1. Create a professional mission statement (suggested length of 1 paragraph) that includes the following:

● a representation of your career goals, your aspirations, and how you want to move forward with your career

● an overview of where you would like to focus your time and energies within the profession

a. Reflect on how your professional mission statement will help guide you throughout your nursing career.

1. Complete a professional summary (suggested length of 3–4 pages) that includes the following:

a. Explain how the specific artifacts or completed work or both in your portfolio represent you as a learner and a healthcare professional.

b. Discuss how the specific artifacts in your portfolio represent your professional strengths.

c. Discuss challenges you encountered during the progression of your program.

i. Explain how you overcame these challenges.

d. Explain how your coursework helped you meet each of the nine nursing program outcomes.

Note: Refer to the attachment “Nursing Conceptual Model.”

e. Analyze how you fulfilled the following roles during your program:

• scientist

• detective

• manager of the healing environment

f. Discuss how you have grown professionally since the beginning of your program.

B. Complete the following within the section “Quality and Safety”:

1. Reflect (suggested length of 1 page) on your professional definition of quality and safety developed in Professional Roles and Values, including any necessary changes to your definition.

a. Discuss how the program assisted you in developing your professional definition.

b. Identify the artifacts in your portfolio that support your definition.

i. Explain how these artifacts support your definition from part B1.

Note: The artifacts should be attached within the portfolio.

1. Discuss the importance of the Institute for Healthcare Improvement (IHI) certificate for your future role as a professional nurse.

C. Complete the following within the section “Evidence-Based Practice”:

1. Reflect (suggested length of 1 page) on your professional definition of evidence-based practice developed in Professional Roles and Values, including any necessary changes to your definition.

a. Discuss how the program assisted you in developing your professional definition.

b. Identify the artifacts in your portfolio that support your definition.

i. Explain how these artifacts support your definition from part C1.

Note: The artifacts should be attached within the portfolio.

1. Reflect (suggested length of 1 page) on your understanding of evidence-based practice and applied nursing research by doing the following:

a. Discuss how you are able to evaluate current primary research and apply the concepts to your nursing practice, considering the following:

• relevancy and believability of data

• differences between quality improvement and research (places and uses of each)

• differences between primary and secondary research and resources and the implications of each in clinical practice

b. Explain how your experience in the program helped you achieve excellence in evidence-based practice.

D. Complete the following within the section “Applied Leadership”:

1. Reflect (suggested length of 1 page) on your professional definition of applied leadership you developed in Professional Roles and Values, including any necessary changes to your definition.

a. Discuss how the program assisted you in developing your professional definition.

b. Identify the artifacts in your portfolio that support your definition.

i. Explain how these artifacts support the definition from part D1.

Note: The artifacts should be attached within the portfolio.

1. Summarize (suggested length of 1 paragraph to 1 page) your Learning Leadership Experience task by doing the following:

a. Discuss the importance of professional collaboration for effective nursing leadership.

E. Complete the following within the section “Community and Population Health”:

1. Reflect (suggested length of 1 page) on your professional definition of community and population health you developed in Professional Roles and Values, including any necessary changes to your definition.

a. Discuss how the program assisted you in developing your professional definition.

b. Identify the artifacts in your portfolio that support your definition.

i. Explain how these artifacts support the definition from part E1.

Note: The artifacts should be attached within the portfolio.

1. Summarize (suggested length of 1 page) your Community and Population Health task (STIs) by doing the following:

a. Discuss what you learned during your Community Health Nursing task (STIs).

b. Discuss what you learned led to your community diagnosis ( Nursing Diagnosis Statement: Sexually transmitted infections are common among adolescent individuals living in Florida).

c. Discuss how your initial focus and diagnosis evolved after working with your population.

Question 1 1 / 1 point

Severe contact dermatitis caused by poison ivy or poison oak exposure often requires treatment with:

Question options:

Topical antipruritics

Oral corticosteroids for 2 to 3 weeks

Thickly applied topical intermediate-dose corticosteroids

Isolation of the patient to prevent spread of the dermatitis

Question 2 1 / 1 point

Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be:

Question options:

PEG 3350 (Miralax)

Bisacodyl (Dulcolax) suppository

Docusate (Colace) suppository

Polyethylene glycol electrolyte solution

Question 3 1 / 1 point

Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:

Question options:

Iron deficiency anemia, vitamin B12 and calcium deficiency

Folate and magnesium deficiency

Elevated uric acid levels leading to gout

Hypokalemia and hypocalcemia

Question 4 1 / 1 point

The drug of choice for treatment of early latent or tertiary syphilis is:

Question options:

Ceftriaxone IM

Benzathine penicillin G IM

Oral azithromycin

Oral ciprofloxacin

Question 5 0 / 1 point

The optimal maximum time frame for HRT or estrogen replacement therapy (ERT) is:

Question options:

2 years

5 years

10 years

15 years

Question 6 1 / 1 point

The Best Pharmaceuticals for Children Act:

Question options:

Includes a pediatric exclusivity rule which extends the patent on drugs studied in children

Establishes a committee that writes guidelines for pediatric prescribing

Provides funding for new drug development aimed at children

Encourages manufacturers specifically to develop pediatric formulations

Question 7 1 / 1 point

Sophie presents to the clinic with a malodorous vaginal discharge and is confirmed to have Trichomonas infection. Treatment for her would include:

Question options:

Metronidazole 2 grams PO x 1 dose

Topical intravaginal metronidazole daily x 7 days

Intravaginal clindamycin daily x 7 days

Azithromycin 2 grams PO x 1 dose

Question 8 1 / 1 point

Jamison has been prescribed citalopram (Celexa) to treat his depression. Education regarding how quickly selective serotonin reuptake inhibitor (SSRI) antidepressants work would be:

Question options:

Appetite and concentration improve in the first 1 to 2 weeks.

Sleep should improve almost immediately upon starting citalopram.

Full response to the SSRI may take 2 to 4 months after he reaches the full therapeutic dose.

His dysphoric mood will improve in 1 to 2 weeks.

Question 9 1 / 1 point

Patients who have a poor metabolism phenotype will have:

Question options:

Slowed metabolism of a prodrug into an active drug, leading to accumulation of Prodrug

Accumulation of inactive metabolites of drugs

A need for increased dosages of medications

Increased elimination of an active drug

Question 10 1 / 1 point

The drug of choice for type 2 diabetics is metformin. Metformin:

Question options:

Decreases glycogenolysis by the liver

Increases the release of insulin from beta cells

Increases intestinal uptake of glucose

Prevents weight gain associated with hyperglycemia

Question 11 1 / 1 point

The first-line therapy for mild-persistent asthma is:

Question options:

High-dose montelukast

Theophylline

Low-dose inhaled corticosteroids

Long-acting beta-2-agonists

Question 12 1 / 1 point

All of the following statements about the Beer’s List are true except:

Question options:

It is a list of medications or medication classes that should generally be avoided in persons 65 years or older because they are either ineffective or they pose unnecessarily high risk for older persons and a safer alternative is available.

It is derived from the expert opinion of one geriatrician and is not evidence-based.

These criteria have been adopted by the Centers for Medicare and Medicaid Services for regulation of long-term care facilities.

These criteria are directed at the general population of patients over 65 years of age and do not take disease states into consideration.

Question 13 1 / 1 point

Isosorbide dinitrate is prescribed for a patient with chronic stable angina. This drug is administered twice daily, but the schedule is 7 a.m. and 2 p.m. because:

Question options:

It is a long-acting drug with potential for toxicity.

Nitrate tolerance can develop.

Orthostatic hypotension is a common adverse effect.

It must be taken with milk or food.

Question 14 1 / 1 point

True contraindications to diphtheria, tetanus, and acellular pertussis (DTaP or Tdap) vaccine include:

Question options:

Fever up to 104oF (40.5oC) after previous DTaP vaccine

Family history of seizures after DTaP vaccine

Adolescent pregnancy

Anaphylactic reaction with a previous dose

Question 15 1 / 1 point

Gender differences between men and women in pharmacokinetics include:

Question options:

More rapid gastric emptying so that drugs absorbed in the stomach have less exposure to absorption sites

Higher proportion of body fat so that lipophilic drugs have relatively greater volumes of distribution

Increased levels of bile acids so that drugs metabolized in the intestine have higher concentrations

Slower organ blood flow rates so drugs tend to take longer to be excreted

Question 16 1 / 1 point

Disease states in addition to hypertension in which beta blockade is a compelling indication for the use of beta blockers include:

Question options:

Heart failure

Angina

Myocardial infarction

Dyslipidemia

Question 17 1 / 1 point

Developmental variation in renal function has what impact on prescribing for infants and children?

Question options:

Lower doses of renally excreted drugs may be prescribed to infants younger than age 6 months.

Higher doses of water soluble drugs may need to be prescribed because of increased renal excretion.

Renal excretion rates have no impact on prescribing.

Parents need to be instructed on whether drugs are renally excreted or not.

Question 18 1 / 1 point

When a pharmacoeconomic analysis looks at two or more treatment alternatives that are considered equal in efficacy and compares the costs of each it is referred to as:

Question options:

Cost-minimization analysis

Cost-of-illness analysis

Cost-effectiveness analysis

Cost-benefit analysis

Question 19 1 / 1 point

Allison is an 18-year-old college student with type 1 diabetes. She is on NPH twice daily and Novolog before meals. She usually walks for 40 minutes each evening as part of her exercise regimen. She is beginning a 30-minute swimming class three times a week at 1 p.m. What is important for her to do with this change in routine?

Question options:

Delay eating the midday meal until after the swimming class.

Increase the morning dose of NPH insulin on days of the swimming class.

Adjust the morning insulin injection so that the peak occurs while swimming.

Check glucose level before, during, and after swimming.

Question 20 0 / 1 point

A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with:

Question options:

Methimazole

Propylthiouracil (PTU)

Radioactive iodine

Nothing, treatment is best delayed until after her pregnancy ends

Question 21 1 / 1 point

Which of the following is a primary benefit of the use of computerized provider order entry for patient medications?

Question options:

Reduces time that prescribing drugs takes

Eliminates the need to chart drugs prescribed

Decreases prescribing and transcription errors

Helps keep the number of drugs prescribed to a minimum

Question 22 1 / 1 point

Lisa is a healthy nonpregnant adult woman who recently had a urinary tract infection (UTI). She is asking about drinking cranberry juice to prevent a recurrence of the UTI. The correct answer to give her would be:

Question options:

Sixteen ounces per day of cranberry juice cocktail will prevent UTIs.

100% cranberry juice or cranberry juice extract may decrease UTIs in some patients.

There is no evidence that cranberry juice helps prevent UTIs.

Cranberry juice only works to prevent UTIs in children.

Question 23 1 / 1 point

Ginseng, which is taken to assist with memory, may potentiate:

Question options:

Aricept

Insulin

Digoxin

Propranolol

Question 24 1 / 1 point

While on testosterone replacement, hemoglobin and hematocrit levels should be monitored. Levels suggestive of excessive erythrocytosis or abuse are:

Question options:

Hemoglobin 14 g/dl or hematocrit 39%

Hemoglobin 11.5 g/dl or hematocrit 31%

Hemoglobin 13 g/dl or hematocrit 38%

Hemoglobin 17.5 g/dl or hematocrit 54%

Question 25 1 / 1 point

What is the role of calcium supplements when patients take bisphosphonates?

Question options:

They must be restricted to allow the medication to work.

They must be taken in sufficient amounts to provide foundational elements for bone growth.

They must be taken at the same time as the bisphosphonates.

They only work with bisphosphonates if daily intake is restricted.

Question 26 1 / 1 point

Clinical judgment in prescribing includes:

Question options:

Factoring in the cost to the patient of the medication prescribed

Always prescribing the newest medication available for the disease process

Handing out drug samples to poor patients

Prescribing all generic medications to cut costs

Question 27 1 / 1 point

The most cost-effective treatment for two or three impetigo lesions on the face is:

Question options:

Mupirocin ointment

Retapamulin (Altabax) ointment

Topical clindamycin solution

Oral amoxicillin/clavulanate (Augmentin)

Question 28 1 / 1 point

Medications are typically started for angina patients when:

Question options:

The first permanent EKG changes occur

The start of class I or II symptoms

The events trigger a trip to the emergency department

When troponin levels become altered

Question 29 0 / 1 point

Rabi is being prescribed phenytoin for seizures. Monitoring includes assessing:

Question options:

For phenytoin hypersensitivity syndrome 3 to 8 weeks after starting treatment

For pedal edema throughout therapy

Heart rate at each visit and consider altering therapy if heart rate is less than 60 bpm

For vision changes, such as red-green blindness, at least annually

Question 30 1 / 1 point

Alterations in drug metabolism among Asians may lead to:

Question options:

Slower metabolism of antidepressants, requiring lower doses

Faster metabolism of neuroleptics, requiring higher doses

Altered metabolism of omeprazole, requiring higher doses

Slower metabolism of alcohol, requiring higher doses

Question 31 1 / 1 point

The dosage of Vitamin B12 to initially treat pernicious anemia is:

Question options:

Nasal cyanocobalamin 1 gram spray in each nostril daily x 1 week then weekly x 1 month

Vitamin B12 IM monthly

Vitamin B12 1,000 mcg IM daily x 1 week then 1,000 mg IM weekly for a month

Oral cobalamin 1,000 mcg daily

Question 32 1 / 1 point

There is often cross-sensitivity and cross-resistance between penicillins and cephalosporins because:

Question options:

Renal excretion is similar in both classes of drugs.

When these drug classes are metabolized in the liver they both produce resistant enzymes.

Both drug classes contain a beta-lactam ring that is vulnerable to beta-lactamase-producing organisms.

There is not an issue with cross-resistance between the penicillins and cephalosporins.

Question 33 1 / 1 point

The reason that two MMR vaccines at least a month apart are recommended is:

Question options:

The second dose of MMR “boosts” the immunity built from the first dose.

Two vaccines 1 month apart is the standard dosing for all live virus vaccines.

If the two MMR vaccine doses are given too close together there is a greater likelihood of severe localized reaction to the vaccine.

Only 95% of patients are fully immunized for measles after the first vaccine, with 99% having immunity after two doses of MMR.

Question 34 1 / 1 point

A laboratory result indicates that the peak level for a drug is above the minimum toxic concentration. This means that the:

Question options:

Concentration will produce therapeutic effects

Concentration will produce an adverse response

Time between doses must be shortened

Duration of action of the drug is too long

Question 35 1 / 1 point

Why is the consistency of taking paroxetine (Paxil) and never running out of medication more important than with most other selective serotonin reuptake inhibitors (SSRIs)?

Question options:

It has a shorter half-life and withdrawal syndrome has a faster onset without taper.

It has the longest half-life and the withdrawal syndrome has a faster onset.

It is quasi-addictive in the dopaminergic reward system.

It is the most activating of SSRI medications and will cause the person to have sudden deep sadness.

Question 36 1 / 1 point

Chee is a 15-month-old male whose screening hemoglobin is 10.4 g/dL. Treatment for his anemia would be:

Question options:

18 mg/day of iron supplementation

6 mg/kg per day of elemental iron

325 mg ferrous sulfate per day

325 mg ferrous sulfate tid

Question 37 1 / 1 point

Education for patients who use an inhaled beta-agonist and an inhaled corticosteroid includes:

Question options:

Use the inhaled corticosteroid first, followed by the inhaled beta-agonists.

Use the inhaled beta-agonist first, followed by the inhaled corticosteroid.

Increase fluid intake to 3 liters per day.

Avoid use of aspirin or ibuprofen while using inhaled medications.

Question 38 1 / 1 point

According to the U.S. Office of Minority Health, poor health outcomes among African Americans are attributed to:

Question options:

The belief among African Americans that prayer is more powerful than drugs

Poor compliance on the part of the African American patient

The genetic predisposition for illness found among African Americans

Discrimination, cultural barriers, and lack of access to health care

Question 39 0 / 1 point

Precautions that should be taken when prescribing controlled substances include:

Question options:

Faxing the prescription for a Schedule II drug directly to the pharmacy

Using tamper-proof paper for all prescriptions written for controlled drugs

Keeping any pre-signed prescription pads in a locked drawer in the clinic

Using only numbers to indicate the amount of drug to be prescribed

Question 40 1 / 1 point

When considering which cholesterol-lowering drug to prescribe, which factor determines the type and intensity of treatment?

Question options:

Total LDL

Fasting HDL

Coronary artery disease risk level

Fasting total cholesterol

Question 41 1 / 1 point

Which of the following patients may be treated with a 3-day course of therapy for their urinary tract infection?

Question options:

Juanita, a 28-year-old pregnant woman

Sally, a 16-year-old healthy adolescent

Jamie, a 24-year-old female

Suzie, a 26-year-old diabetic

Question 42 1 / 1 point

If an adult patient with comorbidities cannot reliably take oral antibiotics to treat pneumonia, an appropriate initial treatment option would be:

Question options:

IV or IM gentamicin

IV or IM ceftriaxone

IV amoxicillin

IV ciprofloxacin

Question 43 1 / 1 point

Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to the patient who is starting varenicline include:

Question options:

The maximum time varenicline can be used is 12 weeks.

Nausea is a sign of varenicline toxicity and should be reported to the provider.

The starting regimen for varenicline is start taking 1 mg twice a day a week before the quit date.

Neuropsychiatric symptoms may occur.

Question 44 0 / 1 point

Harold, a 42-year-old African American, has moderate persistent asthma. Which of the following asthma medications should be used cautiously, if at all?

Question options:

Betamethasone, an inhaled corticosteroid

Salmeterol, an inhaled long-acting beta-agonist

Albuterol, a short-acting beta-agonist

Montelukast, a leukotriene modifier

Question 45 1 / 1 point

Absolute contraindications that clinicians must consider when initiating estrogen therapy include:

Question options:

Undiagnosed dysfunctional uterine bleeding

Deep vein or arterial thromboemboli within the prior year

Endometriosis

Both a. and b.

All of the above

Question 46 1 / 1 point

Several classes of drugs have interactions with cholinergic blockers. Which of the following is true about these interactions?

Question options:

Drugs with a narrow therapeutic range given orally may not stay in the GI tract long enough to produce an action.

Additive antimuscarinic effects may occur with antihistamines.

Cholinergic blockers may decrease the sedative effects of hypnotics.

Cholinergic blockers are contraindicated with antipsychotics.

Question 47 1 / 1 point

Leonard is completing a 6-month regimen to treat tuberculosis (TB). Monitoring of a patient on TB therapy includes:

Question options:

Monthly sputum cultures

Monthly chest x-ray

Bronchoscopy every 3 months

All of the above

Question 48 1 / 1 point

The action of “gliptins” is different from other antidiabetic agents because they:

Question options:

Have a low risk for hypoglycemia

Are not associated with weight gain

Close ATP-dependent potassium channels in the beta cell

Act on the incretin system to indirectly increase insulin production

Question 49 1 / 1 point

Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true?

Question options:

Screening TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to remain above 5.0.

Screening values are much narrower than the acceptable range used to keep a person stable on hormone replacement.

Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10.

Screening values are between 5 and 10, and therapeutic values are greater than 10.

Question 50 1 / 1 point

Azithromycin dosing requires that the first day’s dosage be twice those of the other 4 days of the prescription. This is considered a loading dose. A loading dose:

Question options:

Rapidly achieves drug levels in the therapeutic range

Requires four- to five-half-lives to attain

Is influenced by renal function

Is directly related to the drug circulating to the target tissues

Question 51 1 / 1 point

Conjunctivitis in a child that is accompanied by acute otitis media is treated with:

Question options:

Sulfacetamide 10% ophthalmic solution (Bleph-10)

Bacitracin/polymyxin B (Polysporin) ophthalmic drops

Ciprofloxacin (Ciloxan) ophthalmic drops

High-dose oral amoxicillin

Question 52 1 / 1 point

To improve actual effectiveness of oral contraceptives women should be educated regarding:

Question options:

Use of a back-up method if they have vomiting or diarrhea during a pill packet

Doubling pills if they have diarrhea during the middle of a pill pack

The fact that they will have a normal menstrual cycle if they miss two pills

The fact that mid-cycle spotting is not normal and the provider should be contacted immediately

Question 53 1 / 1 point

An acceptable first-line treatment for peptic ulcer disease with positive H. pylori test is:

Question options:

Histamine2 receptor antagonists for 4 to 8 weeks

Proton pump inhibitor bid for 12 weeks until healing is complete

Proton pump inhibitor bid plus clarithromycin plus amoxicillin for 14 days

Proton pump inhibitor bid and levofloxacin for 14 days

Question 54 1 / 1 point

Larry is taking allopurinol to prevent gout. Monitoring of a patient who is taking allopurinol includes:

Question options:

Complete blood count

Blood glucose

C-reactive protein

BUN, creatinine, and creatinine clearance

Question 55 1 / 1 point

When discussing with a patient the different start methods used for oral combined contraceptives, the advantage of a Sunday start over the other start methods is:

Question options:

Immediate protection against pregnancy the first week of using the pill

No back-up method is needed when starting

Menses occur during the week

They can start the pill on the Sunday after the office visit

Question 56 1 / 1 point

Sadie is a 90-year-old patient who requires a new prescription. What changes in drug distribution with aging would influence prescribing for Sadie?

Question options:

Increased volume of distribution

Decreased lipid solubility

Decreased plasma proteins

Increased muscle-to-fat ratio

Question 57 1 / 1 point

Rose is a 3-year-old patient with an upper respiratory infection (URI). Treatment for her URI would include:

Question options:

Amoxicillin

Diphenhydramine

Pseudoephedrine

Nasal saline spray

Question 58 1 / 1 point

Instructions for the use of nicotine gum include:

Question options:

Chew the gum quickly to get a peak effect.

The gum should be “parked” in the buccal space between chewing.

Acidic drinks such as coffee help with the absorption of the nicotine.

The highest abstinence rates occur if the patient chews the gum when he or she is having cravings.

Question 59 0 / 1 point

Howard is a 72-year-old male who occasionally takes diphenhydramine for his seasonal allergies. Monitoring for this patient taking diphenhydramine would include assessing for:

Question options:

Urinary retention

Cardiac output

Peripheral edema

Skin rash

Question 60 0 / 1 point

Vicky, age 56 years, comes to the clinic requesting a refill of her Fiorinal (aspirin and butalbital) that she takes for migraines. She has been taking this medication for over 2 years for migraines and states one dose usually works to abort her migraine. What is the best care for her?

Question options:

Switch her to sumatriptan (Imitrex) to treat her migraines.

Assess how often she is using Fiorinal and refill her medication.

Switch her to a beta blocker such as propranolol to prevent her migraine.

Request she return to the original prescriber of Fiorinal as you do not prescribe butalbital for migraines.

Question 61 1 / 1 point

Drugs that have a significant first-pass effect:

Question options:

Must be given by the enteral (oral) route only

Bypass the hepatic circulation

Are rapidly metabolized by the liver and may have little if any desired action

Are converted by the liver to more active and fat-soluble forms

Question 62 1 / 1 point

First-line therapy for treating topical fungal infections such as tinea corporis (ringworm) or tinea pedis (athlete’s foot) would be:

Question options:

OTC topical azole (clotrimazole, miconazole)

Oral terbinafine

Oral griseofulvin microsize

Nystatin cream or ointment

Question 63 1 / 1 point

A client asks the NP about the differences in drug effects between men and women. What is known about the differences between the pharmacokinetics of men and women?

Question options:

Body temperature varies between men and women.

Muscle mass is greater in women.

Percentage of fat differs between genders.

Proven subjective factors exist between the genders.

Question 64 1 / 1 point

Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?

Question options:

All opiates are scheduled drugs which require a DEA license to prescribe.

Opiates stimulate only mu receptors for the control of pain.

Most of the adverse effects of opiates are related to mu receptor stimulation.

Naloxone is an antagonist to opiates.

Question 65 1 / 1 point

A potentially life-threatening adverse response to angiotensin-converting enzyme inhibitors is angioedema. Which of the following statements is true about this adverse response?

Question options:

Swelling of the tongue or hoarseness are the most common symptoms.

It appears to be related to the decrease in aldosterone production.

Presence of a dry, hacky cough indicates a high risk for this adverse response.

Because it takes time to build up a blood level, it occurs after being on the drug for about 1 week.

Question 66 1 / 1 point

The benefits to the patient of having an Advanced Practice Registered Nurse (APRN) prescriber include:

Question options:

Nurses know more about Pharmacology than other prescribers because they take it both in their basic nursing program and in their APRN program.

Nurses care for the patient from a holistic approach and include the patient in decision making regarding their care.

APRNs are less likely to prescribe narcotics and other controlled substances.

APRNs are able to prescribe independently in all states, whereas a physician’s assistant needs to have a physician supervising their practice.

Question 67 1 / 1 point

Education of women who are being treated with ophthalmic antibiotics for conjunctivitis includes:

Question options:

Throwing away eye makeup and purchasing new

Redness and intense burning is normal with ophthalmic antibiotics

When applying eye ointment, set the tip of the tube on the lower lid and squeeze in inch

Use a cotton swab to apply ointment, spreading the ointment all over the lid and in the conjunctival sac

Question 68 1 / 1 point

When determining drug treatment the NP prescriber should:

Question options:

Always use evidence-based guidelines

Individualize the drug choice for the specific patient

Rely on his or her experience when prescribing for complex patients

Use the newest drug on the market for the condition being treated

Question 69 1 / 1 point

Class I recommendations for stage A heart failure include:

Question options:

Aerobic exercise within tolerance levels to prevent the development of heart failure

Reduction of sodium intake to less than 2,000 mg/day to prevent fluid retention

Beta blockers for all patients regardless of cardiac history

Treatment of thyroid disorders, especially if they are associated with Tachyarrhythmias

Question 70 1 / 1 point

Male patients who should not be prescribed phosphodiesterase type 5 (PDE-5) inhibitors include:

Question options:

Diabetics

Those who have had an acute myocardial infarction in the past 6 months

Patients who are deaf

Patients under age 60 years of age

Question 71 1 / 1 point

The first-line drug choice for a previously healthy adult patient diagnosed with community-acquired pneumonia would be:

Question options:

Ciprofloxacin

Azithromycin

Amoxicillin

Doxycycline

Question 72 1 / 1 point

If a patient with symptoms of gastroesophageal reflux disease states that he has been self-treating at home with OTC ranitidine daily, the appropriate treatment would be:

Question options:

Prokinetic (metoclopramide) for 4 to 8 weeks

Proton pump inhibitor (omeprazole) for 12 weeks

Histamine2 receptor antagonist (ranitidine) for 4 to 8 weeks

Cytoprotective drug (misoprostol) for 2 weeks

Question 73 1 / 1 point

Patients who are prescribed exogenous androgens need to be warned that decreased libido:

Question options:

Is an unusual side effect of androgens and should be reported to the provider

Is treated with increased doses of androgens, so the patient should let the provider know if he is having problems

May be a sign of early prostate cancer and he should make an appointment for a prostate screening exam

May occur with androgen therapy

Question 74 1 / 1 point

Which diuretic agents typically do not need potassium supplementation?

Question options:

The loop diuretics

The thiazide diuretics

The aldosterone inhibitors

They all need supplementation

Question 75 0 / 1 point

Jim is being treated for hypertension. Because he has a history of heart attack, the drug chosen is atenolol. Beta blockers treat hypertension by:

Question options:

Increasing heart rate to improve cardiac output

Reducing vascular smooth muscle tone

Increasing aldosterone-mediated volume activity

Reducing aqueous humor production

Question 76 1 / 1 point

Patient education regarding taking iron replacements includes:

Question options:

Doubling the dose if they miss a dose to maintain therapeutic levels

Taking the iron with milk or crackers if it upsets their stomach

Iron is best taken on an empty stomach with juice

Antacids such as Tums may help the upset stomach caused by iron therapy

Question 77 1 / 1 point

Patient education for a patient who is prescribed antibiotics for sinusitis includes:

Question options:

Use of nasal saline washes

Use of inhaled corticosteroids

Avoiding the use of ibuprofen while ill

Use of laxatives to treat constipation

Question 78 1 / 1 point

Patients who are treated with greater than 100 grams per week of topical calcipotriene for psoriasis need to be monitored for:

Question options:

High vitamin D levels

Hyperkalemia

Hypercalcemia

Hyperuricemia

Question 79 1 / 1 point

Sook has been prescribed gabapentin to treat neuropathic pain and is complaining of feeling depressed and having “strange” thoughts. The appropriate initial action would be:

Question options:

Increase her dose

Assess for suicidal ideation

Discontinue the medication immediately

Decrease her dose to half then slowly titrate up the dose

Question 80 1 / 1 point

Nonadherence is especially common in drugs that treat asymptomatic conditions, such as hypertension. One way to reduce the likelihood of nonadherence to these drugs is to prescribe a drug that:

Question options:

Has a short half-life so that missing one dose has limited effect

Requires several dosage titrations so that missed doses can be replaced with lower doses to keep costs down

Has a tolerability profile with fewer of the adverse effects that are considered “irritating,” such as nausea and dizziness

Must be taken no more than twice a day

Question 81 1 / 1 point

Which the following persons should not have a statin medication ordered?

Question options:

Someone with 3 first- or second-degree family members with history of muscle issues when started on statins

Someone with high lipids, but low BMI

Premenopausal woman with recent history of hysterectomy

Prediabetic male with known metabolic syndrome

Question 82 1 / 1 point

The Combat Methamphetamine Epidemic Act, which is part of the 2006 U.S. Patriot Act:

Question options:

Requires all providers to screen their patients for methamphetamine use

Restricts the prescribing of amphetamines to U.S. citizens

Requires a prescription be written for all methamphetamine precursors in all states

Restricts the sales of drugs that contain methamphetamine precursors, including a daily and 30-day limit on sales

Question 83 0 / 1 point

Monitoring for patients who are on long-term antifungal therapy with ketoconazole includes:

Question options:

Platelet count

BUN and creatinine

White blood cell count

AST, ALT, alkaline phosphatase, and bilirubin

Question 84 0 / 1 point

Which of the following holds true for the pharmacokinetics of women?

Question options:

Gastric emptying is faster than that of men.

Organ blood flow is the same as that of men.

Evidence is strong concerning renal differences in elimination.

Medications that involve binding globulins are impacted by estrogen levels.

Question 85 0 / 1 point

Henry is 82 years old and takes two aspirin every morning to treat the arthritis pain in his back. He states the aspirin helps him to “get going” each day. Lately he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?

Question options:

Add an H2 blocker such as ranitidine to his therapy.

Discontinue the aspirin and switch him to Vicodin for the pain.

Decrease the aspirin dose to one tablet daily.

Have Henry take an antacid 15 minutes before taking the aspirin each day.

Question 86 1 / 1 point

When prescribing a tetracycline or quinolone antibiotic it is critical to instruct the patient:

Question options:

Not to take their regularly prescribed medications while on these antibiotics

Regarding the need for lots of acidic foods and juices, such as orange juice, to enhance absorption

Not to take antacids while on these medications, as the antacid decreases absorption

That there are no drug interactions with these antibiotics

Question 87 1 / 1 point

A provider may consider testing for CYP2D6 variants prior to starting tamoxifen for breast cancer to:

Question options:

Ensure the patient will not have increased adverse drug reactions to the tamoxifen

Identify potential drug-drug interactions that may occur with tamoxifen

Reduce the likelihood of therapeutic failure with tamoxifen treatment

Identify poor metabolizers of tamoxifen

Question 88 1 / 1 point

IV forms of bisphosphonates are used for all the following except:

Question options:

Severe gastric irritation with oral forms

Known cancer mets into the bone

Persons with advancing renal dysfunction

Progression of bone loss on oral formulations

Question 89 1 / 1 point

The New York Heart Association and the Canadian Cardiovascular Society have described grading criteria for levels of angina. Angina that occurs with unusually strenuous activity or on walking or climbing stair after meals is class:

Question options:

I

II

III

IV

Question 90 1 / 1 point

ACE inhibitors are contraindicated in pregnancy. While treatment of heart failure during pregnancy is best done by a specialist, which of the following drug classes is considered to be safe, at least in the later parts of pregnancy?

Question options:

Diuretics

ARBs

Beta blockers

Nitrates

Question 91 1 / 1 point

Pharmacoeconomics is:

Question options:

The study of the part of the U.S. economy devoted to drug use

The study of the impact of prescription drug costs on the overall economy

The analysis of the costs and consequences of any health-care-related treatment or service

The analysis of the clinical efficacy of the drug

Question 92 1 / 1 point

Goals when treating tuberculosis include:

Question options:

Completion of recommended therapy

Negative purified protein derivative at the end of therapy

Completely normal chest x-ray

All of the above

Question 93 1 / 1 point

Elena Vasquez’s primary language is Spanish, and she speaks very limited English. Which technique would be appropriate to use in teaching her about a new drug you have just prescribed?

Question options:

Use correct medical terminology because Spanish has a Latin base.

Use a family member who speaks more English to act as an interpreter.

Use a professional interpreter or a reliable staff member who can act as an interpreter.

Use careful, detailed explanations.

Question 94 1 / 1 point

Which of the following statements is true about acute pain?

Question options:

Somatic pain comes from body surfaces and is only sharp and well-localized.

Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates.

Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.

Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area.

Question 95 1 / 1 point

The role of the NP in the use of herbal medication is to:

Question options:

Maintain competence in the prescribing of common herbal remedies

Recommend common over-the-counter herbs to patients

Educate patients and guide them to appropriate sources of care

Encourage patients to not use herbal therapy due to the documented dangers

Question 96 1 / 1 point

Being competent in the use of information technology in clinical practice is expected in professional nurses. Advanced practice competence includes the ability to:

Question options:

Search for information using the most common search engines

Serve as content experts in developing, implementing, and evaluating information Systems

Write programs to assure the integrity of health information

Use information technology to prescribe drugs

Question 97 0 / 1 point

Sally has been prescribed aspirin 320 mg per day for her atrial fibrillation. She also takes aspirin four or more times a day for arthritis pain.What are the symptoms of aspirin toxicity for which she would need to be evaluated?

Question options:

Tinnitus

Diarrhea

Hearing loss

Photosensitivity

Question 98 1 / 1 point

Nurse practitioner prescriptive authority is regulated by:

Question options:

The National Council of State Boards of Nursing

The U.S. Drug Enforcement Administration

The State Board of Nursing for each state

The State Board of Pharmacy

Question 99 1 / 1 point

An Investigational New Drug is filed with the U.S. Food and Drug Administration:

Question options:

When the manufacturer has completed phase III trials

When a new drug is discovered

Prior to animal testing of any new drug entity

Prior to human testing of any new drug entity

Question 100 1 / 1 point

Preventative therapy for cluster headaches includes:

Question options:

Massage or relaxation therapy

Ergotamine nightly before bed

Intranasal lidocaine four times a day during “clusters” of headaches

Propranolol (Inderal) daily

Reflect on your experiences with the integration of new technology. How have these implementations affected the procedures that you perform at work? As the end user, it can be easy to overlook all of the important decisions that went into the finished product that you see before you. In looking at the final data management screens, you may find yourself at the crossroads of two options. You may either 1) be ecstatic about the needed change that this system brought, or 2) frustrated because you feel the system brings new hurdles into your already busy day. If you have ever experienced the latter option, the comment “I could have implemented a better system than this” may resonate strongly with you. Though research agrees that user input assists HIT designers, the development and implementation of new systems is not as straightforward as it may appear. HIT development teams find themselves in constant phases of trial and error as they strive to meet the needs of all users within the proposed development timeline. Failure to achieve promised usability benefits can lead to increased costs and job complications. Applying effective strategies to overcome usability challenges is essential.

In this week’s Discussion, you move from the standpoint of the “outsider looking in” (end user) and place yourself into a real-world implementation example. To complete this Discussion, you evaluate a case study to determine where the implementation process took a wrong turn. Use this week’s Learning Resources to propose changes that could have put this operation on the road to success.

To prepare:

Review the Learning Resources, focusing on the TIGER Usability and Clinical Application Design Collaborative.

Consider the “Best Practice Exemplars” provided in the course text Nursing Informatics: Where Technology and Caring Meet.

Review “Case Study 1: A Usability and Clinical Application Design Challenge” presented on page 238 of the course text Nursing Informatics: Where Technology and Caring Meet. (see bottom of this page for the case study)

Determine the causes of the noted usability challenges (i.e., human factors, ergonomics, human-computer interaction), as well as potential usability concerns experienced by staff during implementation. Consider the possible design failures that lead to the usability challenges.

What strategies might you employ to overcome these HIT usability challenges and concerns?

By tomorrow Tuesday 10/03/17, 5 pm, write a minimum of 550 words essay in APA format with a minimum of 3 references from the list of Required Readings below. Include all level one headings as numbered below:

post a cohesive response to the following:

Place yourself in the role of the clinical administrator tasked with implementing the case study’s new health information technology system.

1) Evaluate the usability challenges that you faced during implementation as well as the factors that caused these challenges.

2) Determine whether these challenges were a result of implementation or design.

3) Formulate strategies for overcoming these usability challenges.

Required Readings

Course Text: Ball, M. J., Douglas, J. V., Hinton Walker, P., DuLong, D., Gugerty, B., Hannah, K. J., . . . Troseth, M. R. (Eds.) (2011). Nursing informatics: Where technology and caring meet (4th ed.). London, England: Springer-Verlag.

Chapter 14, “Usability and Clinical Application Design”

This chapter begins by defining the terms usability and application design as they are used in the field of nursing informatics. The authors then describe the literature review and analytic process that the TIGER Collaborative group underwent to positively transform the development of HIT systems.

Gruber, D., Cummings, G. G., LeBlanc, L., & Smith, D. L. (2009). Factors influencing outcomes of clinical information systems implementation: A systematic review. CIN: Computers, Informatics, Nursing, 27(3), 151–163.

The authors analyze the outcomes of prior IT implementations to determine if certain strategies can guarantee success when launching new clinical information systems.

Kaufman, D., Roberts, W. D., Merrill, J., Lai, T., & Bakken, S. (2006). Applying an evaluation framework for health information system design, development, and implementation. Nursing Research, 55(2, Suppl. 1), S37–S42.

This article emphasizes the indispensable role of continuous evaluation throughout the development and real-time application of new information systems into the workplace.

Schlotzer, A., & Madsen, M. (2010). Health information systems: Requirements and characteristics. Studies in Health Technology and Informatics, 151, 156–166.

Use this article to examine the importance of focusing on sound design, interoperability of systems, and fulfillment of user needs when developing an effective database.

Case Study 1: A Usability and Clinical Application Design Challenge

A medical center implemented an EMR with orders, clinical documentation, and results retrieval to improve efficiencies and enhance patient safety in the perinatal units of a small medical center, including Labor and Delivery (L& D), NICU, and Newborn Nursery Selection process The system was installed elsewhere in this integrated delivery network The executives wanted a fast 6-month installation at the maximum Usability challenges Existing order sets and documents from other sites were not uploaded and tailored to this site. Clinicians were asked to input individual orders (not acceptable). Needed computer terminals were ordered late and arrived the day of go-live. Clinicians competed for working terminals at the nurses’ stations Workflow among units was not considered or tested. Shared information such as mother’s blood type and L& D information was not available to NICU or Newborn Nursery, causing confusion about potential patient safety issues Generic training was given because the site tailoring was not done. On go-live, users did not know where to locate information before it had changed in the lag between training and go-live Outcomes The clinicians had to endure an unnecessarily painful implementation and its potential patient safety impacts Working out usability issues took months after go-live

The system was tested/ validated for usability, design, and practice needs Education included practice changes along with how to use the system Developed a methodology to respond rapidly to end users Outcomes Standardized practice in three different acute care hospitals in 15 months Significant improvement in core measures and nurse-sensitive outcomes.

Consider the following scenario:

The psychiatric mental health nurse practitioner is working for a community health clinic that offers state mandated “intensive outpatient rehabilitation” services for individuals who face incarceration for driving while under the influence. Mr. Smith, a 24-year-old male patient, shows up for his initial intake appointment and says, “Look, this sounds like it’s going to be an AA meeting. Can’t I just go there? I only had a couple of drinks. I don’t know why the judge was such a jerk.”

Clients with addictive disorders may present for therapy for various reasons. Some, like Mr. Smith, attend because it is court mandated. Some attend because family or friends have pushed them to do so, while others may attend because life has become unmanageable. Regardless of clients’ reasons for presenting for therapy, to reach these clients and effectively treat them, you must be able to break down barriers, establish relationships, and help them see the benefits of this therapeutic approach.

PLEASE REMEMBER TO REVIEW THE ATTACHED 7 VIDEO TRANSCRIPTS BEFORE DOING THE ASSIGNMENT, and to include a title page, introduction, summary, and references

                                                          The Assignment

In a 2- to 3-page paper, address the following:

· Identify the psychotherapeutic approach that the group facilitator is using and

explain why she might be using this approach.

· Determine whether or not you would use the same psychotherapeutic approach

if you were the counselor facilitating this group and justify your decision.

· Identify an alternative approach to group therapy for addiction and explain why

it is an appropriate option.

· Support your position with evidence-based literature.

                                                                Learning Resources

Required Readings

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

Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565–596)

Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.

Chapter 13, “Problem Group Members” (pp. 391–427)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Gamble, J., & O’ Lawrence, H. (2016). An overview of the efficacy of the 12-step group therapy for substance abuse treatment. Journal of Health & Human Services Administration, 39(1), 142–160. Retrieved from http://jhhsa.spaef.org/

Kim, J. W., Choi, Y. S., Shin, K. C., Kim, O. H., Lee, D. Y., Jung, M. H., … Choi, I. (2012). The effectiveness of continuing group psychotherapy for outpatients with alcohol dependence: 77-month outcomes. Alcoholism: Clinical & Experimental Research, 36(4), 686–692. doi:10.1111/j.1530-0277.2011. 01643.x

Required Media

Allyn & Bacon (Producer). (2000). Motivational interviewing [Video file]. Mill Valley, CA: Psychotherapy.net.

Note: You will access this media from the ATTACHED TRANSCRIPT. The approximate length of this media piece is 102 minutes.

Laureate Education (Producer). (2013d). Levy family: Sessions 1-7 [Video file]. Baltimore, MD; Author.

Question

Question 1

Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node?

Answers:

A. Potassium permeability is allowing the cell membrane to remain depolarized, and Ca2+ channel opens moving Ca2+ back into the cell.

B. The cells are capable of responding to a greater than normal stimulus before the resting membrane potential is reached.

C. A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.

D. The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity.

Question 2

A 31-year-old woman with a congenital heart defect reports episodes of light-headedness and syncope, with occasional palpitations. A resting electrocardiogram reveals sinus bradycardia, and she is suspected to have sick sinus syndrome. Which of the following diagnostic methods is the best choice to investigate the suspicion?

Answers:

A. Signal-averaged ECG

B. Holter monitoring

C. Electrophysiologic study

D. Exercise stress testing

Question 3

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

Answers:

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

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

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

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

Question 4

Of the following list of patients, who would likely benefit the most from hyperbaric oxygen therapy?

Answers:

A. A football player who has torn a meniscus in his knee for the third time this year

B. A patient who developed a fistula between her bowel and vagina following cervical cancer surgery

C. A school-aged child who fell on gravel and has terrible road rash

D. A trauma patient who developed Clostridium spp., an anaerobic bacterial infection in his femur

Question 5

A 71-year-old male patient with a history of myocardial infarction (MI) and peripheral vascular disease (PVD) has been advised by his family physician to begin taking 81 mg aspirin once daily. Which of the following statements best captures an aspect of the underlying rationale for the physician’s suggestion?

Answers:

A. Aspirin inhibits the conversion of fibrinogen into fibrin and consequent platelet plug formation.

B. Platelet aggregation can be precluded through inhibition of prostaglandin production by aspirin.

C. Aspirin can reduce unwanted platelet adhesion by inhibiting TXA2 synthesis.

D. Aspirin helps to inhibit ADP action and minimizes platelet plug formation.

Question 6

Which of the following assessments and laboratory findings would be most closely associated with acute leukemia?

Answers:

A. Increased serum potassium and sodium levels

B. Increased blood urea nitrogen and bone pain

C. High blast cell counts and fever

D. Decreased oxygen partial pressure and weight loss

Question 7

A 55-year-old male who is beginning to take a statin drug for his hypercholesterolemia is discussing cholesterol and its role in health and illness with his physician. Which of the following aspects of hyperlipidemia would the physician most likely take into account when teaching the patient?

Answers:

A. Hyperlipidemia is a consequence of diet and lifestyle rather than genetics.

B. The goal of medical treatment is to eliminate cholesterol from the vascular system.

C. Cholesterol is a metabolic waste product that the liver is responsible for clearing.

D. HDL cholesterol is often characterized as being beneficial to health.

Question 8

A 6-year-old girl with a diagnosis of Marfan syndrome is being assessed at a community health clinic. Which of the following assessments would be the health care professional’s lowest priority?

Answers:

A. A musculoskeletal assessment

B. A test of the child’s visual acuity

C. Tests of kidney function

D. Cardiovascular assessment

Question 9

In the ICU setting, a patient transported from surgery following open heart bypass grafting will likely have his core temperature measured by a/an

Answers:

A. esophageal flexible thermometer monitoring aorta distention.

B. rectal tube inserted to prevent evacuation from bowels while recovering from anesthesia.

C. pulmonary artery catheter being used to measure cardiac output.

D. temperature probe taped behind his ear.

Question 10

The son of an 80-year-old man has noticed that in recent weeks his father has become incontinent of urine for the first time in his life. The man is later diagnosed with transient urinary incontinence, a condition that is most often attributable to

Answers:

A. medications.

B. detrusor instability.

C. decrease in bladder and sphincter tone.

D. bladder outlet obstruction.

Question 11

A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which of the following statements is most accurate?

Answers:

A. “Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus.”

B. “Endogenous pyrogens induce host cells to produce exogenous pyrogens.”

C. “PGE2 induces Kupffer cells to initiate a fever response via hepatic sinusoids.”

D. “Arachidonic acid induces cytokines to act on the temperature regulation center.”

Question 12

A patient experiencing immotile cilia syndrome should be frequently assessed by the nurse for which priority complication?

Answers:

A. Epistaxis resulting from loss of cilia in the nasal passageway

B. Sterility caused by inability of the sperm to swim downstream

C. Bronchiectasis due to interferences with clearance of inhaled bacteria along the respiratory tract

D. Inability to hear soft sounds related to kinocilium on the hair cells in the inner ear

Question 13

The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis?

Answers:

A. “Is there any mold in your home that you know of?”

B. “Is there any family history of neuromuscular diseases?”

C. “Has your baby ever been directly exposed to any chemical cleaning products?”

D. “Have you ever given your child any honey or honey-containing products?”

Question 14

In the context of a workshop on rheumatoid arthritis, a clinical educator is teaching a group of nurses about autoimmune diseases. Which of the following statements by an attendee would the educator most likely want to follow up with further teaching?

Answers:

A. “Often the problem can be traced to antigens that sensitize T cells without the need for presentation.”

B. “In some cases, the body attacks its own cells that are chemically similar to those of infectious organisms.”

C. “Introduction of a foreign antigen can sometimes induce a cascade of immune response that is not self-limiting”

D. “Sometimes when the body’s own cells are released after a long time, they are interpreted as being foreign.”

Question 15

Which of the following pregnant women has most likely encountered the greatest increase in the risk that her child will have a fetal anomaly?

Answers:

A. A woman with diagnoses of syphilis and cirrhosis of the liver

B. A woman who has herpes simplex and who has recently recovered from endocarditis

C. A woman with chronic obstructive pulmonary syndrome and tuberculosis

D. A woman with diagnoses of insulin-dependent diabetes mellitus and peripheral neuropathy

Question 16

In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis?

Answers:

A. A 70-year-old woman whose blood work reveals large numbers of immature granulocytes

B. A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges

C. A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated

D. An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever

Question 17

A group of novice nursing students are learning how to manually measure a client’s blood pressure using a stethoscope and sphygmomanometer. Which of the following statements by students would the instructor most likely need to correct?

Answers:

A. “If my client’s arm is too big for the cuff, I’m going to get a BP reading that’s artificially low.”

B. “I’ll inflate the cuff around 30 mm Hg above the point at which I can’t palpate the client’s pulse.”

C. “The accuracy of the whole process depends on my ability to clearly hear the Korotkoff sounds with the bell of my stethoscope.”

D. “With practice, my measurement of clients’ blood pressures with this method will be more accurate than with automated machines.”

Question 18

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

Answers:

A. Tissue destruction results from neutrophil deactivation.

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

C. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

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

Question 19

0 out of 1 points

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

Answers:

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

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

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

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

Question 20

A number of clients have presented to the emergency department in the last 32 hours with complaints that are preliminarily indicative of myocardial infarction. Which of the following clients is least likely to have an ST-segment myocardial infarction (STEMI)?

Answers:

A. A 70-year-old woman who is complaining of shortness of breath and vague chest discomfort

B. A 66-year-old man who has presented with fatigue, nausea and vomiting, and cool, moist skin

C. A 71-year-old man who has moist skin, fever, and chest pain that is excruciating when he moves but relieved when at rest

D. A 43-year-old man who woke up with substernal pain that is radiating to his neck and jaw

Question 21

In which of the following situations would blood most likely rapidly relocate from central circulation to the lower extremities?

Answers:

A. A client does isotonic exercises in a wheelchair.

B. A client reclines from a sitting to supine position.

C. A client is helped out of bed and stands up.

D. A client undergoes a stress test on a treadmill.

Question 22

When talking about the various types of granulocytes, which granule contains heparin, an anticoagulant?

Answers:

A. Lymphocytes

B. Neutrophils

C. Eosinophils

D. Basophils

Question 23

A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which of the following characteristics of the client’s history is most likely to have a bearing on his current diagnosis?

Answers:

A. The client is cachexic and an African American.

B. The client is malnourished, hypomagnesemic, and hypocalcemic.

C. The client is HIV positive and homeless.

D. The client is receiving intravenous normal saline with 20 mEq KCl.

Question 24

As part of a screening program for prostate cancer, men at a senior citizens’ center are having their blood levels of prostate-specific antigen (PSA) measured.Which of the following statements would best characterize a high positive predictive value but a low negative predictive value for this screening test?

Answers:

A. All of the men who had low PSA levels were cancer-free; several men who had high levels also remained free of prostate cancer.

B.Men who had low PSA levels also displayed false-positive results for prostate cancer; men with high levels were often falsely diagnosed with prostate cancer.

C. The test displayed low sensitivity but high specificity.

D. All of the men who had high PSA levels developed prostate cancer; several men who had low PSA levels also developed prostate cancer.

Question 25

When looking at a granulocyte under a microscope, the anatomy student would describe it as a cell

Answers:

A. having a kidney-shaped nucleus.

B. having no nuclei.

C. lacking granules.

D. shaped like a sphere with multilobar nuclei.

Question 26

The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening?

Answers:

A. “You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart.”

B.“There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast.”

C. “This means that the SA node (which is the beginning of your heart’s electrical system) has been damaged and is no longer functioning normal.”

D. “For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better.”

Question 27

In the ED, a homeless patient is brought in with severe hypothermia. The police officers also state that they found a “bottle of booze” on the sidewalk next to him. This puts the nurse on high alert since alcohol contributes to hypothermia by

Answers:

A. causing the person to have less fat on his body.

B. interfering with the appetite center in the brain causing the person to not respond to hunger pains.

C. increasing his basal metabolic rate, so he will run out of ATP faster than expected.

D. dulling the mental awareness that impairs judgment to seek shelter.

Question 28

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

Answers:

A. Growth factors and cytokines

B. Natural killer cells and granulocytes

C. Neutrophils and eosinophils

D. T lymphocytes and natural killer cells

Question 29

A professor is teaching a group of students about the role of mitochondria within the cell. Which of the following statements is true of mitochondria?

Answers:

A. They are the site of adenosine triphosphate (ATP) production.

B. Mitochondrial DNA is inherited patrilineally.

C. The number of mitochondria in a cell is equal to the number of nuclei.

D. They are replicated within the smooth endoplasmic reticulum (ER).

Question 30

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

Answers:

A. Infections

B. Jaundice

C. Blood clots

D. Anemia

Question 31

A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. What physiological processes could best underlie her care provider’s teaching about her new diet?

Answers:

A. Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation.

B. Free radicals contribute to atherosclerosis and decreased immune response.

C. Free radicals act as direct mediators in the inflammatory process.

D. Free radicals inhibit the inflammatory response, limiting preadaptive response to infection.

Question 32

A male client of a nurse practitioner has an autosomal dominant disorder. The client and his partner are considering starting a family. Which of the following statements indicates the client has an adequate understanding of the genetic basis of this health problem?

Answers:

A. “I know that a single mutant allele is to blame for the health problem.”

B. “I know that new genetic mutations won’t occur between generations.”

C. “I know there’s no way of accurately determining the chance that my child will inherit the disease.”

D. “My children who don’t have the disease still run the risk of passing it on to their children.”

Question 33

In which of the following hospital patients would the care team most realistically anticipate finding normal cholesterol levels?

Answers:

A. A 44-year-old male admitted for hyperglycemia and with a history of diabetic neuropathy

B. A 51-year-old male with a diagnosis of hemorrhagic stroke and consequent unilateral weakness

C. A 77-year-old female admitted for rheumatoid arthritis exacerbation who is receiving hormone replacement therapy and with a history of hypothyroidism

D. A morbidly obese 50-year-old female who is taking diuretics and a beta-blocker to treat her hypertension

Question 34

As of November 1, 2012, there were a total of 10 confirmed cases of Hantavirus infection in people who were recent visitors (mid-June to end of August, 2012) to Yosemite National Park. Three visitors with confirmed cases died. Health officials believe that 9 out of the 10 people with Hantavirus were exposed while staying in Curry Village in the Signature Tent Cabins. This is an example of

Answers:

A. the low rate of morbidity one can expect while traveling to Yosemite National Park.

B. the prevalence of Hantavirus one can anticipate if he or she is going to vacation in Yosemite National Park.

C. what the anticipated mortality rate would be if a family of five were planning to vacation in Yosemite National Park.

D. the incidence of people who are at risk for developing Hantavirus while staying in Yosemite National Park.

Question 35

A 1-year-old child who has experienced low platelet counts and bacterial susceptibility has been admitted to a pediatric medical unit of a hospital for treatment of Wiskott-Aldrich syndrome. The nurse who has admitted the child to the unit would anticipate which of the following short-term and longer-term treatment plans?

Answers:

A. Neutropenic precautions; fresh frozen plasma transfusions; treatment of gastrointestinal symptoms

B. Transfusion of clotting factors XII and XIII and serum albumin; splenectomy

C. Intravenous immunoglobulin (IVIG) treatment; thyroidectomy

D. Treatment of eczema; management of bleeding; bone marrow transplant

Question 36

A 60-year-old woman is suspected of having non-Hodgkin lymphoma (NHL). Which of the following aspects of her condition would help to rule out Hodgkin lymphoma?

Answers:

A. The lymph nodes involved are located in a large number of locations in the lymphatic system.

B. The woman complains of recent debilitating fatigue.

C. Her neoplasm originates in secondary lymphoid structures.

D. The presence of Reed-Sternberg cells has been confirmed.

Question 37

An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular venous distention. Why is jugular venous distention a useful indicator for the assessment of the client’s condition?

Answers:

A. Peripheral dilation is associated with decreased stroke volume and ejection fraction.

B. Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest.

C. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart.

D. Heart valves are not capable of preventing backflow in cases of atrial congestion.

Question 38

A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate?

Answers:

A. Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis.

B. There is a break in the normal wall between the right and left atria that results in compromised oxygenation.

C. The aortic valve is stenotic, resulting in increased afterload.

D. The right ventricle is atrophic as a consequence of impaired myocardial blood supply.

Question 39

Which of the following hypertensive individuals is most likely to have his or her high blood pressure diagnosed as secondary rather than essential?

Answers:

A. A 40-year-old smoker who eats excessive amounts of salt and saturated fats

B. A 69-year-old woman with a diagnosis of cardiometabolic syndrome

C. An African American man who leads a sedentary lifestyle

D. A 51-year-old male who has been diagnosed with glomerulonephritis

Question 40

A 72-year-old female has been told by her physician that she has a new heart murmur that requires her to go visit a cardiologist. Upon examination, the cardiologist informs the patient that she has aortic stenosis. After the cardiologist has left the room, the patient asks, “What caused this [aortic stenosis] to happen now?” The clinic nurse responds,

Answers:

A.“Aortic stenosis is commonly seen in elderly patients.Basically, there is a blockage in the valve that is causing blood to pool, causing decreased velocity of flow.”

B.“Because of the high amount of energy it takes to push blood through the aortic valve to the body, your valve is just had to work too hard and it is weakening.”

C.“This is caused by a tear in one of the papillary muscles attached to the valve. They can do a procedure where they thread a catheter into the heart and reattach the muscle ends.”

D. “Heart murmurs result from tumultuous flow through a diseased heart valve that is too narrow and stiff. This flow causes a vibration called a murmur.”

Question 41

Which of the following patients is most likely to have impairments to the wound-healing process? A patient with

Answers:

A. chronic obstructive pulmonary disease.

B. congenital heart defects and anemia.

C. poorly controlled blood sugars with small blood vessel disease.

D. a diagnosis of multiple sclerosis and consequent impaired mobility.

Question 42

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

Answers:

A. Increasing the functional ability of the underactive dopaminergic system

B. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions

C. Preventing axonal degradation of motor neurons

D. Preventing demyelination of the efferent cerebellar pathways

Question 43

A 4-year-old boy presents with a chronic cough and swollen lymph nodes. His records show that he has been given antibiotics several times in the past year with limited success, most recently for a liver abscess, and that he also has a recurring fungal skin condition. Which of the following is his most likely diagnosis?

Answers:

A. Selective IgA deficiency

B. Ataxia–telangiectasia

C. A deficiency in IgG2 subclass antibodies

D. Chronic granulomatous disease

Question 44

A nurse is teaching a client with a recent diagnosis of diabetes about the roles that glucose and insulin play in the disease pathology and the fact that glucose must enter the body cell in order to provide energy for the client. The nurse knows that which of the following processes allows glucose to enter body cells?

Answers:

A. Active transport

B. Diffusion

C. Osmosis

D. Facilitated diffusion

Question 45

Two health care workers are comparing the etiology and incidence of multifactorial inheritance disorders and single-gene disorders. Which of the following statements best captures the relationship between the two types of genetic disorders?

Answers:

A. “A couple with a child with a multifactorial disorder has a higher risk of having another with the same disorder.”

B. “Multifactorial disorders are more likely to involve multiple organs.”

C. “Multifactorial disorders and single-gene disorders can both be predicted quite accurately.”

D. “Multifactorial disorders manifest themselves at birth.”

Question 46

A 44-year-old female who is on her feet for the duration of her entire work week has developed varicose veins in her legs. What teaching point would her care provider be most justified in emphasizing to the woman?

Answers:

A. “Your varicose veins are likely a consequence of an existing cardiac problem.”

B. “Once you have varicose veins, there’s little that can be done to reverse them.”

C. “The use of blood thinner medications will likely relieve the backflow that is causing your varicose veins.”

D. “If you’re able to stay off your feet and wear tight stockings, normal vein tone can be reestablished.”

Question 47

At 4 AM, the hemodynamic monitor for a critically ill client in the intensive care unit indicates that the client’s mean arterial pressure is at the low end of the normal range; at 6 AM, the client’s MAP has fallen definitively below normal. The client is at risk for

Answers:

A. left ventricular hypertrophy.

B. pulmonary hypertension.

C. organ damage and hypovolemic shock.

D. orthostatic hypotension.

Question 48

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

Answers:

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

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

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

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

Question 49

Which of the following individuals is likely to have the best prognosis for recovery from his or her insult to the peripheral nervous system? An adult

Answers:

A. who had nerves transected during surgery to remove a tumor from the mandible.

B. who developed rhabdomyolysis and ischemic injury after a tourniquet application.

C. who suffered a bone-depth laceration to the shoulder during a knife attack.

D. who had his forearm partially crushed by gears during an industrial accident.

Question 50

A woman gives birth to a small infant with a malformed skull. The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits. The child also has facial abnormalities that become more striking as it develops. What might you expect to find in the mother’s pregnancy history?

Answers:

A. Active herpes simplex infection

B. Chronic alcohol use

C. Chronic cocaine use

D. Folic acid deficiency

Question 51

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

Answers:

A. Spinal infection

B. Encephalitis

C. Lyme disease

D. Rocky Mountain spotted fever

Question 52

The homecare nurse is making a home visit to a 51-year-old female client with a long-standing diagnosis of multiple sclerosis. The nurse knows that the muscle wasting and weakness associated with the disease process are ultimately manifested as a failure of what normal process in muscle tissue?

Answers:

A. The contraction of fascicles within myofibrils

B. The contraction of the epimysium

C. The surrounding of fascicles by perimysium

D. Thick myosin and thin actin filaments sliding over each other

Question 53

A 24-year-old woman presents with fever and painful, swollen cervical lymph nodes. Her blood work indicates neutrophilia with a shift to the left. She most likely has

Answers:

A. a mild viral infection.

B. a severe fungal infection.

C. a mild parasitic infection.

D. a severe bacterial infection.

Question 54

The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage?

Answers:

A. Monitoring in the ICU for signs and symptoms of cerebral insult

B. Stat administration of tissue plasminogen activator (tPA)

C. Administration of a diuretic such as mannitol to reduce cerebral edema and ICP

D. Craniotomy and clipping of the affected vessel

Question 55

A 40-year-old woman who experiences severe seasonal allergies has been referred by her family physician to an allergist for weekly allergy injections. The woman is confused as to why repeated exposure to substances that set off her allergies would ultimately benefit her. Which of the following phenomena best captures the rationale for allergy desensitization therapy?

Answers:

A. Injections of allergens simulate production of IgG, combining with the antigens to prevent activation of IgE antibodies.

B. Repeated exposure stimulates adrenal production of epinephrine, mitigating the allergic response.

C. Allergens in large, regular quantities overwhelm the IgE antibodies that mediate the allergic response.

D. Repeated exposure to offending allergens binds the basophils and mast cells that mediate the allergic response.

Question 56

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

Answers:

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

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

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

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

Question 57

A 37-year-old male with HIV who has recently become symptomatic has begun highly active antiretroviral therapy (HAART). Among the numerous medications that the man now regularly takes are several that inhibit the change of HIV RNA to DNA in a CD4+ cell. Which of the following classes of medications addresses this component of the HIV replication cycle?

Answers:

A. Protease inhibitors

B. Entry inhibitors

C. Non-nucleoside reverse transcriptase inhibitors

D. Integrase inhibitors

Question 58

A male international business traveler has returned from a trip to Indonesia. While there, he hired a prostitute for companionship and engaged in unprotected sex on more than one occasion. Unbeknownst to him, this prostitute harbored the hepatitis C virus. Upon return to the United States, he exhibited no symptoms and returned to his usual activities. During this period of no outward symptoms, the man would be classified as being in

Answers:

A. the clinical disease stage of hepatitis C.

B. the preclinical stage of disease.

C. the chronic phase of hepatitis C.

D. remission and unlikely to develop hepatitis C.

Question 59

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

Answers:

A. Philadelphia.

B. interleukin cells.

C. BRCA-1.

D. PSA.

Question 60

A school nurse is teaching high school students about HIV and AIDS in the context of the school’s sexual health curriculum. Which of the students’ following statements would the nurse most likely want to correct or clarify?

Answers:

A. “Lots more heterosexual people get HIV these days than they used to.”

B. “Drugs for AIDS reduce the virus in your body, but they don’t get rid of it.”

C. “They have to take a blood sample from you in order to test you for AIDS.”

D. “Condoms provide really good protection from AIDS.”

Question 61

A nurse on a neurology unit is assessing a female brain-injured client. The client is unresponsive to speech, and her pupils are dilated and do not react to light.She is breathing regularly, but her respiratory rate is 45 breaths/minute. In response to a noxious stimulus, her arms and legs extend rigidly. What is her level of impairment?

Answers:

A. Delirium

B. Coma

C. Vegetative state

D. Brain death

Question 62

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

Answers:

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

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

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

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

Question 63

Which of the following patients would be considered to be in the latent period of HIV infection?

Answers:

A. A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months

B. A 24-year-old college student who has developed a chronic cough that will not go away, even after taking two courses of antibiotics.

C. A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood that started 2 weeks ago

D. A 16-year-old prostitute who has open sores on her labia that drain purulent secretions

Question 64

When discussing the sequence of clot dissolution, the science instructor will talk about which item that begins the process?

Answers:

A. Plasminogen

B. α-plasmin inhibitor

C. Dabigatran

D. Platelets

Question 65

A 30-year-old male’s blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man’s most likely diagnosis?

Answers:

A. Multiple myeloma

B. Acute lymphocytic leukemia

C. Hodgkin lymphoma

D. Acute myelogenous leukemia

Question 66

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

Answers:

A. A+

B. B–

C. A–

D. B+

Question 67

A nurse is providing care for a 17-year-old boy who has experienced recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobulins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy’s most likely diagnosis?

Answers:

A. X-linked hypogammaglobulinemia

B. Transient hypoglobulinemia

C. Common variable immunodeficiency

D. IgG subclass deficiency

Question 68

A patient diagnosed with H pylori asks the nurse, “How an infection can occur in the stomach since it is an acid environment?” The nurse responds,

Answers:

A. “This parasite secretes an enzyme called coagulase, which protects the pathogen from the antibodies.”

B. “H. pylori produces an enzyme called urease that converts gastric juices into ammonia, which neutralizes the acidic stomach environment.”

C. “H. pylori is a virus and is still being researched as to how it is able to survive in the stomach acids.”

D. “We have many infectious agents that can live in an acidic environment with a pH more than 8.0.”

Question 69

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

Answers:

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

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

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

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

Question 70

A 14-year-old boy is participating in his school’s track meet; the outdoor temperature is 99°F, and a teacher has found the boy sitting restless in the shade and disoriented to time. The teacher notes that the student has dry skin in spite of the high temperature and the fact that he has recently completed a running event. The teacher calls for the school nurse, who will recognize which of the following potential diagnoses and anticipated hospital treatments?

Answers:

A. Heat exhaustion, likely treated with oral rehydration with cool water

B. Heat stroke, likely treated with rehydration by intravenous hypotonic solution

C. Heat stroke, likely treated with submersion in cold water

D. Heat exhaustion, likely treated with rest, shelter from the sun, and salt tablets

Question 71

A 40-year-old male who has been HIV positive for 6 years is experiencing a new increase in his viral load along with a corresponding decrease in his CD4+ count. Which of the following aspects of his immune system is likely to remain most intact?

Answers:

A. Activation of B lymphocytes

B. Phagocytic function of monocytes and macrophages

C. Orchestration of natural killer cells as part of cell-mediated immunity

D. Presentation of major histocompatibility molecules on body cells

Question 72

The nurse practitioner working in an overnight sleep lab is assessing and diagnosing patients with sleep apnea. During this diagnostic procedure, the nurse notes that a patient’s blood pressure is 162/97. The nurse explains this connection to the patient based on which of the following pathophysiological principles?

Answers:

A. When airways are obstructed, the body will retain extracellular fluid so that this fluid can be shifted to intravascular space to increase volume.

B. During apneic periods, the patient experiences hypoxemia that stimulates chemoreceptors to induce vasoconstriction.

C. When the patient starts to snore, his epiglottis is closed over the trachea.

D. When the airway is obstructed, specialized cells located in the back of the throat send signals to the kidney to increase pulse rate.

Question 73

A female dental assistant has developed signs and symptoms of a latex sensitivity and is undergoing allergy testing as well as blood work. Which of the following components of the assistant’s blood work would most likely be the focus of her health care provider’s analysis?

Answers:

A. Analysis of class II MHC antigens

B. Serum IgE immunoassays

C. Serum CD8+ levels

D. Serum B-lymphocyte levels

Question 74

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

Answers:

A. has vomited and complained of a severe headache.

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

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

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

Question 75

As part of the diagnostic workup for a male client with a complex history of cardiovascular disease, the care team has identified the need for a record of the electrical activity of his heart, insight into the metabolism of his myocardium, and physical measurements and imaging of his heart. Which of the following series of tests is most likely to provide the needed data for his diagnosis and care?

Answers:

A. Cardiac catheterization, cardiac CT, exercise stress testing

B. Ambulatory ECG, cardiac MRI, echocardiogram

C. Serum creatinine levels, chest auscultation, myocardial perfusion scintigraphy

D. Echocardiogram, PET scan, ECG

Question 76

Which of the following statements best captures an aspect of the process of hematopoiesis?

Answers:

A. Colony-stimulating factors (CSFs) produce cytokines that activate progenitor cells.

B. Various subtypes of pluripotent stem cells eventually differentiate into the cellular components of blood.

C. Progenitor cells differentiate into precursor cells.

D. Self-replicating precursor cells differentiate into specific CSFs.

Question 77

A 54-year-old man with a long-standing diagnosis of essential hypertension is meeting with his physician. The patient’s physician would anticipate that which of the following phenomena is most likely occurring?

Answers:

A. Epinephrine from his adrenal gland is initiating the renin–angiotensin–aldosterone system.

B. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction.

C. The patient’s juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation.

D. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption.

Question 78

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

Answers:

A. Hemophilia B

B. Vitamin K deficiency

C. Idiopathic immune thrombocytopenic purpura (ITP)

D. Excess calcium

Question 79

Members of an AIDS support group who have more advanced cases are sharing some of their recent health problems with a member who has just been diagnosed. Which of the member’s statements is most accurate?

Answers:

A. “The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend the life expectancy of a lot of persons living with AIDS.”

B. “As people with HIV live longer, most of us are eventually succumbing to the cancers that are associated with HIV.”

C. “One of the scariest things out there now is the huge increase in drug-resistant tuberculosis.”

D. “Those of us with HIV are so much more prone to loss of vision and hearing.”

Question 80

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

Answers:

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

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

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

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

Question 81

Which of the following patients has an absolute neutrophil count that is critically low and that the standard of care would recommend they be placed on neutropenic precautions?

Answers:

A. A 75-year-old renal failure patient receiving Epogen for anemia with hemoglobin level of 9.7.

B. A 37-year-old patient with leukemia being treated with chemotherapy with ANC of 400

C. A patient on long-term steroids for rheumatoid arthritis with WBC of 7000

D. A 65-year-old prostate cancer patient receiving radiation therapy with neutrophil count of 2000

Question 82

A medical student is working with a 61-year-old male client in the hospital who has presented with a new onset of atrial fibrillation. Which of the following courses of treatment will the student most likely expect the attending physician to initiate?

Answers:

A. Diuretics, total bed rest, and cardioversion if necessary

B. Anticoagulants and beta-blockers to control rate

C. Immediate cardioversion followed by surgery to correct the atrial defect

D. Antihypertensives and constant cardiac monitoring in a high acuity unit

Question 83

A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems?

Answers:

A. The patient has a history of acute and chronic renal failure.

B. The patient’s cardiac ejection fraction was 40% during his last echocardiogram.

C. The patient is male and has a history of hypertension.

D. The client is 89 years old and takes a diuretic medication for his congestive heart failure.

Question 84

Which of the following procedures reduces the potential for infection primarily by addressing the portal of entry?

Answers:

A. Wearing gloves when contact with blood or body fluids is anticipated

B. Wiping down common areas with buffered bleach on a regular basis

C. Isolating patients who have antibiotic-resistant infections

D. Disposing of soiled clothing and bed linens in a dedicated receptacle

Question 85

0 out of 1 points

A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment?

Answers:

A. Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker.

B. Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role.

C. Defibrillation must be coincided with the R wave of the ECG in order to be successful.

D. The goal is to depolarize the entire heart during the passage of current.

Question 86

In the ICU, the nurse hears an emergency cardiac monitor go off. The nurse looks at the telemetry and notices the patient has gone into ventricular tachycardia.The nurse will likely assess for signs/symptoms of

Answers:

A. increasing cardiac index by correlating the volume of blood pumped by the heart with an individual’s body surface area.

B. decreasing cardiac output due to less ventricular filling time.

C. development of hypertension with BP 190/98.

D. oxygen deprivation with O2 saturation decreasing to approximately 90%.

Question 87

An agricultural worker is picking fruit on a day when the air temperature is 106°F. Which of the following processes will most likely be occurring while he works?

Answers:

A. Conduction of heat from the air will be heating his skin surface and raising his core temperature.

B. His autonomic nervous system will be stimulating him to sweat.

C. Blood volume at his skin surface will be increasing to dissipate heat.

D. Radiation from his skin surfaces will be dissipating heat into the environment.

Question 88

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

Answers:

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

B. Cerebellar lesions; surgical and immunosuppressive treatment

C. Excess acetylcholinesterase production; treatment with thymectomy

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

Question 89

A student asks the instructor about the origins of different tissues and their cellular origins during the process of development. Which of the instructor’s following statements best describes the process of cell differentiation?

Answers:

A. “A fertilized ovum undergoes a series of divisions, yielding many different cell types.”

B. “A single stem cell differentiates into approximately 200 different types of cells.”

C. “Cells differentiate into necessary body cells peaking after conception and ceasing near the time of birth.”

D. “Cells of the hematopoietic system produce the appropriate body cells that are required at each stage of development.”

Question 90

A physician is providing care for several patients on a medical unit of a hospital. In which of the following patient situations would the physician most likelyrule out hypertension as a contributing factor?

Answers:

A. A 66-year-old woman with poorly controlled angina and consequent limited activity tolerance

B. A 61-year-old man who has a heart valve infection and recurrent fever

C. An 81-year-old woman who has had an ischemic stroke and has consequent one-sided weakness

D. A 44-year-old man awaiting a kidney transplant who requires hemodialysis three times per week

Question 91

A geriatric clinical nurse educator is teaching the other members of the health care team about the incidence, prevalence, and course of depression among older adults. Which of the following statements is most likely to appear in the physician’s teaching?

Answers:

A. “Bronchodilators and antiplatelet medications have been correlated with depression in the elderly.”

B. “Many older adults lack the symptoms of sleep disturbances and lack of concentration that suggest depression in younger adults.”

C. “Even though suicide rates are lower among older adults than younger adults, depression needs to be diagnosed and treated early.”

D. “Though they are certainly not synonymous, depression can be an indicator of dementia.”

Question 92

The nurse working in the ICU knows that chronic elevation of left ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations?

Answers:

A. Petechia and spontaneous bleeding

B. Dyspnea and crackles in bilateral lung bases

C. Muscle cramping and cyanosis in the feet

D. Chest pain and intermittent ventricular tachycardia

Question 93

A 51-year-old patient with a history of alcohol abuse and liver disease has low serum levels of albumin and presents with ascites (excess fluid in his peritoneal space) and jaundice. A health care professional would recognize that which of the following processes is most likely underlying his health problems?

Answers:

A. Insufficient albumin is causing insufficient absorption of fluid into the capillaries.

B. Low albumin contributing to an inability to counter gravitational effects.

C. Low albumin is contributing to excess hydrostatic pressure and inappropriate fluid distribution.

D. Low albumin is inducing hypertension and increased filtration of fluid into interstitial spaces.

Question 94

A community health nurse is teaching a group of recent graduates about the large variety of factors that influence an individual’s health or lack thereof. The nurse is referring to the Healthy People 2020 report from the U.S. Department of Health and Human Services as a teaching example. Of the following aspects discussed, which would be considered a determinant of health that is outside the focus of this report?

Answers:

A.The client has a diverse background by being of Asian and Native American descent and practices various alternative therapies to minimize effects of stress.

B. The client has a family history of cardiovascular disease related to hypercholesterolemia and remains noncompliant with the treatment regime.

C. The client lives in an affluent, clean, suburban community with access to many health care facilities.

D. The client has a good career with exceptional preventative health care benefits.

Question 95

The clinical educator of a hospital medical unit has the mandate of establishing evidence-based practice guidelines for the nursing care on the unit. Which of the following statements most accurately captures a guiding principle of the nurse’s task?

Answers:

A. Evidence-based practice guidelines will be rooted in research rather than nurses’ subjective practice preferences and experiences.

B. Guidelines are synonymous with systematic research reviews.

C. The need for continuity and standardization of guidelines will mean that they will be fixed rather than changeable.

D. The guidelines will combine individual expertise with external systematic evidence.

Question 96

A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive ?-adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers?

Answers:

A. They counteract arrhythmias and tachycardias by increasing vagal stimulation.

B. They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential.

C. They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions.

D. They inhibit the potassium current and repolarization, extending the action potential and refractoriness.

Question 97

Which of the following teaching points would be most appropriate for a group of older adults who are concerned about their cardiac health?

Answers:

A. “The plaque that builds up in your heart vessels obstructs the normal flow of blood and can even break loose and lodge itself in a vessel.”

B. “Infections of any sort are often a signal that plaque disruption is in danger of occurring.”

C. “The impaired function of the lungs that accompanies pneumonia or chronic obstructive pulmonary disease is a precursor to plaque disruption.”

D. “People with plaque in their arteries experience attacks of blood flow disruption at seemingly random times.”

Question 98

A 40-year-old male client is shocked to receive a diagnosis of mature B-cell lymphoma and is doing research on his diagnosis on the Internet. Which of the following statements that he reads on various Web sites is most reliable?

Answers:

A. “Like most forms of Hodgkin lymphoma, mature B-cell lymphoma often requires radiation treatment.”

B. “Doctors are able to diagnose mature B-cell lymphoma by the presence of Reed-Sternberg cells.”

C. “The lymph nodes are usually affected, and often the spleen and bone marrow.”

D. “Unlike many other lymphomas, mature B-cell lymphoma is often self-limiting, and treatment is focused on symptoms.”

Question 99

Which of the following processes would most likely be considered an anomaly during the cellular phase of inflammation?

Answers:

A. Platelet aggregation

B. Vasoconstriction

C. Migration of phagocytic white cells

D. Macrophage activity

Question 100

A geriatrician has ordered an echocardiogram and stress test for an 80-year-old male client in an effort to gauge the client’s cardiovascular health status.Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change?

Answers:

A. Increased resting, supine heart rate

B. Low maximal heart rate and cardiac output

C. Increased left ventricular wall thickness

D. Delayed left ventricular filling