Details: This should be a NURSING problem 

Write a paper of 500-750 words (not including the title page and reference page) on your proposed problem description for your EBP project. The paper should address the following:

1. Describe the background of the problem. Tell the story of the issue and why it deserves attention.
2. Identify the stakeholders/change agents. Who or what organizations are concerned about, may benefit from, or are affected by this proposal. List the interested parties, patients, students, agencies, Joint Commission, etc.
3. Provide the PICOT question. (PICOT: Population-Intervention-Comparison-Outcome-Timeframe). Make sure that the question fits with your graduate degree specialization.
4. State the purpose and project objectives in specific, realistic, and measurable terms. The objective should address what is to be gained. This is a restatement of the question, providing focus. Measurements need to be taken before and after the evidence-based practice is introduced to identify the expected changes.
5. Provide supportive rationale that the problem or issue is an important one for nursing to resolve using relevant professional literature sources.

Develop an initial reference list to ensure that there is adequate literature to support your evidence-based practice project. Follow the “Steps to an Efficient Search to Answer a Clinical Question” box in chapter 3 of the textbook. Refer to the “Search Method Example” as the format in which to compile this data.

1. The majority of references should be research articles. However, national sources such as Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Department of Health and Human Resources (HHS), or the Agency for Healthcare Research and Quality (AHRQ) and others may be used when you are gathering statistics to provide the rationale for the problem.
2. Once you get into the literature, you may find there is very little research to support your topic and you will have to start all over again. Remember, in order for this to be an evidence-based project, you must have enough evidence to introduce this as a practice change. If you find that you do not have enough supporting evidence to change a practice, then further research would need to be conducted. 

Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required for the individual sections, but is required for the final paper.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center. 

Upon receiving feedback from the instructor, refine Section A for your final paper submission.

Before the digital revolution, health information technology supplied very limited support for evidence-based practice. If nurses wanted to be informed about cutting-edge research, their best bet was to either subscribe to leading journals or make periodic trips to the library. With the establishment of research databases, however, nurses became empowered to learn about and facilitate interdisciplinary and translational research. Databases are just one example of how health information technology supports evidence-based practice.

To prepare:







Read the following scenario from the text (McGonigle & Mastrian, 2012, p. 482):



Twelve-hour shifts are problematic for patient and nurse safety, and yet hospitals continue to keep the 12-hour shift schedule. In 2004, the Institute of Medicine (Board on Health Care Services & Institute of Medicine, 2004) published a report that referred to studies as early as 1988 that discussed the negative effects of rotating shifts on intervention accuracy. Workers with 12-hour shifts realized more fatigue than workers on 8-hour shifts. In another study done in Turkey by Ilhan, Durukan, Aras, Turkcuoglu, and Aygun (2006), factors relating to increased risk for injury were age of 24 or less, less than 4 years of nursing experience, working in the surgical intensive care units, and working for more than 8 hours.







Consider how the resources identified in the scenario above could influence an organization’s practice.







Select an issue in your practice that is of concern to you (my area of practice area of concern is the nursing shortage, we often have to work short in my hospital which creates many issues). Using health information technology, locate at least three evidence-based practice resources that address your concern and that could possibly inform further action.







post a description of your practice concern. Outline how you used health information technology to locate evidence-based practices that address this concern. Cite and include insights from the resources. Analyze how health information technology supports evidence-based practice.

Required Resources





Readings

• McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning. 
  • Chapter 26, “Nursing Research: Data Collection, Processing, and Analysis”
    
    
    
    The authors of this chapter relate nursing research to the foundation of knowledge model. The chapter assesses informatics tools for collecting data, storing information, and processing and analyzing data. 
  • Chapter 27, “Translational Research: Generating Evidence for Practice”
    
    
    
    In this chapter, the authors differentiate evidence-based practice and translation research. They also describe models used to introduce research findings intro practice.
• Hynes, D. M., Weddle, T., Smith, N., Whittier, E., Atkins, D., & Francis, J. (2010). Use of health information technology to advance evidence-based care: Lessons from the VA QUERI program. Journal of General Internal Medicine, 25(Suppl. 1), S44–S49. 
  
  Retrieved from the Walden Library databases. 
  
  
  
  This article presents a study that evaluated the role of health information technology (HIT) in the Department of Veteran Affairs’ Quality Enhancement Research Initiative. The authors convey their findings on how HIT provided data and information to aid implementation research, and how implementation research helped further HIT development. Additionally, the text details methods of overcoming common HIT barriers to implementation research. 
• Jamal, A., McKenzie, K., & Clark, M. (2009). The impact of health information technology on the quality of medical and health care: A systematic review. Health Information Management Journal, 38(3), 26–37. 
  
  Retrieved from the Walden Library databases. 
  
  
  
  This text details a study that reviews the published evidence concerning the impact of health information technology (HIT) on the quality of health care. The study investigated the use of HIT in medical care and allied health and preventive services. The authors primarily focus on the impact of electronic health records, computerized provider order-entry, and decision support systems.
• Umscheid, C. A., Williams, K., & Brennan, P. (2010). Hospital-based comparative effectiveness centers: Translating research into practice to improve the quality, safety and value of patient care. JGIM: Journal of General Internal Medicine, 25(12), 1,352–1,355. 
  
  Retrieved from the Walden Library databases.
  
  
  
  This article revolves around the usage of the hospital-based comparative effectiveness (CE) center model. The authors highlight the model’s benefits and the increasing usage of CE evidence. The article also reviews solutions to overcoming many of the challenges to operating hospital-based CE centers.  APA format1 1/2  to 2 pages

Application: Using Microsoft Project

Starting a project without a plan is like going on a road trip without any directions. You may progress along the way, but you might not end up at your desired destination. A project plan provides basic information that guides the execution and control of the project. At its most fundamental level, a project plan will describe the “who, what, when, and why” of a project. Microsoft Project is one of the most widely used project planning tools. The ability to understand and create project plans in Microsoft Project enables a project manager to effectively plan and manage project implementations.

In this Assignment, you generate a project plan using Microsoft Project.

To prepare:

• Review the information in this week’s Learning Resources on using Microsoft Project.
• Consider how to efficiently schedule tasks in a project plan.
• Think about how you should sequence tasks that have dependencies.

To complete this Assignment, you will create a Microsoft Project plan for a patient information management system. The primary deliverable for the plan is the patient information management system itself, but it is comprised of many modules. Include the following tasks, subtasks, and timeframes:

1) Create the Admission, Discharge, and Transfer Module (requires subtask I, configuration period: 25 days, training period: 10 days) 

2) Subtask I: Create the Patient Registration Module (requires subtask II, configuration period: 4 days, training period: 4 days)

3) Subtask II: Create the Master Patient Index (configuration period: 4 days)

4) Subtask III: Create the Patient Scheduling Module (requires subtask II, configuration period: 7 days, training period: 15 days)

Required Readings

Biafore, B. (2010). Microsoft Project 2010: The missing manual. Sebastopol, CA: O’Reilly.

• Chapter 2, “Planning a Project” (pp. 39–57)

 This chapter supplies a brief introduction on project planning. The chapter describes the contents of a project plan along with the process of creating relevant documents.

Coplan, S., & Masuda, D. (2011). Project management for healthcare information technology. New York, NY: McGraw-Hill.

• Chapter 5, “Change Management” (pp. 193–237)

 In this chapter, the authors review change management knowledge areas. The authors describe a variety of analysis methods applicable to change management processes and outputs.

Project Management Institute. (2013). A guide to the project management body of knowledge (PMBOK guide) (5th ed.). Newtown Square, PA: Author.

• Chapter 3, “Project Management Processes” (pp. 47–61)

 This chapter supplies information on managing a project that uses networked processes. The chapter describes project management processes related to each phase of a project.

Campbell, R. J. (2008). Change management in health care. The Health Care Manager, 27(1), 23–39. 

Retrieved from the Walden Library databases.

 In this article, the author highlights the work of two leaders in the field of change management. The author demonstrates how the work of these leaders can be applied to health care organizations.

Merrell, P. (2012). Effective change management: The simple truth. Management Services, 56(2), 20–23. 

Retrieved from the Walden Library databases.

 In this article, the author provides six steps for effective change management. The author also supplies supplementary information on the importance of learning activities, measuring success, and managing change management strategies.

Required Media

Laureate Education (Producer). (2013a). Establishing a team [Video file]. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 8 minutes.

 In this video, Dr. Mimi Hassett discusses important considerations when assembling a project team, such as who to include and whom to consult. She talks about how project size, goals, and timelines can impact those decisions, and she also offers examples of how to keep enthusiasm for a project moving forward as the challenges toward completion arise.

Schifalacqua, M., Costello, C., & Denman, W. (2009). Roadmap for planned change, part 1: Change leadership and project management. Nurse Leader, 7(2), 26–29. 

Retrieved from the Walden Library databases.

 In this article, the authors explore the essential elements of change theory and project management. The article details many tools and concepts that assist in managing and planning change at various scales.

Microsoft Corporation. (2012). Getting started: Introduction to project management. Retrieved from http://office.microsoft.com/en-us/project-help/getting-started-introduction-to-project-management-HA010359477.aspx?CTT=3

 Review this web page, which provides an overview of basic project management concepts. It also provides links to other pages which demonstrate how to apply the aforementioned concepts in Microsoft Project 2010.

DUE TUESDAY 01/10/2017 —> ADVANCE NURSING PRACTICE 1

Assignment 2: Case Study Analysis and Care Plan Creation

Click here (I COPIED AND PAST IT ON BELOW)  to download and analyze the case study for this week. Create a holistic care plan for disease prevention, health promotion, and acute care of the patient in the clinical case. Your care plan should be based on current evidence and nursing standards of care.

CASE STUDY

Week 2: Respiratory Clinical Case

Patient Setting:

65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily.  She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.

HPI

Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.

PMH

History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.

Past Surgical History

None

Family/Social History

Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF

Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.

Medication History

Theophylline SR Capsules 300 mg PO BID

Albuterol inhaler, PRN

Phenytoin SR capsules 300 mg PO QHS

HTCZ 50 mg PO BID

Enalapril 5 mg PO BID

Allergies

NKDA

ROS

Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.

Physical exam

BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”

VS after Albuterol breathing treatment – BP 134/79, HR 80, RR 18

Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.

Laboratory and Diagnostic Testing

Na – 134

K – 4.9

Cl – 100

BUN – 21

Cr – 1.2

Glu – 110

ALT – 24

AST – 27

Total Chol – 190

CBC – WNL

Theophylline – 6.2

Phenytoin – 17

Chest Xray – Blunting of the right and left costophrenic angles

Peak Flow – 75/min; after albuterol – 102/min

FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%

Visit the South University Online Library and research for current scholarly evidence (no older than 5 years) to support your nursing actions. In addition, consider visiting government sites such as the CDC, WHO, AHRQ, and Healthy People 2020. Provide a detailed scientific rationale justifying the inclusion of this evidence in your plan.

Next determine the ICD-10 classification (diagnoses). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) is the official system used in the United States to classify and assign codes to health conditions and related information.

Click here to access the codes.

https://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx?generalError=Thank+you+for+your+interest+in+the+Medicare+Coverage+Database.+You+may+only+view+the+page+you+attempted+to+access+via+normal+usage+of+the+Medicare+Coverage+Database.

I PUT IT AT THE END OF THIS POST

Click here to download the care plan template to help you design a holistic patient care plan. The care plan example provided here is meant only as a frame of reference for you to build your care plan. You are expected to develop a comprehensive care plan based on your assessment, diagnosis, and advanced nursing interventions. Reflect on what you have learned about care plans through independent research and peer discussions and incorporate the knowledge that you have gained into your patient’s care plan.

Format

Your care plan should be formatted as a Microsoft Word document. Follow the current APA edition style. Your paper should be 2 pages excluding the title page and references and in 12pt font.

Name your document: SU_NSG6001_W2_A2_LastName_FirstInitial.doc.

Submit your document to the W2 Assignment 2 Dropbox by Tuesday, January 10, 2017.

Assignment 2 Grading Criteria	Maximum Points
Subjective DataThe submission included the patient’s interpretation of current medical problem. It included chief complaint, history of present illness, current medications and reason prescribed, past medical history, family history, and review of systems.	15
Objective DataThe submission included measurements and observations obtained by the nurse practitioner. It included head to toe physical examination as well as laboratory and diagnostic testing results and interpretation (especially those that pertain to the diagnosis).	15
AssessmentThe submission included at least three priority diagnoses. Each diagnosis was supported by documentation in subjective and objective notes and free of essential omissions. All diagnoses were documented using acceptable terminologies and current ICD-10 codes.	15
Plan of CarePlan included diagnostic and therapeutic (pharmacologic and non-pharmacologic) management as well as education and counseling provided. The plan was supported by evidence/guidelines, and the follow-up plans were noted.	20
APAUsed APA standards consistently and accurately when citing in the SOAP note and reference page. Utilized proper format with coversheet and header.	10
Total	75

SAMPLE (OR TEMPLETE) FOR THE WORK

Title of Plan of Care

Name

South University Online

Faculty Name

NSG 6001

Date

**Please delete this statement and anything in italics prior to submission to shorten the length of your paper.

Patient Initials ______

Subjective Data: (Information the patient tells you regarding themselves: Biased Information):

Chief Compliant: (In patient’s exact words)

History of Present Illness: (Analysis of current problems in chronologic order using symptom analysis [onset, location, frequency, quality, quantity, aggravating/alleviating factors, associated symptoms and treatments tried]).

PMH/Medical/Surgical History: (Includes medications and why taking, allergies, other major medical problems, immunizations, injuries, hospitalizations, surgeries, psychiatric history, obstetric and history sexual history).

Significant Family History: (Includes family members and specific inheritable diseases).

Social History: (Includes home living situation, marital history, cultural background, health habits, lifestyle/recreation, religious practices, educational background, occupational history, financial security and family history of violence).

Review of Symptoms: (Review each body system –This section you should place POSITIVE for… information in the beginning then state Denies…). – General:; Integumentary:; Head:; Eyes:  ; ENT:; Cardiovascular:; Respiratory: ; Gastrointestinal:; Genitourinary:; Musculoskeletal:; Neurological:; Endocrine:; Hematologic:; Psychologic: .

Objective Data:

Vital Signs:  BP – ; P ; R ; T ; Wt. ; Ht. ; BMI .

Physical Assessment Findings: (Includes full head to toe review)  

HEENT:

Lymph Nodes:

Carotids:

Lungs:

Heart:

Abdomen:

Genital/Pelvic:

Rectum:

Extremities/Pulses:

Neurologic:

Laboratory and Diagnostic Test Results: (Include result and interpretation.)

Assessment: (Include at least 3 priority diagnosis with ICD-10 codes.  Please place in order of priority.)

Plan of Care: (Addressing each dx with diagnostic and therapeutic management as well as education and counseling provided).

References

Question

1. Osteopenia is diagnosed in a 55-year-old woman who has not had a period in 15 months. She has a positive family history of breast cancer. The primary care NP should recommend:

testosterone therapy.

estrogen-only therapy.

nonhormonal drugs for osteoporosis.

estrogen-progesterone therapy for 1 to 2 years.

Question 2. A patient takes a cardiac medication that has a very narrow therapeutic range. The primary care NP learns that the particular brand the patient is taking is no longer covered by the patient’s medical plan. The NP knows that the bioavailability of the drug varies from brand to brand. The NP should:

contact the insurance provider to explain why this particular formulation is necessary.

change the patient’s medication to a different drug class that doesn’t have these bioavailability variations.

accept the situation and monitor the patient closely for drug effects with each prescription refill.

ask the pharmaceutical company that makes the drug for samples so that the patient does not incur out-of-pocket expense.

Question 3. A patient brings written information about a medication to a primary care NP about a new drug called Prism and wants to know if the NP will prescribe it. The NP notes that the information is from an internet site called “Prism.com.” The NP should tell this patient that:

this information is probably from a drug advertisement website.

this is factual, evidence-based material with accurate information.

the information is from a nonprofit group that will not profit from drug sales.

internet information is unreliable because anyone can post information there.

Question 4. A primary care NP is reviewing written information about a newly prescribed medication with a patient. To evaluate this patient’s understanding of the information, the NP should ask the patient to:

read the information aloud.

describe how the medication will be taken.

write down questions about the medication.

tell the NP if the information is unclear.

Question 5. A patient is diagnosed with lupus and reports occasional use of herbal supplements. The primary care NP should caution this patient to avoid:

ginseng.

echinacea.

ginkgo biloba.

St. John’s wort.

Question 6. A patient who has chronic pain and who takes oxycodone (Percodan) calls the clinic to ask for a refill of the medication. The primary care NP notes that the medication refill is not due for 2 weeks. The patient tells the NP that the refill is needed because he is going out of town. The NP should:

fill the prescription and document the patient’s explanation of the reason.

review the patient’s chart to see if this is a one-time or repeat occurrence.

call the patient’s pharmacist and report suspicion of drug-seeking behaviors.

confront the patient about misuse of narcotics and refuse to fill the prescription.

Question 7. The primary care NP prescribes an extended-cycle monophasic pill regimen for a young woman who reports having multiple partners.Which statement by the patient indicates she understands the  regimen?

“I have to take a pill only every 3 months.”

“I should expect to have only four periods each year.”

“I will need to use condoms for only 7 more days.”

“This type of pill has fewer side effects than other types.”

Question 8. The primary care NP sees a patient covered by Medicaid, writes a prescription for a medication, and is informed by the pharmacist that the medication is “off-formulary.” The NP should:

inform the patient that an out-of-pocket expense will be necessary.

write the prescription for a generic drug if it meets the patient’s needs.

call the patient’s insurance provider to advocate for this particular drug.

contact the pharmaceutical company to see if medication samples are available.

Question 9. A 55-year-old woman has not had menstrual periods for 5 years and tells the primary care nurse practitioner (NP) that she is having increasingly frequent vasomotor symptoms. She has no family history or risk factors for coronary heart disease (CHD) or breast cancer but is concerned about these side effects of hormone therapy (HT). The NP should:

tell her that starting HT now may reduce her risk of breast cancer.

advise a short course of HT now that may decrease her risk for CHD.

tell her that HT will not help control her symptoms during postmenopause.

recommend herbal supplements for her symptoms to avoid HT side effects.

Question 10. A primary care NP recommends an over-the-counter medication for a patient who has acid reflux. When teaching the patient about this drug, the NP should tell the patient:

to take the dose recommended by the manufacturer.

not to worry about taking this drug with any other medications.

to avoid taking other drugs that cause sedation while taking this drug.

that over-the-counter acid reflux medications are generally safe to take with other medications.

Question 11. A patient will begin taking two drugs that are both protein-bound. The primary care NP should:

prescribe increased doses of both drugs.

monitor drug levels, actions, and side effects.

teach the patient to increase intake of protein.

stagger the doses of drugs to be given 1 hour apart.

Question 12. The primary care NP has referred a child who has significant gastrointestinal reflux disease to a specialist for consideration for a fundoplication and gastrostomy tube placement. The child’s weight is 80% of what is recommended for age, and a recent swallow study revealed significant risk for aspiration. The child’s parents do not want the procedure. The NP should:

compromise with the parents and order a nasogastric tube for feedings.

initiate a discussion with the parents about the potential outcomes of each possible action.

refer the family to a case manager who can help guide the parents to the best decision.

understand that the child’s parents have a right to make choices that override those of the medical team.

Question 13. A primary care NP is developing a clinical practice guideline for management of a patient population in a midsized suburban hospital. The NP should:

use an existing guideline from a leading research hospital.

follow the guideline provided by a third-party payer to help ensure reimbursement.

review expert opinion and experimental, anecdotal, correlational study data.

write the guideline to adhere to long-standing practice protocols already in use.

Question 14. The primary care nurse practitioner (NP) writes a prescription for an antibiotic using an electronic drug prescription system. The pharmacist will fill this prescription when:

the electronic prescription is received.

the patient brings a written copy of the prescription.

a copy of the written prescription is faxed to the pharmacy.

the pharmacist accesses the patient’s electronic record to verify.

Question 15. A primary care NP is preparing to prescribe a drug and notes that the drug has nonlinear kinetics. The NP should:

monitor frequently for desired and adverse effects.

administer a much higher initial dose as a loading dose.

monitor creatinine clearance at baseline and periodically.

administer the drug via a route that avoids the first-pass effect.

Question 16. An important difference between physician assistants (PAs) and NPs is PAs:

always work under physician supervision.

are not required to follow drug treatment protocols.

may write for all drug categories with physician co-signatures.

have both inpatient and outpatient independent prescriptive authority.

Question 17. A primary care NP writes a prescription for an off-label use for a drug. To help ensure compliance, the NP should:

include information about the off-label use on the E-script.

provide the patient with written instructions about how to use the medication.

tell the patient to let the pharmacist know that the drug is being used for an off-label use.

follow up by phone in several days to see if the patient is using the drug appropriately.

Question 18. A patient reports taking antioxidant supplements to help prevent cancer. The primary care NP should:

review healthy dietary practices with this patient.

make sure that the supplements contain large doses of vitamin A.

tell the patient that antioxidants are especially important for patients who smoke.

tell the patient that evidence shows antioxidants to be effective in preventing cancer.

Question 19. A woman comes to the clinic to talk about weight reduction. The primary care nurse practitioner (NP) calculates a body mass index (BMI) of 28. The woman’s waist measures 34 inches. The woman tells the NP that she would like to lose 20 lb for her daughter’s wedding in 6 months. The NP should:

suggest she try over-the-counter (OTC) orlistat.

consider prescribing phentermine short-term.

discuss her short-term and long-term weight loss goals.

give her information about physical activity and diet modification.

Question 20. A patient comes to the clinic and asks the primary care NP about using a newly developed formulation of the drug the patient has been taking for a year. When deciding whether or not to prescribe this formulation, the NP should:

tell the patient that when postmarketing data is available, it will be considered.

review the pharmaceutical company promotional materials about the new medication.

prescribe the medication if it is less expensive than the current drug formulation.

prescribe the medication if the new drug is available in an extended-release form.

Question 21. An adolescent girl has chosen Depo-Provera as a contraceptive method and tells the primary care NP that she likes the fact that she won’t have to deal with pills or periods. The primary care NP should tell her that she:

should consider another form of contraception after 1 year.

may have irregular bleeding, especially in the first month or so.

will need to take calcium and vitamin D every day while using this method.

will have to take oral contraceptive pills in addition to Depo-Provera when she takes antibiotics.

Question 22. A patient receives an inhaled corticosteroid to treat asthma. The patient asks the primary care NP why the drug is given by this route instead of orally. The NP should explain that the inhaled form:

is absorbed less quickly.

has reduced bioavailability.

has fewer systemic side effects.

provides dosing that is easier to regulate.

Question 23. A patient who has breast cancer has been taking toremifene for 2 weeks. She tells her primary care NP that she thinks her tumor has grown larger. The NP should:

schedule her for a breast ultrasound.

reassure her that this is common and will subside.

tell her she may need an increased dose of this medication.

contact her oncologist to discuss adding another medication.

Question 24. The primary care NP is prescribing a medication for an off-label use. To help prevent a medication error, the NP should:

write “off-label use” on the prescription and provide a rationale.

call the pharmacist to explain why the instructions deviate from common use.

write the alternative drug regimen on the prescription and send it to the pharmacy.

tell the patient to ignore the label directions and follow the verbal instructions given in the clinic.

Question 25. The primary care NP sees a woman who has been taking HT for menopausal symptoms for 3 years. The NP decreases the dosage, and several weeks later, the woman calls to report having several hot flashes each day. The NP should:

increase the HT dose.

discontinue HT.

recommend black cohosh to alleviate symptoms.

reassure her that these symptoms will diminish over time.