related to obvious structural diseases of the brain, describes: 

a. delirium.
b. dementia.
c. depression.
d. anxiety.

Question 18

Flight of ideas or loosening of associations is associated with: 

a. aphasia.
b. dysphonia.
c. multiple sclerosis.
d. psychiatric disorders.

Question 19

An older adult is administered the Set Test and scores a 14. The nurse interprets this score as indicative of: 

a. depression.
b. cognitive impairment.
c. delirium.
d. dementia.

Question 20

Assessing orientation to person, place, and time helps determine: 

a. ability to understand analogies.
b. abstract reasoning.
c. attention span.
d. state of consciousness.

Question 21

Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for the assessment of: 

a. mood and feelings.
b. attention span.
c. thought process and content.
d. abstract reasoning.

Question 22

A 69-year-old truck driver presents with a sudden loss of the ability to understand spoken language. This indicates a lesion in the: 

a. temporal lobe.
b. Broca area.
c. frontal cortex.
d. cerebellum.

Question 23

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

a. attention-deficit/hyperactivity disorder.
b. autism.
c. dementia.
d. mental retardation.

Question 24

Facial muscle or tongue weakness may result in: 

a. aphasia.
b. impaired comprehension.
c. neologisms.
d. echolalia.

Question 25

Adolescents most likely to smoke, abuse substances, perform poorly in school, and be depressed are those who are: 

a. from dual-income families.
b. from families that emphasize strong reli-gious beliefs.
c. from deprived socioeconomic groups.
d. unsupervised after school.

Question 26

An aspect of traditional Western medicine that may be troublesome to many Hispanics, Native Americans, Asians, and Arabs is Western medicine’s attempts to: 

a. use a holistic approach that views a par-ticular medical problem as part of a bigger picture.
b. determine a specific cause for every prob-lem in a precise way.
c. establish harmony between a person and the entire cosmos.
d. restore balance in an individual’s life.

Question 27

An image of any group that rejects its potential for originality or individuality is known as a(n): 

a. acculturation.
b. norm.
c. stereotype.
d. ethnos.

Question 28

A 22-year-old female nurse is interviewing an 86-year-old male patient. The patient avoids eye contact and answers questions only by saying, “Yeah,” “No,”or “I guess so.” Which of the following is appropriate for the interviewer to say or ask? 

a.“Why are you so depressed?”

b.“It’s hard for me to gather useful information because your answers are so short.”

c.“Are you uncomfortable talking with me?”

d.“Does your religion make it hard for you to answer my questions?”

Question 29

An example of a cold food is: 

a. chocolate.

b. hard liquor.

c. oil.

d. onions.

e. a dairy product

Question 30

An example of a cold condition would be: 

a. a fever.
b. a rash.
c. tuberculosis.
d. an ulcer.

Question 31

As the health care provider, you are informing a patient that he or she has a terminal illness. This discussion is most likely to be discouraged in which cultural group? 

a. Navajo Native Americans
b. Dominant Americans
c. First-generation African descendants
d. First-generation European descendants

Question 32

A flat, nonpalpable lesion is described as a macule if the diameter is: 

a. larger than 1 cm.
b. smaller than 1 cm.
c. 3 cm exactly.
d. too irregular to measure.

Question 33

A 17-year-old student complains of a “rash for 3 days.” You note pale, erythematous oval plaques over the trunk. They have fine scales and are arranged in a fernlike pattern, with parallel alignment. What is the nurse’s next action? 

a. Teach infectious control measures.
b. Inquire about another recent skin lesion.
c. Inspect the palms and the soles.
d. Inform the patient that this will resolve within a week.

Question 34

A 5-year-old child presents with discrete vesicles on an erythematous base (dew drops on a rose petal appearance) that began near her scalp and are spreading to the trunk. The child has a low-grade fever and feels tired. What is the nurse’s next action? 

a. Teach infectious control measures.
b. Inquire about other patterns of physical abuse.
c. Inspect the buccal mucosa for Koplik spots.
d. Inform the parent that this will resolve within a couple of days.

Question 35

Age spots are also called: 

a. seborrheic keratoses.
b. solar lentigines.
c. cutaneous horns.
d. acrochordon.

Question 36

A single transverse line seen in the palm of a small child may imply: 

a. Down syndrome.
b. Turner syndrome.
c. systemic sclerosis.
d. profound dehydration.

Question 37

A 29-year-old white woman appears jaundiced. Liver disease as a cause has been excluded. What history questions should the nurse ask? 

a. Whether she had unprotected sex
b. Whether she has a history of diabetes mellitus
c. Whether she had unusual bleeding prob-lems
d. Whether she eats a lot of yellow and orange vegetables

Question 38

A slightly elevated brownish papule with indistinct borders is a typical characteristic of a(n) _____ nevus. 

Compound 

Question 39

A Dennie-Morgan fold is probably caused by: 

a. birth trauma.
b. high fever.
c. excess adipose tissue.
d. chronic rubbing.

Question 40

A cause for alarm during chest assessment of a newborn is: 

a. crackles.
b. rhonchi.
c. gurgles from the gastrointestinal tract.
d. stridor.

Question 41

A pregnant woman is expected to develop: 

a. tachypnea and decreased tidal volume.
b. deep breathing but not more frequent breathing.
c. dyspnea and increased functional residual capacity.
d. bradypnea and increased tidal volume.

Question 42

A musical squeaking noise heard on auscultation of the lungs is called: 

a. a friction rub.
b. rales.
c. rhonchi.
d. wheezing.

Question 43

A 44-year-old male patient who complains of a cough has presented to the emergency department. He admits to smoking one pack per day. During your inspection of his chest, the most appropriate lighting source to highlight chest movement is: 

a. bright tangential lighting.

b. daylight from a window.

c. flashlight in a dark room.

d. fluorescent ceiling lights

Question 44

A 29-year-old patient presents with a new complaint of productive cough, with purulent sputum. He also complains of right lower quadrant abdominal pain. You suspect pneumonia in which lobe? 

a. Right lower
b. Right upper
c. Left upper
d. Left lower

Question 45

Bone spicule pigmentation is a hallmark of: 

a. chorioretinal pigmentosa.
b. cytomegalovirus infection.
c. lipemia retinalis.
d. retinitis pigmentosa.

Question 46

A pterygium is more common in people heavily exposed to: 

a. high altitudes.
b. tuberculosis.
c. ultraviolet light.
d. cigarette smoke.

Question 47

A condition that typically develops by the age of 45 years is: 

a. presbyopia.
b. hyperopia.
c. myopia.
d. astigmatism.

Question 48

An increased level of lysozyme in the tears will occur normally during which life stage? 

a. Adolescence
b. Childhood
c. Infancy
d. Pregnancy

Question 49

Ask the patient to look directly at the light of the ophthalmoscope when you are ready to examine the: 

a. retina.
b. optic disc.
c. retinal vessels.
d. macula.

ORDER A FREE-PLAGIARISM PAPER HERE

Question 50

Changes seen in proliferative diabetic retinopathy are the result of: 

a. anoxic stimulation.
b. macular damage.
c. papilledema.
d. minute hemorrhages.

Question 51

A condition in which the eyelids do not completely meet to cover the globe is called: 

a. glaucoma.
b. lagophthalmos.
c. exophthalmos.
d. hordeolum.

Question 52

An abnormal growth of conjunctiva extending over the cornea from the limbus is known as: 

a. a cataract.
b. erythematous.
c. glaucoma.
d. a pterygium.

Question 53

A 36-year-old woman complains that she has had crushing chest pain for the past 2 days. She seems nervous as she speaks to you. An appropriate response is to: 

a. continue to collect information regarding the chief complaint in an unhurried man-ner.
b. finish the interview as rapidly as possible.
c. ask the patient to take a deep breath and calm down.
d. ask the patient if she wants to wait until another day to talk to you.

Question 54

Constitutional symptoms in the ROS refer to: 

a. height, weight, and body mass index.
b. fever, chills, fatigue, and malaise.
c. hearing loss, tinnitus, and diplopia.
d. rashes, skin turgor, and temperature.

Question 55

A tool used to screen adolescents for alcoholism is the: 

a. CAGE.
b. CRAFFT.
c. PACES.
d. HITS.

Question 56

A guideline for history taking is for caregivers to: 

a. ask direct questions before open-ended questions so that data move from simple to complex.
b. ask for a complete history at once so that data are not forgotten between meetings.
c. make notes sparingly so that the patient can be observed during the history taking.
d. write detailed information as stated by patients so that their priorities are reflect-ed.

Question 57

A pedigree diagram is drafted for the purpose of obtaining: 

a. sexual orientation and history.
b. growth and developmental status.
c. genetic and familial health problems.
d. ethnic and cultural backgrounds.

Question 58

A brief statement of the reason the patient is seeking health care is called the: 

a. medical history.
b. chief complaint.
c. assessment.
d. diagnosis.

Question 59

Behaviors that diffuse anxiety during the interview include: 

a. avoiding wearing uniforms or laboratory coats.
b. providing forthright answers to questions.
c. providing all necessary information before the patient has to ask for it.
d. completing the interview as quickly as possible.

Question 60

After you ask a patient about her family history, she says, “Tell me about your family now.” Which response is generally most appropriate? 

a. Ignore the patient’s comment and contin-ue with the interview.
b. Give a brief, undetailed answer.
c. Ask the patient why she needs to know.
d. Tell the patient that you do not discuss your family with patients.

Question 61

If only two blood pressure values are recorded, they are the _______________ sounds. blank(s) with correct word

first systolic and second diastolic

Question 62

A normal adult’s pulse pressure should range from _____ to _____ mm Hg.  Fill in the blank(s) with correct word

30; 40

Question 63

Body language that leads you to suspect that a person is in pain is: 

a. talkative, verbose speech.
b. fretful hand movements.
c. focused, fixed eye stares.
d. marked salivation.

Question 64

During respiration, the internal intercostals: 

a. increase the force of muscular contraction.
b. decrease the lateral diameter during expi-ration.
c. decrease the intrathoracic space.
d. increase elastic recoil during expiration.

Question 65

Hypertension in the adult is generally defined as pressure in excess of: 

a. 120 mm Hg plus the patient’s age.
b. 140 mm Hg.
c. 160 mm Hg.
d. 200 mm Hg.

Question 66

If a sufficiently large cuff is unavailable to fit an obese arm, which technique may be used to assess blood pressure? 

a. Wrap a standard cuff around the deltoid area and place the stethoscope over the radial artery.
b. Wrap a standard cuff around the forearm and place the stethoscope over the radial artery.
c. Wrap a standard cuff around the thigh and place the stethoscope on the dorsalis pedis.
d. Wrap a pediatric cuff around the ankle and place the stethoscope on the popliteal artery.

Question 67

In a syndrome in which regional pain extends beyond this specific peripheral nerve injury, you would notice which of the following: (Select all that apply.) 

a. Allodynia
b. Sleep disturbance
c. Blood flow changes
d. Numbness
e. Edema

Question 68

A blood pressure cuff bladder should be long enough to: 

a. cover 20% to 25% of the arm circumfe-rence.
b. cover 45% to 50% of the arm circumfe-rence.
c. cover 75% to 80% of the arm circumfe-rence.
d. completely encircle the arm.

Question 69

A variant of the percussion hammer is the neurologic hammer, which is equipped with which of the following? 

a. Brush and needle
b. Tuning fork and cotton swab
c. Penlight and goniometer
d. Ruler and bell

Question 70

Auscultation should be carried out last, except when examining the: 

a. neck area.
b. heart.
c. lungs.
d. abdomen.

Question 71

A rubber or plastic ring should be around the bell endpiece of a stethoscope to: 

a. prevent the transmission of static electric-ity.
b. prevent cold metal from touching the pa-tient.
c. prevent the sharp edge of the stethoscope from damaging the patient’s skin.
d. ensure secure contact with the body sur-face.

Question 72

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

a. healthy lung tissue.
b. emphysemic lungs.
c. the liver.
d. most of the abdomen.

Question 73

According to the guidelines for Standard Precautions, the caregiver’s hands should be washed: 

a. only after touching body fluids with un-gloved hands and between patient con-tacts.
b. only after touching blood products with ungloved hands and after caring for infec-tious patients.
c. only after working with patients who are thought to be infectious.
d. after touching any body fluids or conta-minated items, regardless of whether gloves are worn.

Question 74

During auscultation, you can limit your perceptual field best by: 

a. asking patients to describe their symp-toms.
b. closing your eyes.
c. performing auscultation before percussion.
d. using an aneroid manometer.

Question 75

A patient in the emergency department has a concussion. You suspect the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient? 

a. Grid
b. Red-free filter
c. Slit lamp
d. Small aperture

Question 76

A scale used to assess patients’ weight should be calibrated: 

a. only by the manufacturer.
b. by a qualified technician at regularly scheduled intervals.
c. each time it is used.
d. when necessary, with the patient standing on the scale.

Question 77

At what age does peak height growth velocity occur in boys? 

a. 10 years
b. 12 years
c. years
d. years

Question 78

An 11-year-old boy is brought in for an annual physical examination by his mother.You suspect _______________ when you measure his arm span at 65 inches and his height at 60 inches. Fill in the blank(s) with correct word

Marfan syndrome

Question 79

A pregnant woman of normal prepregnancy weight should be expected to gain how much weight per week during the second and third trimesters of pregnancy? 

a. 1 pound
b. pounds
c. 2 pounds
d. pounds

Question 80

A prominent forehead, large nose, large jaw, and elongation of the facial bones and extremities are signs of: 

a. infantile hydrocephalus.
b. acromegaly.
c. Cushing syndrome.
d. achondroplasia.

Question 81

A marker for nutritional status is the: 

a. head circumference.
b. waist-to-hip ratio.
c. standing height.
d. triceps skinfold thickness.

Question 82

A woman with a normal prepregnancy body mass index (BMI) should gain approximately _____ pounds during pregnancy. Fill in the blank(s) with correct word

30

Question 83

After 50 years of age, stature: 

a. becomes fixed.
b. begins a barely perceptible secondary in-crease.
c. increases at a rate of 0.5 cm/ year.
d. declines.

Question 84

A Mexican American mother brings her 12-year-old daughter to the clinic because this child is not maturing as quickly as her classmates. You examine the daughter and determine that her growth and physical findings are within normal limits. You should explain to the family that: 

a. Mexican Americans may develop more slowly than other ethnic groups.
b. more tests should be conducted because the family appears so worried.
c. the daughter should drink more juices and eat more fruit.
d. there is a serious problem with the daugh-ter’s development.

Question 85

A 29-year-old woman presents to the urgent care center with a history of a severe headache of 2 hours’ duration. She describes it as bandlike and constricting.In interviewing the woman about her complaint, you would ask: 

a. whether she has experienced increased tearfulness.
b. the date of her last menstrual period.
c. whether these headaches started in child-hood.
d. whether she is particularly stressed or overworked.

Question 86

An inconsequential finding on the head of an adult is a palpable: 

a. embryonic remnant.
b. posterior fontanel.
c. sagittal suture ridge.
d. skull indentation.

Question 87

Closure of the anterior skull fontanel should occur by ______________.  Fill in the blank(s) with correct word

24 months of age

Question 88

During a head and neck assessment of a neonate, it is important to screen for: 

a. the presence of torticollis.
b. signs and symptoms of cerebral palsy.
c. uneven movement of the eyes.
d. unilateral movement of the tongue.

Question 89

A stethoscope is used in a head and neck examination to assess: 

a. intracranial fluid.
b. pulsating fontanels.
c. skull bone development.
d. thyroid vascular sounds.

Question 90

During a 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: 

a. ask the patient if this characteristic runs in his family.
b. perform monofilament testing on the face.
c. consult with the physician regarding the laboratory tests needed.
d. record the finding in the patient’s chart.

Question 91

A bruit, or blowing sound, over the skull or temporal region of an adult indicates a: 

a. degenerative change.
b. hyperthyroid storm.
c. skull fracture.
d. vascular anomaly.

Question 92

Coarse, dry, and brittle hair is associated with which metabolic disorder? 

a. Hypothyroidism
b. Diabetes mellitus
c. Addison disease
d. Cushing syndrome

Question 93

A red streak that follows the course of the lymphatic collecting duct is a finding associated with: 

a. Hodgkin disease.
b. lymphangitis.
c. lymphedema.
d. lymphoma.

Question 94

As adults age, their ability to resist infection is reduced because of the lymphatic nodes becoming more: 

a. fibrotic.
b. mucoid.
c. porous.
d. profuse.

Question 95

Equipment for examining the lymphatic system includes a: 

a. caliper.
b. centimeter ruler.
c. goniometer.
d. syringe and needle.

Question 96

Cells that line the lymph node sinuses perform the specific function of: 

a. fat absorption.
b. fetal immunization.
c. hematopoiesis.
d. phagocytosis.

Question 97

An organ that is essential to the development of protective immune function in the infant but has little or no demonstrated function in the adult is the: 

a. spleen.
b. liver.
c. thymus.
d. pancreas.

Question 98

A congenital defect in the immune system of a 2-week-old infant may be suspected if: 

a. there are small femoral nodes palpable.
b. the umbilical cord has not yet dropped off.
c. the tonsils are visible.
d. the thymus is visible on a chest radio-graph.

Question 99

Hodgkin disease is most common in ______________________. Fill in the blank(s) with correct word

late adolescence and young adulthood

Question 100

Enlarged inguinal nodes are likely to be associated with: 

a. genital herpes.
b. pelvic inflammatory disease.
c. uterine cancer.
d. testicular cancer.

First Steps on Becoming a Grassroots Lobbyist/Advocate for Health Care Policy  

This assignment has two parts, numbered below. Write each question as a new topic area, then follow with a paragraph or two to answer the question. You may find it necessary to search for answers to the questions outside of the assigned reading. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources.  

Tasks: 

1.Imagine that you are going to make a visit to your representative in Congress. Develop a one-page document that supports your position on the AHCA that you would leave with your representative or his or her aide when you make your visit. This one-pager, also called a “leave behind,” should state your position clearly in bullet points and give your reasons why your position is preferred. This “leave behind” should have 1 inch margins and utilize 14-point font throughout. If you were making this visit in person, you would present your “leave behind” to the person with whom you speak during your visit. Include a second page that describes your rationale for the position in your “leave behind” page supported by at least two journal articles.

ORDER A FREE-PLAGIARISM PAPER HERE

2.Write a two-page brief to describe the scenario surrounding your legislative visit. Understanding the political affiliation of your representative, include answers to the following: 

•Was your member in support or in opposition to the AHCA? 

•State three points that you would cover in support or opposition to your representative’s position. 

•How does your nursing experience influence the advocacy position that you take on the AHCA?