Nursing Decision-making

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Question 20

A patient recovering from shingles presents with tenderness and sensitivity to the upper back. He states it is bothersome to put a shirt on most days. This patient has end stage renal disease (ESRD) and is scheduled to have hemodialysis tomorrow but states that he does not know how he can lie in a recliner for 3 hours feeling this uncomfortable. What will be the PMHNP’s priority?

a) order herpes simplex virus (HSV) antibody testing

b) Order a blood urea nitrogen (BUN) and creatinine STAT

c) Prescribe lidocaine 5%

d) Prescribe hydromorphone (dilaudid) 2mg

Question 21

The PMHNP prescribed a patient lamotrigine (Lamictal), 25 mg by mouth daily, for nerve pain 6 months ago. The patient suddenly presents to the office with the complaint that the medication is no longer working and complains of increased pain. What action will the PMHNP most likely take?

a) Increase the dose of lamotrigine (Lamictal) to 25mg twice daily

b) Ask if the pt has been taking the medication as prescribed

c) Order gabapentin, 100mg TID because lamotrigine is no longer working for this patient

d) Order a CBC to assess for an infection

Question 22

An elderly woman with a hx of alzheimer’s disease, coronary artery disease, and myocardial infarction had a fall at home 3 months ago that resulted in her receiving an open reduction internal fixation. While assessing this patient, the pmhnp is made aware that the patient continues to experience mild to moderate pain. What is the pmhnp most likely to do?

a) order an X-ray because it is possible that she dislocated her hip

b) order ibuprofen because she mayneed long term treatment and chronic pain is not uncommon

c) Order naproxen because she may havarthritis and chronic pain is not uncommon

d) Order morphine and physical therapy

Question 23

The PMHNP is assessing a 49-year-old male with a history of depression, post-traumatic stress disorder (PTSD), alcoholism with malnutrition, diabetes mellitus type 2, and hypertension. His physical assessment is unremarkable with the exception of peripheral edema bilaterally to his lower extremities and a chief complaint of pain with numbness and tingling to each leg 5/10. The PMHNP starts this patient on a low dose of doxepin (Sinequan). What is the next action that must be taken by the PMHNP?

a) Orders liver function tests

b) Educate the patient on avoiding grapefruits when taking this medication

c) Encourage this patient to keep fluids to 1500ml/day until the swelling subside

d) Order BUN/Creatinine test

Question 24

The PMHNP is evaluating a 30-year-old female patient who states that she notices pain and a drastic change in mood before the start of her menstrual cycle. The patient states that she has tried diet and lifestyle changes but nothing has worked. What will the PMHNP most likely do?

a) Prescribe estrin FE 24 birth control

b) Prescribe Ibuprofen 800mg every 8 hours as needed for pain

c) Prescribe desvenlafaxine (Pristiq) 50mg daily

d) Prescribe Risperdal 2mg TID

Question 25

A patient with chronic back pain has been prescribed a serotonin-norepinephrine reuptake inhibitor (SNRI). How does the PMHNP describe the action of SNRIs on the inhibition of pain to the patient?

a) “the SNRI can increase noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”

b) “the SNRI can decrease noradrenergic neurotransmission in the descending spinal pathway to the dorsal horn”

c) “the SNRI can reduce brain atrophy by slowing the gray matter loss in the dorsolateral prefrontal cortex”

d) “the SNRI can increase neurotransmission to descending neurons”

Question 26

A patient with fibromyalgia and major depression needs to be treated for symptoms of pain. Which is the PMHNP most likely to prescribe for this patient?

a) Venlafaxine (Effexor)

b) Duloxetine (Cymbalta)

c) Clozapine (Clozaril)

d) Phenytoin (Dilantin)

Question 27

The PMHNP prescribes gabapentin (Neurontin) for a patient’s chronic pain. How does the PMHNP anticipate the drug to work?

a) It will bind to the alpha-2-delta ligand subunit of voltage-sensitive calcium channels

b) It will induce synaptic changes, including sprouting

c) It will act on the presynaptic neuron to trigger sodium influx

d) It will Inhibit activity of dorsal horn neurons to suppress body input from reaching the brain

Question 28

Mrs. Rosen is a 49-year-old patient who is experiencing fibro-fog. What does the PMHNP prescribe for Mrs. Rosen to improve this condition?

a) Venlafaxine (Effexor)

b) Armodafinil (Nuvigil)

c) Bupropion (Wellbutrin)

d) All of the above

Question 29

The PMHNP is caring for a patient with fibromyalgia. Which second-line treatment does the PMHNP select that may be effective for managing this patient’s pain?

a) Methylphenidate (Ritalin)

b) Viloxazine (Vivalan)

c) Imipramine (Tofranil)

d) Bupropion (Wellbutrin)

Question 30

The PMHNP is attempting to treat a patient’s chronic pain by having the agent bind the open channel conformation of VSCCs to block those channels with a “use-dependent” form of inhibition. Which agent will the PMHNP most likely select?

a) Pregabalin (Lyrica)

b) Duloxetine (Cymbalta)

c) Modafinil (Provigil)

d) Atomoxetine (Strattera)

Question 31

A patient with irritable bowel syndrome reports chronic stomach pain. The PMHNP wants to prescribe the patient an agent that will cause irrelevant nociceptive inputs from the pain to be ignored and no longer perceived as painful. Which drug will the PMHNP prescribe?

a) Pregabalin (Lyrica)

b) Gabapentin (Neurontin)

c) Duloxetine (Cymbalta)

d) B and C

Question 32

The PMHNP wants to use a symptom-based approach to treating a patient with fibromyalgia. How does the PMHNP go about treating this patient?

a) Prescribing the patient an agent that ignores the painful symptoms by initiating a reaction known as “fibro-fog”

b) Targeting the patient’s symptoms with anticonvulsants that inhibits gray matter loss in the dorsolateral prefrontal cortex

c) Mzatching the patient’s symptoms with the malfunctioning brain circuits and neurotransimitters that might mediate those symptoms

d) None of the above

Question 33

The PMHNP is working with the student to care for a patient with diabetic peripheral neuropathic pain. The student asks the PMHNP why SSRIs are not consistently useful in treating this particular patient’s pain. What is the best response by the PMHNP?

a) “SSRIs only increase norepinephrine levels”

b) “SSRIs only increase serotonin levels”

c) “SSRIs only increase serotonin and norepinephrine levels”

d) “SSRIs do not increase serotonin or norepinephrine levels”

Question 34

A patient with gambling disorder and no other psychiatric comorbidities is being treated with pharmacological agents. Which drug is the PMHNP most likely to prescribe?

a) Antipsychotics

b) Lithium

c) SSRI

d) Naltrexone

Question 35

Kevin is an adolescent who has been diagnosed with kleptomania. His parents are interested in seeking pharmacological treatment. What does the PMHNP tell the parents regarding his treatment options?

a) “Naltrexone may be an appropriate option to discuss”

b) “there are many medicine options that treat Kleptomania”

c) “Kevin may need to be prescribed antipsychotics to treat this illness”

d) “Lithium has proven effective for treating kleptomania”

Question 36

Which statement best describes a pharmacological approach to treating patients for impulsive aggression?

a) Anticonvulsant mood stabilizers can eradicate limbic irritability

b) Atypical antipsychotics can increase subcortical dopaminergic stimulation

c) Stimulants can be used to decrease frontal inhibition

d) Opioid antagonists can be used to reduce drive

Question 37

A patient with hypersexual disorder is being assessed for possible pharmacologic treatment. Why does the PMHNP prescribe an antiandrogen for this patient?

a) It will prevent feelings of euphoria

b) It will amplify impulse control

c) It will block testosterone

d) It will redirect the patient to think about other things

Question 38

Mrs. Kenner is concerned that her teenage daughter spends too much time on the Internet. She inquires about possible treatments for her daughter’s addiction. Which response by the PMHNP demonstrates understanding of pharmacologic approaches for compulsive disorders?

a) “Compulsive internet use can be treated similarly to how we treat people with substance use disorders”

b) “internet addiction is treated with drugs that help block the tension/arousal state your daughter experiences”

c) “When it comes to internet addiction, we prefer to treat patients with pharmaceuticals rather than psychosocial methods”

d) “there are no evidence-based treatments for internet addiction, but there are behavioral therapies your daughter can try”

Question 39

Mr. Peterson is meeting with the PMHNP to discuss healthier dietary habits. With a BMI of 33, Mr. Peterson is obese and needs to modify his food intake. “Sometimes I think I’m addicted to food the way some people are addicted to drugs”, he says. Which statement best describes the neurobiological parallels between food and drug addiction?

a) There is decreased activation of the prefrontal cortex

b) There is increased sensation of the reactive reward system

c) There is reduced activation of regions that process palatability

d) There are amplified reward circuits that activate upon consumption

Question 40

The PMHNP is caring for a patient who reports excessive arousal at nighttime. What could the PMHNP use for a time-limited duration to shift the patient’s brain from a hyperactive state to a sleep state?

a) Histamine 2 receptor antagonist

b) Benzodiazepines

c) Stimulants

d) Caffeine

Question 41

The PMHNP is caring for a patient who experiences too much overstimulation and anxiety during daytime hours. The patient agrees to a pharmacological treatment but states, “I don’t want to feel sedated or drowsy from the medicine.” Which decision made by the PMHNP demonstrates proper knowledge of this patient’s symptoms and appropriate treatment options?

a) Avoiding prescribing the patient a drug that blocks H1 receptors

b) Prescribing the patient a drug that acts on H2 receptors

c) Stopping the patient from taking medicine that unblocks H1 receptors

d) None of the above

Scholarly Activities

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FOLLOW EVERY REQUIREMENTS..

I send my new Assignment, I also send you everything you need, you must guide yourself through the Scholarly Activity Summary to be able to perform the Assignment of 5 paragraphs, remember that it is a single activity.

Always all the projects you did were based on PROBLEMS OF HYPERTENSION,

Individual Success Plan (ISP), I send it to you ,if you need it in the last paragraph (Program Competencies Addressed) of the Scholarly Activity Summary

This section consists of a list of program competencies that were addressed in this scholarly activity. Please use the list from the ISP.

LET ME KNOW IF YOU NEED ANYTHING ELSE..THANK YOU

Details:

Throughout the RN-to-BSN program, students are required to participate in scholarly activities outside of clinical practice or professional practice. Examples of scholarly activities include attending conferences, seminars, journal club, grand rounds, morbidity and mortality meetings, interdisciplinary committees, quality improvement committees, and any other opportunities available at your site, within your community, or nationally.

You are required to post one scholarly activity while you are in the BSN program, which should be documented by the end of this course. In addition to this submission, you are required to be involved and contribute to interdisciplinary initiatives on a regular basis.

Submit, as the assignment, a summary report of the scholarly activity, including who, what, where, when and any relevant take-home points. Include the appropriate program competencies associated with the scholarly activity as well as future professional goals related to this activity.

You may use the “Scholarly Activity Summary” resource to help guide this assignment.

While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are not required to submit this assignment to Turnitin.

PICOT

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A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the time frame needed to implement the change process.

Formulate a PICOT statement. (CHILDWOOD OBESITY). The PICOT statement will provide a framework for your capstone project.

In a paper of 750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

Evidence-Based Solution

Nursing Intervention

Patient Care

Health Care Agency

Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style.

NO PLAGIARISM PLEASE. CHECK FOR PLAGIARISM BEFORE GIVING THE ANSWER BACK.

Health Policy And Legal Aspect

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Overview: Peer Review

In the Module 3 Reflection Assignment, you will reflect upon what you have learned about Peer Review Committee processes and Texas Board of Nursing rules as you consider the actions of fictitious nurses and committee members in scenarios. REMEMBER, YOU ARE USING THE TEXAS BOARD OF NURSING RULES, NOT THE STATE YOU LIVE IN. Please use the link provided in the assignment for the Texas BON Rule 217.16.

ALSO, THERE ARE 2 PARTS TO THIS ASSIGNMENT. PLEASE MAKE SURE YOU COMPLETE BOTH PARTS.

Refer to your course readings and lectures as you complete the assignment.

Performance Objectives:

· Apply the Minor Incident Rule to specific incidents.

· Describe the due process protections for a nurse who is peer-reviewed.

Rubric

Use this rubric to guide your work on the assignment, “Peer Review.”

Task

Accomplished

Proficient

Needs Improvement

Part 1 (a)

Applying Rule 217.16

(Total 50 points)

Lists all the correct 5 criteria, accurately explains application of criteria clearly. (25 points)

Lists 3 or 4 of the correct criteria, accurately explains application of these criteria

(15 points)

Lists 2 applications of criteria.

10 points)

Incorrectly lists criteria (0 point)

Part 1 (b)

Reflects upon applications

of Rule 217.16

(Total 25 points)

Correctly states if nurse should be reported or not reported with 3 substantial sentences. (25 points)

Correctly states if nurse should be reported or not reported with 2 sentences.

(15 point)

Writes 1 sentence.

(10 points)

Incorrectly judges whether violations occurred (0 point)

Part 2

Violation of IBPR Rule 217.19 (Total 25 points)

Correctly listed the 4 violations and provides correct explanations (25 points)

Correctly lists 2-3 violations and explanations (15 points)

Lists 1 violation and explanation (10 points)

Incorrectly lists criteria (0 point)

All 5 questions correct (25 points)

4 questions correct (20 points)

3 questions correct (15 points)

2 questions correct (10 points)

1 question correct (5 points)

0 questions correct (0 point)

Part 1: (a) Applying Rule 217.16(h) Minor Incidents

Read the following scenario and then answer the questions that follow:

You are on your hospital’s Peer Review Committee (PRC). You are reviewing Nurse A’s practice. She works on the pediatric unit. In the past, Nurse A has practiced safely without incidents. However, four months ago, Nurse A gave immunizations to five pediatric patients (3 months, 9 months, 2 years, 4 years, and 5 years of age). She used a vial of Hepatitis B vaccine that had been expired for 30 days but still was being stored in the unit refrigerator. She gave the five immunizations within a few minutes of each other, and she got the vial from the refrigerator only once (i.e., She did not take it out and replace it five times). She took responsibility for the errors when she was informed by her unit manager.

Should Nurse A be reported to the BON?

Let’s review what deems a minor vs. a reportable (NOT minor) incident-

A minor incident is- 217.16(a)- as defined under the Texas Nursing Practice Act, Texas Occupations Code §301.401(2), means conduct by a nurse that may be a violation of the Texas Nursing Practice Act or a Board rule but does not indicate the nurse’s continued practice poses a risk of harm to a patient or another person.

A reportable incident is- 217.16(h)- conduct that falls outside of the definition of a minor incident and must be reported to a PRC or BON.

Apply the Minor Incident Rule to reach and support your decision. This Rule 217.16 can be found at http://www.bon.texas.gov/rr_current/217-16.asp

Use this specific link only- it is the official updated Texas Board of Nursing information. Click on the link and scroll down to the bottom to find the letter (h), where criteria are listed that describes actions that must be reported to the Peer Review Committee or BON.

Criteria. In the first column of the table, list the 5 criteria as it appears in the rule that are essential in determining if an incident is a reportable action. All 5 must be listed for full credit. Then, in the second column, record your explanation as to why or why not the nurse’s actions deem it reportable and therefore harmful to a patient.

Criteria that determine an incident is reportable

Rule 217.16(h)

Explanation of whether or not Nurse A’s actions are minor vs. reportable

Criteria :

Part 1: (b) Report vs. Not Report

Based on the Rule 217.16(h) criteria you listed above, would you report Nurse A to the Board? Please explain why or why not. At least 3 substantial sentences are needed for full credit.: (Explain below)

Part 2: Applying Rule 217.19 Incident-Based Peer Review

Read the following scenario and then reflect upon the actions it portrays.:

Last month, the chairperson of your hospital’s Peer Review Committee (PRC) passed you in the hallway and said, “I’m glad I ran into you. You’re going to be peer-reviewed.” The chairperson continued, saying, “Your manager found out that you called the Texas Department of State Health Services two months ago and reported that LVNs were being allowed to do the complete initial assessment on patients. Also, you made some medication errors over the past couple of months. I’ll let you know when the meeting is to occur.”

You heard nothing more about the PRC meeting. Today, the chairperson came to you and told you that you had been reported to the Texas Board of Nursing. She said, “It was just felt by the work group that you are a troublemaker and lack the skills to practice due to your med errors. I’m also giving you a ‘heads up’ that you are going to be put on suspension for at least three days by your unit manager.”

Applying Rule 217.19, what violations of the rule occurred in the above scenario?

First, review your learning about incident-based peer review. In the first column of the table, list any 4 criteria from Rule 217.19 that were violated (there are more than 4 to choose from).

1-

2-

3-

4-

In the second column, explain how each criterion was violated. All 4 boxes must be completed for full credit. Please use the link provided at http://www.bon.texas.gov/rr_current/217-19.asp

Which part of the rule was violated?

(Subsection number and letter OR descriptive phrase)

(Rule 217.19)

Explanation of violation ( from the 4 criteria above):

attachment
N3375-2_Module3_Assignment-updated.072118..docx

Case Study And Moral Status

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Based on “Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:

What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?

Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?

How does the theory determine or influence each of their recommendations for action?

What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Rubric

Explanation of the Christian view of the nature of human persons and the theory of moral status that it is compatible is clear, thorough, and explained with a deep understanding of the connection between them. Explanation is supported by topic study materials. 30%

The theory or theories that are used by each person to determine the moral status of the fetus is explained clearly and draws insightful relevant conclusions. Rationale for choices made is clearly supported by topic study materials and case study examples. 15%

Explanation of how the theory determines or influences each of their recommendations for action is clear, insightful, and demonstrates a deep understanding of the theory and its impact on recommendation for action. Explanation is supported by topic study materials. 15%

Evaluation of which theory is preferable within personal practice along with how that theory would influence personal recommendations for action is clear, relevant, and insightful. 10%

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Writer is clearly in command of standard, written, academic English.

All format elements are correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Research Article Critique

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Research Article Critique, Part 2

Occupational Stressors, Stress Perception Levels, and Coping Styles of Medical Srugical RNs: A Generalized Perspective

(Wakim, 2014)

Your assigned article for critique is:

Wakim, N. (2014). Occupational stressors, stress perception levels, and coping styles of medical surgical RNs. Journal of Nursing Administration, 44(12), 632-639. doi:10.1097/NNA.0000000000000140

Instructions: A major skill that is learned in this course is how to critically read and critique nursing research articles. The purpose for critiquing an article is to critically evaluate the research process followed by the author(s) of the assigned article. This is an information-intensive, time-intensive process that is not learned overnight. To demonstrate your skill at critiquing an article, you will complete this open-book multiple choice assignment.

Here’s how you should approach completing this week’s assignment to finish critiquing an article:

  1. First, do your assigned reading in Grove, Gray, and Burns (2015) and complete the reading worksheets early in the week. This will introduce you to the critique skills you will need for the week.
  2. Skim the entire instructor assigned research article that has been posted on Blackboard for you so that you will have an idea of what it is about. Lightly cross out the abstract for the article (you won’t be using it). Then, for this week, re-read carefully from the study design section through the end of the article.
  3. Print this document and find the best answer to each question below based on your Grove, Gray, and Burns (2015) assigned reading for the week and what you have read in the instructor assigned research article.
  4. Some of the questions in the critique assignment below will seem unfamiliar to you. Look up key terms from the question in your textbook. Some examples of these terms might be: power analysis, inter-rater reliability, and generalization. You can also look in Chapter 12 for an example of a critical appraisal (or critique) of a quantitative research article.
  5. Once you have completed this assignment “on paper”, go into blackboard and enter your answers by the assignment due date and time listed in the syllabus. Ignore any wording from Blackboard that indicates that “this is a test” and carefully enter your answers from this document.
  6. You will have two access attempts to record your answers. This is given to you so that if you encounter technical difficulties on your first attempt, or you would like a second attempt to try to improve your grade, you may do so. You will not be able to see the questions that you missed when you submit your attempt. Blackboard will record the highest grade from the two submissions.

If you have questions about this assignment, you can post them to your group discussion board for help. Please do not post the exact question from the assignment below and ask the group for the answer as this would constitute academic dishonesty.

Questions 1 – 9: Sample. (For help with these questions, refer to chapters: 9 & 12)

  1. What sampling method or plan was used by the authors in this study? a. Simple random sampling b. Systematic sampling c. Convenience sampling d. Network sampling</code></pre></li>According to Grove, Gray, and Burns (2015), what are the potential biases of this sampling method?

a. This is a strong probability sampling method with very little potential for bias

b. This method is used when an ordered list of all members of the population are available, and provides a random but not equal chance for inclusion in the study.

c. This method provides little opportunity to control for bias because subjects are included in the study merely because they happen to be in the right place at the right time.

d. This method is specific to the individuals who were recruited and the information gained cannot be generalized to others who don’t share these types of experiences.

e. None of the above biases best describe the sampling method chosen by the author.

  1. What was the final sample size reported by the authors for this study? a. 200 participants b. 84 participants c. 159 participants d. 161 participants</code></pre></li>Was a power analysis conducted? If so, which statement best describes the results of the power analysis?

a. The authors mention that an a priori power analysis was conducted, and 200 subjects were determined to be needed for the study. b. The authors mention that a power analysis was conducted using four predictors and 1-way ANOVA using three independent groups for a needed sample size of 159. c. The authors do not report that a power analysis was conducted. Which of these statements would be considered an inclusion criterion for the sample in the research article? a. English-speaking b. Have at least two years of experience as a nurse c. Work on a Medical Surgical unit d. Be a member of the Medical Surgical Nurses Association </code></pre></li>Which of these statements would be considered to be exclusion criterion specifically identified by the author for the sample in the research article? a. The exclusion criteria were explained verbally during recruitment. b. History of depression/ mental health issue.</code></pre></li> c. Report of no stress related problems by the participant. d. Participants only worked on the night shift. What is the refusal rate for this study? (Hint: see page 253 in your text) a. 161/200 X 100% = 80% b. 84/159 X 100% = 53% c. unknown / cannot be calculated. d. 39/200 x 100% = 19.5%</code></pre></li>Which of the following would be accurate for the attrition rate for this study? a. 161/200 X 100% = 80% b. 39/200 X 100% = 20% c. 84/159 X 100% = 53% d. 0%</code></pre></li>What was the setting for this research study? Briefly describe the setting and indicate whether it was appropriate for conducting this study. a. The setting for this study was a partially controlled setting and was appropriate for this study’s research design. b. The setting for this study was not well described by the authors and therefore not appropriate for conducting this study. c. The setting for this study was a highly controlled setting and was appropriate for this study’s research design. d. The setting for this study was a natural or field setting and was appropriate for this study’s research design. Question 10 - 14: Measurement Methods. (For help with these questions, refer to chapters 10 & 12.) Which ones of these questionnaires, scales, or physiologic measures is used in this research study? (Select all that apply). a. The Ways of Coping Questionaire (WAYS) b. The Nursing Stress Scale (NSS) c. The Perceived Stress Scale (PSS) d. The Quality of Life Scale (QOLS) How do the authors describe the reliability of the Nursing Stress Scale (NSS) in previous studies? a. Two follow-up emails were sent to potential participants. b. they compared the odd and even questions on the test to determine their equivalence. c. a team of staff nurses was trained by the primary investigator to administer the questionnaire. d. they tested a group of subjects twice using the same questionnaire (test-retest reliability). e. they computed a Cronbach’s alpha on the Nurse Stress Scale that was administered to this group of subjects. How do the authors describe the validity of The Ways of Coping Questionnaire (WAYS). a. discriminant validity demonstrated that each subscale measured the same constructs. b. evidence of validity from contrasting groups because they gave it to spouses of MS nurses.</code></pre></li> c. no was no mention of determining the validity of WAYS questionnaire. d. The authors had experience with administering this questionnaire. What types of questionnaires or surveys were used in this research study? (Select all that apply.) a. The authors developed the Professional Quality of Life Scale. b. Interviews were reportedly used, but the authors do not explain what was included in them.</code></pre>c. The authors developed their own questions to ask about demographic information. d. The authors report adding a few of their own questions at the end of the demographic questionnaire. e. This study did not use any questionnaires or surveys. f. The authors used previously developed questionnaires or surveys to measure the study variables. Were any physiological measurements collected from the subjects for the purpose of this study? a. Yes b. No</code></pre></li> Question 15- 16: Data Collection. (For help with these questions, refer to chapters 10 & 12) Which one of the following best describes the data collection process used in this study? a. questionnaires / surveys were completed via the telephone. b. participants were given the questionnaires on enrollment in the study and asked to drop the sealed envelope in a locked box at the nurse’s station. c. questionnaires / surveys were mailed to the prospective participants and returned in a self- addressed stamped envelope. d. nurse researchers interviewed the study participants in a focus group. If there were more than one data collector for the study, would an estimation of inter-rater reliability be an important concept for the authors to report on for this study? a. yes, and the authors reported their efforts to achieve inter-rater reliability. b. yes, but the authors do not discuss any efforts to achieve inter-rater reliability. c. no, the issue of inter-rater reliability does not apply here. Question 17 - 19: Data Analysis. (For help with these questions, refer to chapters 11 & 12) What descriptive statistics are used in this study? (Select all that apply). a. mean b. median c. mode d. standard deviation e. z-scores f. percentage distributions</code></pre></li>What inferential statistics were used to examine the data obtained from the subjects? (Select all that apply) a. Bivariate correlational analysis b. Factor Analysis c. t-Test d. Chi-Square e. ANCOVA f. ANOVA g. regression analysis h. None of the above inferential statistics were used in this study.</code></pre></li>What is the level of significance (alpha) set at for this study? a. .05 or 5% b. .10 or 90% c .01 or 1% d. an alpha level or level of significance chosen by the authors was not specifically mentioned in the text of the article.</code></pre></li> Question 20-25: Researcher’s Interpretation of the Findings. (For help with these questions, refer to chapters 11 & 12) There are several statistically significant findings in this study. Which of these statements from the article would be considered a significant and predicted result? (select all that apply) a. As MS nurses’ perceptions of their stress increases, their use of ways to cope increases (r = .357, P<.00) b. Younger nurses have lower levels of perceived stress, per post hoc Tukey analysis. c. Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses when dealing with occupational stressors. d. The stress perception level is thus determined by the type of occupational stressor that the nurse is exposed to. Which of these statements from the article would be considered a non-significant result. (Select all that apply) a. The older the nurse, the higher the level of stress. b. There was no difference between the scores on ways of coping related to age cohorts (F2158 = 1.12, P=.33) c. Age, years of experience, and educational levels are not significant factors in levels of perceived stress among MS nurses. d. Baby boomers tend to report higher use of self-controlling behaviors than Gen X and Gen Y nurses when dealing with occupational stressors. Which one of these statements from the article would be considered clinically important? a. According to this study results, a high level of occupational stress is not a known factor for nursing turnover in MS nurses. b. Younger nurses have better coping skills to combat perceived stress compared to more experienced nurses. c. Baby boomers reported higher use of self-controlling behaviors when dealing with occupational stressors compared with Gen X and Gen Y.</code></pre></li> d. Six participants were removed from the study due to incomplete surveys. Which statements below implied from the article would be considered a limitation of the study? (Select all that apply) a. The researchers utilized a qualitative method in the research design. b. Lack of standardization of the conditions of administering the instruments. c. A small sample size with a low response rate. d. A measure of social desirability in giving responses as the participants worked with the researcher. Which one of these statements would be considered a statement regarding generalization of these results? a. The results indicated that there were high levels of perceived stress in this group of MS nurses and can be generalized to all MS nurses in the United States. b. The survey was mailed only to MS nurses who were members of the Medical Surgical Nurses Association (MSNA). c. A convenience sample of MS nurses decreases generalizability. d. The use of a power analysis influenced the generalization of the results to all MS nurses. Which one of these statements from the article would be considered a recommendation for future studies? (Select al that apply.) a. Future development of programs to help relieve the occupational stress in MS nurses. b. Research to discover why older nurses have a higher perceived stress compared to younger nurses. c. Sufficiently educating nursing leaders in generational differences. d. Identification of occupational stressors, perceived stress, and coping styles among generational cohorts.

Diseases And Illnesses

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Question 1

A 40-year-old female presents complaining of pain near the midline in the epigastrium. Assuming the pain is caused by a stimulus acting on an abdominal organ, the pain felt is classified as:

a. Visceral

b. Somatic

c. Parietal

d. Referred

Question 2

An 8-week-old male was recently diagnosed with cystic fibrosis. Which of the following digestive alterations would be expected?

a. Insufficient bile production

b. Gastric atrophy

c. Hypersecretion of stomach acid

d. Nutrient malabsorption

Question 3

In alcoholic cirrhosis, hepatocellular damage is caused by:

a. acetaldehyde accumulation.

b. bile toxicity.

c. acidosis.

d. fatty infiltrations.

Question 4

Where does the nurse expect the obstruction to be in a patient with extrahepatic portal hypertension?

a. Sinusoids

b. Bile ducts

c. Hepatic portal vein

d. Hepatic artery

Question 5

Kwashiorkor is a severe dietary deficiency of:

a. fat-soluble vitamins.

b. carbohydrates.

c. protein.

d. calcium and magnesium.

Question 6

A 27-year-old male presents with fever, GI bleeding, hepatomegaly, and transient joint pain. He reports that as a child he received blood transfusions following a motor vehicle accident. He also indicates he was vaccinated against hepatitis B. Which of the following types of hepatitis does the clinician think he most likely has?

a. A

b. B

c. C

d. D

Question 7

Prolonged diarrhea is more serious in children than adults because:

a. children have lower adipose reserves.

b. fluid reserves are lower in children.

c. children have a lower metabolic rate.

d. children are more resistant to antimicrobial therapy.

Question 8

A 40-year-old male develops an intestinal obstruction related to protrusion of the intestine through the inguinal ring. This condition is referred to as:

a. Intussusception

b. A volvulus

c. A hernia

d. Adhesions

Question 9

A 60-year-old male presents with GI bleeding and abdominal pain. He reports that he takes NSAIDs daily to prevent heart attack. Tests reveal that he has a peptic ulcer. The most likely cause of this disease is:

a. Increasing subepithelial bicarbonate production

b. Accelerating the H+ (proton) pump in parietal cells

c. Inhibiting mucosal prostaglandin synthesis

d. Stimulating a shunt of mucosal blood flow

Question 10

Acute pancreatitis often manifests with pain to which of the following regions?

a. Right lower quadrant

b. Right upper quadrant

c. Epigastric

d. Suprapubic

Question 11

A 60-year-old male is diagnosed with cancer of the esophagus. Which of the following factors most likely contributed to his disease?

a. Reflux esophagitis

b. Intestinal parasites

c. Ingestion of salty foods

d. Frequent use of antacids

Question 12

The primary complication of enterocolitis associated with Hirschsprung disease is related to which finding?

a. Fecal impaction

b. Pancreatic insufficiency

c. Hyperactive peristalsis

d. Ileal atresia

Question 13

The most common cause of chronic vascular insufficiency among the elderly is:

a. Anemia

b. Aneurysm

c. Lack of nutrition in gut lumen

d. Atherosclerosis

Question 14

The most common clinical manifestation of portal hypertension is _ bleeding.

a. rectal

b. duodenal

c. esophageal

d. intestinal

Question 15

A 54-year-old male is diagnosed with peptic ulcer disease.This condition is most likely caused by:

a. Hereditary hormonal imbalances with high gastrin levels

b. Breaks in the mucosa and presence of corrosive secretions

c. Decreased vagal activity and vascular engorgement

d. Gastric erosions related to high ammonia levels and bile reflux

Question 16

The cardinal sign of pyloric stenosis caused by ulceration or tumors is:

a. Constipation

b. Diarrhea

c. Vomiting

d. Heartburn

Question 17

A 55-year-old male died in a motor vehicle accident. Autopsy revealed an enlarged liver caused by fatty infiltration, testicular atrophy, and mild jaundice secondary to cirrhosis. The most likely cause of his condition is:

a. Bacterial infection

b. Viral infection

c. Alcoholism

d. Drug overdose

Question 18

Manifestations associated with hepatic encephalopathy from chronic liver disease are the result of:

a. hyperbilirubinemia and jaundice.

b. fluid and electrolyte imbalances.

c. impaired ammonia metabolism.

d. decreased cerebral blood flow.

Question 19

The most common disorder associated with upper GI bleeding is:

a. diverticulosis.

b. hemorrhoids.

c. esophageal varices.

d. cancer.

Question 20

A 3-month-old female develops colicky pain, abdominal distention, and diarrhea after drinking cow’s milk. The best explanation for her symptoms is:

a. Deficiency of bile that stimulates digestive secretions and bowel motility

b. Excess of amylase, which increases the breakdown of starch and causes an osmotic diarrhea

c. Overgrowth of bacteria from undigested fat molecules, which leads to gas formation and de creased bowel motility

d. Excess of undigested lactose in her digestive tract, resulting in increased fluid movement into the digestive lumen and increased bowel motility

Question 21

A 55-year-old female has general symptoms of gallstones but is also jaundiced. IV cholangiography would most likely reveal that the gallstones are obstructing the:

a. Intrahepatic bile canaliculi

b. Gallbladder

c. Cystic duct

d. Common bile duct

Question 22

A 1-week-old female is brought to her pediatrician for abdominal distention and unstable temperature. Physical examination reveals bradycardia and apnea. Tests reveal hypoxic injury to the bowel resulting in bacterial invasion and perforation. This condition is referred to as:

a. Infective enteropathy

b. Necrotizing enterocolitis (NEC)

c. Mucoviscidosis

d. Ileus

Question 23

For the patient experiencing esophageal reflux, the nurse would expect which sphincter to be malfunctioning?

a. Pyloric

b. Lower esophageal

c. Upper esophageal

d. Gastric

Question 24

Cholecystitis is inflammation of the gallbladder wall usually caused by:

a. accumulation of bile in the hepatic duct.

b. obstruction of the cystic duct by a gall-stone.

c. accumulation of fat in the wall of the gallbladder.

d. viral infection of the gallbladder.

Question 25

A 6-month-old male infant is brought to the ER after the sudden development of abdominal pain, irritability, and vomiting followed by passing of “currant jelly” stool. Ultrasound reveals intestinal obstruction in which the ileum collapsed through the ileocecal valve and invaginated into the large intestine. This type of obstruction is referred to as:

a. Prolapse

b. Pyloric stenosis

c. Intussusception

d. Imperforation

Question 26

A 22-year-old male underwent brain surgery to remove a tumor. Following surgery, he experienced a peptic ulcer. His ulcer is referred to as a(n) _ ulcer.

a. Infectious

b. Cushing

c. Ischemic

d. Curling

Question 27

Chronic gastritis is classified according to the:

a. severity.

b. location of lesions.

c. patient’s age.

d. signs and symptoms.

Question 28

Reflux esophagitis is defined as a(n):

a. Immune response to gastroesophageal reflux

b. Inflammatory response to gastroesophageal reflux

c. Congenital anomaly

d. Secretory response to hiatal hernia

Question 29

The cardinal signs of small bowel obstruction are:

a. Vomiting and distention

b. Diarrhea and excessive thirst

c. Dehydration and epigastric pain

d. Abdominal pain and rectal bleeding

Question 30

The nurse assessing the patient with biliary atresia would expect to find which primary clinical manifestation?

a. Anemia

b. Jaundice

c. Hypobilirubinemia

d. Ascites

Question 31

A 20-year-old male was recently diagnosed with lactose intolerance. He eats an ice cream cone and develops diarrhea. His diarrhea can be classified as _ diarrhea.

a. Motility

b. Hypotonic

c. Secretory

d. Osmotic

Question 32

Which of the following symptoms would help a health care provider distinguish between ulcerative colitis and Crohn disease?

a. Pattern of remission/exacerbations

b. Abdominal pain

c. Malabsorption

d. Diarrhea

Question 33

A 45-year-old male complains of heartburn after eating and difficulty swallowing. He probably has:

a. Pyloric stenosis

b. Hiatal hernia

c. Gastric cancer

d. Achalasia

Question 34

The exocrine portion of the pancreas contains:

a. alpha cells.

b. beta cells.

c. acinar cells.

d. islets of Langerhans.

Question 35

Outbreaks of hepatitis _ often occur in young children attending day care centers and can be attributed to poor hand washing.

a. A

b. B

c. C

d. D

Psychiatric Nursing Questions

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

See the attachment for the open book quizzes and study guide.

                                            Learning Resources

Required Readings

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

attachment

Medical Coding

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1) Assign the CPT Code(s) and appropriate modifiers to each statement.

The physician treated a soft tissue abscess that was due to osteomyelitis by making an incision and examining, debriding, and draining the subfascia; the physician also irrigated the affected area, examined underlying tissue and bone for signs of infection, and closed the site.

2) Patient underwent exploration of a penetrating wound of the chest, which involve surgical exploration and enlargement of the wound, debridement, removal of a foreign body, and ligation of subcutaneous tissue.

3) Open bone biopsy, superficial, left femur.

4) Patient underwent aspiration of ganglion cyst, right wrist.

5) Patient received a cortisone injection to a single trigger point, which consisted of the trapezius deltoid, and latissimus dorsi muscles.

6) A patient diagnosed with joint contracture of the right ankle underwent application of a multiplane external fixation device.

7) A patient severed his right index finger while using a chain saw. He underwent successful replantation of the index finger, which included metacarpophalangeal (MCP) joint insertion of flexor sublimis tendon.

8) Fascia lata graft was harvested using a stripper.

9) Patient underwent structural allograft as part of an arthrodesis, posterior technique, craniocervical (occiput-C2).

10) Electrical stimulation procedure was performed to aid bone healing, invasive type.

1) Arthrotomy of temporomandibular joint, right and left sides.

2) Excision of two facial bones (due to bone abscesses).

3) Impression and custom preparation of speech aid prosthesis.

4) Sliding osteotomy genioplasty, single piece.

5) Reconstruction midface, Lefort II with anterior intrusion.

6) Osteotomy of mandible, segmental.

7) Malar augmentation with prosthetic material.

8) Closed treatment of orbit fracture, with manipulation.

9) Closed treatment of maxillary alveolar ridge fracture.

10) Open treatment of mandibular condylar fracture.

1) Deep incision with opening of bone cortex, thorax.

2) Hyoid myotomy and suspension.

3) Closed treatment of sternum fracture.

4) Partial excision of rib.

5) Sternal debridement.

6) Needle biopsy, soft tissue, thorax.

7) Excision of tumor, subcutaneous soft tissue of back, 2.5 cm.

8) The physician removed a 4-cm malignant soft tissue tumor, including adjacent tissue, from the patient’s flank. Radial resection was performed to remove the tumor and adjacent tissue. The 5-cm surgical wound was repaired with complex closure.

9) Patient underwent biopsy of superficial soft tissues of the back.

10) Biopsy, soft tissue flank, deep.

1) Patient underwent arthrodesis at L4-L5 interspace. Posterior interbody technique laminectomy was performed. Discectomy was also performed to prepare the verbal interspace for fusion.

2) Physician performed “spinal manipulation under anesthesia, “cervical, thoracic, and lumbar spine.

3) Patient underwent osteotomy and discectomy of a single cervical spine vertebral segmet. Anterior approach was used.

4) Physician performed arthrodesis using posterior technique of atlas-axis (C1-C2) with internal spinal fixation by wiring the spinous processes.

5) Patient underwent poster arthrodesis of L2-L3 for spinal deformity, with casting. Morselized autogenous iliac bone graft was harvested through a separate skin incision.

Community Teaching Work Plan Proposal

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Report Issue

Note: This is an individual assignment. Applying what you have learned thus far, develop a community teaching proposal designed to address the needs of your community.

Select one of the following as the focus for the teaching plan:

Primary Prevention/Health Promotion

Secondary Prevention/Screenings for a Vulnerable Population

Bioterrorism/Disaster

Environmental Issues

Complete the “Community Teaching Work Plan Proposal.” This will help you organize your plan and create an outline for the written assignment.

After completing the teaching proposal, review the teaching plan with a community health and public health provider in your local community.

Request feedback (strengths and opportunities for improvement) from the provider.

Complete the “Community Teaching Experience” form.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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