Communication Skills for the Health Care Professional

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1) Discuss the differences between verbal and non-verbal communication.

2) Give at least 3 examples of each  (be specific and provide details as appropriate). Use examples from your readings, “Communicating with Patients in Crisis” and “Communicating Effectively with Patients Displaying Significant Negative or Resistive Coping Responses”.

Discussion Board Requirements: 250 word count One original post and two reply posts, APA Format, please include references 

Communication

Skills

for the

Health Care

Professional

Concepts, Practice, and Evidence

Gwen van Servellen

CHAPTER 15

© 2009 Jones and Bartlett Publishers

Chapter 15
Communicating with Patients in Crisis

© 2009 Jones and Bartlett Publishers

Objectives

  • Define crisis response
  • Individuals and groups in crisis
  • Dysfunctional communication in times of crisis
  • Relevance of stress and adaptation in periods of crisis
  • Adaptive and maladaptive coping responses

© 2009 Jones and Bartlett Publishers

Objectives Continued

  • Stressors, coping resources, and stress resistance resources
  • Differentiate between situational and developmental crisis
  • Stages of crisis resolution
  • Interventions to manage highly anxious patients
  • Interventions to manage agitated and/or confused patients

© 2009 Jones and Bartlett Publishers

Definition of Crisis and Crisis Responses

  • More change is required of an individual than capable to deal with at the time
  • Assumptions
  • Not all crises are incapacitating
  • Persons experience crisis in isolation of others
  • Persons can worsen each others responses through further excitation
  • Crisis is not the same as the stressor itself

© 2009 Jones and Bartlett Publishers

Dysfunctional Aspects of Crisis Communication

  • Difficulty in perceiving accurately
  • Abilities of processing information may be impaired
  • Ability to express ideas, thoughts, and emotions may be limited
  • Perceived state of disorganization can increase these deficits

© 2009 Jones and Bartlett Publishers

Impact: Over Stimulation and Under Stimulation

  • Over stimulation
  • Rapid bombardment or excessive stimuli
  • Not too much but stimuli are noxious
  • Exceed tolerance level
  • Inability to hear, speak, and if they do hear, unable to move

© 2009 Jones and Bartlett Publishers

Stress Theories and Understanding Crisis

  • Levels of anxiety and effects on patients; mild to severe and panic
  • Stress and adaptation
  • Lazarus and Folkman (1984) coping always discussed when stress effects are analyzed
  • Studies of stress of different kinds; and stress of the same kind across several groups of individuals

© 2009 Jones and Bartlett Publishers

Adaptive Coping Responses

  • Seek information
  • Seek comfort/support from friends or family
  • Search for solutions to the problem(s)
  • Self-talk that will help them feel better
  • Seek professional counseling or advice

© 2009 Jones and Bartlett Publishers

Types of Crisis

Developmental Crises: interruption or unsatisfactory passing from one psychosocial task and developmental phase that correspond also to physical developmental growth

Situational: Crisis emanates from precipitating events that occur and are typically out of the person’s realm of expectancy.

© 2009 Jones and Bartlett Publishers

Caring for Patients in Crisis

  • Do not re-victimize in the process of helping
  • Establish an emotional or psychological connection with the patient and family
  • Do not challenge the validity of the crisis situation or underestimate its effect
  • Practice active listening skills, direct straightforward approach, become aware of personal responses and their impact

© 2009 Jones and Bartlett Publishers

Summary

Crisis is unavoidable; many illness or injury events can be perceived as a crisis to the patient and family. More needs to be known about the unique expression of crisis across individuals and communities.

© 2009 Jones and Bartlett Publishers

Adolescence: Contemporary Issues and Resources

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Research the range of contemporary issues teenagers face today. In a 500-750-word paper, choose one issue (besides teen pregnancy) and discuss its effect on adolescent behavior and overall well-being. Include the following in your submission:

  1. Describe the contemporary issue and explain what external stressors are associated with this issue.
  2. Outline assessment strategies to screen for this issue and external stressors during an assessment for an adolescent patient. Describe what additional assessment questions you would need to ask and define the ethical parameters regarding what you can and cannot share with the parent or guardian.
  3. Discuss support options for adolescents encountering external stressors. Include specific support options for the contemporary issue you presented. 

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

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

Rubic_Print_Format

Course Code Class Code Assignment Title Total Points
NRS-434VN NRS-434VN-O505 Adolescence: Contemporary Issues and Resources 100.0
Criteria Percentage Unsatisfactory (0.00%) Less than Satisfactory (75.00%) Satisfactory (79.00%) Good (89.00%) Excellent (100.00%) Comments Points Earned
Content 80.0%
Contemporary Issue and Associated External Stressors 25.0% A contemporary issue facing adolescents is omitted. An issue facing adolescents is partially summarized; the issue is not relevant to adolescents. No explanation of external stressors associated with this issue is described; or, the external stressors are not relevant. A relevant issue facing adolescents is generally discussed. A general explanation of external stressors associated with this issue is summarized. More information is needed. There are some inaccuracies. A relevant issue facing adolescents is discussed. An explanation of external stressors associated with this issue is presented. A relevant issue facing adolescents is thoroughly discussed. An explanation of external stressors associated with this issue is well presented. Insight into adolescent issues and external stressors is demonstrated.
Assessment Strategies to Screen for the Issue and External Stressors 30.0% Strategies to screen for the chosen issue and external stressors during an assessment for an adolescent patient are omitted. Strategies to screen for the chosen issue and external stressors during an assessment for an adolescent patient are partially presented. The strategies are not relevant to screening for the issue or external stressors. Additional assessment questions to ask and the ethical parameters regarding what cannot be disclosed to the parent or guardian are omitted. Significant evidence or rationale is needed. Strategies to screen for the chosen issue and external stressors during an assessment for an adolescent patient are partially presented. The strategies are not relevant to screening for the issue or external stressors. Additional assessment questions to ask and the ethical parameters regarding what cannot be disclosed to the parent or guardian are omitted. Significant evidence or rationale is needed. Strategies to screen for the chosen issue and external stressors during an assessment for an adolescent patient are described. The strategies are relevant to screening for the issue and external stressors. Additional assessment questions to ask and the ethical parameters regarding what cannot be disclosed to the parent or guardian are outlined. Strategies to screen for the chosen issue and external stressors during an assessment for an adolescent patient are well described. The strategies are highly relevant to screening for the issue and external stressors. Additional assessment questions to ask are presented and relevant. The ethical parameters regarding what cannot be disclosed to the parent or guardian are clearly presented. The strategies demonstrate insight into assessment development for adolescent issues.
Support Options for Adolescents Encountering External Stressors 25.0% Support options for adolescents encountering external stressors are omitted. Support options for adolescents encountering external stressors are partially described. Specific support options for the contemporary issue are omitted. Support options for adolescents encountering external stressors are summarized. Specific support options for the contemporary issue are generally discussed. More detail or evidence is needed for support. There are some inaccuracies. Support options for adolescents encountering external stressors are discussed. Specific support options for the contemporary issue are described. Some detail or evidence is needed for support. Overall, the support options are relevant to address external stressors, including those specific to the contemporary issue. Support options for adolescents encountering external stressors are thoroughly discussed. Specific support options for the contemporary issue are described in detail. The support options are relevant for addressing the external stressors, including those specific to the contemporary issue. The options are well-supported by evidence and rationale.
Organization and Effectiveness 15.0%
Thesis Development and Purpose 5.0% Paper lacks any discernible overall purpose or organizing claim. Thesis is insufficiently developed or vague. Purpose is not clear. Thesis is apparent and appropriate to purpose. Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose. Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.
Argument Logic and Construction 5.0% Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources. Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility. Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis. Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative. Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.
Mechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0% Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used. Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present. Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.
Format 5.0%
Paper Format (use of appropriate style for the major and assignment) 2.0% Template is not used appropriately or documentation format is rarely followed correctly. Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent. Template is used, and formatting is correct, although some minor errors may be present. Template is fully used; There are virtually no errors in formatting style. All format elements are correct.
Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style) 3.0% Sources are not documented. Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors. Sources are documented, as appropriate to assignment and style, although some formatting errors may be present. Sources are documented, as appropriate to assignment and style, and format is mostly correct. Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
Total Weightage 100%

Electronic Health Records

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Why are many health care organizations hesitant to adopt electronic health records (EHR) when they have the potential to improve quality, increase access, and reduce costs? Some organizations are concerned with the ethical and legal issues that may arise in daily operations. In 2010, legislators noticed health care’s reluctant transition into full EHR integration, and began to provide financial incentives to those organizations that not only adopt EHRs, but also use them meaningfully to improve quality of patient care. As an advanced practice nurse, it is important to be aware of the challenges, policies, and incentives associated with integrating EHR systems. It is also critical that you understand the concept of “meaningful use” and how it plays out in today’s health care organizations.

To prepare:

In this Application Assignment, you analyze meaningful use criteria to determine the authentic legal, financial, and ethical issues that may surround it.

Reflect on the information presented in the Learning Resources, focusing on meaningful use legislation and the “Ethics in Nursing Informatics” section of your course text.

Investigate the legal, financial, and ethical issues surrounding meaningful use.

Ask yourself: What are the goals of meaningful use?

By Friday 10/06/17 10 pm, write a 4- to 5-page essay in APA format with at least 5 references from my list of required readings provided below, in which you include the level one as per APA format guidelines:

1) A cover page.

2) An introduction ending with a purpose statement (e.g. “The purpose of this paper is…)

3) Summarize the legal, financial, and ethical issues that may arise as a result of meaningful use legislation.

4) Explain how these issues might present barriers to successful implementation within an organization.

5) Discuss ways that health care organizations can make the most of their electronic health record (EHR) investments in light of meaningful use.

6) Explain how EHR-related meaningful use legislation is being implemented in your organization.

7) A conclusion

8) A references pages in APA format.

Required Readings

California HealthCare Foundation. (2011).

Retrieved from http://www.chcf.org/

The California HealthCare Foundation outlines quality reform plans that improve efficiency and reduce cost for California’s patients.

Centers for Medicare & Medicaid Services. (2010). CMS EHR meaningful use overview.

https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp

The U.S. Department of Health and Human Services defines the term meaningful use and also its view of meaningful use criteria, requirements, and financial impact.

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.

Course Text: American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: Author.

“Ethics in Nursing Informatics” (p. 49-52)

This page of the text introduces three common ethical codes used in health care today.

Croll, P. (2010). Privacy, security and access with sensitive health information. Studies in Health Technology and Informatics, 151, 167-175.

The author proposes a model for controlling the security of health information networks and systems.

Hjort, B. (2007). AHIMA report addresses evolving role of health care privacy and security officers. Journal of Health Care Compliance, 9(3), 47-68.

This article identifies the challenges and responsibilities of health care workers employed in privacy and security positions.

Layman, E. J. (2008). Ethical issues and the electronic health record. The Health Care Manager, 27(2), 165-176.

The findings within this article provide recommendations for health personnel, leaders, and policy makers when attempting to design ethically sound electronic health records.

Mackenzie, G., & Carter, H. (2010). Medico legal issues. Studies in Health Technology and Informatics, 151, 176-182.

Within this article, the authors provide an overview of the legal issues, precautions, and potential breaches that surround the privacy and security of electronic patient records

O’Keefe-McCarthy, S. (2009). Technologically-mediated nursing care: The impact on moral agency. Nursing Ethics, 16(6), 786-796.

Examine technology’s ability to negatively affect the patient/nurse relationship as decisions are based more on data and less on emotional and pedagogical reasoning by referencing the material found in this article.

Withrow, S. C. (2010). How to avoid a HIPAA horror story. Healthcare Financial Management, 64(8), 82-88.

The HIPAA horror story that is detailed here underlines the importance of adopting HIPAA privacy and security provisions in efforts to reduce potential violations and financial threats.

Centers for Medicare & Medicaid Services. (2010). CMS EHR meaningful use overview.

https://www.cms.gov/EHRIncentivePrograms/30_Meaningful_Use.asp

The U.S. Department of Health and Human Services defines the term meaningful use and also its view of meaningful use criteria, requirements, and financial impact.

American Nurses Association. (2011). Ethics and human rights.

Diseases Illnesses And Disorders

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Question 1

2 / 2 pts

Dilated and sluggish pupils, widening pulse pressure, and bradycardia are clinical findings evident of which stage of intracranial hypertension?

Stage 4

Stage 2

Stage 1

Stage 3

Question 2

2 / 2 pts

Posthyperventilation apnea (PHVA) ceases and rhythmic breathing is resumed when levels of arterial

carbon dioxide become normal.

oxygen increase.

oxygen decrease.

carbon dioxide increase.

Question 3

2 / 2 pts

Uncal herniation occurs when

the hippocampal gyrus shifts from the middle fossa through the tentorial notch into the posterior fossa.

the diencephalon shifts from the middle fossa straight downward through the tentorial notch into the posterior fossa.

the cingulate gyrus shifts under the falx cerebri.

a cerebellar tonsil shifts through the foramen magnum.

Question 4

2 / 2 pts

What are the areas of the brain that mediate several cognitive functions, including vigilance, reasoning, and executive functions?

Occipital

Limbic

Parietal

Prefrontal

Question 5

0 / 2 pts

The most critical aspect in diagnosing a seizure disorder and establishing its cause is

computed tomography (CT) scan.

cerebrospinal fluid analysis.

health history.

skull x-ray films.

Question 6

2 / 2 pts

Cerebral edema is an increase in the fluid content of the

brain tissue.

meninges.

neurons.

ventricles.

Question 7

2 / 2 pts

Which is a characteristic of brainstem death?

Comatose

Vegetative state

Apnea

Locked-in syndrome

Question 8

2 / 2 pts

Which disease process is infratentorial?

Cerebellar neoplasm

Parkinson disease

Encephalitis

Cerebral neoplasm

Question 9

2 / 2 pts

Microinfarcts resulting in pure motor or pure sensory deficits are the result of which type of stroke?

Lacunar

Hemorrhagic

Embolic

Thrombotic

Question 10

0 / 2 pts

Spinal cord injuries are most likely to occur in which of the following regions?

Cervical and thoracic

Lumbar and sacral

Cervical and lumbar

Thoracic and lumbar

Question 11

2 / 2 pts

A right hemisphere embolic cerebrovascular accident has resulted in left-sided paralysis and reduced sensation of the left foot and leg. The vessel most likely affected by the emboli is the right _ artery.

middle cerebral

posterior cerebral

vertebral

anterior cerebral

Question 12

2 / 2 pts

In children most intracranial tumors are located

laterally.

below the tentorium cerebelli.

above the tentorium cerebelli.

posterolaterally.

Question 13

2 / 2 pts

What are the most common side effects of selective serotonin reuptake inhibitors (SSRIs)?

Hypertensive crisis and agitation

Orthostatic hypotension and weight gain

Dry mouth and sexual dysfunction

Sleep disturbances and nausea

Question 14

0 / 2 pts

Which neurotransmitter is reduced in people with schizophrenia?

Acetylcholine

Dopamine

Gamma-aminobutyric acid (GABA)

Serotonin

Question 15

0 / 2 pts

Which electrolyte imbalance contributes to lithium toxicity?

Hyponatremia

Hypernatremia

Hypokalemia

Hyperkalemia

Question 16

2 / 2 pts

Benign febrile seizures are characterized by

onset after the fifth year of life.

respiratory or ear infections.

lasting 30 minutes or more.

a temperature less than 39° C.

Question 17

2 / 2 pts

The clinical manifestations of dyskinetic cerebral palsy include

exaggerated deep tendon reflexes, clonus, and rigidity of extremities.

scoliosis, contractures, and stiffness of trunk muscles.

increased muscle tone and prolonged primitive reflexes.

jerky uncontrolled and abrupt fine musculoskeletal movements.

Question 18

2 / 2 pts

A _ is the test done on amniotic fluid and maternal blood to test for neural tube defect.

α-fetoprotein (AFP)

total protein

culture

C-reactive protein

Question 19

2 / 2 pts

Symptoms characteristic of bulimia nervosa include:

a perception that the body is fat when it is actually underweight.

recurrent episodes of binge eating with fears of not being able to stop eating.

absence of three consecutive menstrual periods.

a fear of becoming obese despite progressive weight loss.

Question 20

2 / 2 pts

Intussusception causes intestinal obstruction by

the loss of peristaltic motor activity in the intestine, causing an adynamic ileus.

twisting the intestine on its mesenteric pedicle causing occlusion of the blood supply.

forming fibrin and scar tissue that attach to intestinal omentum and cause obstruction.

telescoping of part of the intestine into another usually causing strangulation of the blood supply.

Question 21

2 / 2 pts

After a partial gastrectomy or pyloroplasty, clinical manifestations that include increased pulse, hypotension, weakness, pallor, sweating, and dizziness are a result of

a rapid gastric emptying and creation of a high osmotic gradient in the small intestine that causes a sudden shift of fluid from the blood vessels to the intestinal lumen.

hemorrhage postoperatively in which a large volume of blood is lost, causing hypotension with compensatory tachycardia.

an anaphylactic reaction in which chemical mediators, such as histamine, prostaglandins, and leukotrienes, relax vascular smooth muscles causing shock.

a concentrated bolus that moves from the stomach into the small intestine, which causes hyperglycemia, resulting in polyuria and eventually hypovolemic shock.

Question 22

0 / 2 pts

Hepatitis _ in children is primarily associated with blood transfusions.

D

B

A

C

Question 23

2 / 2 pts

_ diarrhea results from lactose intolerance.

Motility

Secretory

Small volume

Osmotic

Question 24

0 / 2 pts

A person with cystic fibrosis has an exocrine pancreatic insufficiency because

the pancreas has a volvulus at the ampulla of Vater.

of the impaired blood supply to the pancreas causing ischemia.

genetically the pancreas is unable to produce digestive enzymes.

the pancreatic ducts are obstructed with mucus.

Question 25

2 / 2 pts

Prolonged diarrhea is more severe in children than in adults because

children have diarrhea more often than do adults.

children have a higher fluid volume intake.

less water is absorbed from the colon in children.

fluid reserves are smaller in children.

Demography

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  1. What demographic variables were measured at the nominal level of measurement in the Oh et al. (2014) study? Provide a rationale for your answer.
  2. What statistics were calculated to describe body mass index (BMI) in this study? Were these appropriate? Provide a rationale for your answer.
  3. Were the distributions of scores for BMI similar for the intervention and control groups? Provide a rationale for your answer.
  4. Was there a significant difference in BMI between the intervention and control groups? Provide a rationale for your answer.

106

  1. Based on the sample size of N = 41, what frequency and percentage of the sample smoked? What frequency and percentage of the sample were non-drinkers (alcohol)? Show your calculations and round to the nearest whole percent.
  2. What measurement method was used to measure the bone mineral density (BMD) for the study participants? Discuss the quality of this measurement method and document your response.
  3. What statistic was calculated to determine differences between the intervention and control groups for the lumbar and femur neck BMDs? Were the groups significantly different for BMDs?
  4. The researchers stated that there were no significant differences in the baseline characteristics of the intervention and control groups (see Table 2). Are these groups heterogeneous or homogeneous at the beginning of the study? Why is this important in testing the effectiveness of the therapeutic lifestyle modification (TLM) program?
  5. Oh et al. (2014, p. 296) stated that “the adherence rate to the TLM program was 99.6%.” Discuss the importance of intervention adherence, and document your response.
  6. Was the sample for this study adequately described? Provide a rationale for your answer.

Measuring Quality Guidelines and Grading Rubric

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In an 8 to 10-page paper, APA format and 5 references, describe three rate based measurements of quality.

Select three rate based measurements of quality that you will use as the primary basis for this paper.

These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care. For the purposes of this assignment, an analysis of staffing levels is not permitted. You can find useful information on quality indicators that are of interest to you on these websites and resources. You may choose only one of the three measures to be some form of patient satisfaction measure.

Deconstruct each measure to include descriptions of the each of the following as numbered below:

1) The definition of the measure

2) The numerical description of how the measurement is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.)

3) Explain how the data for this measure are collected

4) Describe how the measurement is compared externally to other like settings; differentiate between the actual rate and a percentile ranking.

5) Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.

6) Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace.

Describe the importance of each measure to a chosen clinical organization and setting.

Using these websites and resources you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might home in a particular health plan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings. Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the instructor for guidance. You do not need actual data from a given organization to complete this assignment.

Relate each measure to patient safety, to the cost of poor quality, and to the overall cost of healthcare.

Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

Chapter 5: “Data Collection”

Chapter 6: “Statistical Tools for QI”

Park, J., Konetzka, R. T., & Werner, R. M. (2011). Performing well on nursing home report cards: Does it pay off? Health Services Research, 46(2), 531–554. doi:10.1111/j.1475-6773.2010.01197.x

The study in this article evaluates whether or not nursing homes benefit from improvements in quality measures. Four financial outcomes are measured before and after the improvements are enacted. The study shows that the nursing homes that improved quality measures benefited financially.

Suchy, K. (2010). A lack of standardization: The basis for the ethical issues surrounding quality and performance reports. Journal of Healthcare Management, 55(4), 241–251.

Because performance reports are easily found online, this article supports creating ethical guidelines for the performance reports of the health care industry. It compares nearly ten different organizations that provide performance reporting, and then it proposes an ethical framework and principles for public quality reporting.

Wachter, R. M., & Pronovost, P. J. (2009). Balancing “no blame” with accountability in patient safety. New England Journal of Medicine, 361(14), 1401–1406.

This article addresses the issue of individual accountability in health care organizations. It suggests moving from a culture within health care that does not place blame on individuals to a culture where individuals become more accountable.

Centers for Medicare & Medicaid Services. (n.d.). Quality initiatives: Overview. Retrieved from http://www.cms.gov/QualityInitiativesGenInfo/

Created by the U.S. Department of Health & Human Services, this website overviews quality initiatives that affect the health care industry. It also provides information and downloadable PDFs on the Post-Acute Care Reform Plan and Development of Quality Indicators for Impatient Rehabilitation Facilities (IRF).

Required Media

Video: Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: External quality improvement. Baltimore: Author.

Note: The approximate length of this media piece is 10 minutes.

The presenters in this video discuss various external organizations involved in quality, and examine the enforcement of standards by governmental agencies versus voluntary organizations. This program also addresses the publication of quality information and why organizations should do their own reporting in addition to mandated reporting. Licensing, credentialing, and certification are discussed as they relate to the social compact that health care providers have for quality and safety.

Practicum Journal Entry

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As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your practicum experience. By applying the concepts you study in the classroom to clinical settings, you enhance your professional competency. Each week, you complete an Assignment that prompts you to reflect on your practicum experiences and relate them to the material presented in the classroom. This week, you begin documenting your practicum experiences in your Practicum Journal.

                                                              The Assignment

In preparation for this course’s practicum experience, address the following in your Practicum Journal:

· Select one nursing theory and one counseling theory to best guide your practice

in psychotherapy.

Note: For guidance on nursing and counseling theories, refer to this week’s

Learning Resources.

· Explain why you selected these theories. Support your approach with evidence-

based literature.

· Develop at least three goals and at least three objectives for the practicum

experience in this course.

· Create a timeline of practicum activities based on your practicum requirements.

PLEASE ACCORDING TO THE INSTRUCTOR:

Student, the objectives for this assignment were:

Select one nursing theory and one counseling theory to best guide your practice in psychotherapy.

Note: For guidance on nursing and counseling theories, refer to this week’s Learning Resources.

Explain why you selected these theories. Support your approach with evidence-based literature.

Develop at least three goals and at least three objectives for the practicum experience in this course.

Create a timeline of practicum activities based on your practicum requirements.

NOTE: THE Practicum Journal Template (Word document) IS ATTACHED WITH 

            THIS ASSIGNMENT.





                                                 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 11, “Group Therapy” (pp. 407–428)

Nichols, M. (2014). The essentials of family therapy (6th ed.). Boston, MA: Pearson.

Chapter 1, “The Foundations of Family Therapy” (pp. 1–6)

Chapter 2, “The Evolution of Family Therapy” (pp. 7–28)

Breeskin, J. (2011). Procedures and guidelines for group therapy. The Group Psychologist, 21(1). Retrieved from http://www.apadivisions.org/division-49/publications/newsletter/group-psychologist/2011/04/group-procedures.aspx

Khawaja, I. S., Pollock, K., & Westermeyer, J. J. (2011). The diminishing role of psychiatry in group psychotherapy: A commentary and recommendations for change. Innovations in Clinical Neuroscience, 8(11), 20–23. Retrieved from http://innovationscns.com/

Koukourikos, K., & Pasmatzi, E. (2014). Group therapy in psychotic inpatients. Health Science Journal, 8(3), 400–408.

Lego, S. (1998). The application of Peplau’s theory to group psychotherapy. Journal of Psychiatric & Mental Health Nursing, 5(3), 193–196. doi:10.1046/j.1365-2850.1998.00129.x

McClanahan, K. K. (2014). Can confidentiality be maintained in group therapy? Retrieved from http://nationalpsychologist.com/2014/07/can-confidentiality-be-maintained-in-group-therapy/102566.html

U.S. Department of Health & Human Services. (2014). HIPAA privacy rule and sharing information related to mental health. 

                                                    Required Media

Sommers, G., Feldman, S., & Knowlton, K. (Producers). (2008a). Legal and ethical issues for mental health professionals, volume 1: Confidentiality, privilege, reporting, and duty to warn [Video file]. Mill Valley, CA: Psychotherapy.net.

To Be Or Not To Be Civil?

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Assignment:

Now that you have discovered what incivility is, let’s review therapeutic communication techniques

Choose one scholarly, peer-reviewed on incivility in the nursing workplace or the classroom. Write a one to two-page summary, using APA 6th edition writing mechanics, of your article. Add three of your personal thoughts or insights (in a few sentences) at the end of your summary. It could be something you have experienced at school or work or saw happen in a classroom or work situation. Finally, give some thought as to how you would manage this situation (remember therapeutic communication techniques): Would you feel comfortable reporting these uncivil actions?; who would you report it to?; if the situation happened to you, would you use productive confrontation to address the person who was uncivil?; if you have been uncivil, what are your plans to change your behaviors?; and what therapeutic communication techniques would be best to use in this situation? You can add anything else you might like to address concerning incivility. Please in-text cite your reference/s and add them to a reference list at the end of the paper in APA 6th format.

Hopefully, you will be able to help advocate for courteous behaviors from here on out in your career. It is critical that we all RESPECT each other!

Additional resources to review (optional):

Weber Shandwick article web link: http://www.webershandwick.com/uploads/news/files/Civility_2010_SocialMediaImplications.pdf

References:

Merriam-Webster Dictionary. (2017). Incivility. Retrieved from https://www.merriam-webster.com/dictionary/incivility

Weber Shandwick. (2010). Civility 2010: Social media implications. Retrieved from: http://www.webershandwick.com/uploads/news/files/Civility_2010_SocialMediaImplications.pdf

This assignment should be 3-4 pages, including the Title and Reference Page, in APA format (including your citations and references).

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

Save your assignment as a Microsoft Word document. (Mac users, please remember to append the “.docx” extension to the filename.) The name of the file should be your first initial and last name, followed by an underscore and the name of the assignment, and an underscore and the date. An example is shown below:

Jstudent_exampleproblem_101504

Need Help? Click here for complete drop box instructions.

Grading Rubric

Module 1 Written Assignment – To Be or Not to Be Civil? That is the Question!

Scoring Rubric:

Criteria

Points

Submitted a one page summary with three of your personal thoughts or insights

10

Write another page with your thoughts as to how you would manage this situation (Remember therapeutic communication techniques):

8

Discusses the following

Would you feel comfortable reporting these uncivil actions?

Who would you report it to?

If the situation happened to you, would you use productive confrontation to address the person who was uncivil?

If you have been uncivil, what are your plans to change your behaviors?

What therapeutic communication techniques would be best to use in this situation?

10

Included TWO web resources. Followed APA format.

2

Total

30

Guideline Development

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NR 511 Week 4 Midterm Exam Version 1

Question 1: Which of the following is a crucial element of developing a guideline?

a. Creating a physician expert panel

b. Reviewing the literature with ratings of available evidence

c. Conducting an external review of a guideline

d. Developing evidence-based tables

Question 2: African American patients seem to have a negative reaction to which of the following asthma medications?

a. Inhaled corticosteroids

b. Long-term beta-agonist bronchodilators

c. Leukotriene receptor agonist

d. Oral corticosteroid

Question 3: Jolene has breast cancer that has been staged as T1, N0, M0. What might this mean?

a. The tumor size cannot be evaluated, the cancer has not spread to the lymph nodes, and the distant spread cannot be evaluated.

b. The cancer is in situ, it is spreading into the lymph nodes, but the spread otherwise cannot be evaluated.

c. The cancer is less than 2 cm in size and has not spread to the lymph nodes or other parts of the body.

d. The cancer is about 5 cm in size, nearby lymph nodes cannot be evaluated, and there is no evidence of distant spreading.

Question 4: Sondra’s peripheral vestibular disease causes dizziness and vertigo. Which of the following medications will help to decrease edema in the labyrinth of the ear?

a. Meclizine

b. Diphenhydramine

c. Diamox

d. Promethazine

Question 5: Mandy presents with a cauliflower-like wart that is in her anogenital region. You suspect it was sexually transmitted and document this as a:

a. Filiform/digitate wart.

b. Dysplastic cervical lesion.

c. Condyloma accuminata.

d. Koilocytosis.

Question 6: Inattention and a sleep-wake cycle disturbance are the hallmark symptoms of?

a. Dementia

b. Alzheimer’s disease

c. Parkinson’s disease

d. Delirium

Question 7: You have taught Jennifer, age 15, about using a flow meter to assess how to manage her asthma exacerbations. She calls you today because her peak expiratory flow rate is 65%. What would you tell her?

a. “Take your short-acting beta-2 agonist, remain quiet, and call back tomorrow.”

b. “Use your rescue inhaler, begin the prescription of oral glucocorticoids you have, and call back tomorrow.”

c. “Drive to the emergency room (ER) now.”

d. “Call 911.”

Question 8: A patient is seen in the clinic with hematuria confirmed on microscopic examination. The clinician should inquire about the ingestion of which of these substances that might be the cause of hematuria?

a. NSAIDs

b. Beets

c. Vitamin A

d. Red meat

Question 9: Which of the following is an example of tertiary prevention in a patient with chronic renal failure?

a. Fluid restriction

b. Hemodialysis 4 days a week

c. High-protein diet

d. Maintain blood pressure at 120/80

Question 10: Which of the following conditions is associated with cigarette smoking?

a. Glaucoma

b. Increased sperm quality

c. Bladder cancer

d. Eczema

Question 11: A chronic cough lasts longer than:

a. 3 weeks

b. 1 month

c. 6 months

d. 1 year

Question 12: The ‘freezing phenomenon’ is a cardinal feature of?

a.Parkinson’s disease

b. Alzheimer’s disease

c. A CVA

d. Bell’s palsy

Question 13: When administered at the beginning of an attack, oxygen therapy may help this kind of headache?

a. Tension

b. Migraine

c. Cluster

d. Stress

Question 14: Which ethnic group has the highest lung cancer incidence and mortality rates?

a. African American men

b. Scandinavian men and women

c. Caucasian women

d. Asian men

Question 15: The most significant precipitating event leading to otitis media with effusion is:

a. Pharyngitis

b. Allergies

c. Viral upper respiratory infection (URI)

d. Perforation of the eardrum

Question 16: Samuel is going to the dentist for some work and must take endocarditis prophylaxis because of his history of:

a. Severe asthma.

b. A common valvular lesion.

c. Severe hypertension.

d. A previous coronary artery bypass graft (CABG).

Question 17: A 34-year-old patient was treated for a urinary tract infection (UTI) and has not responded to antibiotic therapy. Which of the following actions should be taken next?

a. Send a urine specimen for microscopy looking for fungal colonies.

b. Increase the dose of antibiotic.

c. Order a cytoscopy.

d. Order a different antibiotic.

Question 18: Which statement best describes a carotid bruit?

a. It is felt with the middle three fingers over the carotid artery.

b. A bruit becomes audible when the lumen is narrowed to 1 mm or less.

c. A low-pitched bruit is a medical emergency.

d. The higher the pitch of the bruit, the higher the degree of stenosis.

Question 19: Which statement is true regarding chloasma, the ‘mask of pregnancy’?

a. It is caused by a decrease in the melanocyte-stimulating hormone duringpregnancy.

b. This condition only occurs on the face.

c. Exposure to sunlight will even out the discoloration.

d. It is caused by increased levels of estrogen and progesterone.

Question 20: Simon presents with alopecia areata with well-circumscribed patches of hair loss on the crown of his head. How do you respond when he asks you the cause?

a. “You must be under a lot of stress lately.”

b. “It is hereditary. Did your father experience this also?”

c. “The cause is unknown, but we suspect it is due to an immunologic mechanism.”

d. “We’ll have to do some tests.”

Question 21: A blood pressure (BP) of 150/90 is considered:

a. Stage 2 hypertension

b. Hypertensive

c. Normal in healthy older adults

d. Acceptable if the patient has DM

Question 22: When teaching post MI patients about their NTG tablets, theclinician should stress that the tablets should remain in thelight-resistant bottle in which they are packaged and shouldnot be put in another pill box or remain in areas that are orcould become warm and humid. Once opened, the bottlemust be dated and discarded after how many months?

a. 1 month

b. 3 months

c. 6 months

d. As long as the tablets are kept in this special bottle, they will last forever

Question 23: Your patient has decided to try to quit smoking with Chantix. You are discussing his quit date, and he will begin taking the medicine tomorrow. When should he plan to quit smoking?

a. He should stop smoking today.

b. He should stop smoking tomorrow.

c. His quit date should be in 1 week.

d. He will be ready to quit after the Frst 30 days

Question 24: When looking under the microscope to diagnose an intravaginal infection, you see a cluster of small and oval to round shapes. What do you suspect they are?

a. Spores

c. Pseudohyphae

b. Leukocytes

d. Epithelial cells

Question 25: The hallmark of an absence seizure is:

a. No activity at all.

b. A blank stare.

c. Urine is usually voided involuntarily.

d. The attack usually lasts several minutes.

Question 26: Which medication used for scabies is safe for children 2 months and older?

a. Permethrin cream

b. Lindane

c. Crotamiton lotion and cream

d. Ivermectin

Question 27: The clinician is seeing a patient complaining of red eye. The clinician suspects conjunctivitis. The presence of mucopurulent discharge suggests which type of conjunctivitis?

a. Viral conjunctivitis

b. Keratoconjunctivitis

c. Bacterial conjunctivitis

d. Allergic conjunctivitis

Question 28: Gabby, aged 22, has Bell’s palsy on the right side of her face. Her mouth is distorted, and she is concerned about permanent paralysis and pain. What do you tell her?

a. “Most patients have complete recovery in a few weeks to a few months.”

b. “Unfortunately, you’ll probably have a small amount of residual damage.”

c. “Don’t worry, I’ll take care of everything.”

d. “You may have a few more episodes over the course of your lifetime but no permanent damage.”

Question 29: How often should drug levels be monitored when a seizure medication has controlled the seizures and the drug level is adequate

a. Every 3 months

b. Every 6 months

c. Annually

d. Whenever there is a problem

Question 30: Immunizations are an example of which type of prevention?

a. Primary

b. Secondary

c. Tertiary

Question 31: The result of the patient’s 24-hour urine for protein was 4.2 g/day. The clinician should take which of the following actions?

a. Repeat the test.

b. Refer to a nephrologist.

c. Measure the serum protein.

d. Obtain a blood urea nitrogen (BUN) and creatinine.

Question 32: Which cranial nerve is afected in a patient with acerebrovascular accident who has difficulty chewing?

a. CN V

b. CN VII

c. CN IX

d. CN X

Question 33: Which of the following diagnostic tests should be ordered for a patient suspected of having bladder cancer?

a. KUB (kidneys, ureter, bladder) x-ray

b. Cystoscopy with biopsy

c. Magnetic resonance imaging (MRI)

d. Urine tumor marker (NMP22)

Question 34: The “B” in the ABCDEs of assessing skin cancer represents:

a. Biopsy.

b. Best practice.

c. Boundary.

d. Border irregularity.

Question 35: Which statement is true regarding driving and patients with a seizure disorder?

a. Once diagnosed with a seizure disorder, patients mustnever drive again.

b. After being seizure free for 6 months, patients may drive.

c. Each state has diferent laws governing driving forindividuals with a seizure disorder.

d. These persons may drive but never alone.

Question 36: Which high-density lipoprotein (HDL) level is considered cardioprotective?

a. Greater than 30

b. Greater than 40

c. Greater than 50

d. Greater than 60

Question 37: The most common etiologic organism for community-acquired pneumonia is:

A. Streptococcus pneumoniae

B. Beta hemolytic streptococcus

C. Mycoplasma

D. Methicillin resistant staphylococcus

Question 38: Sandra has palpitations that occur with muscle twitching, paresthesia, and fatigue. What specific diagnostic test might help determine the cause?

a. Serum calcium

b. Electrocardiogram (ECG)

c. Thyroid-stimulating hormone test

d. Complete blood cell count

Question 39: A patient presents to the clinician with a sore throat, fever of 100.7?F, and tender anterior cervical lymphadenopathy. The clinician suspects strep throat and performs a rapid strep test that is negative. What would the next step be?

a. The patient should be instructed to rest and increase fluid intake as the infection is most likely viral and will resolve without antibiotic treatment.

b. Because the patient does not have strep throat, the clinician should start broad spectrum antibiotics in order to cover the offending pathogen.

c. A throat culture should be performed to confirm the results of the rapid strep test.

d. The patient should be treated with antibiotics for strep throat as the rapid strep test is not very sensitive.

Question 40: Patients with acute otitis media should be referred to a specialist in which of the following situations?

a. Concurrent vertigo or ataxia

b. Failed closure of a ruptured tympanic membrane

c. If symptoms worsen after 3 or 4 days of treatment

d. All of the above

Question 41: Which of the following tests is most useful in determining renal function in a patient suspected of chronic renal failure (CRF)?

a. Blood urea nitrogen (BUN) and creatinine

b. Electrolytes

c. Creatinine clearance

d. Urinalysis

Question 42: Marci has a wart on her hand. She says she heard something about “silver duct tape therapy.” What do you tell her about his?

a. It is an old wives’ tale.

b. It is used as a last resort.

c. Salicylic acid is more effective.

d. It is a simple treatment that should be tried first.

Question 43: What is the first-line recommended treatment against Group A b-hemolytic streptococci (GABHS), the most common cause of bacterial pharyngitis?

a. Penicillin

b. Quinolone

c. Cephalosporin

d. Macrolide

Question 44: Which of the following is an example of sensorineural hearing loss?

a. Perforation of the tympanic membrane

b. Otosclerosis

c. Cholesteatoma

d. Presbycusis

Question 45: Which of the following is “a linear crack extending from the epidermis to the dermis?”

a. An ulcer

b. A fissure

c. Lichenification

d. An excoriation

Question 46: A 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night visio0n, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The clinician suspects chronic open-angle glaucoma. Which of the following statements is true concerning the diagnosis of chronic open-angle glaucoma?

a. The presence of increased intraocular pressure measured by tonometry is definitive for the diagnosis of open-angle glaucoma.

b. The clinician can definitively diagnosis open-angle glaucoma based on the subjective complaints of the patient.

c. Physical diagnosis relies on goniscopic evaluation of the angle by an ophthalmologist.

d. Early diagnosis is essential in order to reverse any damage that has occurred to the optic nerve.

Question 47: The majority of HSV-1 and HSV-2 infections are asymptomatic so that only which elevated antibody titer shows evidence of previous infection?

a. IgA

b. IgE

c. IgG

d. IgM

Question 48: A patient is seen with a sudden onset of ±ank painaccompanied by nausea, vomiting, and diaphoresis. Inaddition to nephrolithiasis, which of the following should beadded to the list of diferential diagnoses?

a. Pancreatitis

b. Peptic ulcer disease

c. Diverticulitis

d. All of the above

Question 49: Which of the following is abundant in the heart and rapidly rises in the bloodstream in the presence of heart failure, making it a good diagnostic test?

a. B-type natriuretic peptide

b. C-reactive protein

c. Serum albumin

d. Erythrocyte sedimentation rate

Question 50: You are doing a cerumen extraction and touch the external meatus of your patient’s ear. He winces and starts coughing. What is the name of this reflex?

a. Baker phenomenon

b. Arnold reflex

c. cough reflex

d. Tragus reflex

Medical Quiz Test

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  1. Cells in _ may act as a reservoir in which HIV can be relatively protected from antiviral drugs.
  2. Which statement is true about fungal infections?
  3. What of the following remains a significant cause of morbidity and mortality worldwide?
  4. What mechanism occurs in Raynaud phenomenon that classifies it as a type III hypersensitivity reaction?
  5. Which statement about vaccines is true?
  6. What is the role if reverse transcriptase in HIV infection?
  7. After sexual transmission of HIV, a person can be infected yer seronegative for _ months.
  8. The class if antibody involved in type I hypersensitivity reactions is
  9. What disease involves the deposition of circulating immune complexes containing an antibody against host DNA, resulting in tissue damage?
  10. Hypersensitivity is best defined as a(n)
  11. What is the mechanism in type III hypersensitivity reactions?
  12. Stress-induced norepinephrine results in
  13. Which hormone increases the formation of glucose from amino acids and free fatty acids?
  14. Cells from a muscle tumor show a reduced ability to form new muscle and appear highly disorganized. This is an example of
  15. Which of the following represents the correct nomenclature for benign and malignant tumors of adipose tissues, respectively?
  16. What is the role of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and transforming growth factor-alpha (TGF-@) in cell metastasis.
  17. Many cancers create a mutation of ras. What is ras?
  18. Which if the following cancers originate from connective tissue?
  19. Inherited mutations that predispose to cancer are almost invariably what kind if gene?
  20. Which characteristic among women correlates with a high morbidity of cancer of the colon, , uterus, liver, gallbladder, pancreas, breast, uterus, and kidney?
  21. What congenital malformation is commonly linked to acute leukemia in children?

WEEK 2

  1. At the arterial end of capillaries, fluid moves from the intravascular space into the interstitial space because the
  2. Which enzyme is secreted by the juxtaglomerular cells of the kidney when circulating blood is reduced?
  3. Water movement between the intravascular fluid compartment and the extracellular compartment is primarily a function of
  4. Physiologic ph is maintained around 7.4 because bicarbonate (HCO3) and carbonic acid (H2CO3) exist in a ratio of
  5. Which are indications of dehydration?
  6. In hyperkalemia, cardiac rhythm changes are a direct result of
  7. What is a major determinant of the resting membrane potential necessary for transmission of nerve impulses?
  8. Which inflammatory mediators are produced in asthma?
  9. _ is a fulminant form of respiratory failure characterized by acute lung inflammation and diffuse alveolocapillary injury.
  10. Dyspnea is not a result of
  11. Which of the following is a true statement?
  12. Clinical manifestations that include unexplained weight loss, dyspnea on exertion, use of accessory muscles, and tachypnea with prolonged expiration are indicative of
  13. The most successful treatment of chronic asthma begins with
  14. Clinical manifestations of pulmonary hypertension include
  15. Pulmonary edema usually begins at a pulmonary capillary wedge pressure or left atrial pressure of ___mmHg.
  16. In tuberculosis, the body walls off the bacilli in a tubercle by stimulating
  17. Kussmaul respirations may be characterized as a respiratory pattern
  18. Which pleural abnormality involves a site of pleural rupture that act as a one-way valve, permitting air to enter on inspiration but preventing its escape by closing during expiration?
  19. Cystic fibrosis (CF) is caused by a(n)
  20. An accurate description of childhood asthma is that it is a(n)
  21. What is the primary cause of Respiratory Distress Syndrome (RDS) of the newborn?
  22. The release of fibroblast growth factor affects ARDS by causing
  23. Chest wall compliance in infants is _ in adults.
  24. Which immunoglobulin is present in childhood asthma?
  25. Which of the following statements about the advances in the tx of RDS of the newborn is incorrect?

WEEK 3

  1. Symptoms of polycythemia vera are mainly the results of
  2. Pernicious anemia generally requires continued therapy lasting
  3. Clinical manifestations of mild to moderate splenomegaly and hepatomegaly, bronze-colored skin, and cardiac dysrhythmias are indicative of which anemia?
  4. In hemolytic anemia, jaundice occur only when
  5. A woman c/o chronic gastritis, fatigue, weight loss, and tingling in her fingers. Laboratory findings show low hemoglobin and hematocrit levels, and a high mean corpuscular volume. These findings are consistent with ____anemia.
  6. The underlying disorder of _ anemia is defective secretion of intrinsic factor, which is essential for the absorption of Vit B12.
  7. Which of the following is a description if consistent with chronic lymphocytic leukemia (CLL)?
  8. Heparin-induced thrombocytopenia (HIT) is described as a(n)
  9. What change is seen in the leukocytes during an allergic disorder (type I) often caused by asthma, hay fever, and drug reactions?
  10. What is the most common cause of vit K deficiency?
  11. The sickle cell trait differs from sickle cell dx in that the child with sickle cell trait
  12. Polycythemia occurs in a fetus because
  13. G6PD and sickle cell dx are
  14. What is the name of the disorder in which levels of bilirubin remain excessively high in the newborn and are deposited in the brain?
  15. In full term infant, the normal erythrocyte life span is __ days, whereas the adult is ___days.
  16. Idiopathic thrombocytopenic purpura (ITP) is an autoimmune process involving antibodies against
  17. The risk of developing coronary artery dx is increased up to threefold by
  18. What is the primary mechanism of atherogenesis?
  19. An individual who is demonstrating elevated levels of troponin, creatine kinase (CK), and lactic dehydrogenase (LDH) is exhibiting indicators associated with:
  20. Which disorder causes transitory truncal rash that is nonpruritic and pink with erythematous macules that may fade in the center, making them appear as a ringworm?
  21. When does most cardiovascular development occur?
  22. The foremen ovale is covered by a flap that creates a check valve allowing blood to flow unidirectionally from _ to the _ .
  23. When does systemic vascular resistance in infants begin to rise?
  24. Which congenital heart defects occur in trisomy 13, 18, and down syndrome?
  25. What is the most important manifestation of aortic coarctation in the neonate?

WEEK 4

  1. What primary problem resulting from respiratory distress syndrome (RDS) of the newborn?
  2. Phagocytosis involves neutrophils actively attacking, engulfing, and destroying which microorganism?
  3. How high does the plasma glucose have to be before the threshold for glucose is achieved?
  4. Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describes the pathophysiologic characteristics of which type of anemia?
  5. Which statement is true concerning the IgM?
  6. Which type of immunity is produced by an individual after either natural exposure to the antigen or after immunization against the antigen?
  7. The coronary ostia are located in the:
  8. Which hepatitis virus is known to be sexually transmitted?
  9. The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks or gestation?
  10. What is the ratio of coronary capillaries to cardiac muscle cells?
  11. What is the most common cause of insufficient erythropoiesis in children?
  12. Which term is used to identify the movement of gas and air into and out of the lungs?
  13. Perceived stress elicits an emotional, anticipatory response that begins where?
  14. Which complex (wave) represents the sum of all ventricular muscle cell depolarizations?
  15. Causes of hyperkalemia include:
  16. Which criterion is used to confirm a dx of asthma in an 8-year-old child?
  17. What is the role of caretaker genes?
  18. What is the action of urodilatin?
  19. The Papanicolaou (Pap) test is used to screen for which cancer?
  20. What is the life span of an erythrocyte (in days)?
  21. Hypersensitivity is best defined as a(n):
  22. What is the final stage of the infectious process?
  23. What is the life span of platelets (in days)?
  24. What process allows the kidney to an increase response in workload?
  25. Which substance has been shown to increase the risk of cancer when used in combination with tobacco smoking?
  26. Hemolytic disease of the newborn (HDN) can occur if the mother:
  27. Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot to relieve spells?
  28. How much urine accumulates in the bladder before the mechanoreceptors sense bladder fullness?
  29. The function of the foramen ovale in a fetus allows what to occur?
  30. Low plasma albumin causes edema as a result of a reduction in which pressure?
  31. In a normal, nonmutant stage, an oncogene is referred to as a:
  32. Causes of hyperkalemia include:
  33. Research supports the premise that exercise has a probable impact on reducing the risk of which cancer?
  34. What is the functional unit of the kidney called?
  35. What is the first stage in the infectious process?
  36. Which statement concerning exotoxins is true?
  37. An infant’s hemoglobin must fall below ___g/dl before signs of pallor, tachycardia, and systolic murmurs occur.
  38. What is the role of collagen in the clotting process?
  39. Where are antibodies produced?
  40. What is the purpose to the spirometry measurement?
  41. What is the most abundant class of plasma protein?
  42. What is the most important negative inotropic agent?
  43. Decrease lung compliance means that the lungs are demonstrating which characteristic?
  44. Blood vessels of the kidneys are innervated by the:
  45. What are the abnormalities in cytokines found in children which cystic fibrosis (CF)?
  46. The generation of clonal diversity occurs primarily during which phase of life?
  47. How is most of the oxygen in the blood transported?
  48. Fetal hematopoiesis occurs in which structure?
  49. What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn?
  50. Which disorder results in decreased erythrocytes and platelets with changes in leukocytes and has clinical manifestations of pallor, fatigue, petechiae, purpura, bleeding, and fever?

SOME MIXED QUESTIONS

  1. Raynaud phenomenon is classified as a type III hypersensitivity reaction and is due to:
  2. Deficiencies in which element can produce depression of both B and T cell functions
  3. During a stress response, increase anxiety, vigilance, and arousal is prompted by
  4. Stress-age syndrome results in decreased
  5. Which of the viruses below are oncogenic DNA viruses?
  6. Which cytokine is involved in producing cachexia syndrome?
  7. Childhood exposure to all of the following risk factors increase susceptibility to cancer, except
  8. What id the mechanism in type II hypersensitivity reactions?
  9. What effect does estrogen have on lymphocytes?
  10. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response?
  11. Intestinal polyps are benign neoplasms and the first stage in development of colon cancer. These findings support the notion that:
  12. In chronic myeloid leukemia (CML), a piece of chromosome 9 fuses to a piece of chromosome 22. This is an example of which mutation of normal genes to oncogenes
  13. Tobacco smoking is associated with cancers of all of the following, except
  14. In which primary immune deficiency is there a partial to complete absence of T-cell immunity?
  15. The effect that low serum albumin has on the central stress response is to
  16. How does the loss of chloride during vomiting cause metabolic alkalosis?
  17. When thirst is experienced, how are osmoreceptors activated?
  18. Why are infants susceptible to significant losses in total body water?
  19. In ARDS alveoli and respiratory bronchioles fill with fluid as a result of the:
  20. A(n) __ is a circumscribed area of suppuration and destruction of lung parenchyma.
  21. Which of the following types of croup is most common?
  22. Kussmaul respirations as a respiratory pattern may be associated with which characteristics?
  23. What is the fundamental physiologic manifestation of anemia?
  24. Which of the following describes how the body compensates for anemia?
  25. Local signs and symptoms of hodgkin’s disease-related lymphadenopathy is a result of:
  26. __ is the virus associated with Burkitt lymphoma in African children:
  27. Which defect produces a systolic ejection murmur at the right upper sternal border that transmits to the neck and left lower sternal border with an occasional ejection click?