Rodents and Associated Health Risks to Humans

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NR 505 Advance Research Method: Evidence-based Practice

(Chamberlain College – Spring 2016)

  • NR 505 Week 3 Assignment; Research Summary Table – Injuries of Children with Non-Helmet Use
  • NR 505 Week 3 Assignment; Research Summary Table – Rodents and Associated Health Risks to Humans 

Develop a research summary table on the issue you studied for the community committee. Follow the guidelines for this assignment located in Course Resources and submit your finished product to the Week 3 Dropbox. Rodents and Associated Health Risks to Humans

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  • NR 505 Week 5 Assignment; Critique of a Systematic Research Review 

Critique a systematic research review related to bicycle safety or one of the issues identified in Week 1. Follow the guidelines for this assignment located in Course Resources and submit your finished product to the Week 5 Dropbox.

  • NR 505 Week 7 Assignment; Analysis and Application of a Clinical Practice Guideline 

Select (1) one of the issues identified in Week 1, (2) the bicycle safety issue, or (3) the surgical infection issue and find a very recent (no more than 5 years) clinical practice guideline related to that issue. Follow the guidelines for this assignment located in Course Resources and submit your finished product to the Week 7 Dropbox. Rodents and Associated Health Risks to Humans

The epidemiology, pathophysiology, risk factors and clinical presentation

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The epidemiology, pathophysiology, risk factors and clinical presentation

Assignment: Adaptive Response

As an advanced practice nurse, you will examine patients presenting with a variety of disorders. You must, therefore, understand how the body normally functions so that you can identify when it is reacting to changes. Often, when changes occur in body systems, the body reacts with compensatory mechanisms. These compensatory mechanisms, such as adaptive responses, might be signs and symptoms of alterations or underlying disorders. In the clinical setting, you use these responses, along with other patient factors, to lead you to a diagnosis.

Consider the following scenarios:

Scenario 1:

Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days. Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oFThe epidemiology, pathophysiology, risk factors and clinical presentation. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell.  Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

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Scenario 2:

Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:

Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep The epidemiology, pathophysiology, risk factors and clinical presentation

To Prepare

  • Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
  • Identify the pathophysiology of the disorders presented in the scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
  • Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

To Complete

Write a 2- to 3-page paper that addresses the following:

  • Explain the pathophysiology of the disorders depicted in the scenarios, including their associated alterations. Be sure to describe the patients’ adaptive responses to the alterations.
  • Construct a mind map of your selected disorder. Include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations

NB:In addition, the 2-3 page paper assignment should include the pathophysiology of the three disorders depicted in the scenarios, followed by selecting one disorder where you are asked to construct a mind map.Rubric needs to be attached to the end of the paper

Rubric:https://class.waldenu.edu/bbcswebdav/institution/USW1/201710_27/MS_NURS/NURS_6501/artifacts/NURS_6501_assignmentRubric.doc The epidemiology, pathophysiology, risk factors and clinical presentation

Impact of patient factors on anemic disorders

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Discussion: Anemia

In clinical settings, advanced practice nurses often encounter patients with blood disorders such as anemia. Consider the case of a 17-year-old girl who is rushed to the emergency room after suddenly fainting. The girl’s mother reports that her daughter has had difficulty concentrating for the past week, frequently becomes dizzy, and has not been eating normally due to digestion problems. The mother also informs the nurse that their family has a history of anemia. With the family history of anemia, it appears that this is the likely diagnosis. However, in order to properly diagnose and treat the patient, not only must her symptoms and family history be considered, but also factors such as gender, ethnicity, age, and behavior. This poses the question: How do patient factors impact the incidence and prevalence of different types of anemia? Impact of patient factors on anemic disorders

To Prepare

  • Review Chapter 20 in the Huether and McCance text. Reflect on the pathophysiological mechanisms of iron deficiency anemia.
  • Select one of the following types of anemia: pernicious anemia, folate deficiency anemia, sideroblastic anemia, chronic inflammation anemia, or post-hemorrhagic anemia. Identify the pathophysiological mechanisms of the anemia you selected.
  • Consider the similarities and differences between iron deficiency anemia and the type of anemia you selected.
  • Reflect on how patient factors such as genetics, gender, ethnicity, age, and behavior might impact these anemic disorders.

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By Day 3

Post an explanation of the pathophysiological mechanisms of iron deficiency anemia and the anemia you selected. Compare these two types of anemia, as well as their potential causes. Finally, explain how genetics, gender, ethnicity, age, and behavior might impact the anemic disorders you selected.

Read a selection of your colleagues’ responses.

Students will:
  • Analyze the pathophysiology of anemia
  • Compare the pathophysiology of iron deficiency anemia to the pathophysiology of other types of anemia
  • Evaluate the impact of patient factors on anemic disorders
  • Understand and apply key terms, concepts, and principles related to alterations of the hematological system. Impact of patient factors on anemic disorders

Culture important when obtaining the health assessment

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Healthy People Initiative

The topic this week asks you to apply what you have learned to the following case study.

As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues.  Culture important when obtaining the health assessmentAfter conducting her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She attends class a total of 15 hours per week, plus she must be present for 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children. She states that she is lucky to get 6 hours of sleep per night, but that is okay with her. She lives 1 hour from campus and commutes each day. Using Healthy People 2020 and your text as a guide, answer the following questions.

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  1. What additional information would you like to gather from Maria?
  2. What are Maria’s real and potential health risks?
  3. Why is Maria’s culture important when obtaining the health assessment?
  4. Pick one of Maria’s health risks. What would be one reasonable short-term goal for this risk?
  5. What nursing interventions would you incorporate into Maria’s plan of care to assist her with meeting your chosen goal? Please provide rationale for your selections. Culture important when obtaining the health assessment

Assessment of the Neurological System

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Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was admitted yesterday morning for 24-hour observation for mild concussion following a motor vehicle accident. Randy lost consciousness during the accident and was very confused when he arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed to think after the accident that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some residual problems from a couple of explosive incidents that occurred while he was in Iraq. The physician is unsure whether Randy’s current symptoms are from the car accident or from prior injuries so he has referred him for consultations to both a neurologist and to a behavioral health specialist Assessment of the Neurological System

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Based on the above please discuss the following.

  1. Pathophysiology of concussive injuries and treatment
  2. Neurological assessment tools used in your current practice setting (if not presently working, please describe one used during prior employment or schooling)
  3. Current best practices associated with post-traumatic stress disorder (PTSD)
  4. Nursing interventions you would include in this patient’s plan of care. Assessment of the Neurological System

The concept of change management and how it is relevant to the role of the nurse informaticist

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The concept of change management and how it is relevant to the role of the nurse informaticist

Change Management

As health care organizations adopt more and more informatics solutions, they inevitably experience significant changes. Such changes are often met with hesitation, resistance, and even outright refusal. Nurse informaticists should be aware of these barriers and be prepared to employ change-management strategies to ensure stakeholder buy-in and end-user adoption.

In this Discussion, you explore the concept of change management and how it is relevant to the role of the nurse informaticist. You consider what steps can be taken during implementation of a project to contribute to more successful end-user adoption. In addition, you explore the competencies and skills a nurse informaticist should have when serving as a change agent within an organization. The concept of change management and how it is relevant to the role of the nurse informaticist

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To prepare

  • Review this week’s Learning Resources, including pages 481–483 (See attached file) in the Dennis course text, on change management. How is change management relevant to the role of the nurse informaticist?
  • Consider steps a nurse informaticist can take to promote more successful end-user adoption.
  • What change-management strategies are most useful for a nurse informaticist to be aware of when implementing a change within an organization? How can those strategies help to mitigate negative attitudes toward change? The concept of change management and how it is relevant to the role of the nurse informaticist
  • Reflect on the competencies and skills required for nurse informaticists to be effective change agents. How can you best prepare yourself to manage change and address resistance?With these thoughts in mind:Post by tomorrow 10/25/16 a 550 words essay in APA format and 3 references that include the level one headings as numbered below:1) An analysis of how change management is relevant to the role of the nurse informaticist. 2) Explain at least two change-management strategies that can be used to promote end-user adoption, and justify their effectiveness in mitigating resistance. 3) Identify at least two skills or competencies necessary for nurse informaticists in serving as change agents, and describe how you plan to cultivate those skills or competencies. Required ReadingsDennis, A., Wixom, B. H., & Roth, R. M. (2015). Systems analysis and design (6th ed.). Hoboken, NJ: Wiley.

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  • Review Chapter 13, “Transition to the New System” (pp. 400–424)

Kulhanek, B. J. (2011). Creating effective electronic medical record change management processes. Computers, Informatics, Nursing, 29(8), 431–435.

Retrieved from the Walden Library databases.

 Efficient implementation and use of electronic medical/health records requires organizationwide restructuring. This article addresses how management procedures, organizational initiatives, and communication needs require adjustment in order to suit the changing health care environment.

Lee, V., Ridzi, F., Lo, A. W., & Coskun, E. (2011). A healthcare case study of team learner style and change management. Journal of Organizational Change Management, 24(6), 830–852.

Retrieved from the Walden Library databases.

 This article discusses the importance of considering the end users’ learning styles when an implementation is planned. The authors conclude that a mix of a variety of learning styles appears to be the strongest approach.

Leyland, M., Hunter, D., & Dietrich, J. (2009). Integrating change management into clinical health information technology project practice. Privacy, Security, Trust and the Management of e-Business, 89–99.

Retrieved from the Walden Library databases.

 The authors of this article contrast “hard changes”—those focusing on cost, schedule, and scope of a process—with “soft changes”—the human side of change. The authors conclude that failure to address the human side of change increases the likelihood of the failure of a project. The concept of change management and how it is relevant to the role of the nurse informaticist

Nurse communication and hourly rounding to be key drivers in patient satisfaction metric improvements

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Nurse communication and hourly rounding to be key drivers in patient satisfaction metric improvements

Select one of the following topics for your project.

1. You have been appointed to chair a hospital-wide committee to develop and implement a plan to improve patient satisfaction in your facility. Your Chief Nursing Officer has provided you a summary report indicating a steady decline in patient satisfaction over the previous six months. You will need to identify the various resources available for tracking patient satisfaction, establish a clear bench mark and design a specific plan of action for reversing this trend. It is essential to note in your development that research has shown nurse communication and hourly rounding to be key drivers in patient satisfaction metric improvements. These points should be a focus of your change initiative Nurse communication and hourly rounding to be key drivers in patient satisfaction metric improvements.

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2. The prevention of Hospital Acquired Infections (HAIs) is a key focus for healthcare organizations of late. Infections acquired during admission not only affect patient care outcomes, but are of high impact to the financial operations of the organization as reimbursement is directly affected. Identify a particular HAI as the focus of your change management and develop a plan to reduce and/or eliminate HAIs in a particular patient population in the facility.

3. Meaningful Use is a hot topic relative to initiatives from the Centers for Medicare and Medicaid Services (CMS). As we move to a virtual, interactive medical record that transcends physical walls of organizations and primary care providers, it is essential that nurses embrace the Electronic Medical Record (EMR) and its documentation capabilities. Devise a plan for improvement of at least two Meaningful Use metrics for your facility; ensure you include education and monitoring as key relative to the established benchmarks from CMS.

Each student will produce a plan for implementing a change project in nursingdepartments throughout theorganization.You will beginby selecting oneoftheoptionsprovided in module oneandproposeachange to solve the problem. If you do not select one of the provided options you will not receive credit for this assignment. Then you will select one of the change theories you have studiedthat modelshowyouwant toimplementtheproposedchange. Youwillconducta SWOTanalysisanddevelop a comprehensive action plan. You will create a PowerPoint presentation of your planwith a“script”intheNotessection below each slide, asifyouarepresentingthistoanaudience. These will be your speaker notes as if you are presenting your PowerPoint to an audience. You MUST have a notes section for your slides. There will be a 50 point deduction if notes are not present. (The Notes section can be found below each slide within the PowerPoint presentation) Nurse communication and hourly rounding to be key drivers in patient satisfaction metric improvements

Duringandafteryourwork,youwillexaminethetypesofcommunications,decision-making processes,andprocessesyouuse,andcommentuponthoseinthelastpartofthe“script.”

PLEASE SEE RUBIC ATTACHMENT FOR REQUIREMENTS AND REFERENCES NEEDED FOR THE POWER POINT AS WELL AS THE NOTES THAT ALSO HAVE TO BE REQUIRED. IF YOU DONT HAVE THE TIME TO DO THIS WELL PLEASE DO NOT WASTE MY TIME AND MONEY

Difference between metastatic lung cancer and primary lung cancer

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Endocrine System Case Study

Joan Barker, age fifty-six years, comes for a routine physical examination. She states that she has been in perfect health and has no complaints. She has a history of asthma but currently requires no medications of any kind. Her physical examination is completely normal, except for a 2-cm firm, nontender, nonmobile mass in the upper outer quadrant of her left breast. She indicates that she does not perform regular breast self-examination and that she did not know the mass was there. She has no family history of breast cancer and has never been pregnant. Difference between metastatic lung cancer and primary lung cancer

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Answer the following questions about Ms. Barker’s condition:

  • What term is used to describe the benign condition that may have caused Ms. Barker’s breast mass?
  • What is inside the cysts of fibrocystic breast disease?
  • Mammography and ultrasonography reveal a solid lesion (not cystic). What is the most common type of breast cancer?
  • Biopsy determines that Ms. Barker has invasive carcinoma of the breast. What is the difference between ductal carcinoma in situ and invasive carcinoma of the breast?
  • Ms. Barker’s breast cancer has metastasized to her lungs. What is the difference between metastatic lung cancer and primary lung cancer? Difference between metastatic lung cancer and primary lung cancer

Advanced Medical Surgical Nursing

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Question

Question 1

A nursing student wants to know why clients with chronic obstructive pulmonary disease tend to be polycythemic. What response by the nurse instructor is best?

a. It is due to side effects of medications for bronchodilation.

b. It is from overactive bone marrow in response to chronic disease.

c. It combats the anemia caused by an increased metabolic rate.

d. It compensates for tissue hypoxia caused by lung disease.

Question 2

A nurse assesses a client who had a myocardial infarction and is hypotensive. Which additional assessment finding should the nurse expect?

a. Heart rate of 120 beats/min

b. Cool, clammy skin

c. Oxygen saturation of 90%

d. Respiratory rate of 8 breaths/min

Question 3

A nurse assesses a client in an outpatient clinic. Which statement alerts the nurse to the possibility of left-sided heart failure? Advanced Medical Surgical Nursing

a.“I have been drinking more water than usual.”

b.“I am awakened by the need to urinate at night.”

c.“I must stop halfway up the stairs to catch my breath.”

d.“I have experienced blurred vision on several occasions.”

Question 4

A nurse assesses clients on a cardiac unit. Which client should the nurse identify as being at greatest risk for the development of left-sided heart failure?

a. A 36-year-old woman with aortic stenosis

b. A 42-year-old man with pulmonary hypertension

c. A 59-year-old woman who smokes cigarettes daily

d. A 70-year-old man who had a cerebral vascular accident

Question 5

A client is receiving rivaroxaban (Xarelto) and asks the nurse to explain how it works. What response by the nurse is best?

a. “It inhibits thrombin.”

b. “It inhibits fibrinogen.”

c. “It thins your blood.”

d. “It works against vitamin K.”

Question 6

A client undergoing hemodynamic monitoring after a myocardial infarction has a right atrial pressure of 0.5 mm Hg. What action by the nurse is most appropriate?

a. Level the transducer at the phlebostatic axis.

b. Lay the client in the supine position.

c. Prepare to administer diuretics.

d. Prepare to administer a fluid bolus.

Question 7

A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition?

a. Sinus tachycardia
b. Speech alterations
c. Fatigue
d. Dyspnea with activity

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Question 8

A client has been diagnosed with hypertension but does not take the antihypertensive medications because of a lack of symptoms. What response by the nurse is best? Advanced Medical Surgical Nursing

a.“Do you have trouble affording your medications?”

b.“Most people with hypertension do not have symptoms.”

c.“You are lucky; most people get severe morning headaches.”

d.“You need to take your medicine or you will get kidney failure.”

Question 9

A client received tissue plasminogen activator (t-PA) after a myocardial infarction and now is on an intravenous infusion of heparin. The client’s spouse asks why the client needs this medication. What response by the nurse is best?

a.“The t-PA didn’t dissolve the entire coronary clot.”

b.“The heparin keeps that artery from getting blocked again.”

c.“Heparin keeps the blood as thin as possible for a longer time.”

d.“The heparin prevents a stroke from occurring as the t-PA wears off.”

Question 10

The nurse is reviewing the lipid panel of a male client who has atherosclerosis. Which finding is most concerning?

a. Cholesterol: 126 mg/dL

b. High-density lipoprotein cholesterol (HDL-C): 48 mg/dL

c. Low-density lipoprotein cholesterol (LDL-C): 122 mg/dL

d. Triglycerides: 198 mg/dL

Question 11

A hospitalized client has a platelet count of 58,000/mm3. What action by the nurse is best?

a. Encourage high-protein foods.

b. Institute neutropenic precautions.

c. Limit visitors to healthy adults.

d. Place the client on safety precautions.

Question 12

A client is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the client to the bathroom and notes the client’s O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best?

a. Administer oxygen at 2 L/min.

b. Allow continued bathroom privileges.

c. Obtain a bedside commode.

d. Suggest the client use a bedpan

Question 13

A nurse is working with a client who takes atorvastatin (Lipitor). The client’s recent laboratory results include a blood urea nitrogen (BUN) of 33 mg/dL and creatinine of 2.8 mg/dL. What action by the nurse is best?

a. Ask if the client eats grapefruit.
b. Assess the client for dehydration.
c. Facilitate admission to the hospital.
d. Obtain a random urinalysis.

Question 14

While assessing a client on a cardiac unit, a nurse identifies the presence of an S3 gallop. Which action should the nurse take next?

a. Assess for symptoms of left-sided heart failure.

b. Document this as a normal finding.

c. Call the health care provider immediately.

d. Transfer the client to the intensive care unit.

Question 15

The nurse is evaluating a 3-day diet history with a client who has an elevated lipid panel. What meal selection indicates the client is managing this condition well with diet?

a. A 4-ounce steak, French fries, iceberg lettuce

b. Baked chicken breast, broccoli, tomatoes

c. Fried catfish, cornbread, peas

d. Spaghetti with meat sauce, garlic bread

Question 16

A client is in shock and the nurse prepares to administer insulin for a blood glucose reading of 208 mg/dL. The spouse asks why the client needs insulin as the client is not a diabetic. What response by the nurse is best?

a. “High glucose is common in shock and needs to be treated.”

b. “Some of the medications we are giving are to raise blood sugar.”

c. “The IV solution has lots of glucose, which raises blood sugar.”

d. “The stress of this illness has made your spouse a diabetic.”

Question 17

The nurse gets the hand-off report on four clients. Which client should the nurse assess first?

a. Client with a blood pressure change of 128/74 to 110/88 mm Hg

b. Client with oxygen saturation unchanged at 94%

c. Client with a pulse change of 100 to 88 beats/min

d. Client with urine output of 40 mL/hr for the last 2 hours

Question 18

A nurse cares for a client with right-sided heart failure. The client asks, “Why do I need to weigh myself every day?” How should the nurse respond?

a. “Weight is the best indication that you are gaining or losing fluid.”

b. “Daily weights will help us make sure that you’re eating properly.” Advanced Medical Surgical Nursing

c. “The hospital requires that all inpatients be weighed daily.”

d. “You need to lose weight to decrease the incidence of heart failure.”

Question 19

A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate?

a. “Make certain that your bath water is warm.”

b.“Avoid straining while having a bowel movement.”

c.“Limit your intake of caffeinated drinks to one a day.”

d.“Avoid strenuous exercise such as running.”

Question 20

A nurse is caring for a client after surgery. The client’s respiratory rate has increased from 12 to 18 breaths/min and the pulse rate increased from 86 to 98 beats/min since they were last assessed 4 hours ago. What action by the nurse is best?

a. Ask if the client needs pain medication.

b. Assess the client’s tissue perfusion further.

c. Document the findings in the client’s chart.

d. Increase the rate of the client’s IV infusion.

Question 21

An emergency room nurse obtains the health history of a client. Which statement by the client should alert the nurse to the occurrence of heart failure?

a. “I get short of breath when I climb stairs.”

b. “I see halos floating around my head.”

c. “I have trouble remembering things.”

d. “I have lost weight over the past month.”

Question 22

The health care provider tells the nurse that a client is to be started on a platelet inhibitor. About what drug does the nurse plan to teach the client?

a. Clopidogrel (Plavix)

b. Enoxaparin (Lovenox)

c. Reteplase (Retavase)

d. Warfarin (Coumadin)

Question 23

A nurse assesses a client’s electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation?

a. The client has hyperkalemia causing irregular QRS complexes.

b. Ventricular tachycardia is overriding the normal atrial rhythm.

c. The client’s chest leads are not making sufficient contact with the skin.

d. Ventricular and atrial depolarizations are initiated from different sites. Advanced Medical Surgical Nursing

Question 24

A nurse caring for a client with sickle cell disease (SCD) reviews the client’s laboratory work. Which finding should the nurse report to the provider?

a. Creatinine: 2.9 mg/dL

b. Hematocrit: 30%

c. Sodium: 147 mEq/L

d. White blood cell count: 12,000/mm3

Question 25

A nurse assesses clients on a medical-surgical unit. Which client should the nurse identify as having the greatest risk for cardiovascular disease?

a. An 86-year-old man with a history of asthma

b. A 32-year-old Asian-American man with colorectal cancer

c. A 45-year-old American Indian woman with diabetes mellitus

d. A 53-year-old postmenopausal woman who is on hormone therapy

Question 26

A student nurse is assessing the peripheral vascular system of an older adult. What action by the student would cause the faculty member to intervene?

a. Assessing blood pressure in both upper extremities

b. Auscultating the carotid arteries for any bruits

c. Classifying capillary refill of 4 seconds as normal

d. Palpating both carotid arteries at the same time

Question 27

A nurse assesses a client after administering a prescribed beta blocker. Which assessment should the nurse expect to find?

a. Blood pressure increased from 98/42 mm Hg to 132/60 mm Hg

b. Respiratory rate decreased from 25 breaths/min to 14 breaths/min

c. Oxygen saturation increased from 88% to 96%

d. Pulse decreased from 100 beats/min to 80 beats/min

Question 28

A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this client’s medication administration record to prevent a common complication of this condition?

a. Sotalol (Betapace)

b. Warfarin (Coumadin)

c. Atropine (Sal-Tropine)

d. Lidocaine (Xylocaine)

Question 29

A nurse assesses an older adult client who has multiple chronic diseases. The client’s heart rate is 48 beats/min. Which action should the nurse take first?

a. Document the finding in the chart.

b. Initiate external pacing.

c. Assess the client’s medications.

d. Administer 1 mg of atropine.

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Question 30

A client presents to the emergency department in sickle cell crisis. What intervention by the nurse takes priority?

a. Administer oxygen.
b. Apply an oximetry probe.
c. Give pain medication.
d. Start an IV line.

Question 31

A nurse assesses a client admitted to the cardiac unit. Which statement by the client alerts the nurse to the possibility of right-sided heart failure?

a.“I sleep with four pillows at night.”

b.“My shoes fit really tight lately.”

c.“I wake up coughing every night.”

d.“I have trouble catching my breath.”

Question 32

A nursing student is caring for a client who had a myocardial infarction. The student is confused because the client states nothing is wrong and yet listens attentively while the student provides education on lifestyle changes and healthy menu choices. What response by the faculty member is best?

a.“Continue to educate the client on possible healthy changes.”

b.“Emphasize complications that can occur with noncompliance.”

c.“Tell the client that denial is normal and will soon go away.”

d.“You need to make sure the client understands this illness.”

Question 33

A client is receiving an infusion of tissue plasminogen activator (t-PA). The nurse assesses the client to be disoriented to person, place, and time. What action by the nurse is best?

a. Assess the client’s pupillary responses.

b. Request a neurologic consultation.

c. Stop the infusion and call the provider.

d. Take and document a full set of vital signs.

Question 34

A client in sickle cell crisis is dehydrated and in the emergency department. The nurse plans to start an IV. Which fluid choice is best?

a.0.45% normal saline

b.0.9% normal saline

c. Dextrose 50% (D50)

d. Lactated Ringer’s solution

Question 35

A student is caring for a client who suffered massive blood loss after trauma. How does the student correlate the blood loss with the client’s mean arterial pressure (MAP)?

a. It causes vasoconstriction and increased MAP.

b. Lower blood volume lowers MAP.

c. There is no direct correlation to MAP.

d. It raises cardiac output and MAP.

Question 36

A client has a serum ferritin level of 8 ng/mL and microcytic red blood cells. What action by the nurse is best?

a. Encourage high-protein Foods.

b. Perform a Hemoccult test on the client’s stools.

c. Offer Frequent oral care.

d. Prepare to administer cobalamin (vitamin B12).

Question 37

A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation?

a. A 45-year-old who takes an aspirin daily

b. A 50-year-old who is post coronary artery bypass graft surgery

c. A 78-year-old who had a carotid endarterectomy

d. An 80-year-old with chronic obstructive pulmonary disease

Question 38

A client hospitalized with sickle cell crisis frequently asks for opioid pain medications, often shortly after receiving a dose. The nurses on the unit believe the client is drug seeking. When the client requests pain medication, what action by the nurse is best?

a. Give the client pain medication if it is time for another dose.

b. Instruct the client not to request pain medication too early.

c. Request the provider leave a prescription for a placebo.

d. Tell the client it is too early to have more pain medication.

Question 39

A nurse is caring for a client after surgery who is restless and apprehensive. The unlicensed assistive personnel (UAP) reports the vital signs and the nurse sees they are only slightly different from previous readings. What action does the nurse delegate next to the UAP?

a. Assess the client for pain or discomfort.

b. Measure urine output from the catheter.

c. Reposition the client to the unaffected side.

d. Stay with the client and reassure him or her.

Question 40

A nurse is assessing a dark-skinned client for pallor. What action is best?

a. Assess the conjunctiva of the eye.
b. Have the client open the hand widely.
c. Look at the roof of the client’s mouth.
d. Palpate for areas of mild swelling. Advanced Medical Surgical Nursing

Effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts

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Question

1. Which disorder is characterized by the formation of abnormal new bone at an accelerated rate beginning with excessive resorption of spongy bone?

Osteomalacia

Paget disease

Osteoporosis

Osteosarcoma

Question 2. Considering the pathophysiology of osteoporosis, what are the effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts? Effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts

ERKs increase the life span of osteoclasts and RANKL decreases the life span of osteoblasts.

ERKs and RANKL increase the life span of osteoclasts and decrease the life span of osteoblasts.

ERKs and RANKL increase the life span of osteoblasts and decrease the life span of osteoclasts.

ERKs increase the life span of osteoblasts and RANKL decreases the life span of osteoclasts.

Question 3. _____ is the temporary displacement of two bones in which the bone surfaces partially lose contact.

Dislocation

Subluxation

Malunion

Nonunion

Question 4. What is the diagnosis of a person who has tennis elbow characterized by tissue degeneration or irritation of the extensor carpi brevis tendon?

Lateral epicondylitis

Medial tendinitis

Bursitis

Lateral tendinitis

Question 5. Which type of osteoporosis would a person develop after having the left leg in a cast for 8 weeks to treat a compound displaced fracture of the tibia and fibula?

Iatrogenic

Regional

Idiopathic

Osteoblastic

Question 6. Bone death as a result of osteomyelitis is because of

formation of immune complexes at the site of infection.

localized ischemia.

TNF-? and IL-1.

impaired nerve innervation at the site of infection.

Question 7. By the time osteoporosis is visible on x-ray, up to ____% of bone has been lost. Effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts

30

40

50

60

Question 8. Osteochondrosis is caused by a(n)

imbalance between calcitonin and parathyroid hormone.

nutritional deficiency of calcium and phosphorus.

bacterial infection of the bone.

vascular impairment and trauma to bone.

Question 9. Ewing sarcoma arises from

bone marrow.

bone-producing mesenchymal cells.

metadiaphysis of long bones.

embryonal osteocytes.

Question 10. An insufficient dietary intake of vitamin _____ can lead to rickets in children.

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C

B12

B6

D

Question 11. Which protein, absent in muscle cells of Duchenne muscular dystrophy, mediates the anchoring of skeletal muscles fibers to the basement membrane?

Syntrophin

Laminin

Dystrophin

Troponin

Question 12. Which serum laboratory test is elevated in all forms of osteogenesis imperfecta?

Phosphorus

Calcium

Alkaline phosphatase

Total protein

Question 13. Cerebral palsy is usually a result of

brain ischemia during birth.

prematurity.

congenital defects.

genetic defect.

Question 14. What diagnosis is given when the infant’s hip maintains contact with the acetabulum, but is not well seated within the hip joint?

Dislocatable hip

Subluxated hip

Dislocated hip

Subluxable hip

Question 15. The total mass of muscle in the body can be estimated from which serum laboratory test value?

Albumin

Blood urea nitrogen

Creatinine

Creatine

Question 16. Which malignancy is characterized by slow-growing lesions that usually have depressed centers and rolled borders and are frequently located on the face and neck?

Squamous cell carcinoma

Kaposi sarcoma

Malignant melanoma

Basal cell carcinoma

Question 17. Which cell is thought to be the progenitor cell of Kaposi sarcoma?

Endothelial

Keratinocyte

Melanocyte

Exothelial

Question 18. Cutaneous vasculitis develops from the deposit of _____ in small blood vessels as a toxic response allergen.

immune complexes

IgE

complement

T lymphocytes

Question 19. Which type of psoriasis is characterized by lesions on the elbows and knees that are well demarcated, thick, silvery, scaly, and erythematous?

Plaque

Inverse

Guttate

Erythrodermic

Question 20. An older adult man states he has a sore above his lip that has not healed and is getting bigger. The nurse observes a red scaly patch with an ulcerated center and sharp margins. The nurse recognizes these features as commonly associated with Bowen disease, a form of

Kaposi sarcoma.

malignant melanoma.

basal cell carcinoma.

squamous cell carcinoma.

Question 21. What is a common source of tinea corporis?

Mites

Kittens

Fleas

Ticks

Question 22. Which skin disorder has as its hallmark clinical manifestation skin lesions that rupture, creating a thin, flat, honey-colored crust?

Rubella

Tinea capitis

Atopic dermatitis

Vesicular impetigo

Question 23. Bullous impetigo is caused by a strain of _____ that produces an exfoliative toxin, resulting in a disruption in cellular adhesion. Effects of extracellular signal regulated kinases (ERKs) and receptor activator of RANKL on osteoblasts and osteoclasts

Staphylococcus aureus

Streptococcus pyogenes

Escherichia coli

Candida albicans

Question 24. Which immunoglobulin is elevated in atopic dermatitis?

IgA

IgM

IgE

IgG

Question 25. Which clinical manifestation is considered the hallmark of atopic dermatitis?

Papular rash

High fever

Vesicles that burst and form crusts

Itching